Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The miracle of immune checkpoint inhibitors: a physician’s unforgettable journey

Richard D. Sontheimer, MD
Meds
January 22, 2025
Share
Tweet
Share

Even a half-century later, a physician cannot forget the first death of a patient under their care. It happened for me during my postgraduate medical training in the 1970s in an academic medical center hospital in the western half of the United States.

She was a delightful young married woman who was the mother of three small children. She was admitted to the hospital for recurring seizures. Her workup revealed a history of malignant melanoma. The question was whether her seizures were due to a melanoma brain metastasis or to something else that might be more treatable.

Today, a CT scan of her brain would have quickly answered that question. However, the first CT scan performed in the United States occurred one year after her hospital admission. In her case, the metastasis in her brain was so prominent that it showed up on plain X-rays.

The five-year survival rate for metastatic malignant melanoma in those days was less than five percent. However, since our patient’s survival projection was not zero percent, our internal medicine hospital team decided to do everything possible to allow her to be with her children as they grew up.

In those days, the traditional chemotherapy strategies that were available had no significant clinical benefit on metastatic malignant melanoma. As such, we felt that her only chance would be surgical removal of the mass in her brain.

This young woman had a steadfast desire to live. But the only option we could offer her was surgery. After much-heated debate with our surgical colleagues, they finally agreed to perform the surgery (perhaps in part to get our medical team off their backs). While she survived the operation, we later learned that she died about six months after the surgery from complications of metastatic melanoma.

Had this young woman presented with metastatic melanoma today, she would have had a much better chance of long-term survival as a result of immune checkpoint inhibitor therapy.

The healthy human immune system has a number of “stop and go” functions. These functions normally protect our bodies from threats such as infections and cancer cells without overreacting and causing autoimmune disorders. Immune checkpoint inhibitor therapy is a form of drug treatment that takes away all of the “stop” functions in our immune system. That allows our immune system to become more aggressive in seeking out and destroying cancer cells in our bodies.

This morning, I saw a report in the New England Journal of Medicine titled “Final, 10-year outcomes with nivolumab plus ipilimumab in advanced melanoma.” This report was a 10-year follow-up study of 945 international patients who either had or were at very high risk of having metastatic melanoma that had been treated with immune checkpoint inhibitor therapy. Those patients who had been treated with both of the first two immune checkpoint inhibitor drugs, nivolumab and ipilimumab, had a median overall survival of 71.9 months (~6 years) and a median melanoma-specific survival of more than 120 months (10 years). This has been among the most miraculous medical breakthroughs that I have witnessed in my five-decade medical career.

American medicine is increasingly coming under fire because of its ballooning costs. The current annual cost of immune checkpoint inhibitor cancer therapy in the United States ranges from $100,000 to $300,000. The many-headed monster of American health care costs desperately needs to be addressed. Each of the heads of that monster will have to give a little in that upcoming political negotiation. However, when that happens, the babies should not be thrown out with the bath water. One of those babies is the relatively low cost of supporting the academic basic and clinical biomedical research consortium, which is the fragile seed from which modern medical miracles like immune checkpoint inhibitor cancer therapy can flower.

Richard D. Sontheimer is a dermatologist.

Prev

How AI is transforming medicine faster than ever before

January 22, 2025 Kevin 0
…
Next

Grief and climate change: a year of lessons we can't ignore

January 22, 2025 Kevin 2
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
How AI is transforming medicine faster than ever before
Next Post >
Grief and climate change: a year of lessons we can't ignore

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Richard D. Sontheimer, MD

  • Is skin really the largest organ? The truth might surprise you.

    Richard D. Sontheimer, MD
  • A Father’s Day golf game to remember

    Richard D. Sontheimer, MD
  • Hope, with a ribbon of uncertainty curling gently around it

    Richard D. Sontheimer, MD

Related Posts

  • Medical facilities: Please keep your immune-deficient patients safe

    Denise Reich
  • A physician’s perspective on the crisis in Massachusetts health care

    Paula Muto, MD
  • Ozempic: miracle drug or a band-aid for obesity?

    Francisco M. Torres, MD

More in Meds

  • Why retail pharmacies are the future of diverse clinical trials

    Shelli Pavone
  • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

    Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO
  • A world without antidepressants: What could possibly go wrong?

    Tomi Mitchell, MD
  • The truth about GLP-1 medications for weight loss: What every patient should know

    Nisha Kuruvadi, DO
  • The hidden bias in how we treat chronic pain

    Richard A. Lawhern, PhD
  • Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies

    Robert Trent
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...