The 2018 Nobel Prize in Physiology or Medicine was awarded today to James P. Allison and Tasuku Honjo for groundbreaking discoveries that have led to a genuine revolution in cancer therapy—techniques that harness the human immune system to fight this family of diseases. It is a damn good choice.
To understand why, it helps to consider one of the central and enduring mysteries of cancer: It’s a pathology that comes from within. The disruption and destruction of healthy tissue by malignant cells is a homegrown terror, a proliferation of biological anarchists that were born and bred and ultimately corrupted within the human organism. It is not, like so many of the diseases we think of when we think of “disease,” a threat from outside the body—a raging infection like influenza, pneumonia, TB, or Ebola.
As it turns out, cancer can trip up the body’s bodyguards in a number of ways—but one particularly insidious trick is to send out signals to immune system regulators to hold back on an attack. In short, they induce the guards to look the other way.
When Jim Allison suggested that hypothesis, the mandarins of the cancer research establishment scoffed—or worse, ignored him. Still, he pressed on. Working out of the University of California, Berkeley, in the 1990s, Allison (who’s now at Houston’s MD Anderson Cancer Center and a seminal force within an exciting collaboration called the Parker Institute for Cancer Immunotherapy), figured out how one such “off” switch, or “immune checkpoint,” known as CTLA-4, could be flipped to preempt an attack by immune defenders called T cells.