The future of cancer is targeting, in one way or another. It has been interesting to watch immunotherapy win out as the dominant approach to targeting; there are other options, such as nanoparticle platforms in which targeting and kill mechanisms could be assembled as needed, or oncolytic viruses, and so forth. All of those are still under development, just with nowhere near as much backing as, collectively, goes to forms of immunotherapy.

Still, most immunotherapies packaged and deployed to trials are more of the same in terms of being very specific to specific types of cancer. There are hundreds of types of cancer, depending on how you want to count. It is much better to be able to build a therapy with few side-effects, given that chemotherapy has a very unpleasant effect on health and life span over the long term even when successful, but the extreme specificity is still problematic from the strategic point of view. The cancer community has shown that they can't produce new therapies for all cancers at a fast enough rate to completely control cancer any time soon. The strategy needs to shift to producing therapies that can target many types of cancer.

Once class of immunotherapy shows particular promise on this count, and that's the chimeric antigen receptor approaches that have produced such good results for leukemia. It should considerably reduce the cost of building new therapies for many types of cancer once a couple of types of cancer have been successfully treated that way and the basic platform is defined. We'll see how that goes over the next fifteen years or so. All in all, immunotherapies look to be the replacement for chemotherapy / radiotherapy as the coming generation of cancer therapies, and people will keep their hair, and will get treated as outpatients in clinics, and cancer survivorship will increase, and it is likely that they won't lose a decade of life expectancy as a result of treatment.

It is worth looking beyond that, however, as the technical basis for the generation of therapies after immunotherapy is actually being worked on today. For my money the thing that comes after immunotherapy will involve blocking telomere lengthening, as that is a - possibly the only - basis for a universal cancer therapy. All cancers need to lengthen telomeres, cannot evolve their way around that need, and building one therapy to control every type of cancer seems a much better path forward than the present strategy of seeking ever more specific biochemistry to interfere with. A fair number of people are working on the telomerase side of that equation, and not enough people are working on the alternative lengthening of telomeres (ALT) side of that equation, but this will all come to a useful conclusion somewhere in the late 2020s, I'd imagine.