Interview with Alexander Eggermont

This article is part of our Thought Leader Series, exploring the ideas shaping the future of science and medicine. In this edition, Professor Alexander Eggermont, Professor of Immunotherapy at the University Medical Center Utrecht, shares his perspective on how cancer immunotherapy has evolved—and where it is heading next. 

Modern cancer immunotherapy began to take shape in the mid-1980s, when early clinical work demonstrated for the first time that the immune system could induce durable tumor regression. In diseases such as advanced melanoma—then considered essentially untreatable—even modest response rates represented a breakthrough and laid the groundwork for future advances. 

The true transformation of the immunotherapy field occurred with the discovery of immune checkpoint inhibition. The introduction of anti-CTLA-4 and, later, anti-PD-1 therapies revealed a fundamental biological principle: while T cells can recognize and infiltrate tumors, they are often functionally neutralized within the tumor microenvironment. Checkpoint inhibitors protect and reactivate these T cells, enabling durable anti-tumor responses. 

Anti-PD-1 therapies, in particular, have reshaped oncology. Initially met with skepticism and thought to be relevant only for highly immunogenic tumors such as melanoma or renal cell carcinoma, they are now approved across approximately twenty solid tumor types. Their impact is defined not by high response rates, but by durability—long-term survival in patients who respond. 

This durability challenges traditional approaches to clinical trial design. Conventional endpoints such as median progression-free survival often fail to capture the true benefit of immunotherapy, which is best reflected in the long-term tail of survival curves. In melanoma, five-year survival rates have increased from roughly 4–5% to more than 50% in the span of just over a decade. 

Despite these successes, many patients still do not respond. One of the major remaining barriers is the complexity of the tumor microenvironment. Immunosuppressive macrophages, cancer-associated fibroblasts, aberrant cytokine signaling, and pro-angiogenic factors collectively create a hostile environment that limits immune activity. Understanding and targeting this “bad neighborhood” remains one of the field’s most urgent challenges. 

A major paradigm shift is now underway: moving immunotherapy earlier in the disease course, particularly into the neoadjuvant setting. Administering immunotherapy before surgery—when tumors are still rich in immune infiltrates and systemic immunosuppression is limited—has produced striking results. 

In melanoma, neoadjuvant immunotherapy achieves major pathological response rates of 70–80%, with relapse rates below 3% among responders. Similar approaches are now enabling organ-sparing strategies in colorectal, bladder, lung, and head and neck cancers, reducing the need for radical surgery while maintaining excellent oncologic outcomes. 

This shift has profound implications for drug development. Immunotherapies tested only in heavily pretreated, late-stage patients risk being underestimated. Neoadjuvant trials provide earlier signals of efficacy, deeper biological insight through access to tumor tissue, and a clearer understanding of mechanism of action. 

Over the next five to ten years, neoadjuvant immunotherapy is expected to dominate clinical development across solid tumors. Combined with next-generation approaches such as bispecific antibodies and T-cell receptor-based therapies, this strategy represents the next major leap forward—one that reframes immunotherapy not as a last resort, but as a frontline, potentially curative intervention. 

Professor Eggermont will continue this scientific discourse at NextGen Biomed 2026 in March 2026, where he will be presenting on the evolving role of immunotherapy in solid tumors. The meeting provides an important forum to exchange ideas on emerging strategies, neoadjuvant approaches, and next-generation immunotherapeutic platforms, and to further advance collaborative thinking across academia, industry, and clinical practice.