Immunological thought in the mainstream of cancer research: Past divorce, recent remarriage and elective affinities of the future.

Immunological thought is exerting a growing effect in cancer research, correcting a divorce that occurred in the mainstream of the field decades ago just as cancer genetics began to emerge as a dominant movement. Today, with a general consensus on the significance of epigenetics, the inflammatory cancer microenvironment and the immune response in determining cancer pathophysiology, a new synthesis of thought is being spurred by a remarriage with cancer immunology, with great implications for the future of the field. This perspective offers a view on how this synthesis is impacting both the understanding and treatment of cancer using adjuvant immunomodulatory modalities in the context of surgical, radiotherapeutic and chemotherapeutic interventions which are present standards of care. With the revolutions in immunochemotherapy and immunoradiotherapy coming this decade, the next great challenge faced by the field will be how to identify simple, cost effective and broadly applicable solutions that do not rely deeply on personalized characters, in an effort to minimize the daunting complexity and costs of a problem that challenges not only physicians and patients but also health care systems and insurers caring for aging populations in the developed world.