The future of affordable cancer immunotherapy.

The treatment of cancer was revolutionized within the last two decades by utilizing the mechanism of the immune system against malignant tissue in so-called cancer immunotherapy. Two main developments boosted cancer immunotherapy: 1) the use of checkpoint inhibitors, which are characterized by a relatively high response rate mainly in solid tumors; however, at the cost of serious side effects, and 2) the use of chimeric antigen receptor (CAR)-T cells, which were shown to be very efficient in the treatment of hematologic malignancies, but failed to show high clinical effectiveness in solid tumors until now. In addition, active immunization against individual tumors is emerging, and the first products have reached clinical approval. These new treatment options are very cost-intensive and are not financially compensated by health insurance in many countries. Hence, strategies must be developed to make cancer immunotherapy affordable and to improve the cost-benefit ratio. In this review, we discuss the following strategies: 1) to leverage the antigenicity of "cold tumors" with affordable reagents, 2) to use microbiome-based products as markers or therapeutics, 3) to apply measures that make adoptive cell therapy (ACT) cheaper, e.g., the use of off-the-shelf products, 4) to use immunotherapies that offer cheaper platforms, such as RNA- or peptide-based vaccines and vaccines that use shared or common antigens instead of highly personal antigens, 5) to use a small set of predictive biomarkers instead of the "sequence everything" approach, and 6) to explore affordable immunohistochemistry markers that may direct individual therapies.

Youth injury in Israel: an appeal for change.

Unintentional injury in children and adolescents have raised public health concerns in recent years, because it is the leading cause of death, a physical burden for the injured person, an emotional and social burden for the families together with an economic burden for society. The National Center for Children's Safety and Health in Israel was established in 1995 at the Schneider Children's Medical Center in order to focus on prevention of childhood and adolescent injury and safety. Over these years data has been collected from the Central Bureau of Statistics, the Ministry of Health, the National Trauma Register, Police and the National Poison Center in order to look for trends and develop strategies for intervention. These efforts, together with the active prevention programs that have been established, resulted in a national report (1) presented to the Minister of Health and other policy makers in 2003. The current situation of youth injuries in Israel, which over the years have not shown any improvement, necessitates a new agenda with a focus on prevention and collaboration between various ministries and agencies in order to implement it. The report alone cannot have an impact upon youth safety, but we hope that it will provide an impetus for developing youth safety strategies and programs based on data. We also believe there is a need for long-term monitoring and follow-up of youth injury trends in Israel.