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Stefan Kaufmann, the most practical of the four at that dinner, San Mateo suggested the best we can hope for is to make things just a bit better, to lower the bar a few centimetres for those hundreds of millions living with the reality, or imminent threat, San Mateo of terrible diseases. Kaufmann has long worked on tuberculosis, which still kills too many in the developing world. We speculated on whether it will ever be possible San Mateo to make vaccines that protect San Mateo against dangerous pathogens like TB, HIV and malaria. Pumped by the fact that his group was getting some very promising results, it’s a measure of the TB vaccine problem that, San Mateo ten years later, Kaufmann’s findings are still ‘promising’. In fact, multiple drug-resistant TB now looks even scarier than it did back then.

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The immunity-based breakthrough we discussed in 2007 was with rheumatoid arthritis (RA). Based on blocking the damage caused to joints by the cytokine TNF, a molecule that operates normally to destroy invading microorganisms, this medical success (benefits to more than 60 per cent of RA patients) was recognised formally by a major award (The Swedish Craaford Prize) and knighthoods for London-based, Melbourne-educated physician/scientist Marc Feldmann and his colleague Ravinder ‘Tiny’ Maini. Their clinical trials were, of course, preceded by an immense amount of intense science done by a great diversity of highly trained and dedicated investigators with different expertise and insights. RA is classical autoimmunity, where the white blood cells that secrete TNF (tumour necrosis factor) lodge in the wrong place and respond to an erroneously delivered message that tells them to keep pumping out this powerful chemical. And this was at just the beginning of a spectrum of new immunotherapies. We could have been more optimistic, but scepticism is central to the science game.

What brought our small group together for this dinner by a Brazilian beach was the 13th International Congress of Immunology (ICI). The 16th ICI was hosted in Melbourne more recently, in 2016, and the immunotherapy discussion had moved forward to focusing on the spectacular cures oncologists were achieving with 20 per cent of an increasing number of formerly lethal cancers, especially melanomas. As US immunologist Jim Allison (who pioneered this research) reminded us, it had taken twenty years of basic science, translation (to develop an acceptable product for human use) and clinical trials to get to this point. Jim presented his very first findings on these ‘immune checkpoint inhibitors’ in 1995, at the 9th ICI in San Francisco. That’s a typical timeline for the development of radically new treatments. It’s a dead certainty that those who attend the 17th ICI in Beijing in 2019 will present, or hear about, further major advances in cancer immunotherapy.

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