HJNO Mar/Apr 2026

HEALTHCARE JOURNAL OF NEW ORLEANS I  MAR / APR 2026 43 Blake Blancher, MD Medical Oncologist Mary Bird Perkins Cancer Center Limitations, Challenges, and the Road Ahead Despite meaningful progress, modern cancer therapies have limitations. Not all patients respond, responses may be tempo- rary, and resistance can develop. Immune- based therapies may cause inflammatory or autoimmune-like toxicities, while targeted therapies can lose effectiveness as tumors adapt. Access and complexity also remain chal- lenges, particularly for cellular therapies that require specialized infrastructure and expertise. Durability of response and long- term safety continue to be active areas of study. Ongoing research focuses on combina- tion strategies to limit resistance, improved biomarkers to better match patients to therapies, and next-generation cellular ap- proaches designed for greater safety and broader applicability. Looking ahead, cancer treatment is likely to become increasingly personalized. Rather than relying on a single defining intervention, cancer care will increasingly resemble a carefully sequenced strategy — guided by biology, informed by data, and refined through continuous learning. The future of oncology lies not in abandoning older tools, but in integrating them thoughtfully to confront a disease defined by its adaptability. n Blake Blancher, MD is a medical oncologist at Mary Bird Perkins Cancer Center in Covington and Slidell. He earned his undergraduate degree in microbiology from Louisiana State University and a graduate degree in biology focused on medical sciences at Mississippi College. He completed his medical degree at Louisiana State University School of Medicine in Shreveport and completed his fellowship in hematology and clinical oncology with Baylor Scott & White in Temple, Texas. T-Cell Receptor (TCR) Therapy TCR therapy follows a similar principle to CAR T-cell therapy but enhances a T- cell’s natural receptor to recognize cancer- associated proteins presented on the tumor surface. This allows targeting cancer cells that lack easily accessible surface antigens. CAR NK Cell Therapy Natural killer (NK) cells are part of the immune system’s innate defense. CAR NK therapy engineers these cells to recognize cancer with targeted specificity. Compared with CAR T-cells, CAR NK cells may carry a lower risk of severe immune-related toxici- ties and can potentially be produced from donors, offering a more scalable approach. Tumor-Infiltrating Lymphocyte (TIL) Therapy TIL therapy builds on immune cells al- ready present within a tumor. These lym- phocytes are extracted, expanded, and re- infused in large numbers, with the goal of enhancing an immune response that has already identified the cancer. A Broader Shift in Cancer Care Together, these therapies reflect a fun- damental evolution in oncology. Cancer treatment is increasingly guided by an un- derstanding of tumor biology and immune regulation rather than nonspecific cell kill- ing alone. The future of cancer therapy lies in thoughtful combinations — integrating immune-based approaches with targeted drugs or cellular therapies — guided by tu- mor biology and patient-specific factors. This evolution does not replace chemo- therapy, but reframes it as one component of a more nuanced therapeutic landscape. allows delivery of powerful cytotoxic agents directly inside tumor cells while limiting ex- posure to healthy tissues. Small-Molecule Therapies: Interrupting Cancer Signaling Many cancers are driven by abnormal sig- naling pathways that regulate cell growth, division, and survival. Small-molecule therapies, such as tyrosine kinase inhibi- tors (TKIs), are designed to interrupt these internal signals. Because of their small size, TKIs read- ily enter cells and inhibit specific enzymes critical to cancer progression. Rather than killing cells outright, they often suppress the biological processes that allow cancer cells to grow and persist. This approach relies on understanding a tumor’s molecular profile and has helped advance more individualized cancer treatment. Cellular Therapies: Living Drugs One of the most significant advances in cancer care has been the development of cellular therapies — treatments derived from living immune cells. CAR T-Cell Therapy Chimeric antigen receptor (CAR) T-cell therapy involves collecting a patient’s T cells and genetically reprogramming them to rec- ognize a specific cancer antigen.Thesemodi- fied cells are expanded in the laboratory and reinfused into the patient. Once administered, CART-cells can recognize and destroy cancer cells and persist over time, contributing to their effectiveness in certain blood cancers while also accounting for unique toxicities that require careful monitoring.