Why Immunotherapy Fails Most Patients — The Truth About Keytruda Doctors Don’t Explain

Dr. Dino Prato discusses custom-building immunotherapy, highlighting its limitations and potential for patients with stage four melanoma.

He explains that treatments like Keytruda only work long-term for a small percentage of patients and that many are not candidates due to "cold" tumors, an important aspect of modern oncology. Dr. Dino Prato explores how advancements in immunotherapy for cancer are shaping the future of cancer treatment, emphasizing the role of the immune system in fighting the disease.

🎯 What You’ll Learn in This Episode

• Why immunotherapy doesn’t work for all patients
• What checkpoint inhibitors actually do
• The role of immune signaling in cancer response
• Why tumor biology differs between patients
• What “cold tumors” mean
• How tumor microenvironment affects treatment
• Why deeper testing is being explored
• How personalized approaches may guide care

📍 Envita Medical Centers – Scottsdale, AZ
🌐 Learn more: www.envita.com
📞 Speak with a care coordinator: 866-830-4576

“Immunotherapy isn’t one-size-fits-all — it depends on how your immune system and tumor interact.”

Disclaimer
This podcast is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your licensed healthcare provider before making any medical decisions. Individual results will vary, and Envita Medical Centers does not guarantee outcomes. Some treatments discussed may not be FDA-approved or available in all locations. Testimonials are shared with patient consent and may not reflect typical results. Do not delay or disregard professional medical care based on the podcast's content. Certain treatments may be available only at Envita’s international clinic in Hermosillo, Mexico. No specific outcomes are promised or implied.
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Outcomes Disclaimer
The results referenced from Envita's Precision Cancer Care: 35-Fold Improvement in Response Rates are from a retrospective analysis of 199 late-stage cancer patients treated at Envita Medical Centers between 2021 and 2023, as published in the Journal of Cancer Therapy. These outcomes are not guaranteed and will vary based on individual factors such as cancer type, stage, genetics, immunity and prior treatments. Any comparisons to standard care or clinical trials are based on published data and internal analysis, not head-to-head studies. Individual results will vary.

You can read the full peer-reviewed study at: 

https://www.scirp.org/journal/paperinformation?paperid=132493

Transcript

SPEAKER_00 0:08

A 58-year-old man, stage four melanoma. The cancer had spread to his lungs, liver, brain, and his oncologist started him on a PD1 inhibitor known as ketruda, one of the top drugs in immunotherapy. The problem is it's highly limited. In only 10% of the patients, will this work long term? That means for 90%, it might give some response. And then there's a whole category of patients who aren't even candidates because their tumors are too cold and not hot enough to respond to immunotherapy. In this episode, I'm going to share with you how to change that because this is the key. We need immunotherapy for long-term response, but it's not just about ketruda. That treatment didn't work for him. So we had to unleash a better immune system program. And we did that by custom building the immune system, looking at a thousand plus markers, immune profiling, immune spatial biology. It's not just about delivering the medicine direct to the tumor, it's delivering the right custom-made medicines specific for that patient. And then you get an immune response you want. That's the key. Then when the patient went back to the oncologist that is a prestigious institution, they were blown away. What happened? How did you respond so well? It's because we had the custom targeting. That's the power of precision oncology. So in this episode, I'm going to go over with you how do we turn cold tumors hot and the methodologies for doing that and going beyond the key truda, PD1 inhibitors, they're a$50 billion market right now, and they're going to become 200 billion by 2030. So these are massive drugs that are pushed on patients, but they don't have the longevity we want. They don't have the responses we want long term. And I'm going to talk to you about custom-building immunotherapy, and our clinical experience leads to longer-term remissions and better quality of life. That's the key here. So the real question is what is the correct immunotherapy for your cancer that you need to turn a cold tumor hot, to make it immune responsive, and finally give your body the information it needs so that it can go after the cancer cells throughout your body and do it in a targeted manner. I'm Dr. Dino Prado, founder of Invito Medical Centers. For the last 25 years, my team and I have helped thousands of patients who failed to top cancer hospitals across the country. And much of it is done with custom building immunotherapy. Immunotherapy is not magic, it needs the right targets. It's unique for each person. And when you can custom build the medicine on off-label repurpose drugs, which we do in our pharmacies, and then deliver them direct to the tumor, that's where you see the advantage. So that's the important piece I want to talk to you about today. Now, before you change anything, make sure you're working with a doctor and let's get started. So let me explain something about immunology in the simplest of ways. Think of cancer like a crime scene. The tumor is a criminal. Your immune system has two main teams. Let's keep things simple. The detectives, the dendritic cells. They need the mugshots, the fingerprints, all of that information. And they take these things called antigens and tumor fragments and they pass this information along to your natural killer cells. The second team, which are T cells and natural killer cells, these are your snipers. They come in and eliminate the target, but they can only do that if they have the full information. Checkpoint inhibitors like Optivo, Kitruda, they remove the brakes so that your snipers can do the work. But most people don't have checkpoint inhibitor blockades going on. Some do. And if you test the tumor, you can see the ratio of these PD1 inhibitors around the tumor. So if you only have 10% expression, you can only expect the medicine to work on 10% of the tumor. But nobody's doing this level of testing, and we do, and this eliminates the guesswork. Now we can look at also the tumor microenvironment. What are the gangs around the tumor that are blocking your immune system from working properly? So the snipers, your natural killer cells and T cells, can now infiltrate the tumor, kill it, get rid of it, and pass the immune system on to the rest of the body. That's the mission of precision oncology. For immunotherapy to work, three biological steps must happen. The tumor must trigger an alarm signal. And when the cancer cells die the right way, they release these things called damage-associated molecular patterns, damps. Just at the right concentration, they stimulate your dendritic cells to mature and they help your body fight the cancer. By giving high dose chemotherapy that's not targeted, you're going to overstimulate, you're going to push inflammation, you're actually going to go against your immune system. Instead of helping it, it's going to make your immune system evade the tumor. So the sirens have to be just the right smoke alarms, just the right concentration. That's part of the secret sauce. So we want to get all these signals. The detective picks them up, passes them on with the right alarm so that now the detectives can do their work. Second, the tumor must release fingerprints. What are these called? Neo antigens. That's one of the big ones. And they're unique and they can mutate and change. So in some advanced cancers, these antigens are like a snake that's shedding its skin. These antigens are shifting every three, four, five, six weeks. And we need to get the antigen information to the T cells so they can do their work. And that's what the dendritic cells do. These detectives get this information, they pass it along to your T cells. So without these neoantigens, you don't have the right targets. That's step two. Step three, the detective must mature. That's the dendritic cell. In this step, you have to get a mature dendritic cell, which happens with the damage associated with molecular patterns being in the right way. And they have to correctly hand off that information to the sniper so that the T cells, the natural killer cells, can be properly trained to hunt and kill and remove the tumor. Now I've oversimplified it, but yes, that's what we need to do is understand that if those things are in place and operating correctly, the game on your cancer has changed completely. Now your immune system can eradicate the cancer. Along the way, we have hot and cold tumors. The hot tumors are ready for those natural killer cells and T cells to infiltrate, kill the tumor. But in some cancers that are cold, they have a tumor microenvironment that's blocking the ability for those cells to work. And only one of them is a PD1 blockade. There are other types, FOXP3. I don't want to go into all of them, but we need to test for this for each patient, which isn't currently being done. Then we need to custom build the medications for each patient, which currently isn't being done, and then deliver them direct to the tumor or build cancer cell vaccines and systemic care to stimulate the immune system. That's what we do in precision oncology, have done this and improved on it over 25 years. But that's how we get immune signaling to work and patients to respond. This is the key piece. This is what's missing when people think, oh, I'm on key true or optiva or on a PD1 inhibitor. They're missing this because it only works on part of it. Here's why. There are other mechanisms for T cells to be evaded. Myeloid-derived suppressor cells, MDSCs, arginase one. These all can do these things, things that starve the T cells like arginine cysteine, macrophages M2 to M1 concentrations, where if you have M2, it's more inflammatory, less tumor killing, too much of IL-10 and TGF beta. I can go on and on, but there's a lot of things. I'm using fancy words and I'm not doing that to throw anybody off, but there's more than a PD1 inhibitor involved. That's the bottom line. You can have cells that have fibroblasts, stromal barriers that are not responding. And we can turn that all on again if we have the right information and we custom build the care. See, the problem is everybody's using the one size fits all oncology from the National Comprehensive Cancer Network, which says, oh, your MSI, micro satellite and stable, fine, you're a candidate for key true or optivo. But then everybody else is out of luck. That does not make sense. And if you even have that, that's only going to work for 10% of the patients long term, according to Frontiers and Oncology. So stick with me because this is the part you need to get. We need to custom build the immunotherapy for each patient based on their markers. Your immune system, when it responds, has the ability to eliminate the cancer, not just short term, but long term. The immune system is the first and last defense against cancer. And the real problem is you're not getting targeted testing and nobody's building the deep mapping, multi-omics, and custom immunotherapy care you need. See, if you go conventional care, it's a one-size-fits-all key truth. You go integrative care, it's high dose vitamin C, ozone, mistletoe. I say that in a nice way because they're just throwing things at it. Until you map it out, you don't know the inflammatory pathways. You don't know what the tumor microenvironment is. You don't know what the immune blockade is. So how are you building the treatment? You're building it blindly. We need to build it targeted. So one of the key techniques we use is called SIPI, chemoimmunoprecision injection. It first starts with deep mapping, then building the medicine custom in the pharmacy for each patient that's going to affect their immune system, meaning making their cold tumors hot or making their hot tumors respond better long term. Then those are delivered direct to tumor. Did you hear what I said? First it was a planning, then the custom drug build, then you deliver the medicine. It's not just delivering the medicine to the tumor. That's the key. That's the custom algorithms that will change the ability for patients to respond long term. So the purpose here is to trigger a proper immune signal with the goal to release things like DAMPs, damage-associated molecular patterns, tumor fingerprints or fragments that are important, neoantigens. All these things are tumor fingerprints that allow your immune system to fight. Create an in-stitu vaccine at the tumor or a cancer cell vaccine like AIT, a togulous adoptive immunotherapy, where we can actually build the natural killer cells into the billions and T cells and lack cells and teach them what to attack. This is the difference. But targeting must be precise. It's not a one size fits all and it needs to be custom built for each patient. So you can't just turn a machine on in a pharmaceutical company, build thousands and thousands of ampules and say, just take this and you're going to be okay. You need to custom build the therapies for each patient. On-label drugs, off-label drugs, targeted agents, phytotherapeutics, immune modulators, all chosen for the patient to help them respond. That's the next level care. Then you get into cancer cell vaccines where you're custom building the natural killer cells, T cells, dendritic cells, all to fight the cancer based on your specific cancer blueprint. Each patient's tumor is different. And that's why immunotherapy needs to be customized. They have different antigens. Even two cancers with the same type and stage are going to have a different response to immunotherapy. The National Comprehensive Cancer Network is what everybody uses across the world, all the big hospitals to treat cancer patients. You fail the first regimen, you go on the second regimen. But here's the problem: all those are built on double blind placebo clinical trials. They worked on a percentage of people in the population with that type of cancer. You see the problem with that? That's not you. And those percentages are like 30%, 34%. It's not 99%. When you custom build the immunotherapy based on your particular blueprint and your molecular markers, the advantages increase tremendously. That's why we saw 35 times improvement in patient responses and 43 times improvement in quality of life in our 2024 paper because of precision targeting and immunotherapy. So if the immune system is being suppressed, we need to turn it back on. If the body's immune system can't see the tumor, we need to make it visible. If there are things blocking the tumor, like T regulatory cells, we change that. And we do that all in the right precision for each patient. That's the reason why checkpoint inhibitors alone are not enough. You may need combinations with it or completely different immunotherapies that are totally different than PD1 inhibitors to affect the tumor microenvironment. So now let's get back to that patient with melanoma and ketruda. His doctor told him there was nothing left that could be done. We custom built an immunotherapy. We actually built an autogless adoptive immunotherapy vaccine and put the patient into remission because we custom built the immunotherapy. See, the answer is not no or there's nothing else that can be done. The answer is you have not yet built a custom immunotherapy for your cancer. This is essential for breast, prostate, colon, lung, melanoma, you name it. It's essential because the immune system is the first and last offense. Even if you're on a smart drug, you're only slowing things down until you get the immune system involved in my clinical experience. So I hope you found this episode helpful. You can see I'm passionate about the subject because I've seen it over and over again. And patients deserve proper immunotherapy. Please subscribe. Help us get this information out there. 90% of you watching haven't subscribed yet. Please help us share it with people so they can understand there's more to their cancer treatment than the one size fits all big pharma model that there's precision targeted care that can help them. I hope you found this episode helpful, and may the Lord bless you on your journey to healing.