Enrolling the body as active agent in cancer treatment: Tracing immunotherapy metaphors and materialities.

Abstract

Immunotherapy is heralded as the 'fifth pillar' of cancer therapy, after surgery, radiotherapy, chemotherapy and genomic medicine. It involves 'harnessing' patients' own immune system T-cells to treat cancer. In this article, I draw on qualitative interviews with practitioners working in oncology and patients in the UK, to trace metaphorical and discursive framing around immunotherapy. Immunotherapy aims to restore the functioning of the immune system to detect cancer (non-self), working with the self/non-self model that pervades immunology discourse more widely. Practitioners draw on metaphors that cement this self/non-self model, and that tend to depict the relationship between cancer and the immune system as an internal battle. Yet the discursive framing around immunotherapy also involves shifts that emphasize the body's own capacity to heal, where it is framed as 'gentle' or 'tolerable' on the body. Through this discursive shift, immunotherapy refigures the antagonism associated with the self/non-self model in the context of cancer. Analysing patients' embodied experiences of treatment, this article attends to the material realities and tensions provoked by this shift in discursive framing. This article contributes to feminist STS analyses of immunology discourse, and extends this literature by arguing that it is critical to address the material stakes of these discursive shifts by paying attention to patients' day-to-day experiences of treatment. The discursive framing of immunotherapy brings into being new forms of embodied patienthood in the context of cancer.