How to safeguard cancer treatments and immune therapies in the era of antimicrobial resistance

Advances in oncology and immunology have transformed patient outcomes. Chemotherapy medicines, stem-cell transplantation, CAR-T cell therapies, biologics and targeted immunomodulators have turned once-fatal conditions into manageable diseases with patients achieving complete remission in some instances. Yet these innovations rest on a largely invisible foundation: the continued availability of effective antimicrobials

That foundation is now eroding. Rising antimicrobial resistance (AMR) is increasingly undermining the safe delivery, effectiveness and scalability of modern medical innovation.

This is not a future risk. So-called 'superbugs' are already killing millions of people a year because they are resistant to the medicines once used to treat them. AMR is a present and growing threat to health systems, patients and the life sciences ecosystem alike.

Cancer patients and people receiving immunosuppressive or immunomodulatory therapies face a uniquely high risk of infection. The very treatments designed to control malignancy or inflammatory disease deliberately weaken immune defences, leaving patients vulnerable to bacterial and fungal infections. In these settings, antimicrobials are not an adjunct to care; they are a prerequisite.

Chemotherapy, CAR-T therapies, stem-cell transplantation and many biologics cannot be delivered safely without reliable antibiotics and antifungals for prophylaxis, early treatment of febrile episodes and management of complications. When antimicrobials fail, infections lead to treatment delays, dose reductions or permanent discontinuation. The consequences are stark: disease progression, avoidable morbidity and preventable deaths.

As resistance rises, this critical safeguard is eroding. Standard prophylactic regimens are losing effectiveness. Common infections are becoming harder to treat. Neutropenic sepsis is more dangerous. The therapeutic window for high-risk, high-value interventions is narrowing. In effect, AMR is silently constraining what modern medicine can safely deliver.

The implications extend far beyond individual patients. For health systems, rising infection risk increases length of stay, complexity of care and costs. For pharmaceutical developers, AMR introduces new strategic and operational challenges across the product lifecycle.

Clinical trials in immunocompromised populations become more complex and expensive as infection risk increases, driving protocol amendments, enhanced safety monitoring and delays. In real-world use, higher rates of infection-related adverse events can reduce treatment eligibility, compromise effectiveness and increase discontinuation. Ultimately, the erosion of effective antimicrobial therapy threatens the return on investment for transformative medicines and limits their population-level impact.

Despite this, AMR is still largely treated as a standalone infectious disease issue. Its downstream effects on cancer care, autoimmune disease management and clinical innovation remain under-measured and undervalued in policy and investment decisions.

One reason AMR’s impact remains poorly addressed is the way data is generated and used. Surveillance systems typically track resistance trends and antibiotic consumption, but rarely connect these data to clinical outcomes, treatment disruption or system-level consequences in high-risk populations.

As a result, policymakers lack information on how AMR affects the delivery of novel and existing oncology and immunology therapies. Life sciences companies also face growing uncertainty when investing in antimicrobial research & development (R&D), as benefits are not comprehensively captured in traditional value frameworks and return on investment is considerably lower than other therapeutic areas. The true cost of AMR – in lost innovation, unrealized patient benefit and avoidable health system impacts – remains largely invisible.

This disconnect matters. Without evidence that links AMR to outcomes decision-makers care about, such as cancer survival, treatment continuity and system resilience, AMR will continue to be deprioritized relative to more visible health challenges.

AMR must be understood not only as a microbial or stewardship problem, but as a strategic threat to the future of modern medicine. Progress in oncology and immunology is structurally dependent on a functioning antimicrobial pipeline. When that pipeline fails, innovation stalls – regardless of how advanced and novel the therapies themselves may be.

This reframing has important implications. It highlights that sustaining antimicrobial effectiveness is a shared interest across governments, health systems and the life sciences sector. It also strengthens the case for renewed public and private investment in antimicrobial research and development, not as an isolated endeavour, but as an enabler of broader health innovation.

Addressing this challenge requires moving beyond awareness towards coordinated, system-level action.

First, evidence generation must evolve. Data on infection risk, resistance, treatment interruption and outcomes need to be integrated across therapeutic areas, particularly in immunocompromised populations. This is essential to make the impact of AMR visible and actionable.

Second, policy frameworks must reflect interdependence. Antimicrobial sustainability should be embedded into health-system planning, cancer and immunology strategies, and innovation policy. Treating AMR separately from non-communicable disease agendas no longer reflects clinical reality.

Third, investment incentives must align with value creation. The benefits of effective antimicrobials accrue across health systems and therapeutic areas, yet current market structures fail to reward this systemic value. Without new approaches to financing antimicrobial development and reimbursement, the antimicrobial pipeline will remain fragile.

Finally, collaboration is essential. Governments, academia, industry and global institutions each hold part of the solution. No single actor can address a problem that sits at the intersection of clinical care, innovation and system resilience.

The advances of modern medicine have raised expectations – among patients, clinicians, and societies – that previously lethal diseases can be treated safely and effectively. Allowing antimicrobial resistance to undermine those gains would represent a profound failure of foresight.

AMR is pushing modern medicine towards a breaking point. Recognising it as a foundational threat to clinical innovation is a necessary first step. Acting on that insight – by strengthening evidence, aligning incentives and investing collectively in antimicrobial sustainability – is now an urgent priority.