Cover image of the thesis. Abiskojokk river, Abisko national park.
Photo: Carl-Jacob Khailat Holmberg

Carl-Jacob Khailat Holmberg: Synergy of surgery and immunotherapy against melanoma


Isolated limb perfusion (ILP) is a specialized cancer treatment method in which Gothenburg is a global frontrunner. The doctoral research of Carl-Jacob Khailat Holmberg reveals how the efficacy of ILP can be boosted when integrated with modern immunotherapy.

Carl-Jacob Khailat Holmberg, a surgeon at Stockholm South General Hospital and a clinical researcher at Sahlgrenska Academy in Gothenburg.

Dissertation defense: 23 February 2024 (click for details)
Doctoral thesis: Melanoma surgery in the era of modern immunotherapy
Research area: Surgery
Sahlgrenska Academy, The Institute of Clinical Sciences

The treatment of advanced melanoma, notorious for its aggressive nature and poor survival rate upon metastasis, has been revolutionized in recent years thanks to the groundbreaking advent of immunotherapy. These Nobel Prize-honored treatments, which activate the body’s own immune system to combat cancer, have radically transformed patient outcomes.

“We’re charting new territory with these advancements. The entire research community is now recalibrating, striving to identify the most effective mix of existing treatments,” explains Carl-Jacob Khailat Holmberg, a surgeon at Stockholm South General Hospital and a clinical researcher at Sahlgrenska Academy in Gothenburg.

Becoming a research physician is in many ways a transition from a two-dimensional to a three-dimensional understanding of medicine

What is your research about?
“My work focuses on further developing surgery in combination with these state-of-the-art immunotherapies. At Sahlgrenska University Hospital, we have the national center for Isolated Limb Perfusion (ILP), a surgical technique where limbs with melanoma metastases are isolated and treated with high-concentration, heated chemotherapy via a heart-lung machine. Part of my study involves enhancing this locally effective technique with immunotherapy, which systematically targets the rest of the body.”

Figure 2, page 10 of the thesis. Isolated Limb Perfusion (ILP), a cancer treatment in which the limb affected by metastases is isolated from the rest of the blood circulation and perfused with high concentrations of heated chemotherapy agents.

Crafting the optimal treatment blend

What are your key research findings?
“Our research demonstrates that ILP remains a potent option even after prior immunotherapy, which was previously uncertain. Additionally, our randomized controlled trials reveal that administering a single dose of immunotherapy a day before surgery can boost ILP’s effectiveness. It’s a thrilling development.”

How will this impact melanoma treatment?
“These advancements enable us to precisely tailor a blend of various technologies, improving disease management for our patients. On a larger scale, it underscores the vital role of surgery in melanoma treatment, especially when combined with modern immunotherapies.”

Becoming a research surgeon

What aspects of your PhD project were most enjoyable?
“I have enjoyed every phase of it, from the initial collaboration with leading international research centers to the translation of preclinical data into practical surgical procedures, and merging immuno-oncology with surgical techniques,” shares Carl-Jacob Khailat Holmberg, adding:

“But above all, it has been exciting to learn the craft of being a research surgeon. This transition has expanded my understanding of medicine from a two-dimensional view to a three-dimensional perspective, which is profoundly gratifying.”

Text: Jakob Lundberg