What Cancer Patients Should Know: Latest Immunotherapy News from ASCO 2016


Hello, I’m Dr. Jill O’Donnell-Tormey
CEO and Director of Scientific Affairs at
the Cancer Research Institute.
I’m here with three experts
who are going to discuss with me
important results coming out of the annual
meeting of
the American Society of Clinical Oncology
here in Chicago.
Thank you all for joining me today.
And I’d like to start by throwing out a question
for each of you
What would you say was the most important
take home results for patients
that you heard at ASCO this week?
So I think one of the exciting developments this year is that
we know that last year the big story was
really the single agent
activity of checkpoint inhibitors
one of the more exciting new approaches to immunotherapy
across a broad number of solid tumors.
And this year,
the story is getting more nuanced.
So we’re still excited
about the activity of these agents across
a broad number of different tumor types
but the story is getting more interesting.
We’re talking about combining
these agents with other agents
for better activity.
We’re talking about predictive
biomarkers that can help us identify
who’s going to respond.
And I think just in general the story
is getting richer and a lot more interesting
and heading in a direction that will ultimately
benefit
a lot more patients.
Thanks very much, Andy.
Leena, do you have anything to add to that?
Well, I would agree with Andy.
I think that the story is still immunotherapy
but it is more about combination
immunotherapy and broadening the group for
whom
immunotherapy might be helpful.
I think what we’ve also learned is
that there’s a lot of differences
in different cancers,
that it’s not a one size fits all story.
That there are different markers,
there are different combinations that will
be useful
in different settings.
Michel.
Well, Jill
immunotherapy is not monolithic.
It comes in many flavors.
And so this was a great meeting for what
we call CARs,
which are chimeric antigen receptors.
Several groups presented very exciting
data showing that the science
of CAR therapy is really moving forward.
That’s all good news for patients, for sure.
Leena, I know you’re an expert in lung cancer
and I think there was some very exciting data
for different types of lung cancer that were
reported.
I think there were several exciting things
but specifically the same
kind of combination therapy that’s
approved in melanoma
a combination of a PD-1 inhibitor and a CTLA-4
inhibitor
two different ways of activating
T cells to attack tumor cells
that same combination has now been tested
in both non-small cell lung cancer
and small cell lung cancer.
And we saw really promising results.
The non-small cell lung cancer data is very, very preliminary.
It was very small numbers of patients
that were treated.
But these were patients that were treated
basically
with a combination of nivolumab and ipilimumab
instead of any chemotherapy.
So patients who had never received any chemotherapy
or any kind of standard therapy
were treated with these agents.
And what we saw were response
rates that rivaled those of chemotherapy,
and in the subset of patients
who had high PD-L1 expression
which can be a predictive marker
in non-small cell lung cancer,
there were very, very high response rates.
It was a very small subset,
but 12 out of 13 patients with major
regressions of their cancers
which is really exciting.
And we hope that translates in a
larger scale setting,
in a randomized setting to something really
meaningful.
So small cell is actually, I think, the more exciting story
because small cell lung cancer is a really
very, very difficult cancer to treat
and it’s a very, very aggressive cancer.
And although patients get a few
months of benefit from chemotherapy typically,
most other therapies really haven’t worked.
So to see any activity
which is exactly what we’re seeing from both
monotherapy PD-1 inhibitors as well this combination with CTLA-4 inhibitors
is really exciting. And that data was first presented
last year.
The response rates in a larger subset
this year were a little bit lower,
but the overall group that was getting clinical
benefit
meaning not having their cancers grow
was really striking.
There were 43 percent of patients who were
still
doing well after a year,
which is almost unheard of for small cell lung cancer,
so we hope that’s really going to make a difference.
Terrific.
So Andy, you’re a specialist in head and neck
cancer, a surgeon
do you think checkpoint blockade is moving
to become
the new standard of care for head and neck
cancers?
One of the really exciting things
that I saw was that we’re seeing responses
in very heavily pre-treated populations:
patients who’ve had one, two, sometimes three rounds of prior therapy.
This is a very hard population to treat
because their tumors have figured out
how to evade almost everything.
So the fact that we’re seeing the responses
we are
in these very difficult, refractory populations
I think is quite exciting.
Michel, you already alluded to some of
the cellular therapies
is there more news in the blood cancers that
came out?
Yes definitely. There were several updates
at this ASCO meeting
on what we call CD-19 CAR therapy.
This is a form of therapy that
again, uses the patient’s own cells,
which are targeted to this molecule
called CD-19.
It’s a target that’s relevant to the majority
of lymphomas and leukemias for
which there is still today obviously
a large unmet medical need.
And what we saw at this meeting are several
groups, four big groups,
presenting data no longer on 12 or 15 patients,
but now in 50 patients, 60 patients
sometimes more.
Confirming the earlier data
and fine-tuning the delivery of this new medicine.
There can be, on occasion,
strong cytokine responses and
investigators are learning how
to mitigate those effects without
compromising any of the efficacy.
Another exciting news was that in
adult acute lymphoblastic leukemia
the data seems to suggest
now that the CAR therapy could stand alone
without requiring a follow up bone marrow transplant
which was given hitherto to some of those
patients.
So what we’ve really seen
is consolidation of this approach.
Finetuning in the chemotherapy,
the T cell dose, the way it is administered,
and really the end of this opening cycle of Phase I studies.
What we look forward to seeing now are
hopefully the first approvals
of these therapies in the not too distant
future.
And the other big question now that’s on everybody’s
mind is: will this work for solid tumors?
For some of your cancers.
And we sure hope that it will
and I think that’s what we look forward to
for next year.
I think there was also a report that
not really treatment, but able to predict
who
among colorectal cancers at different
stages would be expected to have
a better response, a better prognosis,
and this is something that’s been called the
immunoscore.
Yes, and what’s very exciting
about that, and really groundbreaking,
is that for so many years the focus
and staging tumors has focused
on the tumor itself, and of course its genetic
alterations, which we all agree are very
important.
However, it is now emerging that
if you examine not just the tumor, but its
surroundings,
which is made up of many cell types, mostly
cells of the immune system
good actors that could help reject the tumor,
but bad actors that impede the immune response
if you score this appropriately,
it turns out that you can have very useful
insights
in the prognosis for these cancers.
So really this reinforces
on yet another level,
on the diagnostic level as well,
the enormous importance of the immune response.
I think that’s exactly right.
I think we’re not just seeing treatment but
showing proof that when a patient
automatically has a strong immune
response, an infiltration of
T cells into their tumors,
that they have a better chance of doing well.
So this is just additional information
that tells us that immunotherapy is important
and I think is here to stay in terms
of the treatment of cancer.
I’ll ask any of you
did you hear any negative news about
immunotherapy that was reported here?
It seemed to me that incremental positive
responses was just adding to the wave of enthusiasm
that we are seeing across the world
among oncologists and among patients.
In the world of thoracic malignancies
I feel like there were a couple presentations
about two different immunotherapies
in mesothelioma that
I think were not the hoped-for results.
We knew that mesothelioma patients express high levels of PD-L1
and we had thought that this would be a very
good therapy for them,
and in fact last year there was data presented
about pembrolizumab that suggested high chances
of benefit.
We didn’t see that with some different drugs
this year but
I think, again, it underscores the fact
that we need to look for the right patients
and for the right patients there can be really durable and strong benefits
and we need to have better ways of identifying people upfront.
Any closing remarks?
Anything else that I’ve missed that you think
is important
that patients need to hear about?
Yes, immunotherapy as the big wave
continues to unfold and gather strength.
The combinations now will provide a vast range
of
exciting trials that we’ll hope to see.
Cell therapies are establishing themselves
as something that’s here to stay and it’s
a younger field
that’s yet to be developed.
And many of us believe that the vaccines
that were so preeminent 20 years ago and that faded
out a little bit are likely to make a comeback as well
as an adjunct to either the cell therapy and
of course to the checkpoint blockade.
Very well said. Well, thank you all for taking
the time
to discuss this with me
I hope you found today’s discussion helpful
and informative.
If you’d like to stay up to date on other
news about immunotherapy
please visit the Cancer Research Institute’s website
at cancerresearch.org
Thank you very much for watching.

5 thoughts on “What Cancer Patients Should Know: Latest Immunotherapy News from ASCO 2016

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  2. The therapy still holds sever side effects on some cancer patients, but it's still very promising for a new generation cancer treatment.

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