Biotech Strategy Blog

Commentary on Science, Innovation & New Products with a focus on Oncology, Hematology & Cancer Immunotherapy

Posts from the ‘Immunotherapy’ category

Cancer Immunotherapy will require personalized treatment based on the type of cancer you have, and the immune response your body has generated to the cancer.

Dr Holbrook Kohrt Stanford

Dr Holbrook Kohrt at Immunology 2015

The sadly missed and visionary Dr Holbrook Kohrt was very prescient when he told BSB in New Orleans back in May 2015:

“Today when I see a patient or you go to a cancer center, the first thing they ask is what type of cancer do you have? Most patients respond – breast cancer, a colon cancer – unfortunately we are not in position where patients can say I have a deficiency in my cytotoxic CD8 cells or I have overly active regulatory T cells.

I actually envision a day when patients will know both sites, they will know they have breast cancer and they’ll also know it’s because there’s a lack of effector cytotoxic CD8 T cells. That combination knowledge, of what your immune system is lacking and what tumor you have, that combination will allow you to identify what type of immunotherapy you need.

Patients may need CAR directed T cells and those will be for patients who have completely non-functional T cells themselves, no matter what therapy you give them, you’re not going to create those cells within the body, therefore you need to do it ex-vivo in a petri dish and give it back to them.

Other patients may have T cells that just need to be turned on and so all they need is a checkpoint modulator and that combination is going to be effective enough for them.

So it’s this dual diagnosis, diagnosing their immune system and diagnosing their tumor that’s going to allow us to identify one, two, or three therapies that’s going to be the right cocktail.” 

See post: Holbrook Kohrt leads the way in Targeting CD137, you can also listen to excerpts on the Novel Targets Podcast: Episode 6: Stepping on the Gas

ICYMI do listen to the tribute to Dr Kohrt on the Novel Targets Podcast from two people who knew him at Stanford: Dr Ron Levy and Dr Dan Chen (@DanChenMDPhD). It’s at the start of Episode 11: Cancer Immunity Cycle.

Immunoscore® — a diagnostic test based on the immune profile of a patient is based on the pioneering work of INSERM scientist Dr Jérôme Galon.

Dr Jerome Galon at ASCO 2016

Dr Jérôme Galon at ASCO 2016

We are fans of his work, and interviewed him at the 2015 European Cancer Congress. See post: Immunosurveillance, Immunoscore & Personalized Cancer Immunotherapy – an interview with Jérôme Galon.

Over 10 years ago, Dr Galon’s research published in The New England Journal of Medicine and Science showed that the type, location and density of immune cells within a tumor predicts clinical outcome in early stage colon cancer.

These findings led to the development of an assay called Immunoscore® that’s based on an analysis of cytotoxic T cells, the ones that kill cancer.

In the process, it has led to a new way of classifying stage 2/3 colon cancer patients: those with a high Immunoscore® (good prognosis), and those with a low Immunoscore® (poor prognosis). Dr Galon’s work has shown that irrespective of whether you are MSI high or MSS, colon cancer prognosis correlates with Immunoscore.

Dr Bernard Fox at #AACR16

Dr Bernard Fox at AACR 2016

As we heard from Dr Bernie Fox (@BernardAFox) at AACR 2016. See post: AACR Cancer Immunotherapy Insights from Dr Bernard Fox, listen to excerpts on Novel Targets Podcast Episode 12: Of Mice and Men:

“What I teach the first year medical students is that if you have metastatic cancer, the only thing that makes a difference in your life is whether you’ve got your immune system turned on. If it’s not turned on, it doesn’t make a difference what you get, chemo, radiation, surgery, you aren’t going to do well.”

Immune response is key to outcome, which means that knowing what your immune profile is will be key to deciding which of the many immunotherapy options, either alone or combination will achieve the desired effect.

A large multinational phase 3 clinical trial sponsored by the Society for Immunotherapy of Cancer (@SITCancer) was set up to validate Immunoscore® as a biomarker in Stage 2 colon cancer.

Dr Galon and co-authors reported the results at ASCO 2016. See post: immunoscore validated as an important biomarker for colon cancer. He featured on the ASCO 2016 episode of the Novel Targets Podcast: Immunotherapy or Bust.

Immunoscore® is now being commercialised by Marseille based HalioDx(See post: HalioDx CEO Vincent Fert outlines commercial strategy for Immunoscore in US and Europe).

ciml40During a recent visit to the Marseille Immunopôle for #CIML40, I had the pleasure to do an impromptu tour of the HalioDx lab.

When listening/watching this, do bear in mind this was not a scripted tour, and also the people I spoke to were speaking English as a second language.

It’s not intended to be a definitive guide; if you are a patient you should talk to your doctor about any questions you have about diagnostic assays such as Immunoscore.  At the moment, it’s only available for research or clinical trial use, but HalioDx has plans to make the assay commercially available on the US and Europe.

The company has more information on their website and also recently published a paper in the Journal for Immunotherapy of Cancer (open access) that describes how the test is done in more scientific detail.

In the meantime, subscribers can login to join me for a lunch-time tour, or you can purchase access below. The audio-slideshow tour was for several weeks open access and available to all, but is now for subscribers only:

ciml40-marseille-luminyThere is a lot of interest in manipulating the microbiota to improve clinical outcomes – there was a whole session dedicated to it earlier this week at the CRI-CIMT-EATI-AACR international cancer immunotherapy conference in New York.

At the recent scientific meeting to celebrate the 40th anniversary of the Centre d’Immunologie de Marseille-Luminy (CIML40) in the South of France, Dr Eric Pamer spoke about his research into microbiota-mediated defense against intestinal infection.

Dr Eric Pamer presenting at CIML40

Photo Credit: ATGC Partners

Dr Pamer is an infectious diseases expert at Memorial Sloan Kettering Cancer in New York, where he runs a laboratory (The Eric Pamer Lab) focused on the role of the microbiota in immune system development and in defense against antibiotic resistant pathogens.

The gazillions of bugs in our gut, collectively the microbiota, interact with the innate immune system.

Researchers have shown that the effectiveness of antibiotics and the type of immune response we generate depends on the type of bacteria and their diversity in our gut.

ciml40Readers may recall the interview we did with Dr Marcel van Brink (@DrMvandenBrink) at the Society for Immunotherapy of Cancer (SITC) 2014 annual meeting, where he talked about his research into how gut bacteria can impact survival post allogeneic bone marrow transplant. See post: Can you reduce Graft Versus Host Disease GvHD by regulating gut bacteria?

Almost a year ago in November 2015, researchers and the pharmaceutical industry were both galvanized by work from Laurence Zitvogel and Tom Gajewski labs, published simultaneously in Science. See post: Gut Bacteria Impact Checkpoint Inhibitor Efficacy.

Not only could the results from mice experiments be influenced by the gut bacteria they had, but the microbiome could also impact the effectiveness of checkpoint inhibitors.

You can listen to Dr Gajewski on Novel Targets Podcast summarize the research from his lab published in Science. Link to Episode 9: Targeting the Microbiome.


Next year’s European Society for Blood and Marrow Transplantation Congress (#EBMT17) will be held in Marseille.

Given the impact the microbiome has on post-transplant GvHD and survival, I expect we’ll hear more about this at the Congress. Marseille is well worth a visit if the opportunity presents.

Marseille Vieux Port

In case you missed them do check out our recent posts from the Marseille Immunopôle and #CIML40:

In the meantime, our latest expert interview with Dr Pamer covers his wide ranging thoughts on a number of issues, including the impact of the microbiota on the innate and adaptive immune systems and where he sees the field going in the future.

Subscribers can login to read more about his insights or you can purchase access below.

Like the Battle of Britain, the cancer immunotherapy landscape is a dynamic one where tactical decisions can make the difference between “winning” and “losing.”

As Bristol Myers recently found out in first-line NSCLC, if you choose the wrong trial design or adopt an overly-aggressive strategy, you can end up losing badly (see post: Detailed thoughts on BMS CheckMate 026 1L trial in NSCLC)

A recent trip to the operations bunker at former RAF Uxbridge, from where the fighters of 11 Group were directed, shows how close we came to losing the Battle of Britain.  Had the German Luftwaffe continued to target RAF airfields instead of diverting their efforts on London, the outcome of the war is likely to have been quite different.

History provides a valuable lesson that strategy and tactics can and do matter; in R&D the targets you choose and how effectively you execute on a plan can make a big difference to outcome.

Battle of Britain Bunker Plot

Pictured: the RAF 11 Group Operations plot as it looked on September 15, 1940.

In Part 2 of the BSB interview with PsiOxus Therapeutics CEO Dr John Beadle, we discuss corporate strategy, and some of the challenges faced by an emerging Biotech company, many of which are likely to be shared by other small companies in the field.

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HMS VictoryThe dog days of summer are usually quiet on the Pharmaland front, although this year has been a bit of an exception, being notable for a batch of deals being completed and announced already.

The cell therapy space is one area that has courted both controversy and new collaborations, for example. Nary a week seems to pass without something appearing in the news! This has proven pretty interesting for a number of subscribers, who write in asking plenty of astute questions.

Today’s questions from BSB readers therefore encompass allogeneic cell therapies and what’s going on in that fast moving dynamic space.  Not all of the announcements may be what they seem though, and some are much more riskier than others.

To learn more, subscribers can log-in or you can sign up in the blue box below…

The Shard from River ThamesMuch has been written about the impact of cancer immunotherapies, particularly the twin pillars of checkpoint blockade and CAR T cell therapies, but beyond that lies a huge wealth of alternative approaches that may come in very useful indeed.

Just as we have seen oncogenic escape witth targeted therapies, there is also a related phenomenon called immune escape. Likewise, this can occur as either primary or secondary resistance.

It’s very important to consider this issue, because, after all, the vast majority of cancer patients with solid tumours do NOT see durable clinical benefit with immunotherapies when given as single agents. Some don’t respond at all (primary resistance), while others may see an initial response, then relapse (secondary resistance).

Understanding the mechanisms involved in resistance may help us design better combination trials to address the underlying biology as well as develop biomarkers to help select appropriate patients for each regimen. Clearly resistance can vary, not only by tumour type, but also by lesion and patient, making it a very complex situation to research.

Some interesting new information has recently come to light that is worthy of futher discussion and analysis, particularly in the context of other published data in this niche.

To learn more about the latest data, subscribers can log-in or you can sign up via the blue box below…

At the recent annual meeting of the American Association for Cancer Research (AACR), one controversial area that arose was centred around targeting OX40, a stimulatory checkpoint. We’ve written extensively about anti-OX40 checkpoint agonists on the blog in the past.

Targeting OX40 is an area of interest to several companies looking to improve the effectiveness of checkpoint inhibitors. As a result, several companies have OX40 agonists in development, including AstraZeneca/MedImmune, Roche/Genentech, Pfizer, GSK and Incyte/Agenus, for example, making it a competitive target and interesting race to market.

Meanwhile, in their recent 1Q earnings call, Roche announced that they expect to present clinical data on their PD-L1/OX40 combination at the forthcoming American Society of Clinical Oncology (ASCO) annual meeting in Chicago from June 4th to 7th. This therefore makes it a timely moment to reflect on the data generated so far and what we can expect next month.

In New Orleans, we spoke to several researchers who are active in the OX40 field, since there were both mouse and human data presented at this year’s conference.

The interviews conducted were wide-ranging and informative, so in our latest mini-series we explore Part 1 today with Part 2 tomorrow.  They are relaxed fireside chats with different experts included in each to discuss their data (and other relevant topics) presented in New Orleans.

This way, you’ll be able to follow along and find out where the common areas are, as well as the differences in perspectives, and even where we could be headed in the near future.

This latest series on OX40 agonists raises many intriguing questions that we hope may be answered at ASCO and other clinical meetings going forward. We also discuss the challenges and opportunities associated with research into cancer immunotherapy combinations.

Dr Bernard Fox at #AACR16

Dr Bernard Fox at #AACR16

Intriguing preclinical data in mice models were presented by Dr David Messenheimer (Portland). We spoke with the senior author of that abstract, Dr Bernard Fox.

He is the Harder Family Chair for Cancer Research and Chief of the Laboratory of Molecular and Tumour Immunology at the Earle A. Chiles Research Institute in Portland, Oregon, and a leading cancer immunotherapy expert. He’s also the CEO of UbiVac, a biotech spin-off from Chiles in 2005 to develop therapeutic vaccines for cancer and infectious diseases.

Subscribers can login to read more on where “the rubber is hitting the road” in cancer immunotherapy clinical research.

If you’re not already a subscriber, you can purchase access to AACR posts and also our immuno-oncology coverage by clicking on the blue icon below.

Dawlish TrainspottingIt’s Day 7 of our 12 day Countdown to AACR 2016 in New Orleans.  After exploring GITR and OX40, we’re now looking at another stimulatory target for cancer immunotherapy: CD40.

We’ve been writing about CD40 as a cancer immunotherapy target for some time. See posts: “CD40 as a Cancer Immunotherapy Target” and “Targeting CD40 in Cancer Immunotherapy.

Anti-CD40 antibodies are agonists that act on stimulatory signalling receptors on T cells and antigen presenting cells (APCs). Targeting CD40 effectively acts to “put the foot on the gas” and may help generate a better immune response. This could be important in cancers that have fewer natural T cells present.

CD40 is an attractive target because it’s expressed in more than 50% of carcinomas and melanomas and almost all hematological B cell malignancies.  Of particular interest is the potential to combine a CD40 agonist with a PD-1/PD-L1 checkpoint inhibitor.

Multiple companies have CD40 agonists in clinical development including Roche, Apexigen, Alligator Biosciences and Seattle Genetics.  There are others coming too.

In this preview of AACR 2016, we’re looking at the CD40 landscape. New products and companies have entered the scene, so we’re highlighting them and some of the CD40 presentations to look out for at AACR 2016 (and why they matter).

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British Javelin TrainIt’s Day 6 of our Countdown to the AACR 2016 annual meeting in New Orleans. We’re at the halfway, 6 posts written and 6 more to go!  Then it will be daily Live blogs from the meeting.

There’s a lot of cancer immunotherapy at AACR this year, so after yesterday’s post on GITR we’re continuing our mini-series with a look at another immune agonist.

Today, we’re moving onto OX40 (CD134) as a novel immuno-target. Regular readers will know that we’ve been following this target for some time.

Immune agonists such as GITR, OX40, CD40, CD27 and 4-1BB help to rev up T cells. As Dr Tom Gajewski (Chicago) told us last year, in an interview published on the blog and excerpted in Episode 6 of the Novel Targets Podcast: Stepping on the Gas:

…there are inhibitory receptors on activated T cells that are involved with shutting immune responses down. There are also activating receptors that help to rev up those T cells. You might question whether you can push an activator and block an inhibitor, and maybe get a good anti-tumor response going as well.

When we drive a car, we both lift our foot off the break and we step on the accelerator. We have really beautiful data in animals that that this is exactly the case, that if you hit one of those strong positive regulators, and block just one of the negative regulators, you can have complete disappearance of the tumors in mice.

Several of those positive agonistic antibodies against costimulatory receptors are in the clinic. One of them is anti-OX40 that a couple of groups have in the clinic. We’re working with Genentech, that has one of those agents in phase I.

What does the OX40 competitive landscape look like?

In those post we’ve provided commentary on some of the new products in development from companies and highlighted a surprising number of abstracts that you’ll want to watch out for at AACR 2016 if you’re on the cancer immunotherapy track.

Subscribers can login to read today’s Road to AACR 2016 post or you can purchase access below in the blue box.

Macarons in shop windowWe’re all familiar by now with the idea of checkpoints that can be inhibitory (release the brake) or stimulatory (put the foot on the gas) on the immune system.

There are multiple checkpoint modulators in development, it’s becoming a bit like buying a macaron – which flavour do you want?

As the late Holbrook Kohrt said on the Novel Targets Podcast last year:

There are two types of checkpoint inhibitors, one checkpoint inhibitor are these series of markers that each of them when you target them, they will slow down the function of that cell. Now that’s a good thing if that cell is a suppressor cell, such as a regulatory T cell. Anti-CTLA-4, ipilimumab, the first approved immunotherapeutic monoclonal antibody targets these regulatory T cells. Essentially is this concept as you said of taking off the brake .

Now if you want to press on the gas pedal, you want to find a target that is essentially that actually increases the function of a cell you want to make work better…….

…. these ideas of the different checkpoint inhibitors, essentially we should really call them, checkpoint modulation, because the checkpoints can either be gas pedals or they can be brakes.

And ultimately, it’s a question about how do you combine them in a rational way so that way you’re not either pushing the car too hard or taking the brake off at a time when the car is rolling in the wrong direction.

So essentially, you need to do checkpoint modulation in a setting where you still have the steering wheel on your car to ensure it’s directed against the right cells, otherwise you’re going to get significant toxicity.”

Which is a good introduction to Day 5 of our Road to AACR 2016 mini-series.

Over the course of 12 days in the run up to the 2016 annual meeting of the American Association for Cancer Research (AACR), we’re taking a look at some of the areas we expect to hear more about in New Orleans.

In today’s post, which continues our look at some of novel cancer immunotherapy targets, we’re look at the modulation of GITR (glucocorticoid-induced tumor necrosis factor receptor related gene) and companies that are targeting this.

GITR was named as the 12th most promising cancer immunotherapy target by the National Cancer Institute (NCI) back in 2006.  Interestingly, high GITR expression can be found on both T cells and NK cells.

There are now several agonist antibodies in development and entering the clinic that seek to activate GITR, and new data is expected at AACR 2016.

What GITR pathway data is worth looking out for at AACR 2016?

If you want to know more about why GITR matters, and where it fits into the cancer immunotherapy landscape then do read more. 

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AACR Annual Meeting 2016 BannerOne of the hot topics at the forthcoming 2016 annual meeting of the American Association for Cancer Research (AACR) in New Orleans is likely to be CAR T cell therapy (Twitter: #AACR16).

Several research groups have shown impressive results in acute lymphoblastic leukaemia (ALL), but challenges remain in using adoptive cell therapy to treat other leukemias such as CLL, as we heard from Dr Porter at the recent BMT Tandem meeting. See post: Challenges and Opportunities of CAR T cell therapy in CLL. Perhaps more significantly, there’s a long way to go before CAR T cell therapies hit prime time in solid tumours.

What is fascinating is the pace of scientific research in the field. By the time the first CAR-T cell therapy is FDA approved, the second generation constructs used in them will most likely be obsolete.

This post reviews completely new research, which we’ve not written about before, that I expect we’ll hear more about at AACR, and discusses novel concepts about how to make CAR T cell therapy more effective in both leukemia and solid tumours.  It’s a good pre-AACR preparation for those interested in cancer immunotherapy and the emerging CAR T cell therapy landscape.

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