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

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Prof Tom Powles GU18 Title SlideAt the 2018 ASCO Genitourinary Cancer Symposium, one of the standout keynote lectures was from Professor Tom Powles, Director of the Bart’s Cancer Cancer Center in London who talked about Immune checkpoint inhibitors in Urothelial Cancer: which one and why?”

We’ve been following the highs and lows around checkpoint inhibitors in bladder cancer for some time, so it was interesting to hear what Prof Powles had to say in San Francisco.

How does he see the landscape evolving for immune checkpoint inhibitors?

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Red Bull Air Race NYC

San Francisco: Today at the 2018 American Society for Clinical Oncology Genitourinary Cancer Symposium, commonly known as ASCO GU (Twitter #GU18), Dr Eric Small (UCSF) will present the results of the SPARTAN phase 3 trial (Link to abstract):

SPARTAN, a phase 3 double-blind, randomized study of apalutamide (APA) versus placebo (PBO) in patients with nonmetastatic castration-resistant prostate cancer (nmCRPC).

Despite the fact this is a positive trial and apalutumide will most likely gain regulatory approval for this indication in the United States, the data presented at ASCO GU is not a winner when viewed in the broader context of the prostate cancer landscape.

BSB subscribers can login to understand why, and also gain the perspective of a global thought leader familiar with both the SPARTAN and PROSPER trial data.

On a day when J&J have just announced that abiraterone (in combination with prednisone) provides a new treatment option for patients with metastatic high-risk castration-sensitive prostate cancer based on the results from the randomised phase 3 LATITUDE study, everyone’s attention is focused on the battle between SPARTAN (apalutamide) and PROSPER (enzalutamide) in M0 disease.

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The abstract has just been published for the phase 3 PROSPER trial to be presented later this week at ASCO GU in San Francisco (#GU18).

@Daniel_J_George

PROSPER: A phase 3, randomized, double-blind, placebo (PBO)- controlled study of enzalutamide (ENZA) in men with nonmetastatic castration resistant prostate cancer (M0 CRPC).

Earlier today Dr Daniel George (pictured), one of the investigators, kindly spoke to BSB about how he interprets the trial data and what it may mean for the treatment of prostate cancer.

Dr George (@Daniel_J_George) is Professor of Medicine and Surgery, and Director of Genitourinary Oncology at the Duke Cancer Institute.

Should men with non-metastatic CRPC receive enzalutamide in order to PROSPER?

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Last week we reported on a paper published in Nature by Bakhoum et al that raised the provocative question, Can STING agonists promote metastasis? (Link to BSB post).

As Dr Bakhoum subsequently tweeted an image from the research made the front page of the print edition of Nature:

In this latest post, we continue the story with a perspective on this research from one of the world’s leading experts on the science behind the STING (stimulator of Interferon genes) pathway.

Glen N. Barber, PhD is Chairman of the Department of Cell Biology at the University of Miami Miller School of Medicine and holds the Eugenia J. Dodson Chair in Cancer Research.

He has published extensively on the biology of STING and targeting the innate immune system.

In science we often hear that the truth is what the data tells us, but what does the data by Bakhoum et al really tell us and what conclusions can we draw from it that will guide future translational and clinical research?

Dr Barber kindly spoke to BSB at his office in the Papanicolaou Cancer Research building at the UM medical school and offers a perspective that reignites the controversy over STING and Metastasis.

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At the recent ASCO 2018 Gastrointestinal Cancer Symposium (GI18), Steven. D Leach MD (Dartmouth) gave an excellent Keynote Lecture on “Mapping the Immune Landscape in Pancreatic Cancer.”

Pancreatic cancer has very poor outcomes, with a one-year relative survival rate (across all stages of the disease of 20%) and five-survival rate of 7% according to the American Cancer Society.  In addition, stage IV exocrine pancreatic cancer has a 5 year survival of about 1%, which is utterly dismal to say the least.

When it comes to cancer immunotherapy, so far we’ve not seen the success in pancreatic cancer that we’ve seen in other tumours, there are no FDA approved cancer immunotherapies for this disease.

Which raises a critical question of what is happening in the immune landscape of pancreatic cancer patients, and how will cancer immunotherapy be effective?

In this post, we discuss some of the key points that Dr Leach made in excellent presentation and look at some new developments on the horizon in PDAC.

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Can STING (stimulator of interferon genes) agonists promote cancer metastasis in some patients?

That’s the intriguing question posed by research published recently in the journal Nature by Dr Samuel Bakhoum @Samuel_Bakhoum and colleagues. (doi:10.1038/nature25432who found that, “chromosomal unstable tumour cells co-opt chronic activation of innate immune pathways to spread to distant organs.”

Samuel F. Bakhoum, MD PhD is a Holman research fellow at Weill Cornell Medicine and a senior resident in radiation oncology at Memorial Sloan Kettering Cancer Center in New York. The joint first author of the Nature article is Bryan Ngo, a student in the Weill Cornell Graduate School of Medical Sciences. It’s impressive work from two early career researchers.

The paper raises several important questions that drug developers – several of whom already have STING agonists in the clinic – may need to carefully think about.  It is, however, important to point out that this data is preclinical, so we don’t yet know what may or may not happen in cancer patients.

We first heard about the data published in Bakhoum, Ngo et al’s Nature article, “Chromosomal instability drives metastasis through a cytosolic DNA response,” at last October’s excellent AACR-NCI-EORTC Molecular Targets and Cancer Therapeutics meeting in Philadelphia.

What we learnt at #Targets17 was that chromosomal instability is linked to tumour metastasis through the STING pathway.

Readers of BSB will know that we’ve been covering activation of innate immunity through the STING pathway for several years now (See posts:What we learnt at AACR about Aduro ADU-S100” and “Tom Gajewski takes the STING out of Cancer,” to name but a few.

So how do we reconcile the positive and encouraging data that has led to development of multiple STING agonists, several of which are now in the clinic, with the potential that there might be a harmful aspect to them?

There are some important subtleties and nuances around this critical issue and that is the essence of this post and what we sought to gain more insight into, beyond the obvious superficial answer that there could be harmful effects involved.

The Roman god Janus is depicted as having two faces – one looking to the future and the other to the past.

There are also two faces to cancer immunotherapy: It can be a force for good, we can harness our immune system in a way that results in a positive outcome – people with cancer live longer, some are even cured.  Alternatively, if we harness the immune system in a negative way it can also be a force for harm. 

We heard on the recent Novel Targets Podcast episode that while combination cancer immunotherapies can be effective in a subset of people, they can also lead to rip-roaring toxicities as well as unwanted auto-immune side effects, and in some cases, these can be fatal.  With multiple inhibitory and activating forces at place, cancer immunotherapy can tread a fine line balancing these out.

Dr Bakhoum kindly spoke to BSB about the translational and clinical implications of this latest research.

Given the potential impact of this research, we also sought additional commentary from experts active in STING research such as Jason Luke, MD FACP (@JasonLukeMD). He’s an Assistant Professor in the Department of Medicine at the University of Chicago and a Principal Investigator for early immunotherapy trials, including those with STING agonists.

BSB readers may recall we did an in-depth interview with him at AACR17 (See post: Overcoming Immunotherapy Resistance). This time around, he shared his perspective on Dr Bakhoum’s research and looked at the potential clinical implications.

Like Janus, does the STING pathway really have two faces to it?

Should companies with STING agonists be concerned or not?

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Buried amongst the intense hurly burly of a major medical meeting such as the American Society of Hematology (ASH) are the unsung preclinical researchers whose work largely makes clinical development possible. After all, few sensible companies would bet on an expensive clinical trial program, especially in combination, without first knowing whether such an approach is rational or not and has a decent shot of working efficaciously.

At stake here is the potential for building a blockbuster cancer drug niche by niche.

Venetoclax (BCL-2 inhibitor) got off to a somewhat slow start compared to say, ibrutinib (BTK inhibitor), which had a much broader initial indication and a lower risk of tumour lysis syndrome (TLS), yet it may actually have a wider application across multiple hematologic malignancies. This could well end up as one of those classic tortoise versus hare stories in the long run.

Back in 2013, we posted five interviews conducted with a range of experts including:

  • Dr Oliver Sartor (prostate cancer)
  • Dr Susan O’Brien (CLL)
  • Dr Deepak Sampath (BCL-2 and ABT-199)
  • Dr John Jenkins (then deputy director at the FDA)
  • Dr Renier Brentjens (CAR-T cell therapy)

To put this in context, consider that we just recorded 15 interviews at ASH this year alone!

As regular readers know, we like to follow people and R&D stories over time, so while in Atlanta at ASH17 we took the opportunity to move a particular story forward – we wanted to learn where Dr Sampath and his colleagues are now and also where they are headed next. This gives readers a head start on anticipating what future clinical developments might be mentioned at JPM18 by either Genentech/Roche or AbbVie.

In our latest expert interview, we pick up and continue the discussion with Deepak Sampath to find out what’s happening with venetoclax four years on… it turns out quite a lot and makes for very interesting reading indeed.

Dr Deepak Sampath (Genentech)

Curious to now more about what this scientist and his work in BCL-2 targeting is all about?  Check out this short excerpt:

 

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In our latest thought leader interview from the annual meeting of the American Society of Hematology (ASH) Dr John Leonard (Weill Cornell) provides a lesson on how to interpret key lymphoma data such as ECHELON–1, CAR T cells, and other topics at ASH, as well as what he’d like to see more of in lymphoma clinical trials.

In this hard-hitting interview, Dr Leonard reminds us that the media should not be a mere extension of the PR of companies. Instead he offers his real world insights into what may or may not be practice changing, and how we should interpret CAR T cell therapy data.

Dr John Leonard (Weill Cornell)

It’s a must read for anyone with an interest in lymphoma… here’s an excerpt to give you a flavour of the wide ranging discussion:

 

 

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Everyone loves a deal, and we at BSB are no different, so here’s a Cyber Monday Flash Sale for you all.

For 24 hours only (until 7am US Eastern Time on Tuesday Nov 28) we’re offering $100 off a 3 month subscription to Biotech Strategy Blog Premium Content. 

This offer is only available to individuals and not to anyone who plans to use our content for business purposes. Please do read our Terms of Use before purchasing.

If you have any questions please feel free to contact us.

Buying now will give you access to most of our coverage of #ASH17, the forthcoming annual meeting of the American Society of Hematology.

Fountain of Rings, Atlanta Centennial Olympic Park

Fountain of Rings, Atlanta Centennial Olympic Park

We’ll be rolling out more #ASH17 previews in the next few days and will have on-site coverage in Atlanta, then post-conference analysis.

If you want additional colour on what we wrote about last year, check out the page with our #ASH16 coverage. You can also listen to Episode 16 of the Novel Targets Podcast, “Controversies in Hematology.

Nearly 80% of our current subscribers are repeat purchasers so we must be doing something right. If you’ve been sitting on the fence, now is a great time to buy and try us out.  We won’t be offering another discount this year!

How to get the Cyber Monday discount rate?

Click here to purchase this offer and use the discount code CYBER100 at checkout to obtain your $100 discount.

[This Offer has Expired]

Cancer immunotherapy has been very much focused on T cells of late, but perhaps we shouldn’t ignore the importance of the innate aspect of the immune system and how that might help generate cytolytic activity to help kill cancer cells.

Regular readers will know that we’ve been following the potential of Natural Killer (NK) cell therapy and targeting NK checkpoints.

Sculpture in Mainz

At the recent CRI-CIMT-EATI-AACR international cancer immunotherapy conference in Mainz, we spoke with a scientist active in NK cancer immunotherapy research.

Dr Nicholas Huntington (@Dr_Nick_Bikes) leads a laboratory at the Walter and Eliza Hall Institute (WEHI) of Medical Research in Melbourne, Australia.  He’s also co-founder of oNKo-innate, a startup company focused on developing innate immunotherapies.

After his presentation in Mainz, he kindly spoke to BSB about his NK cell research and its potential as a novel target for cancer immunotherapy.

Here’s a short excerpt from our discussion:

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