Biotech Strategy Blog

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

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Posts by Pieter Droppert

In her ASCO Gastrointestinal Cancer symposium (ASCO GI) keynote presentation earlier this year, Elizabeth M. Jaffee MD described the future of immunotherapy as being in combinations.

Overcoming or delaying resistance mechanisms or hitting multiple targets to greater effect will be achieved through combinations of drugs rather than single agent therapy. Combination strategies are the accepted future, whether drug companies like it or not.

In her keynote, Dr Jaffee also likened the revolution in immunotherapy to the same excitement the Beatles brought to music or the same magnitude of technology advances made by Apple. We agree completely.

Thought leaders at ASCO expressed similar sentiments. Steven O’Day (UCLA) said,

This is truly a brave new world of immunotherapy. I think the message is that the revolution is here, it’s ongoing, and it’s bursting out of melanoma into solid tumors.”

Interestingly, no immunotherapy data was considered to be of worthy of presentation in the plenary session at ASCO this year for the second year running, a decision that may reflect either an unwillingness to showcase early data, however good it may appear to be, or the influence of politics on the selection committee.

One potential combination is to target more than one checkpoint pathway to see if you can obtain a synergistic response. This is the rational for combining the monoclonal antibody ipilimumab and nivolumab. Ipilimumab (Yervoy) targets the CTLA-4 checkpoint protein that prevents dendritic cells from priming T cells to recognize tumors while nivolumab targets the PD-1 checkpoint protein that prevents T cells from attacking cancer cells. Yervoy is an FDA approved therapy for the treatment of metastatic melanoma.

Data published last year in The New England Journal of Medicine by Wolchok et al, showed that combining ‘ipi’ with ‘nivo’ gave more frequent and deeper responses in melanoma, but at the expense of much greater toxicity. Some 53% of patients receiving concurrent treatment had a grade 3-4 adverse event (see Table S-1B in the article).

Does it make sense to combine two immune pathway modulating agents? Does the enormous potential for synergy outweigh the additional toxicity? 

To learn more about these insights, log-in for our analysis of the data on nivolumab in renal cell carcinoma (RCC) presented at ASCO 2014.

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A predictive biomarker for prostate cancer drug resistance may lead to new drug development opportunities.

At ASCO 2014, one of the prostate cancer highlights was the oral presentation by Emmanuel Antonarakis MB BCh, Assistant Professor of Oncology at Johns Hopkins.

He presented elegant research, albeit in a small group of patients, about how constitutively active splice variants (AR-V’s) may represent one potential mechanism of resistance to androgen receptor (AR) signalling inhibitors such as enzalutamide (Astellas/Medivation) and androgen synthesis inhibitors such as abiraterone (JNJ).

I spoke to Dr Charles Ryan, Professor of Medicine and Urology at the University of California San Francisco (UCSF) about the significance of the data to clinical practice, and the new drug development opportunities that may follow-on from it.

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Chicago – it’s the last day of the American Society of Clinical Oncology (ASCO) annual meeting. There’s been a record attendance this year with over 30,000 people coming to Chicago to hear the latest news and research on cancer treatments.

The message I am left with is the considerable hope it offers cancer patients around the well as researchers harness the latest techniques in genome sequencing and through a deeper understanding of cancer biology, develop new targets and ways of attacking this disease. Attacking the immune system (immuno-oncology) is one of the most exciting areas in cancer drug development.

I only wish other areas of biomedical research where there is an unmet need e.g. new and effective treatments for neuro-degenerative diseases such as Alzheimers, offered such hope and focused research activity.

It’s the final day of ASCO 2014 and only the diehards are left (or those who couldn’t get a plane out early).  We hope you’ve enjoyed the “live” blog and our notes from the road each day.

What are we covering this morning? Subscribers can log-in to find out more.

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Chicago – it’s day 4 of the ASCO (American Society of Clinical Oncology) annual meeting. Sunday at ASCO can be a bit hit or miss depending on whether the plenary selection committee makes a good choice in which studies to give the “glory” and how interesting they are. It’s certainly been a busy meeting, although I have to say going round the poster halls has been a horrible experience so far.

To learn more about our highlights and lowlights of the day, you can log-in.

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Chicago: The ASCO 2014 conference is in full swing as it enters day 3. We’re continuing our coverage of the meeting with our daily live blog where we post regular updates of data that catches our interest or quick notes from sessions we’ve been to.

What have been the highlights so far – well the AZD9291 vs. CO-1686 debate is keeping the analysts busy. I interviewed Dr Pasi Jänne yesterday about the AZD9291 data and will be talking with Dr Lecia Sequist later today to talk about CO-1686. Meetings such as ASCO do afford the opportunity to talk to thought leaders.

What’s on the agenda this morning?

Subscribers can login to read where we’ll be at and what we will be covering.

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Good morning from Chicago and the annual meeting of the American Society of Clinical Oncology (ASCO) where we are continuing our coverage of the meeting with a live blog from day 2 of the meeting.

As the day progresses we’ll be adding in tweets we want to share, short comments on sessions we attend (blog posts will follow later), and time-permitting excerpts of interviews. It’s an experiment, so bear with us, we hope it works and doesn’t distract too much from time spent gathering data and talking to people.

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Chicago: Welcome to ASCO 2014 (#ASCO14), and this year’s annual meeting of the American Society of Clinical Oncology (ASCO) and the world’s largest cancer conference.

It’s the Super Bowl of cancer conferences – the meeting you not only have to be at if you’re in the field, but where you want to have your data presented. The press room is truly multinational.

The weather I have to say is glorious in Chicago, it’s probably the best time of year to visit, but as anyone who has ever been to ASCO knows, it’s an all consuming meeting and you never have any chance to visit the sights, although the travel department has kindly provided a room with a view.

This year we’ll be writing daily blog posts that provide rolling coverage – as and when the opportunity presents – we’ll be updating the post with news, commentary, and the occasional picture or clip from an interview.

Today, despite being primarily a travel day, we made it to a couple of the poster highlights sessions.

Sadly, with flights, hotels and bar bills to pay, the ASCO coverage is for subscribers only. The first of our live blogs begins below. It will probably kill us to do this, but here goes…..we’re kicking off with some commentary on the poster highlights sessions.

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Healthcare innovation can take many forms. It can be a breakthrough in our understanding of the biology of cancer, or a disease that allows new drugs to target it in an effective way, for example. We also see it with advances in medical technology such as implants that can help restore vision or imaging techniques that may allow faster and more accurate diagnoses.

However, one area that I had not thought about until recently was how innovation in a building’s design can impact the delivery of healthcare.

We interact with design every day without thinking much about it. Advertisers use design in brand marketing all the time to create instantly recognizable logos that we automatically associate with a product.

Listeners to Roman Mars’ outstanding podcast, 99% Invisible, will already be familiar with the power of design in everyday life. This podcast is well worth a listen!

Currently, I’m in Liverpool in the North West of England for personal and professional reasons, and while here I’m looking at some of the innovative work being done in the area around dementia care.

Last week I visited Everton FC who, in partnership with Mersey Care NHS Trust, use their facilities to engage and provide support to local people in the community who have dementia.

Since then I have also been to Liverpool City Councils’ Sedgemoor Dementia Support Centre in Norris Green.  The Centre recently won a national design award at the health care equivalent of the Oscars (Best Care Complex at the Healthcare Design Awards).

My mother, Audrey, had Alzheimer’s disease – a form of dementia – and spent the last two years of her life in a nursing home.  While the carers were wonderful people, I always found it rather depressing to visit.  She spent everyday sitting in a standard care home chair in a lounge area that had little cognitive stimulation other than a TV blaring in the background, high up on the wall, just creating mindless noise.

While Audrey’s memory was a bit like a Swiss cheese, she was able to engage in a conversation and had moments of great lucidity. As Tommy Dunne (@TommyTommyTee18), who has early onset Alzheimer’s told me at Everton FC: he has dementia, but he’s not demented!

I was curious to know what was innovative about the Sedgemoor dementia support centre; can design really make such a difference in the delivery of health care to those with dementia?  You can judge for yourself after watching the audio slideshow from my visit.

Sedgemoor shows what can be done in the public sector. Like many examples of successful innovation it had a champion with a vision, willing to take risks, think outside the box and break from the norm of what might otherwise have been a utilitarian oblong box.

That champion with a vision is Liverpool City Council’s Joy McDonnell, a qualified architect who was the client lead. Joy spent two hours giving me a guided tour of Sedgemoor, explaining how each part of the building, even down to the fixtures and fittings, was designed to afford the maximum benefit to users with dementia. I was blown away.

What I hope is that Sedgemoor is not just an isolated example, but sets a precedent for future buildings. This is how more dementia care facilities could be designed. If Liverpool City Council can create a publicly funded building like this for the same price as they would an oblong box, why can’t others repeat it around the country?

I would have loved the nursing home my Mother ended up in to have had many of the design features I saw at Sedgemoor.  I could see how this would have improved her quality of life, helped stimulate her memories and keep her more active and engaged.

For anyone who has a chronic long-term illness, such as cancer or dementia, it’s not just about how long you live, but having a good quality of life while you are alive. That is something we should all aspire to for our loved ones and ourselves.

I would like to thank Liverpool City Council, and in particular the press office and dementia support lead, Phil Wong, for making my visit happen. Thanks also to Sedgemoor Manager Mary Plumpton for a warm welcome. Joy McDonnell was not only generous with her time, but gave of herself to bring Sedgemoor to life for me. Thank you, Joy!

If you have come across some innovative programs in the dementia or Alzheimer’s area, do feel share them in the comments section below.

Update June 5, 2014: listen to Living well with dementia – a personal journey

My research into designing for dementia was undertaken while on a BJTC accredited diploma in radio journalism course based at Radio City in Liverpool. You can listen via SoundCloud to the documentary I produced on living well with dementia – a personal journey:

UPDATE November 20th, 2014: BJTC Awards by @maverickny

I’m delighted to announce that Pieter’s fantastic work on dementia won the BJTC 2014 Award for Best Radio Documentary!

Thank goodness for Twitter and being able to follow the live event in Birmingham, UK remotely…

BJTC Awrd 2014

Dementia care is a “quiet crisis” that already touches many families and will touch many more as we live longer in our old age and the huge baby boomer population reaches retirement age.

The Alzheimer’s Research Trust estimate that 1 in 3 over the age of 65 will have dementia by the time they die. Alzheimer’s disease is one type of dementia.

To cope with this explosion, more care will need to be provided in the community.

Mersey Care NHS Trust, who provide mental health care in Liverpool, Sefton and Kirby, have partnered with Everton FC, an English Premier League Club to support members of the local community with dementia.

The innovative program called “Pass on the Memories” (Twitter: @efc_potm) helps more than 120 people with memory loss through activities that take place two days a week at Goodison Park. Support is offered via facilitators in the club and health professionals from Mersey Care.

The meetings help trigger sporting memories, but also engages participants in group social activities and visits, thereby keeping them mentally active and engaged.

When I visited, members of the group were about to head off for a visit to the Museum of Liverpool, which would no doubt stimulate powerful memories for many.

As some readers of the blog may know, my mother Audrey (who died recently at age 89) had Alzheimer’s disease.  It’s a progressive disease with no known cure.  I watched her memory slowly but surely deteriorate over several years.  A keen dancer, she reached a point where she couldn’t remember how to dance anymore.

What Everton FC is doing by lending their support to the Pass on the Memories scheme, is something that sporting clubs around the world should all consider in their communities.

 

Sporting clubs derive considerable support from local communities and have facilities that are vastly underused outside of games. Many of their fans will sadly develop dementia. Engaging the local community in this way is a tremendous way of giving back.

As social services continue to be cut back in Liverpool due to budget cuts, I’m impressed by the way Mersey Care and Everton FC are helping those with dementia have the best quality of life they can through this type of local partnership.

If it didn’t exist, I expect many people would end up just sitting at home all day with little mental stimulation or interaction.

During my visit to Goodison Park, I spoke with Everton FC Community Engagement Manager, Henry Mooney (@HMooney23) who plays a key role in running the Pass on the Memories program at the club. He told me you don’t have to be an Everton fan to participate. 🙂

Living with Alzheimer’s disease is not easy.  Unlike a physical disability, you can’t readily tell if someone has dementia, they look normal much like the rest of us.

Tommy Dunne

Tommy Dunne, 61, was diagnosed with early stage Alzheimer’s disease three years ago. He told me that just because he has dementia, does not mean he is demented. Raising awareness of dementia and getting rid of the stigma associated with it is something we all can help with.

As the number of people with dementia grows, those who provide services (shops, transport etc) will need to be educated on how they can help people with dementia maintain their independence and undertake the activities of daily living that we all take for granted.

I was pleasantly surprised and pleased to see that Tommy is active on Twitter (@TommyTommytee18). It’s a great way to share his experiences.

I’ve included excerpts of the interviews I did with Tommy and Henry Mooney in the radio documentary on dementia that I produced – you can listen via the embedded SoundCloud at the end of this post or using this link.

If you are in the Liverpool area and have a family member with dementia, I encourage you to find out more about this innovative program.

Taking a more strategic view, I’m still shocked by how little progress there has been in drug development to tackle dementia, and in particular Alzheimer’s disease.

In comparison to oncology where research is focused on multiple new targets for drugs, as well as novel biomarkers that can help predict who are more likely to respond, dementia research seems like a record stuck in the groove.

Focusing on one target has failed to yield an effective Alzheimer’s drug despite spending hundreds of millions on clinical research.

More needs to be done to understand the biology of Alzheimer’s disease and generate new insights into potential new targets that at the very least delay the progression of a disease that many of us will possibly end up with in the future.

Update April 30, 2014: Everton FC write up my visit on their Community news site

I was thrilled to hear that John Howard, (@JHowEFC08) Media Officer for Everton in the Community has written about my visit to the Pass on the Memories program. He’s published a really well written post on the Everton FC community website that goes into more detail about the program.

Pieter Droppert interviewing Tommy Dunne. Picture Credit: John Howard, Everton FC

Here’s the link to John’s piece if you are interested in more information: Pieter’s views on Pass on the Memories

Update May 19, 2014: Talking about Dementia on BBC Radio Merseyside Daybreak show

At the start of Dementia Awareness Week in the UK, I was very grateful for the opportunity to go on the May 18, 2014 edition of BBC Radio Merseyside’s Daybreak show, produced by Helen Jones.

I talked about my late mother, Audrey and some of the innovations in dementia care that I’ve written about on the blog. If you have the chance do listen to an excerpt from the show:

Update June 5, 2014: listen to living well with dementia – a personal journey

My research into Everton’s Pass on the Memories program was undertaken while on a BJTC accredited diploma in radio journalism course based at Radio City in Liverpool. You can listen via SoundCloud to the documentary I produced on living well with dementia – a personal journey:

San Francisco – In the ASCO GU prostate cancer session yesterday morning one of the most interesting presentations was by Andrew J Armstrong, Associate Professor of Medicine and Surgery at the Duke Cancer Institute.

I previously referenced Dr Armstrong’s excellent education presentation at ASCO 2012 in my piece on Xconomy about the emerging challenges of prostate cancer drug development.

He’s a speaker that I particularly enjoy listening to, so my attention was immediately drawn to his presentation at ASCO GU on, “Beyond Enzalutamide and Abiraterone: What’s Next in Androgen Therapy.

Looking at this title, at first glance the question that comes to mind is do we really need new treatments that target the Androgen Receptor (AR), after all we’ve heard this week about the PREVAIL trial with enzalutamide?

Based on Dr Armstrong’s presentation the answer is a resounding yes!

To learn more insights on this intriguing topic, subscribers can log-in or you can purchase access to BSB Premium Content. 

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