I read a very witty and apt tweet at this week’s American Society of Clinical Oncology (ASCO) annual meeting—the medical conference attended by over 30,000 oncologists and others in the field from all over the world: “Immunotherapy is like the hashtag—it’s here to stay.”
The pithy 100 or so characters—replete with fitting hashtags of course—not only epitomized the enthusiasm of the future of the field, but also the successes happening right now for patients. Promising clinical data lit up last month’s American Association for Cancer Research meeting, and it continued to shine at ASCO as well. Checkpoint inhibitors, gene therapy, and monoclonal antibodies: When conventional treatments don’t work, these immunotherapies, in many cases, step in to finish the job, harnessing the power of the immune system to kill cancer cells. And the list of cancers keeps growing.
Researchers from Penn’s Abramson Cancer Center (ACC) are big players in the field—for melanoma, blood and pancreatic cancers, to name a few—and were well represented at this year’s meeting. I actually spotted the tweet up on the screen during a T cell therapy symposium on Monday when two ACC physicians—Stephen Schuster, MD, the Robert and Margarita Louis-Dreyfus Associate Professor in Chronic Lymphocytic Leukemia and Lymphoma Clinical Care and Research, and Alfred Garfall, MD, an instructor of Hematology/Oncology—presented new data on the chimeric antigen receptor (CAR) therapy in lymphoma and myeloma patients. Gregory Beatty, MD, PhD, an assistant professor of Hematology/Oncology, also presented an abstract from a pancreatic cancer trial using the CAR therapy.
The first day kicked off with four abstracts on clinical trials involving the PD-1 targeted drugs nivolumab and pembrolizumab. The results were important because they demonstrated the drugs’ potential beyond melanoma. Approved for advanced melanoma patients in just the last year, these drugs are being put to the test in liver, colon, head and neck and non-squamous non-small cell lung cancer. Nivolumab extended survival rates for lung cancer patients compared with chemotherapy, and shrank tumors in 30 percent of liver cancer patients, researchers found.
“PD-1 immunotherapies continue to break new ground in diseases where nothing else seems to work well,” said Lynn Schuchter, MD, chief of Hematology/Oncology in the ACC. “The fact that this drug might stop advanced liver cancer in its tracks for months, even a year, is great news for patients.”
Researchers also presented results from a smaller genomic marker study that may help determine which colorectal cancer patients benefit from PD-1. Tumors with a specific type of mutation—known as mismatch repair (MMR) deficiency—were more likely to respond to pembrolizumab. This is the first study to use tumor genetics to guide immunotherapy, the researchers from Johns Hopkins reported.
Having that mutation is “like putting a red flag on cancer cells and saying to the immune system, 'Here I am,' and allows the immune system to recognize these cancer cells as foreign," Schuchter told MedPage Today.
The second day featured results from a multiple myeloma abstract co-authored by Brendan Weiss, MD, an assistant professor in the division of Hematology/Oncology. The team found that the monoclonal antibody daratumumab, after median follow up period of 9.4 months, elicited responses in third of myeloma patients who were previously treated with up to four different therapies. Three of the patients also had complete remissions. News outlets called it “unprecedented responses” and “impressive,” as this is the first monoclonal antibody in myeloma that has shown single-agent activity.
A tweet is one thing, but a packed room that had its doors shut—and caused staff to open up an over flow room—is another. The attendance for Monday’s “Developmental Therapeutics—Immunotherapy” oral abstract session spoke to just how enthusiastic clinicians, pharmaceutical representatives and others were to hear the latest results in some of the toughest cancers out there to beat.
The talks were mostly high-level and went deep into the data and science, much that was admittedly over my head—and likely would be for the general public and journalists covering the conference. The basic concept of immunotherapy—helping the immune system fight off cancer—is easy to wrap your head around, but when you look more closely at the treatment, you’ll see it’s very nuanced, complex, and personal.
So if immunotherapy is here to stay, most people are going need some help to better understand it, because it’s only going to get more sophisticated. We can’t all go back to school to take a few biology classes, but hitting the chalkboard is one idea.
My colleague wrote a blog post a few years back about a doctoral student named Florie Charles, founder of Youreka Science, who uses a white board and colored markers to explain findings from papers in an accessible, fresh, and engaging way. The video very simply explains the science behind the work, making it easier to digest.
A conversation during the meeting between Schuchter and Natasha Loder, a reporter for the Economist, about potential metaphors to illustrate the action of PD-1 therapies in videos sparked another Eureka moment: “These are incredibly complex concepts – cancer drugs are no longer a one-size-fits all prescription, and we are entering a new era where we need to be creative about how we communicate with patients, the public, and the press, and increasingly, these visual representations of drug mechanisms are so useful, ” said Schuchter, who notes that she draws simple sketches to illustrate the treatment of stage IV melanoma for patients and their families several times a week.
Something tells me we’ll be seeing #immunotherapy on Twitter for many ASCOs to come, and I’ll bet there will be new innovations in visual communication methods keeping pace with all the news.