Published date: 17 Jul 2018
Advances in medicine are often made in baby steps. Slowly, cautiously, apprehensively. But every so often, they leap onto the scene and nothing’s ever the same again.
Just look at what happened with the discovery of penicillin: it kick-started a golden era of antibiotic discovery. Or consider how the introduction of vaccination in the 1920s knocked infection off the number one spot as a cause of death.
Reproduced from the Office for National Statistics, 2017.1
The discovery of a single new molecule drove the standard of care to a completely new level.
And that’s exactly what immuno-oncology is doing for cancer now.
For millennia, the only way to treat cancer was through surgery – the first pillar of cancer care.2 However, before the advent of anaesthetics and aseptic technique in the 19th century, it had never been a particularly successful or desirable option.
Over the last century, the standard of cancer care was vastly improved with new approaches to killing cancer cells: radiation, chemotherapy, and targeted therapy – the second, third and fourth pillars.2 We continue to innovate in each of the traditional four pillars, but it’s the recent advances in the new, fifth, pillar which is ushering in a new golden era of oncology medicine: immuno-oncology.
Immuno-oncology is a whole new approach, harnessing the body’s immune system to fight cancer. There are several strategies, the best characterised of which is T-cell modulation, which unmasks the tumour from the immune system, allowing it to work against the tumour. Other mechanisms include modulation of other immune cells, vaccines, cell therapy (collecting immune cells from a patient, engineering them to act on new targets and reintroducing them), oncolytic viruses (viruses with specific anti-tumour activity and which induce immune response), and bispecific antibodies (which bring immune cells closer to the tumour to elicit an immune response).3
There’s an elegance to every one of these routes. Superficially, there’s pure simplicity, but they’re driven by mind-bending technologies that make you cock your head in disbelief.
They’re very promising too: these new approaches have huge potential to improve both duration of survival and quality of survival, as compared with previous routes.
The efficacy profiles in the trials suggest that, in terms of survival, immuno-oncology could be absolutely transformational. We’re starting to talk about lung cancer survival in terms of years. Trials in melanoma are beginning to release 5-year data – these are patients with advanced cancer living for half a decade without disease progression.4
There’s a whole raft of products in development. Immuno-oncology pipelines are thriving. Sophisticated programs have been set up to trial agents across dozens of indications and in multiple combinations. One review from earlier this year estimated that 940 agents were in clinical development, with a further 1,064 in preclinical phase.3 And competition is getting fierce … with over 800 companies entering the fray, every week we see more acquisitions in the big dogs’ bids to boost their portfolios.
And this means lots of new products, license expansions and launches …
Purple first supported the launch of an immuno-oncology agent three years ago, and the atmosphere in the agency was one of excitement. There was genuine belief in the words breakthrough and revolutionary (consider this from a medical writer’s point of view – we don’t get to use words like that very often). But it’s only now that we’re seeing their impact in practice.
Three years on, the anecdotal evidence from practitioners who use these products is heartening: their patients are generally responding well and the medicines are much softer on patients than traditional chemotherapy.
We love launching new products, especially in healthcare. But witnessing improvements in patient outlook in a therapy area where long-term, quality survival remains a challenge, is the reason I have a particular soft spot for an oncology launch.
Immuno-oncology is at the cutting edge of medicine, and seeing its impact from a front-row seat to the evolving oncology landscape is a real privilege.
1. Office for National Statistics. Causes of death over 100 years. September 2017. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causesofdeathover100years/2017-09-18 [accessed July 2018].
2. Baselga J, Bhardwaj N, Cantley LC, et al. American Association for Cancer Research. AACR Cancer Progress Report 2015. Clin Cancer Res 2015;21(Supplement 1):SI-S128.
3. Tang J, Shalabi A, and Hubbard-Lucey VM. Comprehensive analysis of the clinical immuno-oncology landscape. Ann Oncol. 2018;29(1):84–91.
4. Maio M, Grob JJ, Aamdal S, et al. Five-year survival rates for treatment-naive patients with advanced melanoma who received ipilimumab plus dacarbazine in a phase III trial. J Clin Oncol. 2015;33(10):1191-6.
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