The next wave in cancer immunotherapy

What is driving the next wave of innovation in cancer immunotherapy?

This was the question the experts tried to answer in the oncology session of the conference Nordic Life Science Days in Stockholm 12 September.

International experts from pharma, biotech, academia and the investment community discussed how different approaches to innovative cancer treatments could address challenges and shape the next wave of innovation in cancer immunotherapy, also known as immuno-oncology.

They touched upon approaches such as big data, personalized medicine, new targets and lessons from neuroscience.

Over the past few years, the rapid development of novel cancer immunotherapy approaches has fundamentally disrupted the oncology space. Cancer immunotherapy has not only become a key component of cancer therapy, but it has also reshaped priorities in oncology research and development (R&D) across the industry, with unprecedented clinical success in certain cancer types continuing to fuel record investment and partnering activity.

As of today, more than 2.000 immuno-oncology agents, including checkpoint-inhibitors, vaccines, oncolytic viruses and cellular therapies are in preclinical or clinical development.

Read more about the cellular therapy research of Oslo Cancer Cluster members Oslo University Hospital and Zelluna.

Why so little effect? 
Despite all of this promising research, only a minority of patients benefits from effective and durable immuno-oncology treatments. Why is this happening?

Part of the answer is found in resistance or unexplained lack of response. This could be addressed through a better understanding of optimal timing of therapy, better combination therapy design, or improved patient selection. Another part of the answer lies in a lack of novel targets and of an overall better understanding of specific immune mechanisms. This lack of understanding is becoming a roadblock to further advance in this research space.

What can the experts do about this? It turns out they have several approaches. Two of the main ones include big data and turning so-called cold tumours hot.

Big data will expand
“We believe that this can be changed by adding deep and broad data from multiple sources”, said Richa Wilson, Associate Director, Digital and Personalized Healthcare in Roche Partnering.

“We use the words meaningful data at scale, that means high quality data with a purpose: to answer key scientific questions”, she said at the session.

These data will continue to evolve from clinical trials and aggregated trials and registries and in the future from real time and linked data. There was about 150 exabytes health data in 2015 and in 2020 it is expected to grow into 2300 exabytes, mainly from digital health apps and scans from the hospitals, Oslo Cancer Cluster member Roche presented.

Hot and cold tumours 
Emilio Erazo-Fischer, Associate Director of Global Oncology Business Development at Boehringer Ingelheim explained the cold and hot tumours and how the cold tumours can be turned hot and thus open for cancer immunology treatment. It is well explained in this short film by Oslo Cancer Cluster member Boehringer Ingelheim

Martin Bonde, CEO of Oslo Cancer Cluster member Vaccibody also presented how they try to turn the cold tumours hot.

The Norwegian company Vaccibody is a leader in the field of cancer vaccines and they are very ambitious. They currently have a trial for melanoma, lung, bladder, renal, head and neck cancer.

The impact of stress
Erica Sloan is the group leader of the Cancer & Neural-Immune Research Laboratory in Monash University in Australia. She gave a talk on how neural signalling stops immunotherapy working. The researchers at Monash University have led mouse studies where the nervous system is stressed. They show that immunotherapies fail unless peripheral neural stresses are excluded.

The threat of a cancer diagnosis is stressful, as are most certainly cancer and cancer treatments. The tumour micro environment inside the cells can hear the stress signal, that is adrenalin.

“So what can we do about it?” Erica Sloan asked, before she answered:

“Treating with beta blockers. Blocking neural signalling prevents cancer progression. It also has an effect on immunotherapies.”

Erica Sloan is the group leader for the Cancer & Neural-Immune Research Laboratory in Monash University, Australia. She gave an introduction to the effect of neural signalling on tumour cells during the NLSDays in Stockholm 2018.

“Could stress be responsible for non responders?”, the moderator Gaspar Taroncher-Oldenburg from Nature Publishing Group asked her in the panel. 

“Absolutely, neural signalling can be responsible for this. And the exciting thing with data sharing here is that it can allow us to see and understand the rest of the patients’ biology. We need to look more at the patients’ physiology and not just the tumour biology” she said.