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Optimal Medical Strategy in Immunotherapy

By Marc Sirockman, Global Chief Executive Officer, MedEvoke

The development of multiple treatment approaches under the cancer immunotherapy banner by the biopharma industry in collaboration with academia has been impressive over the last several years. The emergence of immunotherapy as a revolutionary oncological treatment strategy has been shown to be highly effective. It works by exploiting the immune system’s ability to recognize and destroy abnormal cells in the body, including cancer cells. As my colleague and MedEvoke Chief Medical Officer David Segarnick, PhD mentioned in an insightful peer-reviewed article a few years back*, there are many targets in development: checkpoint modulators (beyond PD-L1/PD-1), cytokines (IL-2, next generation interferons), therapeutic cancer vaccines, oncolytic viruses, adjuvants (RNA surrogates), cell therapies, TNK (CD-19+ targeted), TAMs and Tregs, and APC activators. For our purposes, here are three.

Use of checkpoint inhibitors. Checkpoints are molecules on immune cells that act as “brakes” to prevent an attack on healthy cells. Cancer cells can exploit these checkpoints to avoid detection by the immune system, and so inhibitors block these checkpoints, allowing the immune system to attack the cancer.

Adoptive cell transfer. Another target is adoptive cell transfer, such as CAR T-cell therapy or tumor-infiltrating lymphocytes (TIL) therapy. Here, extracted T cells from the patient’s own immune system are genetically modified to recognize and attack cancer cells. These modified T-cells are then infused back into the body, with the most promise shown in treating leukemia and lymphoma.

Personalized cancer vaccines. These vaccines target the unique mutations present in a patient’s cancer cells. The patient’s immune system is trained to recognize and attack these specific mutations, leading to the destruction of the cancer cells.

Despite the promising results of immunotherapy, challenges still must be overcome, including primary and acquired resistance and immune-related adverse events (irAEs). Cancer cells can develop mechanisms to evade the immune system even when checkpoint inhibitors or other immunotherapy treatments are used. Researchers are developing new approaches to overcome this resistance, such as combination therapies that target multiple checkpoints or use different types of immunotherapy together. Another challenge is the potential for autoimmune adverse events. Because immunotherapy stimulates the immune system, it can cause that very system to attack healthy cells, which can lead to a variety of side effects, including inflammation, rash, and fatigue. Researchers are working to better understand these side effects and minimize their impact on patients.

One looming question then is how can the biopharma industry, especially those on the front lines such as medical affairs teams, best prepare for and capitalize on these developments to the benefit of both their company and customers (in the broadest sense)? How can they acknowledge the power of innovation while balancing it with a healthy respect for issues like autoimmune reactions? This presumes a standard collaborative, cross-functional approach is already in place.

We have found that conducting a quantitative and qualitative analysis of the separate but overlapping scientific exchange and digital domain conversations allows for a truly diagnostic assessment of what’s happening in the therapeutic space, including competitive activity. This allows key questions to be answered intelligently against the team’s backdrop of scientific imperatives, forming the basis for a new or stronger medical strategy in any area of immunotherapy.

  • What are the prominent discussions around, for example, CAR T-cell therapy in solid tumors?
  • Which influencers are successfully impacting perspectives and points of view on relevant conversations about areas like resistance, or anti-tumor T-cell responses with vaccines?
  • What are gaps and opportunities within the specific immunotherapy and product landscape?
  • Is [product X] being discussed and if so in what way? How are efficacy and irAEs characterized? What are seen as challenges, and why?
  • What are competitors doing and how does that influence our efforts?
  • How do we need to develop our product value story?

In conclusion, cancer immunotherapy has emerged as a revolutionary treatment strategy for a variety of cancers. Because of the inherent challenges to be overcome with customers as well as in research, it’s critical to have the optimal medical strategic approach in place that will help form a productive bridge between the great assets emerging and HCPs, patients, and payers.

*Segarnick, D.J., Chien, H. PD-L1/PD-1 Inhibitors and Beyond: The Evolving Role of Checkpoint Inhibitors and Biomarkers in Cancer Immunotherapy. J of Pharmacol & Clin Res. 2017; 2(1): 555577. DOI: 10.19080/JPCR.2017.02.555577 004

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