Innovation in immuno-oncology is exploding and new technologies that are set to benefit many patients with cancer are being showcased in the highly diverse array of topics to be discussed at the ESMO Immuno-Oncology Congress, to be held 13-16 December in Geneva, Switzerland.
Prof. John Haanen, Congress Scientific Co-Chair, said: "Immuno-oncology has made great steps forward. Checkpoint inhibitors have been a notable advance, yet just 15-20% of patients with cancer respond to this treatment. Because of fast-paced research developments, we are moving to the next level of being able to treat a greater proportion of patients. This research will find a home in ESMO's Immuno-Oncology Technology Journal, which will educate medical oncologists so they are ready to use new drugs when they enter clinical practice."
A wide range of promising technologies expected to become standard of care in the future are being discussed at the congress. Some will be applicable across many cancer types, while others are specific to particular situations, or even to individual patients.
Multiplex immunohistochemistry is one example which Haanen said "should become the mainstay of how we look at tumors". Antibodies and tumor samples are used to identify the types of cells in and around the tumor, the so-called "tumor microenvironment", thereby pointing to the best treatment. "Hot tumors" contain many immune cells and are the most likely to respond to checkpoint inhibitors. Different approaches would be needed for "cold tumors" which lack immune cells and "immune excluded tumors" which are surrounded by T cells that cannot penetrate a tumor.
Bispecific antibodies also look promising for multiple types of cancer. They combine two different antibodies so that the immune system is stimulated and the tumor is inhibited. CD137/PD-L1 bispecific antibodies, for example, target the co-stimulatory molecule CD137 on T cells and PD-L1 on tumor cells.
Chimeric antigen receptor (CAR) T-cell therapy is a type of adoptive cell therapy that is being developed for tumors expressing particular antigens. Viral vectors are used to transduce a gene encoding for CAR into T cells, which are then used to target cancer cells. Currently this results in continuous expression of CAR on the T cell. But researchers are developing "conditional expression" so that it can be switched on and off. This should focus the treatment by switching it on when needed and improve safety by switching it off if there are side-effects.
Epstein-Barr virus (EBV) infection is common and people with a healthy immune system generate antigens to keep the viral load under control. When the immune system becomes suppressed, for example after organ transplantation, patients may be unable to control the viral load. Allogeneic EBV-directed T cells are being developed for this situation, which can lead to EBV-associated lymphomas and leiomyosarcomas.
Neoantigen therapeutics are where personalized immuno-oncology comes into play. Because DNA mutations are random, every tumor has a different combination of mutations. When proteins formed from mutated DNA break down, this generates mutated peptides, which are called neoantigens. Researchers are developing individualized vaccines against these neoantigens. And, for patients with T cells that are specific for these neoantigens, scientists are growing large amounts of the T cells outside the body for infusion back into the patient.
"Knowledge is accumulating at such a high speed that keeping up-to-date is a challenge. The wealth of novel research and need for oncologists to understand emerging therapies has sparked the launch of ESMO's Immuno-Oncology Technology Journal," added Haanen who is the Editor-in-Chief of the journal. "The journal will cover improvements in existing immunotherapies and cutting-edge findings in novel areas. Review papers will be published to summarise milestones and explain how innovative therapies work."