by Mark Gelder, MD, Chief Medical Officer

In late February, the American Society of Clinical Oncology (ASCO) partnered with the Society for Immunotherapy of Cancer (SITC) to host the first ASCO-SITC Clinical Immuno-Oncology Symposium, held in Orlando. We learned, along with 1000 other attendees, about the leading clinical research regarding immunotherapy (IO) treatment and the exciting, yet, gradual move from IO research to actual patient application.

The concept of immunotherapy, using the body’s immune system to help fight cancer, is making tremendous strides in today’s cancer research. In just the last five years, research has proven that manipulation of the immune system can control, or in some cases, completely eradicate tumors.[1] As chemotherapy, targeted therapy, radiation therapy, and surgery are used to aggressively destroy cancer cells, with IO, researchers are working to develop strategies to harness the body’s own immune system to combat cancer.  When the immune system is strengthened, risk on the patient’s long-term health is reduced in comparison to more aggressive cancer treatment approaches.[2]

What happens when IO therapy is combined with traditional treatment approaches? The potential for positive outcomes in the oncology field grows even more substantially[3]. Researchers have been testing immunotherapy as one component in combination cancer treatment, and the idea is gaining traction. At ASCO’s symposium, many presenters mentioned the theory of the “abscopal effect” (ab meaning “away from,” and scopus meaning “target”), a term coined in the 1950s to describe the phenomenon when treating metastatic cancer with radiation. The abscopal effect occurs when the localized treatment of a tumor causes not only a shrinking of the treated tumor, but also a shrinking of other tumors outside the scope of irradiated area.[4] In 2015, EB Golden and colleagues ran a clinical trial which demonstrated that abscopal responses were consistently detected in patients treated with the combination of radiation therapy and immunotherapy.[5] In practice, a breast cancer patient receiving IO  combined with radiation has been shown to demonstrate a positive response on a spinal lesion  or other location in addition to the irradiated tumor. The thinking is that radiation primes the immune system to recognize tumor-specific targets as those cells die, which is then translated into a systemic effect.[6]

Research combining chemotherapy and immunotherapy was also presented and discussed. To change the tumor’s microenvironment, researchers are using doses of chemo to destroy cells that are blocking the immune system from functioning, instead of using the dosage required to kill cancer cells. This process converts the “unresponsive” cancers to responsive, allowing immunotherapy to work effectively.[7]

But what dose and schedule of chemotherapy is enough to kill the cells blocking the immune system, yet not so strong that it wipes out the body’s defense mechanism? Which cytotoxic is best, what is the best dose and schedule, is this approach beneficial for all tumor types and all patients?  Which patients would respond better to a combination of immunotherapy plus chemotherapy as opposed to those who would fare better with one treatment or the other? There are clearly more questions than answers at this time.

At the symposium, a recognized leader in the field, Lisa Butterfield, led a session on “Immune Biomarkers in the Blood” featuring research findings on immune biomarkers and their ability to offer insight into the interactions between the immune system and cancer. These interactions can help to define which immunotherapy should be selected to best defend the body using its immune system.

The current research focus is on finding markers that suggest a patient will respond to any immunotherapy (IO), rather than using the biomarker to determine which IO would work best for their specific tumor and cancer[8].

The more we know, the better the outcome. At Pierian Biosciences, we’ve invested years of research in developing a series of functional assays including our latest platform, ImmunoINTEL. The ImmunoINTEL platform is a functional I-O platform incorporating information from intra-tumoral as well as peripheral immune mediators that will predict which immunotherapeutic will be of greatest benefit for each individual patient. The information provided by the assay will deliver the intelligence needed to determine which treatment or combinations of treatment will be most effective based on a patient’s actual tumor response in the lab, before introducing the treatment to the patient’s body.   A functional assay can more precisely predict a cancer treatment outcome, cut costs by eliminating ineffective treatments, and improves the quality of the selected treatment(s), resulting in a more effective and successful treatment experience from day one.  We call that a win/win.

Immunotherapy is making great strides in the treatment of cancer, evidenced by the fact that the ASCO-SITC Immuno-Oncology Symposium drew 1,000 of us who came to listen. At Pierian, we too, are embracing immunotherapy by providing the tools that oncologists need to develop customized treatments that result in a low-risk, low-cost, and high-value outcome.

[1] Ribas, A. N. Releasing the Brakes on Cancer Immunotherapy. Engl J Med. 2015; 373:1490-2. Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMp1510079

[2] Winslow, R. Cancer’s Super-Survivors/How the Promise of Immunotherapy Is Transforming Oncology. Wall Street Journal. Dec 4 2016.

[3] Disis, M.L. & Kaufman, H.L. Cancer Immunotherapy: The End of the Beginning or the Beginning of the End. Ummunsym.org Daily News, published February 17, 2017.

[4] Mole, R.H. Whole body irradiation; radiobiology or medicine? Br J Radiol 1953; 26:234-41. 10.1259/0007-1285-26-305-234 

[5] Golden EB, Chhabra A, Chachoua A, et al. Local radiotherapy and granulocyte-macrophage colony-stimulating factor to generate abscopal responses in patients with metastatic solid tumours: a proof-of-principle trial. Lancet Oncol 2015;16:795-803. 10.1016/S1470-2045(15)00054-6

[6] Carolson, R. H. (2016, June 27) Immunotherapy ‘Plus’: Adding Radiation and Chemo to Immune Therapies. Medscape Oncology [Online]. Retrieved from: http://www.medscape.com/viewarticle/865242

[7] Thaker, P. H. (2017, February). Phase I study of the safety and activity of formulated IL-12 plasmid administered intraperitoneally in combination with standard neoadjuvant chemotherapy in patients with newly diagnosed advanced stage ovarian cancer. Poster session presented at the ASCO-SITC Clinical Immuno-Oncology Symposium, Orlando, FL.  Retrieved from: http://meetinglibrary.asco.org/content/178595-194

[8] Nyberg, K. (2017, February 24). Leveraging Immune Biomarkers in the Blood to Guide Immunotherapy—Current Application and Future Prospects [Daily News]. Retrieved from http://immunosym.org/daily-news/leveraging-immune-biomarkers-blood-guide-immunotherapy-current-application-and-future


Mark Gelder, MD is Chief Medical Officer for Pierian. An experienced researcher and clinician, Dr. Gelder is board certified in Internal Medicine, Obstetrics and Gynecology. He is currently a fellow in the American College of Obstetrics and Gynecology.