Post on 24-Dec-2019
transcript
So Jin Shin, M.D. Department of Obstetrics
and Gynecology, Keimyung University, School of
Medicine, Daegu, Korea
Emerging Targets in Immunotherapy
nno-0ncology
Cancer Immunotherapy?
and immunotherapy in cancer
nno-0ncology Todays is …..
Cancer Immunotherapy overview
War for Cancer
Chemotherapy : lack of selectivity, long-term resistance
Target therapy : acquired resistance
Immunotherapy : from promising to disappointing ?
New active substance Launches 2011-2015
Cancer Immunotherapy overview
Rapid uptake of new immune- oncology drug: PD-1 inhibitor uptake in the U.S.
Cancer Immunotherapy overview
135 clinical trial ---- additional indication for 30 tumor type
Pipeline of oncology drug in clinical development
• Small molecule protein kinase inhibitor
• biologic monoclonal antiboides
Cancer Immunotherapy overview
Cancer Immunotherapy
• Immuno-oncology focuses on harnessing the tremendous power of the human immune system to detect and destroy cancer
Cancer Immunotherapy overview
Cancer Immunity Cycle Cancer Immunotherapy overview
Cancer Immunotherapy
To specifically target cancer cells
To recruit efficient immune cells that can generate a robust and long lasting response
Most importantly prevent relapse
➔ To educated and boost tumor-specific immune cells
Cancer Immunotherapy overview
Type of Cancer Immunotherapy
Active : Induced Directly in the Tumor-Bearing Animal or in the Patient : Can be Specific or Non Specific
Passive or Adoptive : Immunologically Active Material Transferred into Mouse or Patient as a Passive Recipient : Can be Specific (Antibodies, T-Cells, Antigen presenting cells – Dendritic Cell Vaccines) Or Non-Specific (Non-specifically-activated T-Cells; Cytokines)
Cancer Immunotherapy overview
nno-0ncology
Cancer Immunotherapy?
and immunotherapy in cancer
Cancer Immunotherapy?
What is Next for Cancer Immunotherapy?
Immunotherapy 2.0 : ASCO 2017
To understand
• Who will benefit,
The growing wave of progress using cancer immunotherapy
• Whether combining immunotherapy treatment is effective
-→ Expanding use and refining Patient selection
Drug Registered name Mechanism of
action FDA approval
date Indication
(advanced Dz)
EMA approval
date Indication
Sipuleucel-T Provenge Dentritic cell vaccine
2010 Prosatate cancer -- --
Ipilimumab Yervoy Anti –CTLA-4 2011
Melanoma 2011 Melanoma
Nivolumab Opdivo Anti-PD1 2014 2015 2016
Melanoma NSCLC, RCC Hodgkin lymphoma
2015 Melanoma NSCLC RCC
Pembrolizumab Keytruda Anti-PD1 2014 2015 2016
Melanoma NSCLC SCCHN
2015 Melanoma
Atezolizumab Tcentriq Anti-PDL1 2015
Urothelial carcinoma
-- --
Durvalumab -- Anti-PDL1 2016 Urothelial carcinoma
-- --
Ipilimumab+ Nivolumab
Yervoy + Opdivo Anti-CTLA4+ Anti PD1
2015 Melanoma 2016 Melanoma
Blinatumumab Blincyto Anti-CD3/CD19 BiTE
2014 B cell ALL 2015 B cell ALL
Talimogene latherparepvec (T VEC)
Imlygic Onolytic virus 2015 Melanoma 2015 Melanoma
-- -- TCR therapy targeting NY-ESO
2016 Synovial sarcoma -- --
FDA and EMA approved immunotherapy drug since 2010
New approved
New uses
What is Next for Cancer Immunotherapy?
Cancer immunotherapy must be personalized
• To identify the rate-limiting steps in patients
• To combine strategies to overcome these hurdles
• To trigger the Cancer –immunity cycle to proceed
What is Next for Cancer Immunotherapy?
Cancer Immunoediting
- paradigm shift toward overcoming immunosuppression
- SCINECE VOL331 p1565 (2011) -
What is Next for Cancer Immunotherapy?
Outline of tumor antigen-specific Immunotherapy
Tissue-specific (e.g. MART-1, gp100)
Denderitic Cells
Cancer Cells
Ag-specific CD8+ T Cells
CAR T Cells
• CAR: (chimeric
antigen receptor)
PD-1/PD-L1 Antibody
PD-L1 (PD-1 ligand)
PD-1 (Programmed
cell death)
apoptosis
Tumor-associated Ag (e.g. MAGE-A1, NY-ESO-
1)
What is Next for Cancer Immunotherapy?
Immune based therapy
• Cytokines
• Immune checkpoint
inhibitor
• Engineered cell therapy
• Oncolytic viruse
--→ durable clinical response in diverse solid tumor and hematological malig
What is Next for Cancer Immunotherapy?
Clinical development of cancer antigen-based vaccine and engineered T cell Immunotherapy
Cancer Vaccine development MAGE-A3 peptide /protein : Phase II/III , NSCLC : failed in phase III
NY-ESO-1 recombinant protein : Melanoma , Ovarian cancer : Antigen specific immune response : failed
NY-ESO-1 recombinant + MHC class I and II : Prostate cancer, Phase I : prolonged median PSA doubling time & decreased PSA level
What is Next for Cancer Immunotherapy?
Clinical development of cancer antigen-based vaccine and engineered T cell Immunotherapy
CAR-engineered T cell immunotherapy CD19-CAR T cell therapy
: refractory B cell malignancy , ALL, CLL : cytokine release syndrome : on-off system using small molecule
CART technology based on NOTCH receptor : T cell activation through recognition of combinational antigen ➢Recurrence (40-50%)
within 1yr ➢Not work in solid tumor
What is Next for Cancer Immunotherapy?
Clinical development of cancer antigen-based vaccine and engineered T cell Immunotherapy
TCR engineered T cell immunotherapy
Patient derived MART-1 or MAGE-A3 TCR engineered T : safety
HLA –A2 restricted NY-ESO-1 TCR transduced T cell : Response rate 55-60% : Metastatic synovial sarcoma , melanoma, myeloma, triple (-) breast ca, : Toxicity (-) : best target
➢NY-ESO-1 TCR-engineered T-cell immunotherapy
➢Solid tumor
What is Next for Cancer Immunotherapy?
The second wave of tumor antigen discovery
Mutation derived neoantigens
Mutated protein expressed in cancer cell and recognized by immune system : Not affected by central T cell tolerance : TCGA data - numbers of predicted MHC class I associated neoepitope and increased patient survival : T cell activity against neoantigen be enhanced by anti CTLA-4 : clinical correlate with mutational load
What is Next for Cancer Immunotherapy?
Breast cacner (2017) 24:16-24
The second wave of tumor antigen discovery : neoantigen based immunotherapy
What is Next for Cancer Immunotherapy?
“ Final common pathway of human cancer immunotherapy
: Targeting random somatic mutation”
Breast cacner (2017) 24:16-24
What is Next for Cancer Immunotherapy?
“Limitation of neoantigen based immunotherpay”
Miss many immunogenic antigens
Necessary to identify neoantigens individually
➢Whole genome sequencing + RNA sequencing
➢Accurate prediction program
➢ Target multiple neoantigens with specific vaccine using RNA, DNA or peptide or TCR based immnunotherapy
Expensive and require new regulatory guideline
What is Next for Cancer Immunotherapy?
➔Consider both cancer specific shared antigens and patient-specific unique neoantigens.
➔ Establishment of neoantigen-specific TCR bank
What is Next for Cancer Immunotherapy?
nno-0ncology
Cancer Immunotherapy?
and immunotherapy in cancer Combining targeted and
immunotherapy in cancer
Combining of Targeted and conventional cancer therapy with Immunotherapy
Metastatic Melanoma : BRAF antagonist (Vemurafenib, debrafenib) MEK antagonist ( trametinib, combimetinib) : CD8+ T세포의 종양 침투 증가 -> immune checkpoint inhibitor 병용
Combined targeted and immunotherapy in cancer
Combined targeted and immunotherapy in cancer
Challenges for combination therapies
Requirement for deeper understanding : targeted, conventional and immune based therapy
Optimization of efficacy, toxicity, and tolerability through appropriate dosing and sequencing
Robust approach to prioritizing and resourcing the myriad possibilities for combination therapy
➢기존의 치료제를 통해 치료받는 환자의 종양 샘플과 혈액의 면역 시스템을 정학하게 분석
➢임상, 면역세포 분석과 유전자 연구가 통합적으로 운영되어야 함
➢소규모의 잘 디자인된 임상연구를 통해 toxicity, tolerability 및 efficacy data를 얻어내고 이를 바탕으로
적절한 병용치료를 위한 임상시도
➢병용 치료를 선택함에 있어서 우선순위는 standard of care를 대처할 수 있을 정도의 의료적 혜택을 줄 수 있는지에
초점. ➢학계, 산업계, 정부와 비영리 연구소간의 협력과 정보 공유
Combined targeted and immunotherapy in cancer
감사합니다