[ Inglés] How Is Immuno-Oncology Evolving?

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Topics include: Treatments

The area of immuno-oncology continues to inspire excitement from cancer researchers. Andrew Schorr caught up with leading CLL expert Dr. Michael Keating at the CLL Live 2015 conference in Niagara Falls, Canada to learn where we stand with this emerging approach to treatment.  

Dr. Keating discusses ongoing research—including the use of immune checkpoint inhibitors—and shares his excitement about patients becoming more empowered through knowledge.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Here we are again, folks, Andrew Schorr in Niagara Falls, this time with Dr. Michael Keating, my doctor for CLL since 1996.  I'm happy to still be here.  Dr. Keating, so I heard your talk here at the CLL live conference, 2-300 people listened.  You took us all through it, and now we're starting increasingly to talk about immuno?oncology. 

Dr. Keating:

Yes. 

Andrew Schorr:

And the idea that our immune systems can be helped to start to do a job, just like when somebody has a transplant and you give them somebody else's immune system so kind of reboot the immune system. Here how do we get our own immune system to take over.  Where are we now with that, because it seems like that's where we're headed, right? 

Dr. Keating:

I think that one of the spin?offs of the increasing technology that's available to us now is that we can now identify this enormous complexity of the immune system.  It used to be that there were only two types of T cells—helper cells and suppressor cells—and now there are 22-plus subtypes. 

When we think about what are the key elements of the immune system, which are the cells that are most important—and I think we're learning a lot from solid tumor at the present time because the solid tumor doctors used to learn a lot from us. But now they're looking at these checkpoint inhibitors and the reasons why the immune cells, particularly T cells and natural killer cells, tend to get trapped and locked into a non?death embrace with the cancer cell. 

So it's as though they just can't get around to kill off the cell, because they're neutralized by proteins on the leukemic cells.  And we've not been able to look at these, because I don't think that companies that are working on drugs for solid tumors like to walk into the field of leukemia where it's a little more unpredictable.  It's more rapidly growing.  There are more problems associated with it. 

But it's clear that these checkpoint inhibitors are working against a whole breadth of different cancers. And for the first time now we have a range of these molecules that either activate elements of the immune system, or they block the interference with the immune system, or they work on activating natural killer cells. And all of these things can be very easily measured in CLL because the CLL cell—the cancer cell—is easy to get hold of.  We can get hold of it in conjunction with T cells and the NK cells in the circulation, so it's not as complicated as in solid tumors.  So that I think this is going to be probably the most exciting 12 months of the immuno-oncology area in CLL. 

I think it's actually going to be a lot more flexible than the CAR T cells, whatever because it's a lot easier to do.  The antibodies are already commercially available.  We can give them intravenously.  We don't have to wait for the six weeks manufacture the cells and have all the purification, etc., that's gone on, so I think there's going to be a more rapid expansion of knowledge on checkpoint inhibitors than there is in the CAR T cells. 

Andrew Schorr:

So as you talk about this as what could be the next wave, someone says, well, if I take one of these other drugs now, whether it's partly a chemo-based regimen, you know, FCR, bendamustine (Treanda®) or rituximab (Rituxan®) or any of these other drugs, the new pills as well, does that preclude me from benefitting from what may be the next wave related to supporting my immune system to do its job? 

Dr. Keating:

No one knows the answer to that. But I can tell you that if you look at patients with CLL and measure, for example the—it used to be that the T-cell number was said to be depressed, and then all of a sudden they found that there are more T cells, both CD4 and CD8, in all the tissues in CLL than in normal people.  So it's almost as though the T cells are trying to do something but can't actually get it together. 

This may be because of this immune paralysis because of these checkpoint interactions.  So that one of the areas that I think is going to be of great interest will be the natural killer cells where we can actually measure the function of the natural killer cells, and it appears that those that have a low function are those that are much more likely to get sick in cancers than the people that have a fairly intact NK cell function. 

The good thing about NK cells is that you don't have to be rigorously matching them for HLA, etc., so we can use cord blood cells rather than having to get identical matches, etc., so it's a much more fluid environment for us to work in.  So that I think there's going to be an explosion of knowledge about the NK system in ways that we can actually amplify the system genetically as well. 

Andrew Schorr:

And not to worry where we are now that that will shoot us in the foot in benefitting from this. 

Dr. Keating:

Sometimes you just have to look after the problem in front of you and let the rest of us worry about how to clean up the mess. 

Andrew Schorr:

Okay.  One of the last thing.  You're here at a meeting where there are hundreds of patients coming together, and you've been part of others.  Does this excite you in your career…

Dr. Keating:

Oh…

Andrew Schorr:

…to see patients talking to patients, getting smart, learning about things that it used to be only some specialized physicians talked about? 

Dr. Keating:

I think that one of the things that it reminded me of is we get told, well, these clinical trials are not representative of the true CLL patient, and I think the same thing happens here.  The patients that come along to these meetings are sort of the pioneers.  They're educating themselves, they share as much as they can.  I think it may also be the subset of patients that end up worrying more about their disease than the others. 

But I think that there's a whole bunch of people out there that just don't know what to ask, so the fact that we're able to not only have these meetings but also for people like yourself to pass the message on so that you're now classified as a reliable source.  

Andrew Schorr:

Mm-hmm. 

Dr. Keating:

Because you've been doing it for a long time, you have personal involvement in it, etc. so that people will actually listen to what your interpretation of a meeting happens to be.  So that rather than just Googling wildly, people are a lot more interested in looking at Patient Power and reading the tidbits from the CLL Global Foundation, etc., because they've been around a long time, and they're transmitting information as honestly as they can.  So keep doing it…

Andrew Schorr:

Yeah, you, too. 

Dr. Keating:

…because you make us look good.  

Andrew Schorr:

Okay.  Thank you.  All right.  Dr. Michael Keating and me, Andrew Schorr, continuing to do what we do.  We hope it's helpful.  I think—we're pretty sure it is, and we hope we've helped you.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on May 1, 2015