Immunotherapies in oncology: the future of cancer treatment lies in combinations and partnerships

Frances Hendry | 19th May 2017

Image: molecules in a particle-based vaccine for cancer therapy  (Flickr: NIH Image Gallery)

**This article originally appeared in PharmaPhorum's Deep Dive magazine - May 2017 edition

With the promise of using the body’s own immune system to fight cancer, immunotherapy has received significant interest from the scientific community, bringing hope to patients across many cancer indications.

The recent development of immunotherapies has led to considerable change in the oncology treatment landscape, driving transformation in the standard of care and yielding lasting responses in patients with metastatic cancers.

While promising, first and second generations of agents have demonstrable weaknesses too, such as:

  • Reduced efficacy in a limited subset of patients
  • Increased resistance mechanism, where patients do not respond or stop responding
  • Toxicity issues, which diminish quality of life for patients.

In order to optimise agent efficacy and overall patient survival, most of these agents are now used in combination. This shift has led to a proliferation of combination studies and approvals, as well as research and commercial partnerships between top pharma companies and small biotechnology companies with innovative product pipelines.

What are the immunotherapy agents currently investigated in monotherapy and in combination?

The first generation of agents has shown some interesting results, while also highlighting the limits of immunotherapies in oncology. Yervoy (ipilimumab, Bristol-Myers Squibb) is a first-generation agent which was approved by the FDA in 2011 for advanced melanoma.

The second wave of agents encompasses checkpoint inhibitors and cell therapies, among others. Nivolumab, pembrolizumab and atezolizumab are checkpoint inhibitors, meaning that they help the immune system to recognise and kill tumour cells. These three agents have been approved in the US and Europe for multiple indications, where they have shown promising efficacy.

Third-generation agents are emerging. These are a broader set, targeting other aspects of the immune system. They promise multiple therapeutic options that can be tailored to the patient and offer a wide range of possibilities for combination (Hoos et al, 2016).
 

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