Immunotherapy and immuno-oncology used to be futuristic-sounding terms or even pipedreams in cancer treatment, yet in what seems like a rather short time they have become more and more the norm, and more in vogue than ever. The brilliant concept of using the immune system, particularly one's own, to attack and defeat the beast that is cancer is at the forefront of modern medicine and blazing a fearless trail into the future; that trail is now being filled with new hope for those diagnosed with this deadly disease category.
Of course, while those of us even remotely connected to the pharmaceutical world tend to be aware of latest developments before they make the domestic news headlines each night, nothing raises the profile higher than some famous face who has faced and (apparently) beaten an aggressive form of cancer. Thus is the case for a beloved ex-President of the United States, a certain Jimmy Carter.
On one of his recent Sunday visits to his local Baptist Church in the Atlanta area, Carter announced that not only is he cancer-free, but that he in fact no longer needs treatment, period. Coming after a battle with multiple melanoma in his brain, that is one incredible piece of news. Carter told the applauding audience that he had been put through over two hours of MRI analysis, after which doctors concluded that he didn't need further treatment.
"So I'm not going to have any more treatment."
I can only imagine what that statement must feel like and mean coming from one who has suffered not only the disease itself but the brutal therapy it often requires, though it's safe to say those sound like words of pure elation. Clearly, he will have to continue to have scans to monitor his condition, and if things did go south then he will have to return to treatment, but that is not the situation today.
Some news reports stated that Carter had melanoma discovered in his liver, and that it had spread to the brain, but that is not the case in all likelihood. It seems that once doctors found it on his liver, and resected it, they made the conclusion that it had gotten there from somewhere else. So after his surgery, they put him through MRI and PET scans and sure enough, they found four other tumours in his brain.
While this sounded like a death sentence to many, and not least to Mr. Carter himself I imagine, well, modern medicine and some hotshot oncologists thought otherwise! After four rounds of radiation therapy every three weeks, Carter was to receive the very latest in cancer treatment - immunotherapy. That immunotherapeutic, pembrolizumab, was then given to him intravenously, and the praying began.
That therapy is better known by its trade name today, which is Keytruda, a novel immunotherapy developed by the Merck pharmaceutical giant; its novelty is underlined by the very fact that it was only approved for melanoma by the FDA as recently as September, 2014. It was given to Carter at three-week intervals between last August and February of this year, and now the results are in.
Those results are not only of life-changing significance to Jimmy Carter, but are of game-changing significance to oncologists-patients everywhere, and you can bet that Merck management were feeling the paradigm shift themselves! Questions still remain about the duration of such treatments, and whether a shorter period is better than continuing until it is considered safe, but that's par for the course for a game-changing therapeutic, and oncologists will work things out with more hands-on experience with the treatment.
Naturally, hardcore science and research is the foundation on which "drugs" such as Merck's Keytruda or Bristol-Myers Squibb's Opdivo are constructed, and in this case such therapies are targeted at cancer's ability (and malignant brilliance) to evade the immune system's attack via vulnerability at an immune checkpoint, often referred to as PD-1.
Essentially, cancer cells reprogram T-cells from being in attack mode, sending them towards a programmed cell death pathway which renders them useless in the fight against cancer. Therapies such as Keytruda inhibit that ability of cancer cells, thereby sending a green light "attack!" signal back to our T-cell armies - giving patients at least a fighting chance of winning. And winning is indeed possible, if you ask Jimmy Carter, or many other patients who have benefited from the treatment, and it's also win-win for Merck (deservedly so) who took in $566 billion in global sales of Keytruda in 2015 alone.
It's a brand new day in immuno-oncology, and as more and more novel approaches hit the decks (including both the "CAR-T" and "MiHA" immunotherapy approaches), well, things can only get more exciting from here on in. But it's worth remembering that aside from a concerted effort such as Obama and Biden's cancer "moonshot", it is the hordes of research scientists working tirelessly at laboratory benches everywhere, in academia as well as in industry, that are fueling the innovation that is at the heart of new drugs such as Keytruda.
Here at AmorChem, we get that, and it is why we will continue to fund exciting and innovative university-based research as often as we can. We have a number of oncology projects in our current portfolio, including two that are very much immunotherapy plays, and with our AmorChem II fund drawing ever closer, well, it's a pretty safe bet that we will add on some more in the not too distant future!
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