The last morning of the 2017 BIO International Convention kicked off with a 9:00am oncology panel titled, “Shooting for the Moon: Creating the Next Generation of Cancer Killers”. With the “Cancer Moonshot” calling for the acceleration of oncology research, the biotech industry is racing to create a new generation of cancer killers. Having learned from the successes and challenges of traditional treatment modalities, companies are developing a powerful new wave of cancer-fighting tools.
Aided by the latest genomic and computational technology, innovators in oncology research are developing novel therapies to transcend the limitations of available cancer treatments. These approaches include developing a universal cellular immunotherapy to treat multiple cancers, unlocking the potential of bicyclic peptides to target tumors, creating oncolytic viruses to kill cancer cells but avoid healthy cells and developing next-generation active immunotherapies that enable the body’s immune system to fight cancer.
The panel was led by moderator Mandy Jackson, Managing Editor, US Commercial News at Scrip/Pink Sheet, and included the following oncology research and development experts:
- Dr. John Beadle, Chief Executive Officer, PsiOxus
- Nicholas Keen, Chief Scientific Officer, Bicycle Therapeutics
- Jan ter Meulen, Chief Scientific Officer, Immune Design
- Dr Charles Wilson, President and Chief Executive Officer, Unum Therapeutics
Jackson asked the panel about the biggest unmet needs and the most promising therapies in this space. Beadle said immune therapies are promising, but many patients do not respond, and we still don’t understand why they don’t respond to immunotherapy.
Keen agreed, emphasizing the role for industry and academia in fixing this. He contended that developing a better understanding of combination toxicology would be helpful.
Ter Meulen discussed overcoming immunosuppression systemically in the patient. He said that the real promise of immunotherapy is the longevity of response. Immunotherapy is the only therapy that can prevent cancer recurrence. Surrogate endpoints based on biomarkers are needed.
Wilson said that providing a high response rate, more sustained and durable responses are what patients need. Existing therapies have a lot of baggage that detract from the value they provide. For example, he pointed out elderly patients in particular don’t respond well, posing a challenge. He also pointed to price as challenge in this space; combination therapies especially can be expensive.
Jackson then asked the panel whether combination therapies the only way forward. What challenges like safety and price exist?
Beadle talked about conducting an enormous global experiment, testing out combination therapies to learn more about efficacy, biomarkers, and toxicity. We will learn a lot of secondary data points from the combination therapy studies going on.
Jackson pointed out that there are thousands of trials going on, with lots of money being thrown at the problem. She asked whether a byproduct of these efforts is using up patients, making it hard to find new patients who aren’t already in trials.
Keen said it’s a shame that there aren’t better predictive treatments. Whoever figures that out, will win. We are having to reply on animal models. Moving to more targeted approaches means less toxic exposure in patients.
Ter Meulen said cancer is a genetically unstable disease, so cancers become resistant to therapies. The way around that is to combine therapies. This is where biomarkers come into play. So what we need are trials in humans, since animal biomarkers are different.
Jackson then followed up by asking whether all the money being put into this space is being used efficiently. Beadle replied that the environment is hypercompetitive for investment at the moment. The competition is what’s driving efficiency; some are getting funding, and some aren’t.
Keen agreed. Competition drives innovation, and he added that all the panelists on the stage are doing things that Big Pharma would not have been doing five years ago.
Ter Meulen said since we’re smaller companies, we have to be more selective with what we do. There are 1,700 trials being run by big companies, and they are essentially throwing everything against the wall to see what sticks. Maybe there is a more effective way to do this without wasting money and time.
Jackson then asked the panel what are the biggest challenges they face working in novel modalities. Is it regulators?
Beadle said that he doesn’t see regulators as a barrier. Rather, they are an enabling influence in his experience, both with United States FDA and regulators in Europe. They “get it” and have embraced it. It feels like we’re on the same track with it. They’re on the page when it comes to major concerns like toxicity. They’re asking the same sorts of questions, like: “How do we the these products into patients safely?”
Keen said he would like to see more collaboration between biotech and cancer charities, as they have been great to work with in his experience.
Jackson asked a follow-up question, asking where manufacturing ranked for the panelists as a challenge.
Keen said that he probably had the easiest time of the panelists, since he works with synthetic peptides. Also, it helps that there are amazing biomarker facilities available to him in the UK.
Wilson said he is on the opposite end, as he works with virus and antibody therapies. A big challenge is how to invest in building out prior to a proof of concept? Admittedly, there are some great contract manufacturing firms to partner with, but that’s not the same as owning it yourself.
Beadle said he was somewhere in the middle in terms of manufacturing challenges. He said that contract manufacturers are scaling up their production capacity, but not to scale, so there’s some competition to for their availability.
Ter Meulen then weighed in, saying that the most important thing was that the therapy has to work. If the therapy can just make it to phase 2, then they can partner with bigger companies who can solve manufacturing problems.
Jackson then asked: Is it still challenging to find funding and partners? After all, there does seem to be a lot more out there in this space than in neurology, for example.
Keen replied that if you have a good idea, it’s still relatively straightforward. The investors are smart and rational in how they pick companies that solve particular problems. They’re good at spotting the innovative approaches.
Beadle agreed, saying that if you have a good proposition, there is funding and partners.
Jackson asked the panel: What kinds of things outside of what you’re working on are you seeing?
Beadle responding by admiring the work of his fellow panelist, saying that they’re all looking at each other’s work and saying, “That’s cool.”
Jackson asked the panel: Are the approaches that we’re looking at now cures? Will cancer be cured in our lifetime? It seems grandiose, but it is possible?
Ter Meulen responsed that it depends how you define “cure.” Do you mean make it manageable?
Keen responded with a personal story about how his mother is a double cancer survivor. She had a rapidly progressing brain tumor, and was on the floor. That was cured. Then she got thyroid cancer later, probably a result of the radiation from the first cancer, but she beat that as well and has been healthy for years. So within one individual, it is possible. Cancer is and will become a curable disease.
Jackson asked: Will cancer become a chronic disease? If so, how would that affect reimbursement? How will we pay for and price these if they are turned into chronic diseases?
Beadle said that immunotherapy is one area where successful treatments should not be lifetime or ongoing treatments. If you can teach the immune system to keep cancer cells in check, then should not be a need to treat continuously.
Jackson then solicited questions from the audience. An audience member pointed out that the economics are huge; there are massive costs at this stage for immunotherapies. These drugs are harder to manufacture than small molecule drugs, so biosimilars will not spring up as smoothly as generics do for chemical medicines to reduce patient costs. How will we solve this and ultimately ensure an affordable therapy reaches the patient?
Wilson said that this is true. It’s harder for the process when things go off patent. The technology will move faster than the patent. We will continue to innovate; it’s not going to be loss of patent that moves things forward, it’s going to be the fast moving next-gen technologies.
Jackson took another question from the audience, and someone asked how we can maximize the learnings from all the research being done in this space.
Wilson said this is a great question, adding that if the information from clinical trials is not shared, it is a waste. We really need a mechanism to share this information.
Beadle added that even when something is tried and doesn’t work, that still needs to be shared. He added that we’re being more collaborative in the current moment then we’ve ever been.
Ter Meulen said that he doesn’t know who would be able to understand the entire field, given the amount of data and complexity. There’s a need for specialization, not just knowledge sharing.