With Checkpoint Inhibitors Here to Stay, Patient Selection Has Become a Science of its Own

CHECKPOINT INHIBITORS — IMMUNOTHERAPY DRUGS that are improving the treatment landscape for many patients across the spectrum of cancers — are relatively new. The science involved in finding and treating the patients most likely to respond to these drugs — without overlooking any or treating those who won’t benefit — is even newer.

The question of appropriate patient selection has existed throughout immunotherapy’s development. But with several such drugs now approved by the Food and Drug Administration, as well as numerous clinical trials being conducted in various cancer types, scientists and oncologists are accumulating new evidence about who is likely to benefit from checkpoint inhibitors.

Our cover story in this special issue of CURE® explores that evidence. We look at methods, such as genomic testing, that doctors can use to look for biomarkers — cellular signals that a patient will respond to immunotherapy. Also important: the discovery that cancers characterized by a quantity or pattern of mutations in the tumor or surrounding area are the most likely to respond to checkpoint inhibitors. With that in mind, scientists are exploring the possibility that giving newer classes of specific drugs to patients whose tumors are less immune responsive, with the aim of altering the tumor or its microenvironment, will in turn make the lesions more susceptible to checkpoint inhibitors. This concept is known as making a “cold” tumor “hot.”

Over the next several years, this and other lines of research could broaden the population able to benefit from checkpoint inhibitors.

At the same time, the research community, as it learns more about the science of cancer immunology, is working to develop alternative immune strategies, and we discuss some of those novel drug classes, including protease activated antibody drugs, co-stimulatory antibodies and agonists of stimulator of interferon genes (STING). One article spells out how these agents work, and another considers the use of engineered viruses as a medication delivery system.

In the quality-of-life arena, we bring you a feature on managing the side effects of checkpoint inhibitors. In addition, we report on a study of the relative cost-effectiveness of several checkpoint inhibitor regimens.

Finally, we speak with one of the groups that is driving cancer immunotherapy research: Stand Up To Cancer. This group has numerous teams of scientists working hard to unravel the mysteries of immunotherapy. In an interview, its president told CURE® about a recent promising study in patients with lung cancer.

Immunotherapy is a constantly evolving field, and we’re happy that we can share some of its latest and most exciting findings. We hope this information will help you better understand how immunotherapy works and where it might fit into your own journey.

As always, thank you for reading.

MIKE HENNESSY, SR. Chairman and CEO