Clinical impact of immunotherapy

Programme stream(s): Treatment
Programme session type(s): Specialist session

Chair: Poulam Patel, University of Nottingham, UK
Speaker: James Larkin, Royal Marsden NHS Foundation Trust, UK
Speaker: Mary O'Brien, Royal Marsden Hospital, UK
Speaker: Paul Nathan, Mount Vernon Hospital, UK

14:00-16:00

Room: Hall 1

Sponsored by:
Roche

Immunotherapy is revolutionising our approach to treating cancer. In some cancer such as melanoma, it has transformed the survival of many patients from a few months to many years and possible cure. These advances are now part of standard of care more common cancers such as lung and urological cancer. This however, comes with new range of toxicities not previously seen with anti-cancer therapies. These developments come with significant opportunities but also challenges.

This session will outline the key clinical developments in immunotherapy focusing on melanoma and lung cancer as exemplars and discuss the treatment of immune related side effects.

Challenges in Managing the Immune Related Toxicities of Cancer Immunotherapy
Speaker: Paul Nathan
Affiliation: Mount Vernon Hospital

Abstract:

Two major challenges have emerged in the management of immune checkpoint inhibitor toxicities:  1. Minimising the side effects of immunosupression in the majority of patients who require active side effect management and whose toxicities respond to treatment. 2. Gaining control of toxicities in the group of patients with refractory toxicity using alternative immunosuppressant approaches.  Improvements in these challenges would be significantly aided by an increased understanding of the mechanisms of immunotherapy induced toxicity.

Lung Cancer IO - hi ho
Speaker: Mary O’Brien
Affiliation: Royal Marsden NHS Hospital

Abstract:

Lung cancer is reaping the rewards of 30 years of research by scientists and clinicians in both academic fields and the pharmaceutical industry. Immunotherapy (IO) is developing in a parallel fashion to targeted therapied. IO appears to be active in the tumours with a large number of non specific mutations caused by smoking without a unique driver mutations. Targeted therapies are changing and prolonging the lives of patients with tumours driven by a unique driver tumour mutation who are either light or never smokers. We see and welcome the progress in both group and recognise there is overlap. The development started with replacement of toxic standard second line treatments like docetaxel by a more active drug – pembrolizumab, nivolumab or atezolizumab. Through this it became obvious that tumour expression of PDL1 was and is a reasonable biomarker to select those tumours with the highest chance of responding. This has now been improved upon by documentation of the tumour mutation burden (TMB). Moving this forward to patients with tumours with high expression of PDL1, in the first line setting, IO without chemotherapy, has produced un precedented median survival of 30 months in patients with stage 4 lung cancer, compared to a historic standard of around 12-14 months (KEYNOTE 024). Moving to earlier stage disease, where cure becomes the aim, PACIFIC using durvalumab has given us the first signal. In the UK we are part of the PEARLS adjuvant study where the use of IO after curative surgery will help us understand the role of the presence of the primary tumour as a source of antigens and TIL cells. So hi ho hi ho, its of to work we go.