Building on the landmark 2017 U.S. Food and Drug Administration approvals of two cancer immunotherapies using engineered immune cells (chimeric antigen receptor T cells, or CAR T) to target blood cancers, the field continued to make strides in 2018 with the Nobel Prize in physiology or medicine awarded for work on using the immune system to attack cancer. (Read Fred Hutch President and Director Dr. Gary Gilliland’s perspective on this year’s Nobel to his former colleague, Dr. Jim Allison.)
Fred Hutch researchers are diving deep into immunotherapy to better understand how best to use the immune system to treat cancer:
CAR T-cell therapies:
- Published in Science Signaling, the first in-depth profile of CAR T-cell signals by Fred Hutch researchers suggests how to fine tune the speed of the engineered response to avoid toxicities and improve their anti-cancer effect.
- One reason why cancer comes back is because it is notoriously good at finding ways to outsmart agents aimed at killing tumors. A Nature Communications paper by Fred Hutch researchers describes one way that cancer adapts to hide from a combination immunotherapy
- Presented earlier this year at the American Society of Clinical Oncology’s annual meeting in Chicago: preliminary evidence of biomarkers predicting longer remissions for CAR T patients shows that characteristics of the patient’s disease and response of the T cells play a role.
- Earlier this month at the American Society of Hematology’s annual meeting in San Diego, Fred Hutch researchers reported that patients with relapsed, refractory chronic lymphocytic leukemia on a phase 1/2 clinical trial combining CAR T-cell therapy and a drug called ibrutinib had fewer side effects and were potentially more likely to see their cancer go into remission compared with those who received CAR T alone. Read more and see other ASH highlights in the Fred Hutch ASH media tip sheet.
- Tumor-infiltrating lymphocytes made headlines over the summer for successfully treating a breast cancer patient, triggering discussion of how immunotherapy could be extended from its success in blood cancers and be used for common solid The experimental therapy works by removing T cells from biopsied tumors, growing the T cells in the lab and then infusing them back into the patient.
- Fred Hutch researchers conducted a case study of melanoma treated with TIL to see how one patient’s remarkable response could guide next-gen immunotherapies for other patients and types of cancer.
We know that not smoking, eating healthily, following cancer-screening recommendations and exercising can help reduce cancer risk. Over the past year, Fred Hutch researchers have been at the forefront of developing new guidelines to help people implement these healthy habits into their daily lives.
Diet and exercise:
- Fred Hutch researchers have served on the Physical Activity Guidelines Advisory Committee to help develop the new U.S. Department of Health and Human Services Physical Activity Guidelines as well as help compile the American Institute for Cancer Research’s report on diet and physical activity, issuing 10 recommendations to prevent cancer.
- With recent headlines about the consequences of excess meat and alcohol consumption, it can be confusing to know what preventive measures to follow. Fred Hutch researchers recommend specific lifestyle steps people can follow to reduce their odds of getting cancer.
With the advancement of technology, cancer researchers have been able to move from a “one- size-fits-all” approach to cancer treatment to a tailored treatment strategy for each patient. Fred Hutch researchers have used precision medicine to both treat and prevent cancer.
- Results from a Phase 3 clinical trial showed that 70 percent of women with the most common type of breast cancer do not get any benefit from chemotherapy in addition to other treatments. The study results, announced in June by the National Institutes of Health, received substantial media attention and showcased an example of using genetic tests of individual patients’ cancer to inform treatment choices —an approach known as precision, or personalized, medicine. Fred Hutch physician-scientist Dr. Kevin Cheung commented on the significance of the findings for patients.
- Current colon cancer screening guidelines recommend that people at average risk get a colonoscopy starting at age 50. Public health researchers at Fred Hutch are studying “precision prevention” approaches to detect colorectal cancer that combine genetic and lifestyle factors to better understand each person’s unique risk profile. This potentially could lead to more personalized colorectal cancer-screening guidelines.
CONVERGENCE OF HEALTH CARE AND TECHNOLOGY
Technology continues to impact the way cancer is diagnosed, treated and managed. Fred Hutch is collaborating with many of its technology neighbors in Seattle to improve research efforts and advance lifesaving therapies for patients.
Better cancer care delivery:
- Research led by Fred Hutch found that more than half of cancer patients undergoing chemotherapy are hospitalized or treated in the emergency room for side effects such as nausea, pain, fever or fatigue. Microsoft and Fred Hutch are working on a pilot technology project to track cancer patients’ vital signs and help them avoid the ER and unnecessary costs through better management of their chemotherapy side effects.
Clinical trials acceleration through automation:
- Historically, identifying potential clinical-trial participants has required a significant time- and labor-intensive effort to abstract unstructured data. Fred Hutch is working with Amazon to test and train a new service that automates the abstraction process, saving researchers valuable time and accelerating clinical-trial enrollment.
INFECTIOUS DISEASE AND CANCER
A Forbes profile of a head-and-neck cancer patient whose cancer was linked to human papillomavirus, or HPV, is part of a growing awareness of cancers caused by or linked to infectious diseases, many of which are preventable. Fred Hutch researchers are gaining new insight into how HPV develops into cancer, and others are investigating parallels between cancer and HIV.
Cancer outcomes and HIV:
- People living with HIV have long been at higher risk for AIDS-defining cancers like non-Hodgkin lymphoma and Kaposi sarcoma, and a new trend shows the risk of non-AIDS-defining cancers is also rising among this group. Fred Hutch experts identify several areas that need to be addressed, including barriers to care, lack of access to clinical trials and infrequent coordination between oncologists and HIV specialists.
A cure for cancer — and HIV?
- There appear to be parallels to how HIV and cancer cells proliferate in the body. A Fred Hutch study published in Nature Communications shows a majority of HIV persistence during antiretroviral therapy is due to cellular proliferation, not viral replication. This finding suggests that reducing cell proliferation may be an effective strategy to shrink or eliminate HIV reservoirs that remain in the body during antiretroviral therapy.
HEALTH CARE ECONOMICS AND DISPARITIES
Research indicates that the high cost of health care, rising drug prices and disparities in access to care can have a significant impact on cancer patients’ quality of life and survival rates.
Cancer-care quality measures linked to cost:
- Fred Hutch’s team of health care economists analyzed how clinics across Washington state performed based on cost and quality of care metrics, releasing a first-in-the-nation report linking clinic-level quality measures to cost in oncology. The researchers’ vision is that other states and regions could replicate this effort, which was informed by patients, cancer-care providers, public and private health insurers and researchers.
Cost of cancer care and geographic disparities:
- Cancer care can cost twice as much in the U.S. as in Canada but with similar outcomes, revealed a Fred Hutch study of colorectal cancer patients on both sides of the border. Disparities in cancer survival rates also exist between rural and urban patients, likely due to the type of care they receive. The study also found that clinical trial participation can reduce the disparity.
Note: Fred Hutch and its scientists who contributed to these discoveries may stand to benefit from their commercialization.
# # #
At Fred Hutchinson Cancer Research Center, home to three Nobel laureates, interdisciplinary teams of world-renowned scientists seek new and innovative ways to prevent, diagnose and treat cancer, HIV/AIDS and other life-threatening diseases. Fred Hutch’s pioneering work in bone marrow transplantation led to the development of immunotherapy, which harnesses the power of the immune system to treat cancer. An independent, nonprofit research institute based in Seattle, Fred Hutch houses the nation’s first National Cancer Institute-funded cancer prevention research program, as well as the clinical coordinating center of the Women’s Health Initiative and the international headquarters of the HIV Vaccine Trials Network.