#jeff rowbottom

In 2010, the first cancer vaccine, Provenge, was approved for prostate cancer patients, and in 2011 a drug that inhibits key checkpoints of the immune system, Yervoy, was approved for patients with late-stage melanoma. Much of the excitement around immunotherapy is that it is one of few cancer treatments that can result in durable, complete remission of cancer.

Melanoma survivor Jeff Rowbottom, managing director of Kohlberg, Kravis, Roberts, said, “I found it pretty interesting that our immune system is the most effective way to cure cancer. Intuitively this seems to make a lot of sense, especially as a non-scientist.”

During a panel discussion at the 2013 Milken Institute Global Conference, panelists provided insight on why these therapies are now working when they had not been previously. 

Suzanne Topalian, professor of surgery and oncology at Johns Hopkins University, and director of the melanoma program at the Sidney Kimmel Comprehensive Cancer Center, simply explained, “The technology has finally caught up with ideas that we have had over the past few decades about how to activate the immune system to fight cancer.”

Michael Giordano, senior vice president and head of development, oncology, and immunoscience at Bristol-Myers Squibb, added, “Immunotherapies have been around for a while, but they have undergone a renaissance as a result of a deeper understanding of the immune system.”

Marie Belldegrun, executive chairman of Kite Pharma, Inc. and director of the UCLA Institute of Urologic Oncology, underscored the point by explaining that the advancement of genetic engineering such that it has become simple, routine, and cost-effective, created a significant turning point that enabled scientists to really shed light on the complex inner-workings of the immune system. “We now understand all of the antennas and the GPS systems that the [immune] cells use to do their jobs.”

Moderator Louise Perkins, chief science officer of the Melanoma Research Alliance, pointed out that immune-based therapies are a form of personalized medicine; however, not necessarily in the way that the public normally thinks about personalized medicine in the context of targeting genetic mutations specific to the individual patient’s tumor. She explained that the immune system can target these genetic mutations specific to each patient, but the power of immunotherapy really lies in the fact that it is a living therapy that persists and can keep pace with new genetic mutations that occur in the tumor over time. This is important because tumors are very dynamic in how they respond to therapeutic stress. Tumors often become resistant to standard treatments by creating new genetic mutations that render treatments ineffective. The immune system can sense these changes in real time and adjust with the tumor to deter treatment evasion. 

Panelists continued the discussion by highlighting what it takes for drugs like Yervoy and other immunotherapies to come to market. Giordano explained that, as a drug developer, first and foremost it is important to remember to keep the patient at the center of the need. Giordano also talked about the importance of collaborating across sectors – industry, government, and nonprofits – in order to efficiently and effectively bring medicines to patients. He stressed the role of patients and nonprofits to serve as honest brokers and push all stakeholders in the right direction to make sure that patients are kept at the center of the effort and that contributions from all stakeholders can be maximally leveraged.

Topalian added, “Nonprofits are becoming increasingly important to drive science forward, especially in the wake of sequestration."

She explained that as other funding sources are shrinking, philanthropy dollars will need to fill a very important funding gap to support cutting-edge ideas that traditional organizations perceive as too risky to put their dollars behind, but may come with high reward. She emphasized the point that taking educated, calculated risks in research can be a very good thing.

Finally, Giordano elegantly pointed out that the essence of what we need to do as a community in order to really meet the needs of patients is “Keep the patient at the center of the need and follow the science. If we follow the science then it will be good business; however, good business is not necessarily good science.”