With World Cancer day just a couple of days away, the future has never looked so bright for the treatment of cancer – including in more difficult to treat solid and blood cancers where there is a high unmet need. 

The FDA approved a record number of cancer treatments and indications from November 2016 to October 2017 (18 new treatments and 13 new indications) compared to the previous two years (8 new cancer therapies and 13 new indications).  

A huge amount of research is being carried out in the area of immune-oncology to harness the body’s ability to mount an effective immune response against cancer.

The success of the PD-1/PD-L1 inhibitors has affirmed this approach and immune-oncology is likely to become the 4th pillar of cancer treatment alongside chemotherapy, surgery and radiotherapy – potentially becoming standard of care in many tumour types.

There has been an explosion of research into the PD-1/PD-L1 checkpoint inhibitors (phase I-III clinical trials are being conducted in 18 solid tumours and 8 haematological cancers).  The FDA historically approved the immune checkpoint inhibitor pembrolizumab for the treatment of any solid tumour with a mismatch repair deficiency – irrespective of tumour type.  

Furthermore, an additional 18 target checkpoint inhibitor molecules are also in trials (with indoleamine 2,3-dioxygenase (IDO) inhibitors showing considerable promise) alongside research into other immune-oncology approaches: cellular immunotherapy including Chimeric Antigen Receptor (CAR) T-cell therapy, oncolytic viruses, bispecific T-cell engagers and peptide vaccines, across multiple tumour sites. 

The most promising of these in the immediate future are the CAR T-Cells.  Indeed in their annual clinical cancer advances report, ASCO named adoptive cell immunotherapy as the clinical advance of the year, due to the recent FDA approval of two CAR T-cell therapies to treat children and young adults with acute lymphoblastic leukaemia and adults with diffuse large B-cell lymphoma – cancers with an extremely poor prognosis and a high area of unmet need.  

With so many clinical trials underway and the FDA and EMA’s accelerated approval processes, the landscape of cancer treatment is likely to dramatically change over the next few years.    

The challenge for physicians going forward will be the appropriate selection of treatment from the plethora of options available, and further raises the importance of the precision medicine movement.  The challenge for pharmaceutical companies will be setting a price for these treatments, in this increasingly cost sensitive environment, which ensures their therapies will be used whilst still recouping the investment in these potentially ground breaking treatments.  I look forward with anticipation to the trial results and advancements of 2018!    

Kirstie Norgate, PhD, Associate Director, Cello Health Insight