Cracking the immunological code of lung cancer
We talked to prof. Karim Vermaelen (MD, PhD), Associate professor, Faculty of Medicine and Health Sciences, UGent and Principal investigator, Tumor Immunology Laboratory of the Dept. of Pulmonary Medicine. He is also co-founder of the ION (Immuno-Oncology Network) Ghent.
How far are we in the effort of beating cancer?
Karim: We haven’t beaten cancer yet, but we have come a very long way and I am speaking from my expertise as a lung cancer specialist. It’s a cancer which always has been very tough to treat. And we have seen some major advances over the past 10 years. For a minority of lung cancers that have specific mutations, which are also the Achilles heel of the tumor. There are specific drugs that target these mutations and we see dramatic responses. But these patients are not cured. And then came the immunotherapies, for the patients without these mutations, they have remarkable activity. So we are progressing really fast, but we are not there yet. Immunotherapy doesn’t work for all cancer patients.
Will we some day be able to beat lung cancer?Karim: The only thing I can say is that every few years we see an incremental step. We are seeing that now for immunotherapy. We are entering an era of next generation immunotherapy, where drugs are combined together to achieve even more response. This is just starting now.
Where do you expect most of the breakthroughs in the field of oncology?
Karim: Yes, I think so. What we observe in some patients is really remarkable. Patients that have been declared incurable, with lots of metastasis, some of them, some of my patients also, are still alive for 4 years or more. This is amazing, this is incredible. So I think conceptually it’s a different thing, revolutionary, the approach is revolutionary, but it has to be combined with other drugs and what we have seen now, is that more and more drugs that have not been designed for immunological purposes, we have discovered that they have immunological effects that are interesting, they can complement the immune-oncology drugs, in combination.
What promise does immunotherapy hold for the future?
Karim: The promise and what we are already seeing now is very durable responses, very durable remission. What’s also very interesting is that the patient will do well with immunotherapy, their quality of life is good. With some other drugs, they stay long on the drugs, but have so many side effects that the balance is not right. Immunotherapy is better, you can resume normal activities, this is important.
Can we also expect a breakthrough from cancer vaccines?
Karim: That’s a very good question, because cancer vaccines have very often failed in oncology. But now thanks to the convergence between immunology and genomics, we will see a revival in cancer vaccines. Because now we know what the real targets are of the immune system. We didn’t have the right targets and probably also not the right vectors to vaccinate. Now we combine these new assets with new insights into immunology. Cause immunology has evolved as well. And we are going to see major breakthroughs in cancer vaccines. Possibly in combination with the current immuno-oncology drugs.
What’s your team and you focusing on?
Karim: The main efforts of my team right now is to finish the development of a vaccine, it’s a cellular vaccine, so we use the body’s own immune cells, we load them with specific targets that are common to a large set of lung cancers and we re-infuse them in the patient and this boosts the immune system.
Patients with severe lung cancer?
Karim: Patients with metastatic lung cancer. Progressively, I hope we find enough financing to progress into more larger trials in the future.
What impact do you expect from this work in the future?
Karim: I think it has the potential to as I said not all patients respond the current generation of immuno-oncology drugs, I think the combination with a vaccine would boost these responses and rescue more patients.
So more patients will benefit?
Karim: Yes, with less toxicity.
What’s your personal moonshot?
Karim: My personal moonshot is to really in a way crack the immunological code of lung cancer. And really find the way to define for each patient which is the ideal combination therapy to use. And we are not there yet, we need new technologies, combination of technology also in machine learning to really integrate the complexity of the cancer immune system to distill information that is useful for the doctor to decide which combination therapy should be given.
It’s really about personalized medicine?
Karim: It’s personalized. Also for immuno-oncology.