In May 2018, Baroness Tessa Jowell, a lifelong public health advocate and Member of Parliament in the British Labour Party, died of glioblastoma. Inspired by her life and work, The Forum at the Harvard T.H. Chan School of Public Health organized an expert panel discussion entitled “Rare Cancers: Charting a Faster Route to Treatment,” in Boston, on February 1, 2019, supported by the Economist Group.
Jill O’Donnell-Tormey, Ph.D., CEO and director of scientific affairs at the Cancer Research Institute (CRI), participated alongside Laurie Glimcher, M.D., president and CEO of the Dana-Farber Cancer Institute; Razelle Kurzrock, M.D., senior deputy director of the Moores Cancer Center at the University of California, San Diego, and Greg Simon, president of the Biden Cancer Initiative and former executive director of the White House Cancer Moonshot Task Force. The panel was moderated by Natasha Loder, health policy editor at The Economist.
The panelists discussed how advances in cancer immunology, innovative clinical trial designs, and international data sharing can accelerate the pace of research progress and create new hope for patients. Immunotherapy was discussed as a relatively new treatment option that has shown tremendous effectiveness for a subset of patients. O’Donnell-Tormey noted that while proof of principle has been shown with immunotherapy, we need to do more research to understand why only a relatively small number of cancer patients have durable responses.
A key theme of the discussion was that the future of cancer treatment lies in combination therapies: combinations of different modalities, such as chemotherapy and immunotherapy, or different forms of the same mode of treatment, such as the combination of two or more immunotherapies.
In order to identify factors that will determine which combinations will be successful in a given patient, the importance of additional scientific research was stressed. Further understanding on both a basic biological level—what is happening at the microenvironment of the tumor site—and an individual level—how each person’s immune system may react—is necessary. The ultimate hope is to personalize treatments so that every cancer patient will experience a durable response. O’Donnell-Tormey stressed a tremendous need for additional funding to support the critical research that will make personalized medicine a reality.
Simon spoke about what we as a society are doing right and what we could be doing better in terms of advancing cancer treatments. We are right to continue to push for the development of new and better treatments, and the FDA has fast-tracked the approval of certain drugs in order to make them available to patients sooner. However, as all panelists agreed, more needs to be done to facilitate and encourage researchers to work together. Not any one scientist, company, or nation can conquer cancer alone. For instance, the cost and lead time required to conduct clinical trials creates impediments to accelerating the drug development process. By working together and pooling resources, intellectual talent, and access to smaller patient populations, clinical testing can become more effective. The importance of data-sharing and the development of consistent standards were also stressed in the discussion.
Leading cancer organizations such as CRI are working to address these challenges. Simon noted that scientists who are part of the Biden Cancer Initiative are required to publish their results in open-access journals. O’Donnell-Tormey cited the CRI iAtlas, an open-access interactive web-based platform and set of analytic tools for studying interactions between tumors and the immune microenvironment. Glimcher referred to a consortium of which Dana-Farber is a member, where smaller patient populations can be combined in order to conduct more meaningful tests. CRI’s Anna-Maria Kellen Clinical Accelerator was one of the first collaborative models in the immunotherapy space, bringing together the top scientific academic experts, industry leaders, clinical trial managers, and dedicated philanthropists to design, implement, and fund the most promising combination trials. O’Donnell-Tormey also talked about CRI’s new platform studies, in which smaller cohorts of 15-20 patients can be tested as part of the same clinical trial, using different combinations. If a given cohort does not show a significant response, that particular segment can be shut down while keeping the trial open, and a different cohort and treatment combination can be tested. This is an enormous savings in terms of cost and set-up time.
CRI was honored to be represented on this elite panel of experts. We continue to move the field forward by addressing the current challenges surrounding data-sharing and combination testing.