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The American Society of Clinical Oncology’s (ASCO) marquee annual meeting went forward this past weekend—albeit digitally due to the coronavirus pandemic.
ASCO usually attracts some 30,000 attendees who span the gamut including life sciences executives, academic experts, investors, scientists, and patient advocates from around the world.
The sheer amount of content can be head spinning. Major pharmaceutical giants and startup biotechs alike present data about their existing and experimental cancer treatments. So what stood out at ASCO 2020?
Cell therapies shine
So-called “cell therapies” have taken greater prominence in cancer drug development over the past few years. These are the kinds of treatments that leverage the body’s own biological machinery, in some shape or form, to ward off malignancies. For instance, cancer immunotherapy drugs may activate defense mechanisms to home in on malignant cells. Technologies such as CAR-T, which involves reengineering the body’s immune cells to become targeted cancer killers, have shown promise in the sick and desperate patients who haven’t improved with more traditional treatments.
Two companies that stood out on this cell therapy front are Johnson & Johnson and the lesser known biotech Allogene, according to investor Brad Loncar, who created an index fund dedicated to cancer immunotherapies in 2016.
Johnson & Johnson is working on a type of CAR-T treatment for the rare blood cancer multiple myeloma—and it’s shown some impressive results so far. The drug giant shared data showing that 25 out of 29 patients in a trial of the experimental JNJ-4528 had what’s called a “complete response,” which means that all signs of their cancer had disappeared through a certain period of time (though that doesn’t mean they’re necessarily cured permanently).
“But the response seems pretty durable based on the data they have,” says Loncar. “That’s pretty important because so far there’s been a pretty high relapse rate for this specific type of CAR-T treatment compared with others.”
That could set Johnson & Johnson up for an advantage against rivals like Bristol-Myers Squibb which are working in the same treatment space. “There are competitive implications. I’m not sure if Bristol-Myers and its partners will be able to catch up,” he says.
And then there’s Allogene. Although the company’s ASCO data is quite preliminary, it comes with a twist that could have massive practical implications for the CAR-T field.
CAR-T is complicated, and there’s different approaches you can take to using such technology: Autologous or allogeneic. Let’s break that down—autologous CAR-T treatments, several of which are already on the market, require extracting cells from individual patients, reengineering them to become cancer killers, and then re-inserting them into a patient’s body.
That’s a time-consuming and difficult process. “You have to draw blood, put it on an airplane, ship it, and then it takes a few weeks to restructure and process the cells, and then it has to be sent back from the lab to where the patient is,” says Loncar. And these patients are the sickest of the sick, meaning time is of the essence. “It’s just an expensive and cumbersome process.”
An allogeneic approach could change all that. This is what’s considered an “off-the-shelf” process: it’s dependent on using cells from donors rather than individual patients. “So it’s being mass produced in a factory like a more traditional therapy, which cuts out a lot of the manufacturing hassles and expenses,” Loncar explains.
Allogene’s experimental CAR-T (in admittedly early-stage studies) is one of the rare instances of this approach working on a similar level to the more hard-to-make existing treatments.
A path forward for combination therapies
Drug companies typically stack treatments on top of each other to see if a cocktail of therapies work better than just one. But in the case of cancer immunotherapies, that hasn’t always worked. There are dozens upon dozens of trials testing approved immuno-oncology drugs in combination with other experimental ones—with little to show in the way of results so far.
Swiss drug giant Roche may change that. The firm is one of the major names in the cancer therapy sector, with blockbuster treatments such as its immunotherapy Tecentriq. At this year’s ASCO, it highlighted early data for a combination of Tecentriq and a so-called “TIGIT inhibitor,” the experimental tiragolumab, in certain patients with advanced lung cancer.
That early data showed that the combo therapy shrank tumors in 31% of such patients compared with those who received Tecentriq alone. “I think you’re going to see a lot of companies invest in TIGIT drugs post-ASCO,” says Loncar.
AstraZeneca may be the ‘winner’ of this year’s meeting
It may seem glib to paint a cancer conference in terms of winners and losers. But that’s often the reality at ASCO, where investors and companies latch on to the most hopeful science.
This year, two firms which stood out were Merck (a perennial titan in the cancer space, especially with its best-selling immunotherapy Keytruda, which has shown to help patients with everything from melanoma to advanced lung cancer live longer) and AstraZeneca.
“I would crown AstraZeneca as the winner this year,” says Loncar. The company shared promising data for multiple treatments, but the most significant one may have been for its already-approved drug Tagrisso in the so-called “adjuvant” setting.
Here’s what that means: When a patient has a cancer which needs to be dealt with via surgery, they often have to take a drug to make sure that the cancer doesn’t come back after the tumor has been removed. Late-stage trials showed that Tagrisso was staggeringly effective in achieving this “adjuvant” goal, with “a 79% reduction in the risk of disease recurrence or death” for lung cancer patients with a certain genetic mutation.
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