ESMO-IO 2019 – Expert Commentary: ESMO-IO novelties and their real-world application

  • Carolina Rojido
  • Univadis
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John Haanen, MD, PhD. Head of the Division of Medical Oncology and Staff Scientist in the Division of Immunology at the Netherlands Cancer Institute. Professor of Translational Immunotherapy of Cancer at Leiden University Medical Centre. Amsterdam, Netherlands

  • There is a sense of hope that targeting neoantigens in a more specific manner will bring further improvement in responses and outcomes, but it’s still early days.
  • We have to realise that although it is actually very promising, there are very few data that really help us demonstrate that this is exactly the right way to go.
  • The technology’s application is complex because you have to make a very personalised treatment for each individual patient, because that’s what neoantigens are based on. It is very costly, complex, time-consuming.
  • Production in a rapid and efficient manner requires still a lot of evolution and I think in the next 2 to 5 years we’ll see how important targeting neoantigens is compared with, let’s say, shared antigens.
  • With shared antigens the advantage is that you can give a drug from the shelf to a couple of patients which would be very difficult for the neoantigens approach.
  • We know neoantigens and tumour mutational burdens (TMBs) are important, but the knowledge we have is still deficient in what it’s going to mean for the patient outcomes.
  • For the real-world it is far away, it is very experimental, phase 1 trials, so it will probably take a couple of years to get to the stage where, if proven very successful, we can deliver them to the real world.
  • You have to consider that if we make a drug for every individual patient, every case is a phase 1 trial in itself, so how do regulators look at that? A lot of evolution is needed.
  • And also, how should they be combined with established immunotherapies?
  • Biomarkers remain a big issue. We have only PD-L1 expression as a more or less solid biomarker. All the others are still in development.
  • The validation of all of these biomarkers for clinical practice is still a huge issue. How do you make sure that if you do the same analysis in different labs the outcome is the same and that you can base on that the care your patient needs?