Breaking Into Breast Cancer, Immune Therapy Shows Wider Promise

(Bloomberg) -- Drugmakers are honing in on which cancer patients will benefit from new immune therapies -- and finding many more than skeptics had thought.

For the first time, a clinical trial showed that a treatment with one of the new generation of drugs designed to unleash the body’s own immune system against tumors can help some women with the most aggressive type of breast cancer live longer. The study was unveiled by Roche Holding AG at Europe’s biggest cancer conference.

These medicines, led by Merck & Co.’s blockbuster Keytruda, are sold for more than a dozen different cancers, and pharmaceutical companies are obsessively working to expand their applications with newer versions and treatment cocktails. There are some 1,300 immune-based treatments in human studies, according to the Cancer Research Institute, largely financed by drugmakers angling for a chunk of a market forecast to exceed $100 billion annually by 2024.

“This is just the tip of the iceberg,” said Axel Hoos, oncology research and development chief at U.K. pharma giant GlaxoSmithKline Plc, which is trying to break back into oncology after selling its existing products to Novartis AG in 2015. “There’s a little bit of hype, but there’s a lot of substance.”

Cold Tumors

At the European Society for Medical Oncology’s meeting over the weekend, Roche disclosed the results of a study that showed one group of patients whose breast tumors tested positive for a protein called PD-L1 lived an average of 25 months when they got an immune therapy called Tecentriq -- about 10 months longer than others who got only chemotherapy.

Immune therapies exploded onto the scene about eight years ago when Bristol-Myers Squibb Co.’s Yervoy became the first medicine of its kind to extend the lives of people with melanoma, a lethal skin cancer. Successes in kidney and lung cancers followed shortly thereafter.

When immune therapies work, the effect can last for years, one of the reasons they’re regarded as revolutionary. But in most patients, nothing helpful happens -- even in skin and lung tumors where some of the most dramatic effects have been seen.

“There are some cancers where the immune system just can’t recognize it,” said Mace Rothenberg, chief development officer for oncology at U.S. pharma giant Pfizer Inc. Flying under the body’s protective radar, scientists refer to them as “cold tumors.”

Companies are starting to rethink their strategy for the toughest cases, said Dan O’Day, Roche’s pharma chief. Testing patients’ tumors for specific proteins and genes will help identify those most likely to benefit, he said.

“We want to get away from this concept of giving cancer immunotherapy to 80 percent of the patients and only half of them respond,” he said in an interview. “Let’s find the other treatment options for the other patient types.”

Roche’s breast cancer study helped support the idea that there are ways for doctors to identify more cancers that will submit to immune therapy. The drug used in the study, Tecentriq, blocks the protein called PD-L1 that hampers the immune system’s attack on cancers, and only women whose tumors had high levels of the protein were helped.

Search for Responders

Another signpost in the search for responders could be the sheer number of mutations in a tumor as a whole, O’Day suggested. It’s a strategy that may extend the reach of immune therapies even further, as indicated by studies presented at the conference. Studies of cancers of the colon and rectum, which have been less responsive to immune therapy, showed that tumors with severe genetic damage may offer better targets for drugs such as Bristol’s Opdivo and Yervoy.

“They’re doing trials in every different tumor that you can imagine,” said Richard Gaynor, research and development chief of Neon Therapeutics Inc., an immune-oncology startup. “There will be subsets of patients within each group that may benefit.”

And in many cases, immune therapy may need help. The question is how to nudge the body’s protective system to act against certain tumors, said Incyte Corp. Chief Executive Officer Herve Hoppenot. His company tried the strategy earlier this year, combining its experimental epacadostat with Merck’s Keytruda, and it failed.

Still, Incyte and other drugmakers are persisting in their search for ways to track down tumors that have eluded immunotherapy.

“We’re scratching the surface,” said Luciano Rossetti, head of global research and development for biopharma for Germany-based Merck KGaA. “We have a first wave of real excitement.”

To contact the reporters on this story: Naomi Kresge in Berlin at nkresge@bloomberg.net;Tim Loh in Munich at tloh16@bloomberg.net

To contact the editors responsible for this story: Eric Pfanner at epfanner1@bloomberg.net, John Lauerman, Marthe Fourcade

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