August 2013, Vol 2, No 5
The Role of Immunotherapies in Personalized MedicineUncategorized
As personalized medicine (PM) continues to expand its presence in cancer care, the need for clarity of its mission increases along with it. In this issue of Personalized Medicine in Oncology (PMO), we examine the expansion of immunotherapy in The Last Word column, which draws out the need for clarity on whether immunotherapy and PM belong in the same sentence. While antigen-specific immunotherapy may be the ultimate personalized therapy, the greatest recent strides have come in the use of immunotherapeutic agents without apparent patient or antigen specificity. It is believed that the patient’s immune system is poised to mount an antigen-specific response to agents such as interleukin-2 and ipilimumab as well as to investigational checkpoint blocking agents such as nivolumab and lambrolizumab. Also, at least in the preclinical setting, immunotherapy and molecularly targeted therapy appear to complement each other’s mechanisms and may possess therapeutic synergy, making them essentially “joined at the hip.”
The anti–CTLA-4 antibody ipilimumab has achieved a significant increase in survival for patients with metastatic melanoma. In a study of immunotherapy, Mellman, Coukos, and Dranoff note that the success of immunotherapy is happening “…together with the advent of targeted therapies…,” working with it “…to obtain a durable and long-lasting response in cancer patients.” The authors hold that these non-PM drugs are succeeding with the help of PM.
All advances in cancer therapy, be they empirically personalized or otherwise, rely on PM to achieve optimal outcomes. In short, nothing moves in cancer care any longer without reference to PM. This de facto synergy between targeted and other medications is telling today’s clinicians to look to PM whenever possible to strengthen the regimen. But the picture is far from clear, and the criteria for what constitutes PM treatment are often lost on the busy oncologists urgently pursuing a treatment strategy that will save the patient. Keeping oncologists focused on the advantages of PM therapies and diagnostics and how best to use them is essential to avoid limiting their utilization.
The goal of PMO is to open up the nuances of PM to our readership, keeping you focused on the continued importance of PM to your patients. The recent crush of attention toward the new immunotherapies underscores why our continued coverage of PM is so necessary. For nothing surpasses the value of enriched, targeted treatment, and physicians must constantly hone their expertise in PM care strategies, even when conventional treatments are introduced. PM and non-PM therapies will continue to coexist for the foreseeable future, requiring all the more working knowledge on the part of oncologists to understand the value that PM brings to treatment.
Kim Margolin, MD
University of Washington/Fred Hutchinson Cancer Research Center
PMO Board Member
With the recent advancements in the treatment of patients with metastatic melanoma, in particular with immunomodulating therapies, the development of unique immune-related side effects has posed novel management challenges. The first drug in this class to receive FDA approval for the treatment of unresectable stage III or IV melanoma is [ Read More ]
Is immunotherapy a type of personalized medicine (PM) or just useful population-based medicine? Look in different directions and you’ll get different answers, but whatever we do, let’s avoid oversimplification. For when we get down to specifics, the accurate answer is, “It depends.” When in doubt, it is often useful to [ Read More ]