the promise of IO.

June 29, 2019

advances in immuno-oncology [IO] have provided benefit to some patients with late stage or metastatic cancer and early results in adjuvant clinical trials in melanoma and lung cancer are showing signs of promise. while innovative approaches to patient selection, and the use of combinations and sequencing of therapies has led to more patients benefitting from IO therapy, there remains a need to better understand its true clinical and economic value, to educate on the potential reach, and to engage with stakeholders in order to fully utilize the promise of and maximize the impact of IO for patients.

until recently, the pillars for treating cancer have included surgery, radiation therapy, chemotherapy, and more recently, targeted therapy. the introduction of immuno-oncology has provided a different approach from conventional chemotherapy – which attacks all cells, malignant and normal. IO aims to stimulate and enhance the immune system’s response to tumours.

IO therapy involves a fundamentally different approach from conventional chemotherapy, which unleashes an indiscriminate, static, and toxic direct attack on all cells – malignant and normal — in hopes of damaging the cancer cells more than the host cells.

the first checkpoint inhibitors first saw dramatic results for patients with melanoma, where objective responses increased to 20-22% with CTLA-4 therapy, 35-40% with anti-PD1 agents and above 50% in combination. IO therapies have since been introduced in the treatment of renal cell carcinoma [RCC], non small cell lung cancer [NSCLC], small cell lung cancer [SCLC] bladder cancer, merkel cell cancer, head and neck cancer, gastrointestinal cancer and in certain lymphomas. further research has led to the FDA approval of PD-1 therapy [pembrolizumab] in MSI-Hi tumours. durable responses have also led to the FDA approval of two chimeric antigen receptor t cell therapy in some hematologic cancers in both the paediatric and adult populations.

IO therapies have been associated with distinct side effect profiles, mainly immune related adverse events and in the case of car-t, cytokine release syndrome [CRS] in both cases, side effects were identified and clinically effective management strategies were quickly developed. despite these potential side effects, patients have described their experience with IO therapies outside traditional measures and have focused rather on the potential for limited treatment duration, more manageable side effects [compared to other therapeutic options] and increased quality of life – creating an important value proposition for patients, their families and society where patients can resume normal activities during and after treatment, including earlier return to work and for longer periods of time, a decreased need for additional or subsequent cancer treatment, and less frequent medical intervention. for patients who respond to IO therapies, this can mean increased productivity and savings for patients, families and caregivers, healthcare systems and society in general.

evaluating these patient-centered outcomes can provide important context in assessing the value of these therapies. because the definition of value varies amongst stakeholders across the cancer ecosystem, a willingness to include this important perspective can provide more complete information in cases of economic uncertainty.

while the field of IO has advanced significantly over the last few years, there is still a need to better understand in order to achieve the full promise of utilizing the immune system to cure cancer for a maximum number of patients.