Important advances in cell therapy — which seeks to harness the immune system to target cancer — have created a scientific environment in which research in the field is flourishing.
Harnessing the immune system to target cancer is the goal of a groundbreaking area of oncology research called cell therapy. Important advances in the field have created a scientific environment in which cell therapy research is flourishing. Christian S. Hinrichs, MD, is chief of Cancer Immunotherapy and co-director of the Duncan and Nancy MacMillan Cancer Immunology and Metabolism Center of Excellence at Rutgers Cancer Institute of New Jersey and a professor of medicine at Rutgers Robert Wood Johnson Medical School.
Christian S. Hinrichs, MD, chief of Cancer Immunotherapy and co-director of the Duncan and Nancy MacMillan Cancer Immunology and Metabolism Center of Excellence at Rutgers Cancer Institute of New Jersey and a professor of medicine at Rutgers Robert Wood Johnson Medical School.
Rutgers Cancer Institute houses a Good Manufacturing Practices (GMP) facility, a fully commissioned clean space for manufacturing of viral vectors and cell products for human administration. It is the link that connects the discovery of new treatments in the laboratories at Rutgers Cancer Institute with the delivery of these treatments to patients – statewide together with RWJBarnabas Health and beyond. Patients in New Jersey have access to these clinical trials through treatment at Rutgers Cancer Institute and through clinical trial recruitment and coordination of care across RWJBarnabas Health. Recently, the first patient was treated with genetically modified T-cells developed within the GMP facility at the state’s only National Cancer Institute-designated Comprehensive Cancer Center.
Dr. Hinrichs shares his insight:
What is the current view on developing more consistent and effective cell therapies for additional types of cancer and what are some of the challenges?
The next frontier for cell therapy is the development of effective treatments for common cancers. We made tremendous advances with the approach for the treatment of certain hematologic malignancies, but translating these early successes in relatively uncommon liquid tumors into effective treatments for common solid tumors has been more difficult.
The greatest challenge has been finding therapeutic targets that are expressed by most or all of the cancer cells and not by critical normal tissues and directing T cells against them. There are at least two important strategies to address this problem: The first is to target cancer drivers that are expressed by malignant but not healthy tissue, such as mutated proto-oncogenes or constitutively expressed viral oncoproteins. The second is to develop new technologies that can distinguish between cancer and healthy tissues through combinations of antigen-targeting receptors.
The cost of cell therapy is substantial, and the bar for efficacy is high. First and foremost, we need more effective treatments and especially treatments that are curative. In addition, we need advances that decrease the costs of manufacturing cell products or that allow for in vivo engineering — i.e., gene engineering of T cells while they are still in the patient.
What are clinical trials in this area examining right now?
There has been considerable work and a recent report of a randomized trial of cell therapy with tumor-infiltrating lymphocytes (TIL) for melanoma, and this approach may be approved as a standard therapy in the not-too-distant future. At Rutgers Cancer Institute, we are focused on bringing cell therapy to patients with common types of cancer for which standard treatments are inadequate. We recently opened a clinical trial for an engineered cell therapy treatment for lung, triple-negative breast, cervical and gastric cancers. Also newly opened is a clinical trial of a new approach for human papillomavirus-associated cancers such as oropharyngeal, cervical and anal carcinomas. Recent work by others has been reported lately with new cell therapies for prostate cancer and gastrointestinal cancers.
As we continue to add to our body of knowledge on cell therapy, what should clinicians keep in mind in determining a treatment approach involving cell therapy for patients?
Cell therapy for solid tumors remains experimental at this point. TIL therapy for melanoma and engineered T cell approaches for certain sarcomas have shown promising clinical trial results. Retrospective data suggest that, as with other oncology drugs, cell therapy becomes less effective after other treatments. Clinical researchers developing these treatments will need to balance the risks and benefits of standard and experimental treatments in increasingly early disease settings.
