No Lack of Enthusiasm for CAR-T Development, Experts Say

Robert H. Carlson, MBA

Disclosures

November 30, 2016

In This Article

Combination Immunotherapy Is the Future

"As a broad category, immunotherapy will become the standard of care, and my guess is that the future is combination therapies," Dr Roy said. "The technologies are competitive, but they are also synergistic."

Combination approaches may be gaining more traction now as clinical studies mature, Dr Yee said. "Combination therapy is really the way to go for dealing with solid tumor cancers, where you have to compensate for the tumor microenvironment as well as for the immune repertoire that's available," he said. "There's a very aggressive enthusiasm to explore combinations in a rational manner because there are going to be toxicities, and those toxicities are either managed or they're avoided by judicious selection or dosing or combinations."

"What we're seeing at [the International Cancer Immunotherapy Conference] are some very real and promising results in the arena of solid tumor cancers when combination approaches are applied, and the science behind them is mature enough that they can be translated into many clinical trials," Dr Yee said.

Keep in mind there are different forms of T-cell therapy that should be considered beyond CAR-T cells, Dr Yee added; these include T-cell receptor [therapy], endogenous T cells, and tumor-infiltrating lymphocytes. "There are efforts in academia and in industry to exploit all of these modalities in cell therapy," he said.

Studies combining standard chemotherapies and radiation therapy with checkpoint inhibitors are ongoing as well.

Chemotherapy is the standard of care today for chemotherapy-sensitive tumors, Dr Grupp noted. "On the other hand, using chemotherapy might be messing with the ability of T cells to actually kill tumors, so the combination of chemotherapy and checkpoint inhibitors is going to have to be very carefully studied," he said.

Some chemotherapies are immunogenic and may augment the effect of the checkpoint inhibitors, Dr Grupp said, but others are profoundly immunosuppressive and may limit the effect. And there will be a role for radiation therapy as well.

"These combinations are a brand-new area in oncology, and there is an opportunity for a lot of study," Dr Grupp said. "We don't know the rules yet."

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