What are the two or three critical issues facing the field of cancer immunotherapy?
I see three of the most important challenges facing cancer immunotherapy to be 1) Increasing IO responsiveness and biomarker development for selection of appropriate patients and combinations, 2) Ensuring that SITC remains the leading organization driving immunotherapies, and 3) Extending deep and durable responses to more patients.
1. Increasing clinical responsiveness with personalized immunotherapy. Neoadjuvant trials are becoming mainstream in many tumor types and provide dynamic insights into biology and follow the adaptive and innate immune response to immunotherapies. SITC should promote neoadjuvant “window” trials to deepen our understanding of individual patient responses and their cancer biology. Newly developed single-cell and spatial technologies now permit highly refined understanding of the TME during therapy and novel combinations, which will be the basis for personalized immunotherapy. Moreover, combinatorial approaches must be guided by science and adaptive designs. Moving IO into earlier lines of therapy, including preoperatively and in cancer immunoprevention, will keep SITC at the forefront of the field. This also requires elucidating the interactions with chemotherapies, radiotherapies, theranostics and novel combinations. SITC should promote the tools for gathering and integrating this information and developing the infrastructure for supporting personalized cancer immunotherapy, which is a key priority for the field. This strategy will help prioritize the most promising agents and combinations to test, facilitating nimble and effective drug development. SITC should promote both grant writing and trial design tools for trainees to enhance biomarker selection and novel discovery efforts.
2. Ensuring that SITC remains the leading organization driving the future of immunotherapy. Given the increasing integration of cancer immunotherapy into other important societies like ASCO, AACR, ASTRO, ESMO etc., SITC should refine and maintain its unique niche as a society driving immuno-oncology. No other society has done what SITC has, and it will need to strategically partner while maintaining its unique identity and contributions. Its recently increased membership size also makes it crucial to broaden the regional meetings that provide important education and collegiality for certain attendees and topics – the ACI program is an ideal example of taking IO to the oncology and scientific community, beyond large once-a-year annual meetings. Through its many educational programs, SITC’s effort should also include non-immunologists who manage adverse events, refer patients for cancer immunotherapy, or may have begun integrating this new type of therapy into their oncology practice. Continuing to integrate and coordinate the stakeholders from diverse disciplines in academia, early phase discovery, biotech/pharma, and regulatory agencies is essential, to drive novel approaches like neoadjuvant therapies, single-cell and AI technologies to harness the evolving immune response to cancer immunotherapy.
3. Expanding patients with deep and durable responses to cancer immunotherapy. With success of CAR T cells for blood cancers and now recently approved TIL product for melanoma, the cost and availability of these therapies is a challenge SITC can help overcome. Broader and cost-effective uptake will expand these therapies to more patients. There are many agents in development, and these are often quite expensive once approved. Developing innovative models for assessment of “value” and methods of reimbursement will also be critical for the optimal application and establishment of cancer immunotherapy strategies in the clinic. We must continue to develop consensus guidelines for optimally implementing cancer immunotherapy in patients, as the efficacy of immunotherapy extends to additional tumor types. This includes developing novel endpoints for drug approval that reflect the unique mechanisms of action and patterns of response, and building new, integrated models for scientific, clinical, regulatory, and payor collaboration in therapeutic development for dissemination into practice. SITC should continue to assemble broad groups of stakeholders, such as bioengineers, immunologists, regulatory agencies and industry, to synergize efforts and devise creative methods to lower costs and enhance the efficiency of delivery for these treatments, to allow more patients to receive these treatments.