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Expert Point of View: Lynn Schuchter, MD, FASCO, and Ravi Salgia, MD, PhD


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LYNN M. SCHUCHTER, MD, FASCO, Chief of Hematology/Oncology at the Penn Medicine’s Abramson Cancer Center, Philadelphia, was optimistic about the vaccine approach in this study. “We have seen broad use of PD-1 and PD-L1 agents across a range of cancers, and it makes sense to combine the immune checkpoint inhibitor atezolizumab with the vaccine to augment the immune response,” she said.

Lynn Schuchter, MD, FASCO

Lynn Schuchter, MD, FASCO

“Thus far, after millions of dollars, the vaccine strategy for cancer has failed. This is a new way to think about a tumor vaccine, using neoantigens related to driver mutations. These relevant neoantigens present a ‘red flag’ to the immune system,” Dr. Schuchter continued.

“Other studies of potential cancer vaccines have been able to generate an immune response, but the side effects were worrisome. This vaccine is safe. It appears to stimulate an immune response specific to the cancer itself that is exquisitely sensitive to cancer cells. We saw the usual toxicities with atezolizumab,” she added.

“The schedule appears to be safe and generates an immune response in this heterogeneous group of pretreated patients. Now the researchers know how to move forward,” Dr. Schuchter noted.

“This is one of the largest studies of the combination of a vaccine with an immune checkpoint inhibitor, and it is an important study. It paves the way for future studies. We know the vaccine won’t work in all patients. If it ever is successful, it will work for a subset of patients with a specific histology, and then it can be augmented with an immune checkpoint inhibitor,” she said.

‘Light at the End of the Tunnel’

“THIS IS A UNIQUE, innovative personalized approach. We have been very excited about immune checkpoint inhibitors and CAR T-cell therapy, and this vaccine represents another way to improve outcomes. We need to identify new approaches because immune checkpoint inhibitors can stop working, and a proportion of patients are nonresponders,” said Ravi Salgia, MD, PhD, Medical Oncologist at City of Hope, Duarte, California.

Ravi Salgia, MD, PhD

Ravi Salgia, MD, PhD

“We all await the formal presentation and subsequent publication of results,” Dr. Salgia said.

“The vaccine takes time and effort to develop. Augmenting the immune response with an immune checkpoint inhibitor is worthy of further study to prevent recurrence and disease progression by revving up the immune system. It will be important to see results earlier in the course of disease and in studies that have a comparator arm,” Dr. Salgia continued.

“There is light at the end of the tunnel. We need to have the light shining brighter and better. It is important to have effective approaches beyond targeting genetic mutations, as in EGFR-mutated lung cancer,” he said. 

DISCLOSURE: Drs. Schuchter and Salgia reported no conflicts of interest.


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