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Thoughts from the ESMO Symposium on Immuno-Oncology in Geneva

November 28, 2013

by William Neilson

Thoughts from the ESMO Symposium on Immuno-Oncology in Geneva

This month I was pleased to attend the European Society for Medical Oncology ESMO Symposium of Immuno-Oncology in Geneva.

The symposium took place over an intense Friday and Saturday full of state-of-the art presentations, discussion and agreement on potential ways to progress Immune Oncology Therapy by employing immune treatment in combination (even as triple modalities!) and also with more classical Radiation, Chemotherapy and Surgical regimens. Oncology MD investigators primarily from Switzerland, France, Germany, Italy and the USA presented their clinical trial findings and ideas for discussion. The variety of immune approaches was explored in great detail, not just from experimental study results but with precise long term data on patient outcomes.

Excitement continued to build during the two days as new insights came to light, ideas, theories and clinical findings were debated and potential new ways forward were recognised. Pictures of Melanoma lesions in patients responding with almost miraculous rapidity and resolution illustrated the targeted power of immune treatments.

Current disappointments with vaccines were carefully reviewed, put into perspective and new ways forward suggested and accepted. Checkpoint blockade PD1 and PDL1 held the limelight with their growing successes. TILs (Tumour Infiltrating Lymphocytes) were promoted with an impressive array of North American experience, experimental data, patient results and in-depth knowledge.

The congress program structure cleverly teased out the complex interrelated facets of immune therapy by looking in a matrix fashion at individual tumour types, body system cancers and the different therapies. Different body system clinical specialists – Lung, GI, GU, Derm, Haem, Renal, CNS, Breast – were able to make comparisons across organs and their immune effects and relate them clinically to solid general medical knowledge such as the blood brain barrier and lymphatic drainage variations, learning from each other’s experiences. Two complex patient case studies underlined the true patient focus of the meeting and there was a clear message that although clinical successes continue to mount, the identification and timing of precise immune mechanism responses in patients, their tumours and treatments, require much additional immunological illucidation. More biopsies and bio markers demonstrating exactly what is happening – at what varying time points to maximise treatment value and avoid counter intuitive adverse effects are needed. Classical measures of oncology therapy progress and failure need to be revisited and refined for immune based therapies. Engineered and not, Tcells are pivotal immune aristocrats now and in all future envisaged scenarios.

Of particular value at the congress were the two summary panel discussions with testing prepared questions that related to the key points that had arisen during the day. This allowed for open disagreement, questions, informed opinions and importantly, suggested improvements and positive ways forward. An extra hour of panel work at the end would have been theoretically beneficial but impractical late on a Saturday afternoon after two days of such explorative creativity. The industry sponsors, BMS and Roche and our Swiss hosts should be well satisfied with the event and all look forward to the next which will update on progress made in this fast moving, important field.

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