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ADVANCEMENTS IN IMMUNOTHERAPY
Q&A with Dr. Jonathan Bramson Dr. Jonathan Bramson, Vice Dean Research and Professor of Medicine for the Faculty of Health Sciences at McMaster University discusses his current research and the potential of innovative immunotherapy treatments for cancer patients. What got you interested in cancer research? Throughout my academic career, I worked in labs that do cancer research. I like to see direct applications of my research and cancer was an area where I knew I could see the direct consequences of the work that I was doing. Finding a cure for cancer struck my sensibilities the right way, and I’ve stuck with it ever since.
Can you explain your current research? In 1994, I started working in immunotherapy, which is based on the idea that you can use your body’s immune system to fight cancer. We were focused on using modified viruses to deliver immune-activating proteins to the tumour site so that we could convert the local state, where the tumour lives, from one that suppresses immunity to one that's susceptible to immunity. Over time, my research shifted from trying to modify local environments to directly modifying the white
blood cells that are responsible for the immune response to cancer. My lab performs immune cell engineering — we take white blood cells from cancer patients and genetically reprogram them to give them the ability to see the tumour and to avoid being shut down by it. The biggest challenge we face is educating the immune cells to only go after the tumour. Choosing the best target on the tumour is the big trick right now! Only through clinical trials will we know if our therapies will work.
Is there anything in your personal pipeline that you’re excited about? We just opened a human trial that’s tackling solid tumours. It’s exciting for us to see that a technology developed in 2015 is now being tested in humans. We’re also working on an off-theshelf solution where the white blood cells will be produced en masse and placed in the hospital pharmacy, and the pharmacist will pull them off the
shelf based on a patient’s profile and infuse them into the patient as needed.
What's the hope for the future of immunotherapy? It’s fantastic. We're learning so much and patients are already seeing their lives change. Individuals who previously had no options will get immunotherapy and they’ll never see cancer again. That's incredibly exciting. The trick for us is figuring out how we can go from those 20 to 30 percent who have had this fantastic response, to 100 percent. We have an incredibly vibrant research community in Canada and young people should be thinking about being a part of that community for their future. People should be aware that amazing discoveries in immunotherapy are being made in Canada, that Canadian scientists are among the best in the world — across all biomedical sciences — and that you can make a life out of biomedical research.
Publisher: Meredith Burt Business Development Manager: Chelsea Siemon Country Manager: Nina Theodorlis Content and Production Manager: Raymond Fan Designer: Lauren Livingston Web Editor: Karthik Talwar All images are from Getty Images unless otherwise credited. This section was created by Mediaplanet and did not involve Toronto Star or its editorial departments. Send all inquiries to ca.editorial@mediaplanet.com.
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The Leukemia & Lymphoma Society of Canada advances the potential of immunotherapy in treating blood cancers Donations to The Leukemia & Lymphoma Society of Canada are currently helping to fund the research of Dr. Jean-Sébastien Delisle from the Hôpital Maisonneuve-Rosemont in Montreal, Quebec in which T-cells can be optimized to successfully treat the disease. Generous contributions are also making it possible for Dr. Peter W Zandstra from the University of British Columbia in Vancouver to investigate how CAR proT-cells can help reduce targeting of healthy tissue, side-effects, and increase the potency against many types of leukemia and lymphoma.
You too can help fund research in immunotherapy and save more lives. Donate now and give hope to people affected by a blood cancer. Go to bloodcancers.ca to make a difference.
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The Evolution of Cell Therapy — Recruiting an Army of Immune Cells to Fight and Kill Cancer Cells A Canadian team of scientists has developed a first-of-its-kind multicellular therapy to kill difficult cancers. Abigail Cukier
I Dr. Riam Shammaa Founder & CEO, IntelliStem Technologies
n the last few years, cell therapy — using a patient’s own cells to kill cancer — has shown much promise. Chimeric antigen receptor T-cells (or CAR T-cells) are taken from the patient’s blood, genetically engineered to target a specific antigen on the cancer, and then injected back to kill the cancer. CAR T-cells have shown promise in certain pediatric leukemias, but the therapy faces multiple challenges. For example, most cancers don’t only have one main antigen but many. The therapy has also faced serious challenges with solid tumours such as breast cancer, due to the difficulty of penetrating the tumour’s microenvironment. To solve these challenges and improve cancer treatment, a team of scientists led by Dr. Riam Shammaa is revolutionizing stem cell therapy. They recognized that the moment they started targeting cancer cells with treatment, the cancer would adapt. “The cancer is able to camouflage and change the antigens on its surface and is more successful than us in playing the environment. To send one type of
engineered stem cells to the cancer is like sending one soldier against an army. The cancer is using so many tools, but we're only using one,” says Dr. Shammaa, Founder and CEO of IntelliStem Technologies.
Taking cancer immune therapy to the next level To mount a better attack against cancer cells, Dr. Shammaa and his team introduced the concept of multicellular therapy (MCT) — multiple kinds of engineered cells to target and attack the cancer from multiple angles. In studies, the team introduced multiple kinds of immune cells, and they mixed some genetically-engineered immune cells with some taken from the cancer environment. In doing so, they programmed the different immune cells to detect and attack multiple aspects of the cancer. The cocktail of cells was then injected into the animals. Not only was MCT able to kill cancer cells, it also showed an 80 percent improvement in survival compared to the older technology. “MCT represents the next generation of cancer immune therapy,” says
Advancing Made-inCanada Immunotherapies to Benefit Patients
Dr. Stéphanie Michaud President & CEO, BioCanRx
Nancy Boyle
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MCT to revolutionize immunotherapy “Now, those cells can make sure that the cancer cannot camouflage itself or evade the immune system and those cancer cells are destroyed.” Dr. Shammaa’s team is now preparing to file a phase 1 human clinical trials to study the therapy. “MCT represents the next step in the fight against cancer,” says Dr. Shammaa. “Now cancer has a lower chance of surviving. The treatment can have a bigger impact and we can ease suffering and save lives.”
Visit intellistemtech.com to learn more. This article was sponsored by IntelliStem Technologies.
How IRICoR Is Transforming Research Into New Cancer Therapies Getting new and promising therapies to cancer patients can take a long time. A Canadian Centre of Excellence is accelerating the process.
espite medical advances in treating cancer t h rou g h s u r ger y, radiation, and chemotherapy, some patients are still not cured. But immunotherapy is offering hope in treating some cancers by using the body’s own immune system to fight cancer. Immunotherapies have helped many patients, but continued research is needed to make these treatments a reality for more patients. “That’s where our network is making a difference,” says Dr. Stéphanie Michaud, President and CEO of BioCanRx — Canada’s Immunotherapy Network. “Our hope is to cure and enhance the quality of life of those living with cancer. BioCanRx brings together scientists, clinicians, cancer stakeholders, academic institutions, NGOs, and industry partners to accelerate the development of leading-edge, madein-Canada immunotherapies for the benefit of patients as quickly and safely as possible, increasing the number of clinical trials available in Canada.”
M
Anne Papmehl
ontreal-based IRICoR is a Centre of Excellence for Commercialization and Research specializing in drug discovery and development. Its mandate is to identify promising research in cancer and related areas taking place at Canadian universities that has the potential to be translated into new therapies, and to accelerate the process of getting these novel therapies to patients. “It would take a lot of time and expense for researchers to go through this entire process on their own,” says Steven Klein, Vice President of Business Development at IRICoR. “By de-risking these projects and then connecting them with private sector partners, like pharma and biotech companies or venture capital groups who have had success in commercializing research, we can move these projects from the lab to the clinical setting quicker, and get the benefits to the patients sooner.”
Steven Klein Vice President of Business Development, IRICoR
Immunotherapy holds promise for treating ovarian cancer
Moving research from the lab to the clinic BioCanRx funds research that will move these new treatments from the lab into early phase clinical trials. The network includes the patient voice in research projects and through its Cancer Stakeholder Alliance and the Learning Institute at the annual Summit for Cancer Immunotherapy. “We’re also training the next generation of cancer immunotherapy researchers and biotechnology workers,” says Dr. Michaud, “while BioCanRx core facilities are manufacturing the products needed to bring the latest immunotherapies to Canadian patients.”
Dr. Shammaa, explaining how MTC works. “In biology, one cell doesn’t do all the work — immune cells coordinate and speak with each other in order to mount a response against cancer cells or infections using different kinds of cytokines, antibodies, and toxicity. “We're learning from Mother Nature that MTC immune therapy gives our cells an advantage in the fight against aggressive cancer cells,” Dr. Shammaa adds.
To learn more, visit biocanrx.com. This article was sponsored by BioCanRx.
Drs. Claude Perreault and Pierre Thibault are two of the researchers affiliated with IRICoR. They have identified several shared tumour-specific antigens (TSAs) in ovarian cancer patients. “Their research suggests you could ultimately develop an off-the-shelf immunotherapy that targets only the cancer cells in the vast majority of these patients, rather than having to develop a specific treatment plan for each patient,” says Klein. IRICoR has been funding the work of Drs. Perreault and Thibault since the researchers first proposed the concept of shared TSAs, including the proof of concept of this research in ovarian cancer and acute myeloid leukemia. “On that basis, we’re continuing to invest in Claude and Pierre’s work in other cancers where patient survival is a very big issue and the current standard of care leaves room for improvement,” says Klein. “At the end of the day, it’s about helping patients improve their quality of life in an oncology setting.”
To learn more about how IRICoR propels and supports promising projects toward innovative solutions for the benefit of patients, visit iricor.ca. This article was sponsored by IRICoR.
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CAR T-cell Immunotherapy Plays an Important Role in Hard- to-Treat Lymphoma For people with certain types of lymphoma, there’s hope with access to emerging immunotherapies Anne Papmehl
Know Your Facts Lymphoma affects thousands of Canadians per year, making It imperative to understand all your treatment options and how immunotherapy is changing the landscape.
C Dr. John Kuruvilla Hematologist, Medical Oncology & Hematology, Princess Margaret Cancer Centre
himeric antigen receptor (CAR) T-cell therapy is an emerging immunotherapy used to treat patients with relapsed or unresponsive forms of lymphomas. It involves removing T-cells from the patient’s body, genetically modifying them in a lab to target specific cancer cell markers, and then infusing the modified cells back into the patient’s body. “It’s more targeted than chemotherapy in that it kills only the cancer cells,” says Dr. John Kuruvilla, a hematologist in the division of Medical Oncology & Hematology at Princess Margaret Cancer Centre in Toronto.
Giving lymphoma patients a better chance
Sabrina Hanna Chief Innovation Officer, The Cancer Collaborative
For people with certain types of lymphomas, CAR T-cell therapy is becoming an important option for patients who have had at least two lines of prior treatment and the disease has returned or failed to respond. “Whereas this group of patients might not have had an option five years ago, we can now offer them a chance with an effective treatment,” says Dr. Kuruvilla. Given its demonstrated efficacy with certain types of lymphoma, researchers are also looking at how CAR T-cell therapy might work with other types of cancers. “There’s a lot of excitement around CAR T-cells because it’s an opportunity to treat patients that wasn’t available before,” says Dr. Kuruvilla. There are currently several clinical trials underway that are evaluating the impact of CAR T-cell therapy for other indications.
There’s a lot of excitement around CAR T-cells because it’s an opportunity to treat patients that wasn’t available before.
To find out if CAR T-cell therapy is a suitable option for you, speak to your doctor.
Access can be a challenge
Access to CAR T- c e l l t h e r a p y is currently a bit of a challenge in Canada. Being a new and expensive treatment, CAR T-cell therapy is currently only given to lymphoma patients who have exhausted two or more lines of treatment. “The data that led to the approval of CAR T-cell therapy was in specific patients who have had standard treatments that haven’t worked,” says Dr. Kuruvilla. Another access challenge is geography. “When we think about every Canadian having access to commercially available CAR T-cell therapy, no matter where they live, the answer is no,” says Sabrina Hanna, Chief
Innovation Officer at The Cancer Collaborative, a Montreal-based hub that advocates for action-oriented changes in cancer care delivery. There are currently CAR T-cell therapy treatment centres in Quebec, Ontario, and Alberta, and one was recently announced for Nova Scotia. “So, when I think of patients in BC, they’re sending their patients across the border to the U.S. or out of province, which means they have substantial out-of-pocket costs. The follow-up care is not the same as it would be if they were being treated close to home, and obviously with COVID-19 that’s a huge issue, including the paperwork and delays that go along with it,” says Hanna. Additionally, patients that must travel out of the country also tend to lack access to the manufacturer patient assistance programs. The need to travel out of province or out of country also has a significant impact on patient family members and caregivers who need to accompany them and take substantial time off work.
Advocating for equitable access The Cancer Collaborative has been working with the Leukemia and Lymphoma Society of Canada, Lymphoma Canada, and the Ac2orn (Advocacy for Canadian Childhood Oncology Research Network) to advocate for CAR T-cell therapy access across Canada. “Our ultimate goal is to have at least one treatment centre in every province,” says Hanna. In the meantime, she encourages patients and their families to advocate for themselves. “Get as much information as you can to see if you’re eligible to receive it and find out about the manufacturer assistance programs and what your province is covering in terms of travel, accommodation, and follow-up care. It’s also really important that people understand what CAR T-cell therapy is,” says Hanna. As promising a therapy as CAR T-cell is, it isn’t suitable for every patient. It also comes with risks and requires close in-hospital monitoring for specific side effects such as cytokine release syndrome, which can lead to systemic inflammation in the patient, or immune effector cell-associated neurotoxicity syndrome.
This content was supported by a member of Innovative Medicines Canada.
● There are over 135 different types of blood cancers and related diseases ● Lymphoma is one of three main groups of blood cancers ● Lymphomas are a type of cancer that starts in immune cells of the lymphatic system
Who are these therapies made available to? ● Patients with certain types of lymphoma ● Approximately 43,334 Canadians are living with or are in remission from lymphoma
How does CAR T-cell therapy work in the body? ● CAR T-cell therapy uses a patient's own re-engineered cells to attack cancer ● T cells are collected from a patient ● T cells are reengineered in a lab ● After the reengineering, the T cells are recognized as CAR T-cells ● Then, CAR T-cells are multiplied and infused into the patient
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Carepath is Helping Immunotherapy Patients Navigate Their Cancer Journey As advancements in immunotherapy offer new hope for Canadians diagnosed with cancer, specialized Carepath nurses emerge as vital patient advocates.
A
ccording to the Canadian Cancer Society, about 1 in 2 Canadians will develop cancer in their lifetime. Fortunately, knowledge of cancer has grown, leading to new targeted treatment options like immunotherapy, which harnesses the power of the body’s own immune system to recognize and destroy cancer cells. Despite the promise of new treatment options, patients and their loved ones often struggle to navigate the complexities of the health care system during their cancer journey. An indispensable resource and support, Carepath Nurse Case Managers provide personalized guidance and support from diagnosis through treatment and recovery to ensure the highest quality of care. “Championing my cause, [my Carepath nurse] pushed for tests and initiated a referral to a specialist,” says Carepath patient Craig. “Both my partner and I owe her a wealth of gratitude, not only for her guidance, but for her demeanour, and
the gentle soul she is.” Offering bilingual services delivered virtually across Canada, Carepath is an employer-sponsored group benefit. Acting as partners and advocates for patients and their loved ones, Carepath Nurse Case Managers use their expert knowledge of the health care system to help clients understand their condition,
disease or condition — patients and their loved ones have a single point of contact to ensure continuity of care. Another patient reflects on her experience: “This is important work that you do — supporting people through such a scary time in their lives and helping them make sense of side effects [and] test results. It really was so reassuring to talk things over with you and get advice. I'm so grateful that Carepath was available to me during this time.” A leader in virtual care, Carepath is an innovative health care navigation service that provides comprehensive and personalized support to patients and their loved ones in the event of illness or other health crises. Available as a group benefit, Carepath has collaborated with em ployers for over 15 years to create enhanced benefits plans for over a million Canadians.
You are like a down home neighbour, a wise aunt, a professional oncology resource, and an angel. Thank you. test results, and treatments while also offering emotional support. Once paired with a Carepath Nurse Case Manager — a specialist in their