Legacy Thread

[basserdan]

We can now customize cancer treatments, tumor by tumor



By Adam Piore
October 17, 2018

But can any company afford to manufacture one-off medical care?

The first time someone pitched Genentech’s senior leadership on a personalized cancer vaccine, it did not go well. “I thought there was going to be a riot,” Ira Mellman, then Genentech’s head of research oncology, recalls.

From across the table, he watched the scientific review committee grimly shaking their heads as his team member and longtime collaborator Lélia Delamarre made her case. Then he overheard the head of clinical development turn to the person sitting next to him and mutter, “Over my dead body. A vaccine will never work.”

That was in 2012. Cancer immunotherapy, which uses a person’s own immune system to attack tumors, is now one of medicine’s most promising fields, and one of the greatest breakthroughs in oncology in decades. But it took a long time to get there. Until the recent advent of a new class of blockbuster immunology drugs, the field was notorious for questionable science, hype, and spectacular disappointments.

And what Mellman and his team were proposing that day went further than turbocharging immune cells to make them better able to attack cancers. They were talking about a vaccine precisely tailored to stimulate the immune system to react to specific tumors. If it worked, the approach could, in some cases, be even more potent than other types of immunotherapy. But it faced a series of daunting hurdles. If Genentech, a San Francisco–based biotech company owned by the Swiss pharma giant Roche, were to attempt to develop a vaccine that could attack individual tumors, it wouldn’t just have to accept new scientific advances; it would also have to embrace an entirely new and untested business model. That’s because the vaccine Mellman and Delamarre envisioned could not be manufactured the traditional way, in large batches that could be packaged in bulk, warehoused, and dispensed off the shelf at your local pharmacy.

When Mellman and Delamarre said “personalized,” they really meant it. The composition of each vaccine would be based on the characteristics of each patient’s tumor DNA. The company would have to, in essence, make a separate treatment for every single patient.

Nor would this be the kind of drug you could order up with a prescription in hand and get in a few days, like Genentech’s highly successful cancer drugs Herceptin and Avastin. To create this drug, the company would have to orchestrate a multi-step process for each patient, performed at multiple sites. Each patient would need a biopsy, the tumor tissue would have to undergo full genome sequencing, the results would require complex computational analysis, and the individual vaccines would then need to be designed and queued up for manufacture. Theoretically, if the vaccines were to be produced on a large scale, this would have to happen hundreds of times a week. And it would have to happen fast.

If any single step in the process went awry, if a shipping mistake occurred or a batch was contaminated, it could prove deadly—because cancer doesn’t wait.

No wonder the Genentech leadership was so skeptical.

After that calamitous first pitch meeting, Mellman and Delamarre retreated to their laboratories. They returned a few months later with more exciting data: they had identified specific targets on cancer cells, targets that would readily be attacked by immune cells. They also had fresh, convincing research from a growing number of other academic groups on the feasibility of their approach. And, critically, they had a preliminary plan for how Genentech itself might take the first tentative steps toward making tailor-made treatments an economically viable product.

Continued at:

https://www.technologyreview.com/s/612268/we-can-now-customize-cancer-cures-tumor-by-tumor/