Dr. Keyoumars Ashkan - minute 45:44
Good afternoon everybody. Can you all hear me? I’d just really like to start out by saying how humbling it is to sit there and listen to our patients talking. Because as a clinician, everything I do, and I’m sure that this is true for the other clinicians as well, is for, and only for… the patients. Also this crystalizes what medicine is all about. Medicine is a science, but it’s equally an art, and patient experiences, patients and what they go through, really, really matters. So that’s a very, very hard act for me to follow for the next five minutes, but I shall try.
So I wear two hats. I’m a neurosurgeon, a clinician working in Kings College Hospital in South London, I deal with patients with glioblastoma day in, day out. I’m also a scientist, and a neuroscientist that obviously does research and understands research. So I fully recognize the limitation of the data that we published earlier this week - and the nice presentation that Marnix showed. What we have at the moment are interim data. And of course, we have to wait for the mature data to come out, for the data to be unblinded until we can make the final conclusions. But the clinician in me cannot help being excited about what we have here. Day in, day out, I sit in the clinic and I see patients with glioblastoma, and I go through the same things over and over again. Limited treatment options: surgery, radiotherapy, chemotherapy, and then ending the conversation with a poor prognosis. So anything that gives us hope, and if it is cautious optimism at this stage, is very, very welcome.
On a personal level, I’ve been involved with DCVax for the past seven years or so, and it’s been very interesting times. Because as I say, I work in London, so UK time and US time are very different. So my days are spent doing my clinical work, operating, seeing patients, etcetera. At nights, I’m on conference calls to the states for research. So again, it’s very nice to see that after seven years of sleepless nights, it hasn’t been wasted either. And you know, the data that Marnix presented also really very much is in harmony with my own personal experience, both in the trial and also outside the trial. So I don’t think it is a one-off. I think it is what we are actually seeing. And I really look forward to the eventual final data when it comes out.
Let’s face it. We work in a field in which advancements are very slow. Really, the last very major development in the field of brain tumor management was over a decade ago when Temodor, as you call it, Temozolimide, as we call it, [??] pathway. And we haven’t really had anything that fantastic to get really excited about. So I think, just about, I think, I think, I hope, we are there with this… DCVax.
So why is GBM difficult to treat, and why do I think DCVax is special? The answer is very complex but actually very simple. It is… GBMs are difficult to treat because of the genetic heterogeneity. And Marnix has already alluded to that. So we now know in a patient, any patient and any given one time, the same tumor, different locations within the same tumor have different genetic characteristics; and therefore, they can behave differently. Now imagine that amongst different patients, and also imagine that from across time, when the tumors recur. So really, in order to be able to cope with that genetic heterogeneity, we need two things, and that’s, I think, what DCVax brings into the equation. So when we produce DCVax, we need as much of the tumor as possible. So that’s what we do. We go in there and take as much of the tumor as possible and that gives us access to the fullest spectrum of the antigens, proteins, all those things which are related to the genetic diversity of the tumor. And therefore, when we make the vaccine apheresis and that gets rid of that all sampling errors. We have the whole lot of the tumor. And I think that’s one of the key aspects of DCVax. The other important aspect is that stimulates the immune system… it works with the immune system. And to my mind, the immune system is the most intelligent system we have available in the twenty first century. Why? Because over millions of years, it has evolved to be able to cope with all those diverse insults that nature throws our way. Different bacteria, different viruses… our own immune system can adapt to cope with that variability. And what better to stimulate the immune system against the genetic diversity of glioblastomas? So I think the science makes sense.
So DCVax is personalized, but also has got other advantages. From my point of view, as a clinician, the first thing we learn in medical school is first, do no harm. And you’ve seen the risk profile based the available data that Marnix presented looked good. And also, it’s very easy to deliver. It’s an intradermal injection so actually it’s quite easy to access and to do for the patients.
So I think what we have at the moment… it is interim data. We’ve got to be very cautious. We have to interpret it within those boundaries. But I think it is something to be hopeful. But there is still a lot to do. We have to work towards unblinding this study. I know Marnix explained the reasons that it’s been delayed, but as a clinician, I’m still going to push for it, because I think that’s very important. That’s what we need to be able to understand the impact of this. So I shall continue asking day in, day out.
We also have to work with the regulatory bodies, and we probably ought to do that now, right, not even waiting, because we want this to be available to all the patients. Again, while it’s very nice about these studies… yes, those patients who are in better prognostic groups are going to benefit more… but there is a benefit to all patients. We want this available to absolutely everybody. And absolutely everybody cannot afford everything. So the cost needs to be brought right down, and again, I’m going to be fighting for that, because I want this available to all my patients. We need to get the prices down, work with the regulatory bodies, approve it at a price which patients can afford. And I think that’s incredibly important. And you know what? I think you have to do all that… why? Because we owe it to these guys [points to the patients on the stage]. Thanks very much.
Transcription of ASCO 2018 video - courtesy of sentiment_stocks
