Patient Scholar Experiences from the Learning Institute
2018 BioCanRx Summit for Cancer Immunotherapy
By Nathalie Baudais & Heather Douglas
We had the privilege of attending BioCanRx’s Summit for Cancer Immunotherapy held October 27-30, 2018, as part of its Learning Institute in Banff, Alberta. The Learning Institute is a patient engagement program that brings cancer patients and researchers together at the Summit for Cancer Immunotherapy (Summit4CI) to translate scientific knowledge from researcher to patient and to integrate the patient perspective and voice in the conference.
Nine patient scholars participated in this year’s Learning Institute (LI). Each patient scholar was paired with an academic scholar. Prior to the conference, the LI hosted three webinars, including: LI overview, effective advocacy, and “Immunotherapy 101”. This training helped the group get a running start at the conference. The science buddy system worked well. Each day the whole group met several times for “Knowledge Exchange” sessions to discuss the presentations in each of the plenary sessions. It was important to hear the multiples perspectives from the group – in terms of explaining the science but also to filter to “what this could mean” for cancer care. A patient-researcher roundtable lunch on Day 1 involved senior researchers and provided a valuable opportunity for a discussion about how patients could get involved in cancer research.
We recommend this Learning Institute as an effective model for other medical conferences in Canada, to ensure that patient and caregiver perspectives are reflected. The significant challenges we see are how to include more patients in these initiatives to ensure a broader representation and how best to disseminate the experiences to the wider patient/caregiver community.
Photos: Nathalie and Heather with their Academic Scholar Buddies, Samuel and Courtney
The amount and depth of information covered over the 2.5 days was impressive to lay people. We have compiled some of the highlights, which are influenced by our experiences as people living with metastatic breast cancer.
Immunotherapy translational research will take time- Crystal Mackall, Stanford University spoke about translational research being an incremental process that takes a long time (the time between Nobel prize and treatment can be 50+ years). Crystal explained that it is often easy to fund the discovery ‘Eureka’ moment but it is difficult to fund the invention, the ongoing ‘slog’ work. She related the typical discovery versus invention timeline to immunotherapy research. So while Dr Mackall was hopeful that immunotherapy research is making faster progress than some of her examples, the message was clear that we are still in the long slog before immunotherapy can be mainstream therapy. The final speaker of the conference, Glenn Begley, BioCurate Pty also injected a dose of reality, emphasizing that while science is amazing, researchers always need to remain skeptical and stay true to doing things properly.
CAR-T cell (Chimeric antigen receptor T cell) therapy – The first plenary session focused on approaches to improving CAR-T cell therapy. Steve Shamah, Obsidian Therapeutics is working on regulating ligands to create safer and more effective immunotherapy treatments. This work could lead to the use of immunotherapy treatment for solid tumours. Jonathan Bramson, McMaster University discussed the use of TAC (t-cell antigen coupler) instead of CAR-T therapy. TAC T-cells are more selective than CAR T-cells and could have less toxicities than CAR T-cells.
Identifying barriers to immunotherapy – Christine Brown, City of Hope, discussed her group’s work to using CAR-T therapy for brain tumours. One of the group’s upcoming trials will be looking at treating brain metastases for metastatic breast cancer. John Stagg, Université de Montréal presented research on CD-73 and how it is linked to immunosuppression. CD-73 promotes anthrocycline resistance and could lead to poor prognosis in triple negative breast cancer. He indicated that clinical trials are planned for triple negative breast cancer. Abera Surendran, University of Ottawa summarized her research indicating that adipocytes/fatty tumors lower the effectiveness of oncolytic virus (VSV) therapy. Tumour cells accumulate lipids (fats), which leads to cellular stress and contributes to lower oncolytic virus infectivity / effectiveness. The final day of presentations addressed combination immunotherapy strategies. John Babock, Zymeworks talked about two investigational antibody drug conjugates (ADCs) in its pipeline that target HER2+ metastatic breast cancer – ZW25, now in clinical trials, and ZW49, expected shortly.
It’s not just about CAR-T cells - Katharine Hsu, Memorial Sloan Kettering Cancer Centre explained how NK cell immunotherapies are an excellent target for research. Brad Nelson, BC Cancer Agency explained that B-cells could be viewed as a secret weapon to combat intratumoural heterogeneity. Patients do better when there is both a T-cell and B-cell immune response. Connie Krawczyk, McGill University presented research on dendritic cells.
Patient involvement in research - Richard Stephens, National Cancer Research Institute, UK summarized the work being done in the UK to involve patients in cancer research. Patients are involved in all phases of research: prioritizing, commissioning, designing and disseminating and the group has grown to 92 patient volunteers. These patient volunteers are provided with training on how they can be successful in research. Since the organization started its work 18 years ago, the participation of UK cancer patients in clinical trials has increased to 24%. A particularly interesting initiative is its Dragon’s Den where researchers can present their ideas and problems to patients/caregivers.
Improving Clinical Trial Design - Mithat Gönen, Memorial Sloan Kettering Cancer Centre provided an overview of novel trial designs (baskets, umbrellas and adaptive) in oncology and how they differed from traditional trial designs. New trial designs can address dosing considerations (at phase 1 level) and can answer more research questions (at phase 2), but Gönen explained that these approaches add complexity, impact statistical analysis and increase the risk of erroneous conclusions. Manoj Lalu and Dean Fergusson, OHRI provided an overview of the OHRI excelerator program which was established to accelerate the progress of research from bench to clinic. The program provides a conceptual framework to address obstacles. A rigorous and informed trial design enhances successful start-up and execution. They discussed the research aspects that would benefit from patient partner involvement. The framework also considers an early economic evaluation.
In conclusion, we were impressed by this tremendous research effort to determine how to make immunotherapies work for a wider range of cancer types and cancer patients. We came away with the renewed understanding that without basic science research, big changes in the outcomes of cancer care won’t be possible. We were also convinced that there is a role for patient advocates to play – that researchers can be too sheltered from what it means to live with cancer. We don’t live in controlled environments, our disease is complicated, our treatments are not standardized (previous treatments, co-morbidities, …), and we have diverse points of view. By incorporating the patient perspective, the bridge from laboratory to clinic might be more direct.
As a final note, we would like to thank the BioCanRx and CIHR IRSC for supporting The Learning Institute, the Working Group, our mentors, our two academic scholar buddies Samuel Rouleau and Courtney Victoria Mowat, and Fozia Mohamed Nur the knowledge mobilization intern who supported us all.
Next year's Summit for Cancer Immunotherapy and Learning Institute will be held in Victoria, BC October 20-23, 2019. It's still in early days, but if you are interested in participating in the 2019 LI, please email Stephanie Michaud, President and CEO of BioCanRx at firstname.lastname@example.org.
Disclaimer –We are grateful to BioCanRx and CIHR who sponsored The Learning Institute and covered our expenses. Opinions are our own and descriptions are based on our perception/understanding.