The mission of the American Association for Cancer Research is to prevent and cure cancer through research, education, communication, and collaboration. AACR hosts an annual meeting attended by ~20,000 cancer researchers and members of the broader cancer community. This year’s theme, “Delivering Cures through Cancer Science,” reinforced the inextricable link between research and advances in patient care. The meeting, held April 15-20 in New Orleans, featured a number of presentations that included exciting new data from cutting-edge clinical trials as well as companion presentations that highlighted the science behind the trials and implications for delivering improved care to patients.
Exciting data on the MMRF CoMMpass study was presented at AACR from a collaborative research effort between the MMRF, the CoMMpass Network and Janssen. The poster presentation was entitled “Peripheral blood circulating MM cells (CMMC) correlate with disease burden and can be used to characterize high-risk cytogenetics in newly diagnosed and SMM myeloma.” Every patient enrolled in CoMMpass has submitted blood samples at various stages of their disease: at diagnosis, at response, and at relapse. Janssen uses these samples to detect and count the number of multiple myeloma cells circulating in the blood called CMMCs. They can now correlate the number of CMMCs detected in the blood to the disease stage of patients; for example, patients who are responding have fewer CMMCs than patients at diagnosis or at relapse. In addition, patients with higher numbers of CMMCs present at response tended to have a worse outcome than patients with lower numbers of CMMCs. Also, patients with smoldering myeloma tended to have higher numbers of CMMCs than patients diagnosed with MGUS, but lower numbers than MM patients. This non-invasive blood test has the potential to be used someday by doctors to monitor MM disease progression and response to treatment, instead of using a bone marrow aspirate.
As immune therapeutic approaches become increasingly more promising in the treatment of different types of cancer, it is not surprising that this years AACR was packed with numerous sessions revealing exciting data in this field. Informative findings in the area of CAR-T cells, immune checkpoint antibodies and personalized cancer vaccine approaches in oncology were presented.
- CAR-T cells: From a better understanding of T cell biology, scientists can now make “turbo-charged” and genetically modified next generation CAR-Ts that remain activated and persist for longer periods of time in the patient so that they can continue to destroy tumor cells. Furthermore CAR-Ts can be tagged so that T cells carrying the CAR can be purified before reinfusing them back into the patient and once infused they can be tracked in the patient as to where they go and how they work against tumor cells. With respect to myeloma, there are trials at U-Penn and the NCI with CAR-T cells that are directed against a target called BCMA which is expressed on the surface of a large majority of myeloma cells. Only a limited number of patients have been tested, however some preliminary and encouraging data is emerging.
- Immune check point antibodies (also known as PD-1 and PDL-1 antibodies): T cells are controlled by a set of brakes and this immunotherapeutic strategy relieves the brakes on T cells so that they can then recognize and destroy tumor cells. There were many talks at this AACR meeting as to what factors allow these antibodies to be more effective in the treatment of cancer. In addition appropriate combination approaches will have to be used. The myeloma field can take the findings from other oncology indications to see if they could design future trials that would identify specific patient populations more responsive to immune check point antibodies.
Personalized cancer vaccines: As mutations are uncovered in the DNA of tumors, some of the mutated DNA can be expressed into mutant proteins and mutant protein fragments that actually have the ability to stimulate immune cells. After obtaining the sequence of a patient’s tumor, sophisticated bioinformatic tools can be used to predict whether the immune system may be stimulated by these mutant peptides uncovered during sequencing called “neoantigens”. It is envisioned in the future that this information can be used to make very personalized vaccines for the treatment of an individual’s cancer.
The meeting also included a session on MM, moderated by Dr. Ken Anderson of Dana Farber Cancer Center in Cambridge, MA. Dr. Faith Davies from Univ of Arkansas gave a presentation on the use of genomic sequencing in diagnosis and treatment of myeloma, pointing out the high number of mutations found in many MM patients, which increases as the disease progresses, and highlighting the need for sequencing as we move toward a personalized medicine approach to MM. Dr. Sagar Lonial from Emory presented on the biology of MM cells and new approaches to stop them from growing based on their normal biological processes. Dr. Anderson wrapped up the session with a presentation on novel therapies in MM, including chemical structures called degronimids, which can help to eliminate proteins inside cancer cells and cause cell death.
In short, this year’s AACR provided exciting evidence of new technologies and therapies in multiple myeloma; physicians and researchers worldwide will use this information to enhance patient care now and work towards an eventual cure for MM.