Expert Point of View: Steven J. O’Day, MD, Don S. Dizon, MD, Michael Birrer, MD, PhD

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Steven J. O’Day, MD

Don S. Dizon, MD

Michael Birrer, MD, PhD

By [using HPV virus to provoke a T-cell response and then expanding those T cells], we can attack a tumor that has not been immunologically targeted before. This is a whole new era in oncology.

—Steven J. O’Day, MD

Steven J. O’Day, MD, Director, Clinical Research, Beverly Hills Cancer Center and Director, Los Angeles Skin Cancer Institute, Beverly Hills, California, commented on cervical cancer study by Hinrichs et al from the National Cancer Institute (NCI) during a press briefing at the ASCO Annual Meeting.

“Today, young women for whom multiple antitumor therapies have failed have achieved complete remission by attacking T cells. We are moving this therapy to a disease that is generally not recognized as well by the immune system (cervical cancer). By identifying T cells targeting cervical cancer HPV oncoproteins, and enriching for and expanding these T cells ex vivo,  we can attack a tumor that has not been immunologically targeted before. This is a whole new era in oncology.”

“The best we can do now for women with metastatic cervical cancer is to offer them chemotherapy, perhaps with targeted treatment. However, median survival is still less than 2 years. It is my hope that immunotherapy for cervical cancer will prove effective,” said Don S. Dizon, MD, a medical oncologist and Director of the Oncology Sexual Health Clinic at Massachusetts General Hospital, Boston. He noted that it is difficult to do these studies and urged oncologists to encourage their patients with advanced cervical cancer to participate in this NCI trial.

“If we could standardize this approach at academic centers and identify which patients should benefit, we could reduce the number of deaths from this disease,” Dr. Dizon said.

Dr. Hinrichs said that it is feasible for other centers to use this technique but that HPV-targeted tumor-infiltrating lymphocyte therapy is offered only at NCI right now.

‘Spectacular’ Response

Michael Birrer, MD, PhD, Director of Gynecologic Medical Oncology, Massachusetts General Hospital, Boston, is enthusiastic about the promise of HPV-targeted tumor-infiltrating lymphocyte therapy. “We are very excited, primary because these patients have a dismal prognosis. Formerly, median survival was about 3.7 months, and with bevacizumab (Avastin) we have extended it to about 6 months.”

Dr. Birrer recently referred a patient with advanced cervical cancer to the NCI phase I trial. Even though this was a very small study, about 30% of patients responded. “The duration of response in the complete responders is spectacular. We would never see this with any combination chemotherapy,” he continued.

“I believe in the strength of the science that exploits a mechanism that underpins a viral-derived tumor targeting E6 and E7. This is not just anecdotal,” he said.

Dr. Birrer thinks it is important to figure out why the other six patients failed to respond. “It is just conjecture, but they may have had other mutations that allowed them to resist
this therapy.”

HPV-targeted tumor-infiltrating lymphocyte therapy is labor intensive and technically sophisticated, requiring patients to give tissue, have cells expanded, and then come back for treatment. “This will not be available at community hospitals,” Dr. Birrer said. ■

Disclosure: Drs. O’Day, Dizon, and Birrer reported no potential conflicts of interest.


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