At the World Vaccine Congress last month we were lucky to meet Dr Nora Disis of the University of Washington (UW), an expert in oncology. We are delighted that she made time to discuss combination therapies, the role of vaccines in cancer treatment, and the significance of access in her work. We are grateful to Dr Disis for her time and hope that you enjoy this interview.
Introducing Dr Disis
Dr Disis kindly outlined her current role for us. She joined us at the Congress to discuss combination immunoprevention and immunotherapy strategies.
Combination approaches
We asked Dr Disis to tell us a bit more about the areas she was in Washington to discuss. She explained that, for cancer, the “antigens or immunogens are more weakly immunogenic” than other proteins.
“You’re kind of battling generating a robust immune response with a tumour that continues to grow.”
Therefore, “another strategy” that can slow the tumour’s growth or “hold the tumour at bay”, without compromising a vaccine’s efforts, “just makes sense”. In therapeutics, Dr Disis has seen that combination approaches “really potentiated the effect of both”. This is also true in prevention, where chemo-prevention agents can “help stimulate the immune response and make the vaccines more effective”.
What role do vaccines play?
To put it simply, Dr Disis thinks vaccines are going to be “very critical” for making immunotherapy drugs “more effective”. She suggests that “most patients” with common solid tumours do not have “highly mutated tumours”. This means that they are “not filled with T cells waiting to be unleashed”.
“I think that’s where vaccines may provide the key component.”
Dr Disis believes if you can immunise patients, get T cells “trafficking to tumour”, and “increase that tumour infiltrating lymphocyte load”, it makes sense!
“You’ll have a certain body of T cells that would be able to become activated and hopefully attack the tumour.”
Clinical trials and patient populations
With lots of discussion about clinical trials at the Congress, we asked Dr Disis what she thinks about improving the process to optimise outcomes. She suggests that “we’ve really struggled to figure out what should be the patient population that we immunise”. A conventional focus on “tumours that were rapidly growing” and “resistant to all chemotherapy” is now understood to be the equivalent of “trying to immunise someone who’s got an overwhelming infection”. In that context, vaccines are not particularly effective.
However, in the adjuvant setting, vaccinating fully treated patients with “no evidence of disease” but an “extremely high risk of relapse”, we are starting to see the “success of vaccines”.
“It’s taken us quite a long time to get to the point where we’re beginning to understand the specific patient populations that would be ideal for vaccination.”
What about access?
Following on from Dr Disis’ comments about patient populations we asked her a bit about access. Cancer treatments are renowned for being costly, so how can this be addressed? Dr Disis acknowledges that it’s “very hard in oncology” with some treatments being beyond reach for many. However, vaccines might offer a solution.
“Vaccines are the great levelling field.”
For her colleagues, she has advice on making vaccines.
“Do not make them complicated!”
She encourages people to think about things like transport potential when creating their vaccines. In fact, she believes that we have technologies that can be “widely applicable to a great number of vaccines and can be made very cheaply”.
“I would put out a call to my field; that should be one of the first things on their mind: “am I making this a therapy that is only going to be for people who have the money to afford it?”
Hopefully, with people like Dr Disis leading the charge, real change can be made in the field to ensure that therapies are available to more patients across the world. We are so grateful to Dr Disis for her time and look forward to hearing more at future events.
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