Edison Themes: The post-ASCO IO pecking order

Immunotherapy has become one of the most relevant areas at the American Society of Clinical Oncology (ASCO) Annual Meeting and the leaders have emerged. Immunotherapies for cancer include a number of technologies such as immune checkpoint inhibitors (ICIs), T-cell-based therapies, oncolytic viruses or cancer vaccines. Several ICIs have been approved across the world for a number of cancer types. Still, a significant number of patients do not benefit from ICI therapies, so combinations with other agents have become increasingly popular. In 2017, 469 clinical trials with such combinations were initiated. This year clinical data in lung cancer were of special relevance, setting a new standard of care in first-line advanced squamous lung cancer and exposing the gaps in improved combinations.

Harness the immune system to fight disease

The field of immunotherapy for cancer has experienced significant growth over the last few years. ICIs target molecules that inhibit the immune system, releasing the brakes on the immune system to fight cancer. In particular, antibodies targeting CTLA-4 and PD-1/L1 from Merck, Bristol-Myers Squibb and Roche have been approved and are on the market. However, some patients do not respond to current immunotherapies and subgroups (according to biomarkers) and combinations are being investigated extensively to find the best therapeutic options for patients. Additionally, chimeric antigen receptor T-cell (CAR-T) therapies from Novartis and Gilead gained regulatory approval in 2017, and are now commercialised for acute lymphoblastic leukaemia (ALL) and diffuse large B-cell lymphoma (DLBCL).

Themes that generate the most attention

There are hundreds of clinical trials with combinations that use an ICI as a backbone. As Incyte and Nektar Therapeutics have shown, not all combinations will succeed. We see two means of playing the space:

• Large-cap companies. This year’s ASCO showed that Merck, Bristol-Myers Squibb (BMS) and Roche are consolidating as the main players in lung cancer and more broadly, in the immunoncology space.




• Smaller players with unique approaches such as oncolytic viruses, cell immunotherapies and cancer vaccines, albeit at a higher risk. For instance, Transgene’s Pexa-Vec (oncolytic virus) and TG4010 (vaccine), Immunicum’s cell therapy ilixadencel or Targovax’s oncolytic virus ONCOS.