Insights From: Ezra Cohen, MD, Moores Cancer Center; UC San Diego Health; Jared Weiss, MD, UNC Lineberger Comprehensive Cancer Center
Ezra Cohen, MD: I think the future holds a few very important steps, especially in the near-term. I think what we’re going to see in 2017 and 2018 is the emergence of many more combinations that, hopefully, will further extend the activity of immunotherapy to a wider spectrum of patients with head and neck cancer. We’ve already seen preliminary data of some combinations and, over the next 18 months, that number will increase dramatically.
One of the other things that we’ll begin to understand is which patients respond—first, to single-agent anti–PD-1 therapy and then, hopefully, which patients respond to specific combinations. Then, lastly, there still is an unmet need of patients who aren’t responding to anti–PD-1 therapy. We’re beginning to recognize some of the mechanisms around that. For instance, a highly suppressive tumor microenvironment that requires addressing of that, usually in combination. Or, there are some patients where the immune system really hasn’t begun to form a response or, at one point, formed a response that now is completely absent. And in those patients, we think we’re going to need a different strategy to now reactivate the immune system and reeducate it to recognize the tumor and begin to respond to it. Those strategies may include viral oncolytics, vaccines, or cell-based therapies, which are slightly different than the combination immunotherapies that may address a different population.
Jared Weiss, MD: There are 2 major next steps for research in immunotherapy. One step is making attempts at the integration of the immunotherapy agents and to cure. And the second are novel agents and novel combinations of agents. There are a lot of combination studies going on in oncology in general. And that’s because there are a lot of checkpoint inhibitors. There are a lot of enzymatic targets known to be of high promise in head and neck cancer.
We’re starting to study innate pathways like the STING pathway. Then, there are more novel approaches—engineered T cells, both autologous products and CAR-T products; oncolytic viruses that might stimulate immune responses; and using chemotherapy or radiation to prime immune responses. We’re going to see all of these combined in different ways. It’s very hard to predict what the winners are going to be right now, but it’s easy to say that, probably, one or more of these will advance in the field.