Photo by Bo Jungmayer/Used with permission by FHCRC.
People in Seattle are going to be reading a lot more about t-cells as the roll-out continues for Juno Therapeutics, one of the biggest launches of a new biotech company in history.
Juno aims to harness the body’s own immune system cells, known as t-cells, to fight cancer. For those of us who’ve been writing about oncology for decades, the notion of “harnessing the immune system” is not new. But Juno has a powerful combination of big-name research institutions and about $120 million to pursue its newest version of targeted immunotherapy. For some people, Juno’s genesis is evidence of a strong culture of immune science and skill unique to Seattle.
Two scientists from Florida offered to help us see this in context. Immunotherapy experts, Jan Moreb and Lung-ji Chang, both of the University of Florida, are not connected financially to Juno or a similar program at the University of Pennsylvania.
Both of them believe the approach could be a revolutionary advance and deserves much of the excitement it has generated. (Just one side note – Juno joined a lawsuit in December over the “rights” to certain technology. )
Moreb and Chang have years of research experience in the immunotherapy realm, including experience with what is called CAR (chimeric antigen receptor) T systems, which are part of the Juno toolbox. Juno’s therapy is based on science from Memorial Sloan-Kettering Cancer Center, Fred Hutchinson Cancer Research Center and Seattle Children’s Research Institute.
“I believe this is a great thing,” Moreb said. “Even if not all patients respond to the therapy, it will still be a great alternative for some patients.” The CAR-T therapies were widely discussed at the American Society of Hematology or ASH conference in December. You can read a comprehensive report here from the National Cancer Institute.
To understand it better, you can watch a video where one of the primary scientists, Phil Greenberg of the Hutch, explains immunotherapy. He begins talking about t-cells at 17 minutes in during this hour-long video. If you want an extreme simplified version, try this from Sloan-Kettering.
To summarize, a patient has some of their own t-lymphocytes or t-cells removed from their blood. The cells are treated in a laboratory in a way that alerts these cells to the presence of cancer in the patient. The t-cell will hunt down cancer cells looking for the antigen “tag” on the outside of the cancer cell and kill those cells with that specific antigen.
In comparison to other immunotherapies, the CAR t-cell system is designed to have better targeting for the best antigen “tag” and more efficient ways of engineering in the lab so the t-cells get their instructions quickly.
One of Juno’s executives, Hans Bishop. worked for Seattle-based Dendreon on a different immunotherapy, Provenge. While the method is different, Provenge requires removal of a patient’s blood, treatment of that in the lab, and returning that to the patient. At Juno, Bishop will be faced with smoothing the patient-lab-patient pathway.
Rolling this sort of therapy out nationwide to the thousands of patients that Juno says it wishes to reach will be tricky, Moreb explained. Writers at this blog explain some of the challenge. Chang said that everyone who is treating patients hopes the price of such therapy – even if it is very high at first – will be able to come down with efficiency.
In all the results of clinical trials that have been released so far, there have been some patients who don’t respond. As Chang asked, “Why didn’t those patients respond?” Until there are larger numbers of patients treated, the non-responder mystery will remain. Stay tuned.