Next generation cell and gene therapies: fine tuning the promise
On 19 November, the UK BioBeat19 summit goes to Stevenage to discuss the potential of cell and gene therapy and how to accelerate these transformational medicines.
Victoria Higgins of GSK and Miranda Weston-Smith from BioBeat spoke to two panellists who gave a sneak peek of their remarks and agree wholeheartedly that the discovery side and clinical side work best when they are teamed up.
Sophie Papa, an oncologist at Guy’s Cancer at Guy’s and St Thomas’ NHS Trust, and Aisha Hasan, a clinical development lead at GSK, both recognise the big challenge ahead for cell therapy researchers: to dial up efficacy and dial down toxicity.
Cell and gene therapies, with their remarkable potential to transform medicine, have seen some important but hard-won milestones: it took 20 years of combined academic and industry research to deliver the first gene therapy approval in 2016 and today there are two CAR-Ts approved for haematological malignancies.
Whilst CAR-Ts recognise proteins expressed on the tumour cell surface, making them ideal for targeting blood cancers, more complicated – but with greater potential to address solid tumours – are the gene modified TCR-T technologies.
These harness the power of T cells to specifically target and destroy tumours – even on the inside of cells. TCR-Ts come with an additional level of complexity, but potentially open the door to a range of untreatable cancer types.
Looking at the TCR opportunity is where Sophie Papa sees the inherent trade-off between risk and benefit as an academic clinician who’s now evaluating modified T-cell based therapies in clinical trials.
Sophie urges her peers to take courage. “It is important to be brave and tolerant of certain toxicities. Academic clinicians and drug researchers need to work closely together to engage the regulators in early discussion, so that we can move cell therapies earlier in treatment schedules as soon as feasible.
“Timing is critical to enable patients to be treated when they are physically fit so they can better tolerate these complex and potentially toxic treatments.”
From her perspective, this is not an ‘either/or,’ but an area where discussion and open dialogue will allow us to make the most of the opportunity. “By allowing clinical academics to play a lead role in developing guidelines to manage patient safety, we can address legitimate concerns but not let them stand in the way of clinical development,” she says.
Aisha brings the perspective of drug discovery and development and starts by asking what is in the realm of the possible from a design perspective.
She says: “A superior T-cell therapy will require engineering approaches that enhance efficacy on one-end while also incorporating switches to minimise toxicity.”
For example, in a counter-intuitive way, a T-cell with high-killing capacity actually can create dangerous levels of inflammation in the body, due to the rapid death of cancer cells. But the beauty of drug design opens up options: “By building a switch within the engineered T-cells, researchers can inactivate the T-cells and prevent harm to the patient,” says Aisha.
But this creative problem solving requires open dialogue between clinicians and pharma. Aisha says: “The more we talk about clinical need and toxicity benchmarks, the more sophisticated we can be when developing the next generation of enhanced engineered cell therapies.”
There’s no doubt that the challenges of delivering cell and gene therapy span the full spectrum of issues related to medicine development. However, the potential for both curative therapy and commercial opportunity is tremendous.
The scientific, clinical, technical, regulatory and commercial challenges are all surmountable when everyone in the ecosystem work together towards a shared goal, united by an unwavering focus on the patient.
Sophie and Aisha are speaking about the translational journey from science to bedside at the BioBeat19 summit.
• The BioBeat19 summit on Accelerating cell and gene therapy, 1-6pm, Tuesday 19 November, GSK Stevenage. Guarantee your place by registering at www.biobeat19.org