The Galien Forum USA 2020

Immunology from Both Sides: Oncology and Autoimmune Disease


The immune system is both a defense against and a driver of disease — a contradiction that reflects its central importance to human health. The best example is seen in the more than 80 autoimmune diseases that pervert normal immune response by mistakenly attacking healthy cells instead of defective or invasive ones, leading to chronic inflammation, pain and, in some cases, life-threatening organ failure. Cancer is the other manifestation of this tendency, but instead of pushing the immune system into overdrive, as occurs with autoimmune disorders, it evades detection by patrolling immune cells, mimicking the behavior of normal cells or taking advantage of inflammation in the body to break down the genetic markers in individual cells and thus render them harmless against malignant ones.

Researchers now recognize that both diseases – and the inflammation that commonly accompanies them – are linked to failure of the immune response. Uncovering its root causes is an important public health priority: 24 million Americans have been diagnosed with an autoimmune disease while 1.8 million new cases of cancer are forecast in 2020 alone. A key area of investigation is the biological relationship between these two conditions. Estimates are that as many as a quarter of cancer patients have suffered from some form of chronic inflammation and autoimmune disease, ranging from rheumatoid arthritis to lupus to Crohn’s disease.

Finding the right pathway of disease formation will also have an impact on the ability of patients with both conditions to benefit from recent impressive therapeutic advances in immunotherapy like checkpoint inhibitor drugs, which enhance the efficacy of immune response in cancer treatment by powerfully targeting cancer-fighting T-cells to attack malignant cells. Because autoimmune patients are characterized by an existing overactive immune response, exposure to the additional immune stimulus from checkpoint inhibitors can pose life threatening side-effects, typified by the so-called cytokine release syndrome, i.e.“storm.” Limiting this risk is critical to realizing the therapeutic potential of these new classes of immunology drugs in the years ahead.

The following group of experts, chaired by Dr. George YANCOPOULOS, President and Chief Scientific Officer, Regeneron Pharmaceuticals, will discuss the scientific and clinical interrelationships among inflammation, autoimmune disease and cancer, with the objective of learning how the underlying biology of immune system behavior affects disease formation and treatment. Topics for discussion include:

• Can patients with autoimmune disease be treated successfully with cancer immunotherapies? What do we know now about the toxicities and level of risk? Is there a remedy relevant to clinical practice in the coming next generation of immunotherapies?

• Will better understanding of how cancer cells inhibit the actions of immune response cells in attacking malignant tumors lead to control of the healthy cell destruction associated with autoimmune and inflammatory disorders – in other words, a cure?

• Which innovations in drug therapy and preventive interventions are likely to play the biggest role in shaping the future of immunology?

Panelists:

Carl JUNE, Professor and Director, Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania.
Nancy SIMONIAN, President and CEO, Syros Pharmaceuticals Inc