Cancer: A Wolf in Sheep’s Clothing

Immunotherapy wolf in disguiseCancer cells can be pretty sneaky, altering their make-up or microenvironment to avoid detection by our body’s immune system. As a result, the immune system, which is designed to fight off “invaders,” can’t detect cancer as foreign and doesn’t have its guard up.

Earlier this month, NewYork-Presbyterian Hospital kicked off a new ad campaign highlighting how immunotherapy is working to change just that. Immunotherapy treatments are designed to help activate the immune system and kick it into high gear, helping it fight the very cancer it was previously unable to detect.

New scientific discoveries happening right here at Weill Cornell Medicine are making this possible. Our physician-scientists and researchers at the Meyer Cancer Center have found ways to help the immune system better recognize and destroy cancer cells by designing new immunotherapy drugs, cancer “vaccines,” and combination treatments. Through precision medicine and an individualized approach to cancer care, we are developing new ways to treat cancer more successfully than ever before. And, we’re accomplishing these results with less toxicity.

Over the past decade, the U.S. Food and Drug Administration (FDA) has approved several new immunotherapy drugs for advanced cancers. At the Weill Cornell Genitourinary (GU) Oncology Program, we have greatly contributed to the efforts to obtain FDA-approval for immunotherapies for GU cancers, including kidney cancer, bladder cancer, and prostate cancer.

For kidney cancer, we have been involved in many studies of drugs utilizing the immune system to fight cancer, including the phase 2 clinical trial that formed the basis for the large trial leading to the FDA approval and general availability of nivolumab (Opdivo) for renal cell carcinoma. Nivolumab is an immunotherapy that works by allowing the body’s existing immune system to kill tumors. Our team is now working on ways to improve this drug and other types of drugs.

For bladder and other urothelial cancers, we have been instrumental in the development of several antibodies that can be used with and without chemotherapy. Sacituzumab Govitecan (IMMU-132), an antibody-drug conjugate, has had remarkable preliminary activity. It works by leveraging the immune system and bringing a powerful drug directly to the interior of cancer cells in order to kill them from the inside out. We are continuing to use this drug as well as other immunotherapeutic agents to improve outcomes for patients with these types of cancer.

Based upon several scientific properties, prostate cancer is a good tumor type for immunotherapy, and in fact, the first therapeutic cancer vaccine (used to treat cancer rather than prevent cancer) was approved for prostate cancer. At Weill Cornell Medicine, exploiting the immune system remains a focus in fighting prostate cancer, with a number of ongoing and upcoming clinical trials. Weill Cornell Medicine continues to be a worldwide leader in work with monoclonal antibodies, which are proteins (like a “key”) that very specifically target cancer cells (with a specific “lock” that is not present on normal cells). In particular, our work with antibodies against prostate-specific membrane antigen (PSMA) has led to the development of several targeted therapies for prostate cancer. These antibodies can be linked to powerful radioactive particles or drugs that seek out prostate cancer cells (like a smart bomb). For men with prostate cancer whose PSAs rise despite hormonal therapy, we are leading a study of targeted radioimmunotherapy that aims to prevent metastatic disease. In addition, the antibody itself may be able to generate an immune response in prostate tumors and lead to clearance of circulating tumor cells. We are also working on developing vaccines for men with rising PSAs following surgery or radiation.

We continue to examine many promising, cutting-edge immunotherapies through our robust clinical trial program. Click the below links to learn more about eligibility and open clinical trials across the spectrum of GU cancers:

Open Immunotherapy-Based Clinical Trials

Prostate Cancer

Kidney, Bladder and Urothelial Cancers

To search our complete list of our open clinical trials, click here.

Weill Cornell Researchers: Encouraging Results from J591 Study

Dr. Tagawa
Dr. Tagawa

Weill Cornell researchers recently published findings from a Phase II study of the lutetium-177-labeled monoclonal antibody J591 (called Lu-J591).

J591 is a man-made monoclonal antibody that is able to recognize a protein antigen (PSMA) expressed on virtually all prostate cancer cells, and more so in men with treatment-resistant metastatic disease. When a tiny tag of radioactive material is attached to the J591 antibody, that specifically targets prostate cancer cells, and delivered systemically this is known as “radioimmunotherapy.” Dr. Scott Tagawa and colleagues at Weill Cornell have been conducting clinical trials of the precision radioimmunotherapeutic J591 to determine its ability to eradicate prostate cancer cells.

In the recently published study, 47 prostate cancer patients with PSA progression after hormonal therapies with or without chemotherapy were treated with Lu-J591. 10.6 percent experienced more than 50% PSA decline, and 36.2% experienced more than 30% decline. Among those treated at the maximum tolerated dose, 46.9% had more than 30% PSA decline. Furthermore, 75% of patients with radiographically measurable disease had some measure of disease control; 67% of those assessed for circulating tumor cells had more than 50% decline in tumor cell counts 4 to 6 weeks after treatment.

The researchers concluded that a single dose of Lu-J591 was well tolerated and they found a measurable response rate. The authors conclude that Lu-J591 is a promising new therapeutic strategy to explore.

Click here to read the published abstract. Click here to read an article about the study and the findings.

Dr. Scott Tagawa Presents Results of PSMA Imaging for Radioimmunotherapy in CRPC at AACR

Dr. Tagawa
Dr. Tagawa

Weill Cornell’s Dr. Scott Tagawa presented updated results of PSMA imaging in 4 phase I and II clinical trials at the recent annual meeting of the American Association of for Cancer Research (AACR) in Washington, DC. The trials presented were performed at Weill-Cornell Medical College, New York Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center. The trials investigated the antitumor activity and safety profile of the experimental drug ATL101. The 4 trials involved patients treated with ATL101 and demonstrated that PSMA imaging might be used to predict response to ATL101 radioimmunotherapy in metastatic castrate-resistant prostate cancer patients.

ATL101 is a new targeted radiotherapy experimental drug for treating prostate cancer. ATL101 combines the humanized J591 monoclonal antibody targeting prostate-specific membrane antigen (PSMA) plus the Lutetium-177 radioisotope, creating the first tumor-specific delivery system able to target radiation to radio-sensitive prostate cancer cells wherever they are in the body.

PSMA is the single most well-validated prostate cancer-specific cell membrane antigen known. It is present at high levels in 95% of prostate cancers, and it is rapidly internalized leading to accumulation of significant amounts of isotopes that can be linked to the J591 antibody. Humanized J591 monoclonal antibody has shown the ability, in several hundred patients studied to date, to exclusively target prostate cancer cells wherever they are in the body without targeting normal cells.

Lutetium-177 is a radioisotope that, once internalized into the cell, is irreversibly sequestered within the targeted tumor cell. It emits radiation over a millimetre range that is ideal for eradication of the small volume lesions commonly found in the bone marrow and lymph nodes of prostate cancer patients.

ATL101 is actively studied at Weill-Cornell Medical College/New York-Presbyterian Hospital in Phase I trials evaluating fractionated administration andcombination with docetaxel. In addition, a randomized, multi-centre Phase II trial of ATL-101 in patients who have relapsed following surgery and/or radiation therapy and hormonal therapy but who do not yet have demonstrable metastatic disease is ongoing at several clinical sites in the USA.

Click here to read a press release summarizing the updated results presented by Dr. Tagawa.