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Roelofsen L, Kaptein P, Thommen D. Multimodal predictors for precision immunotherapy. IMMUNO-ONCOLOGY TECHNOLOGY 2022; 14:100071. [PMID: 35755892 PMCID: PMC9216437 DOI: 10.1016/j.iotech.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Immune checkpoint blockade (ICB) unleashes immune cells to attack tumors, thereby inducing durable clinical responses in many cancer types. The number of patients responding to ICB is modest, however, and combination treatments are likely needed to overcome the multifaceted suppressive pathways active in the tumor microenvironment (TME). The development of precision immuno-oncology (IO) strategies allowing to identify the optimal treatment of each patient upfront is therefore a pivotal question in the field of cancer immunotherapy. Although single-parameter biomarkers can enrich for response to ICB, their predictive capacity is far from perfect and their clinical utility is complicated by their continuous nature and the difficulty to determine cut-offs that reliably distinguish responding patients from those without clinical benefit. The antitumor immune response that is induced or reinvigorated by immunotherapy is a complex cascade of events requiring the interplay of multiple cell types. To move towards precision IO, it is therefore essential to understand for each individual patient at which level(s) the antitumor immune response failed and how it can be therapeutically restored. Holistic approaches to profile human tumor microenvironments and treatment-induced responses may help to identify critical rate-limiting factors of antitumor immunity. These factors need to be translated into clinically applicable multimodal predictors that allow for the selection of the best IO treatment. This review discusses strategies to (i) create such holistic views of antitumor immunity, (ii) identify measurable parameters capturing the complexity of a patient's immune status, and (iii) facilitate the incorporation of precision IO research in the clinic.
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Affiliation(s)
| | | | - D.S. Thommen
- Division of Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Mulder J, Verjans R, Verbaanderd C, Pean E, Weemers J, Leufkens HGM, Pignatti F, de Boer A, Voest EE, Stoyanova-Beninska VV, Pasmooij AMG. Extension of Indication for Authorised Oncology Products in the European Union: A Joint Effort of Multiple Stakeholders. Front Med (Lausanne) 2021; 8:790782. [PMID: 34957158 PMCID: PMC8695872 DOI: 10.3389/fmed.2021.790782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
After marketing authorisation, the development of a medicinal product often continues with studies investigating new therapeutic indications. Positive results can potentially lead to changes to the terms of the marketing authorisation, such as an extension of therapeutic indication(s). These studies can be initiated and sponsored by the marketing authorisation holder (MAH) or by others. When results from an investigator-initiated trial suggest that an authorised medicinal product is safe and effective for a new therapeutic indication, physicians may want to treat their patients with this medicinal product. In such a situation, it is desirable to extend the therapeutic indication(s) via the regulatory approval process, as this can facilitate patient access within the European Union. There may however be challenges when the MAH did not conduct the study and might not have access to the data. In this perspective, we focus on the possibilities to extend the therapeutic indication(s) of an already authorised medicinal product based on results from investigator-initiated trials. We address: (1) the advantages of an extension of indication; (2) the regulatory requirements for a variation application; (3) investigator-initiated trials as a basis for regulatory approval; (4) the role of the MAH in extending the indication. With this article, we want to emphasize the importance of a collaborative approach and dialogue between stakeholders with the aim to facilitate access to effective medicinal products.
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Affiliation(s)
- Jorn Mulder
- Dutch Medicines Evaluation Board, Utrecht, Netherlands
| | | | - Ciska Verbaanderd
- European Medicines Agency, Amsterdam, Netherlands.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Elias Pean
- European Medicines Agency, Amsterdam, Netherlands
| | | | - Hubert G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Anthonius de Boer
- Dutch Medicines Evaluation Board, Utrecht, Netherlands.,Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Emile E Voest
- Department of Molecular Oncology and Immunology, The Netherlands Cancer Institute, Amsterdam, Netherlands.,Oncode Institute, Amsterdam, Netherlands
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