Dr Hesham El Ghazaly - Ain Shams University, Cairo, Egypt
Prof Leisha Emens - Johns Hopkins Kimmel Cancer Center, Baltimore, USA
HEG: I'm Dr Hesham El Ghazaly, I'm Professor of Clinical Oncology and Head of Research Institute at Ain Shams University and the Head of the BGIICC.
LE: Hi, I'm Leisha Emens, I'm an Associate Professor of Oncology at the Sidney Kimmel Comprehensive Cancer Center and the Bloomberg-Kimmel Immunotherapy Institute at Johns Hopkins University. Thank you so much for inviting me to come back to your meeting, it's really wonderful.
HEG: Thank you for coming and we're very happy this year to have interactive sessions about the immunotherapy and also the breast cancer, immunotherapy in breast cancer. So I want to now and also discuss yesterday about our future plans for the young oncologists in the next BGIICC. So I think we want to discuss more about the immuno-oncology and immunotherapy in breast cancer and what is the progress in this?
LE: I think we're on the cusp of making some major progress. The preliminary data looked very promising in the early phase I and phase II trials. There's clearly a signal in triple negative breast cancer with response rates with single agent blockade of the PD-1/PD-L1 axis of about 10-15% or so. The really remarkable thing is that these responses seem to be durable and if there's an objective response that emerges that is equivalent to a complete or a partial response there's a very clear survival benefit with that. So it's a very exciting time, particularly for triple negative breast cancer patients because they have no therapeutic options at this point other than chemotherapy. So the tumour microenvironment really is the target of modern immunotherapy with immune checkpoint agents. There are two immune checkpoint blockade agents that are currently approved, one targets CTLA-4, that's ipilimumab, there are several that target either PD-1 or its ligand PD-L1. It's very clear that particularly the PD-1/PD-L1 agents have been transformative for a variety of solid tumour types but the reality remains that even those tumour types for which there's a very clear signal, the vast majority of patients don't respond to them and there are other tumour types for which there's a very low signal. So the challenge for the field is really trying to determine the best strategies for increasing the number of patients who can respond to these agents, both in those tumour types for which the agents are approved as well as those tumour types that are emerging as attractive candidates for therapy. So combinations will be the answer to that, transforming cold tumours that don't have T-cells into hot tumours that do have T-cells is really the big challenge for the field right now. I think we're beginning to see some evidence of that with immunotherapy-chemotherapy combinations. There will be novel immuno-oncology combinations that come into play as well, as well as the combination of immunotherapy with targeted therapies.
HEG: And also we have the trial to go for a recommendation between the BGIC and the CT immuno-oncology. I think it's very important because there are a lot of areas of uncertainties, including the sequence, timing. So what's your feeling about this and do you feel that it may help the practitioners to go for the time, the sequence, combination or not and all of these? Should we need this even in the future to update these recommendations or not?
LE: Given where the field has grown to at this point there are a number of diseases for which immunotherapy has been approved by the regulatory agencies. So there are very clearly defined indications for immunotherapy but it's a very exciting time as well so there's a lot of emerging information for which the data are not yet completely clear. So clarifying those areas which are fairly well defined and should be followed through a guideline and those areas which are still emerging and more in flux is very important.
HEG: Yes. And the brighter day of the young oncologists, you told me yesterday, so I'm very happy for this and I think it's better to tell it more and to go for a practical, effective programme for the young oncologists here next year. So what have you been about this and what is the plan you advise for the young oncologists next year?
LE: I think it's really a terrific opportunity because this meeting is so well put together and so comprehensive and there's so much excitement in oncology now with the advances in immunotherapy as well as advances in basic science and precision medicine and targeted therapies. The young people are very excited about learning about this, this is the era of team science - we can't do things on a one-off, on an individual basis anymore. So really networking internationally with leading authorities in the field is a great opportunity for emerging leaders in the field and it's incumbent upon us to help them develop to their full potential. So creating programming for them to network with each other and with both local and international experts would be very valuable.
HEG: The networking is like a secret ingredient for us.
LE: It really is, yes.
HEG: Thank you very much Leisha. Thank you.
LE: Absolutely, thank you.
HEG: I'm asking all the oncologists from all over the world and especially the young oncologists who are especially interested to have supporting them to the next eleventh BGIICC, and we're now splitting the 'I', the international and the immuno-oncology, to the next BGIICC, it will be in January. Don't forget the date and please mark your calendar. It will be 19th and 20th of January 2019.