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Flipping the Switch: Immunotherapy Explained

April 2, 2015

Fred Hutchinson Cancer Research Center President Dr. Gary Gilliland explains how immunotherapy can cure some cancers.

Dr. Gary Gilliland: The opportunity at the Hutch, with its roots in bone marrow transplantation that I mentioned to you, is that we’ve had an understanding for decades, in part through marrow transplants, that the host immune response can be a very effective weapon in fighting cancer. But we haven’t quite known how to harness the incredible power that our immune system has. It is capable of recognizing tumor cells as being foreign and destroying them the same way that it recognizes parasites or bacteria or viruses as being foreign, and can eliminate them from the system. We’re just beginning to understand that tumors elaborate essentially a cloaking device, where they can hide from the immune system, and they can actually put the immune system to sleep. They have ways of engaging the immune system and turning it off or turning it down. We now have molecular switches that we can turn on that take the cloaking device down and activate the immune system, and, remarkably, that’s all that it takes. No chemotherapy, no radiation therapy. There are now treatments for metastatic melanoma — that had been a universally fatal disease — where we have 50% response rates, and in some cases look like true cures doing nothing more than flipping the switch on the immune system.

Deborah Wang: And this is called immunotherapy?

Dr. Gary Gilliland: Immunotherapy. It’s one form of immunotherapy. And we have several here that we’re working on. It includes what’s called chimeric antigen receptor T-cells, or CAR T-cells, where we take an individual’s T-cells and we extract them from the body, and we genetically engineer them and educate them on how to kill tumors, reintroduce them into the body, and those — in some cases with a single treatment — will induce cures in people who have widely metastatic refractory cancers. It’s stunning. I’ve been in this business for 30 years and it raises the hackles on the back of my neck to see these types of responses.

Deborah Wang: Well, I guess the question is, you know, we traditionally think of cancer treatments as themselves being quite toxic and invasive, but is the idea here that you literally just use your own immune system to battle and eventually defeat the cancers?

Dr. Gary Gilliland: Yeah, that’s it.

Deborah Wang: That’s it?

Dr. Gary Gilliland: It’s nothing more than helping our immune system do its job. The other wonderful thing about these types of treatments is that, apart from the fact that they can be curative in some cases, or the reason they can be curative, is that most of our treatments… Tumors are very clever — they will ultimately figure out how to evade our treatment and become resistant. So we’re constantly chasing with different treatments, different chemotherapies, different small molecule inhibitors to try to overcome the resistance that develops. With the immune system activation, that makes it a fair fight, because the immune system can migrate. And if a tumor begins to evolve to a resistant state, another part of the immune system can come in and pick that up, so that we can actually maintain the disease in abeyance, or sometimes cure it.

Deborah Wang: So, how far along are you in terms of making these immunotherapies available to cancer patients?

Dr. Gary Gilliland: We’re one of several centers around the United States. This is a communal effort. There’s a lot of collaboration between centers. But in terms of… for certain types of cancers like B-cell malignancies — these are blood-borne cancers — we’re fairly far down the path toward developing new drugs. They’re cell-based medicines that are derived from the patient’s own T-cells. Those are in clinical trials, and we have a partnership and a collaboration with a commercial entity, Juno Therapeutics, to try to bring this into the registration path of the FDA, and then ultimately [make it] available to all patients.

Deborah Wang: Is this years away from hitting the market?

Dr. Gary Gilliland: The typical time from when you go first in human with a medicine to the time it is approved by the FDA is about eight years. But these effects are so dramatic — and we’ve been in the clinic now for several years — they’re so dramatic that we’re hopeful that the FDA will consider helping us accelerate the path toward advancement so they’ll be more broadly available. For other types of medicine, some of which are FDA-approved, there’s accessibility, in theory, to anyone in the general public and their oncologist. They are expensive medicines, and I think even in our health care system with the Affordable Care Act that not every patient has equal access to some of the more sophisticated approaches that can be taken for these therapies. But some of them are FDA-approved and in the clinic now and some of them are on the way.

Watch the full interview:



Made possible in part by

Deborah Wang

Deborah Wang is host of IN Close, the weekly public affairs program on KCTS 9 that features in-depth stories from across the Pacific Northwest.

She is also a news and feature reporter for KUOW Public Radio in Seattle. She covers a range of subjects, but mainly focuses on politics.

Deborah is an award–winning radio and television journalist whose career spans close to three decades. A long–time network foreign correspondent, she has reported from close to two dozen countries, including China, Vietnam, Cambodia, India, Saudi Arabia, Somalia, Rwanda, Kuwait, and Iraq.

Deborah's first reporting job was at public radio station WFCR in Amherst, Massachusetts, where she filled just about every role at the station, from newscaster to reporter to show host to news director. In 1988, she transitioned from radio to public television, working as a reporter and fill-in host at “The Ten O’Clock News” on WGBH-TV in Boston. In 1990, Deborah went to work for National Public Radio, serving as NPR's Asia correspondent based in Hong Kong. In 1993, ABC News hired Deborah to be a television correspondent based in Beijing, where she covered, among other things, Hong Kong's handover from British to Chinese rule. In 1999, she set up the network's first news bureau in Seattle.

Deborah has also worked as a news anchor for CNN International, and as a fill-in host for the nationally syndicated public radio show “Here and Now.”

Deborah has won numerous awards for her reporting, including the Alfred I. DuPont Silver Baton for coverage of the first Gulf War, and the Overseas Press Club's Lowell Thomas Award for best radio documentary on Cambodia.

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