Dr. Robert Schreiber

It’s an exciting time for cancer research, and that’s true of mesothelioma as much as it is for many more common types of cancer. One of the areas that has seen a lot of activity in recent years is immunotherapy, a category of different treatments that aim to activate or boost the body’s natural ability to fight diseases, such as cancer.

One of the researchers at the forefront of investigating new cancer immunotherapy treatments is Dr. Robert Schreiber, Director of the Center for Human Immunology and Immunotherapy Programs at Washington University, which recently received a $10 million donation to study the immune system’s ability to fight disease, including cancer. The Mesothelioma Cancer Alliance reached out to Dr. Schreiber with some questions about his research, the future of immunotherapy, and how these new funds will be used.

Exciting Immunotherapy Developments

Dr. Schreiber says there is currently emphasis on two major types of immunotherapy research: one, called “immune checkpoint blockade therapy,” involves antibodies, while the other, called “adoptive T-cell therapy,” involves T-cells. “Immune checkpoint blockade uses antibodies to block molecules that come up in a cancer patient that suppress the immune system,” Dr. Schreiber explained. “Over the last five to ten years, it's been shown that antibodies that block two specific inhibitory molecules have good therapeutic effects when used individually to treat certain kinds of cancers. The new exciting aspect is that when you use them in combination, you get a synergistic effect compared to employing the treatments individually.”

“Great progress has also been made in different types of adaptive T-cell therapy involving generating, expanding and transferring tumor-killing T-cells into a cancer patient. I suspect that someday soon we’re going to see combinations of adoptive T-cell therapies with immune checkpoint blockade,” Dr. Schreiber adds. “A third approach that currently lags behind the other two is actually the oldest idea of all: Specifically, why can’t we vaccinate against cancer? Today, we now have a way to identify targets that are uniquely expressed in tumor cells and vaccinate against them. We think that we will soon be able to use tumor specific vaccines in combination with checkpoint antibodies and adoptively transferred T-cells to direct the immune system to specifically kill tumor cells in a personalized manner. Some of this work has already been successful in preclinical models, and now is now being tried in human cancer patients.”

Challenges in Current Immunotherapy Research

This research into new immunotherapy treatments for cancer is exciting, but it’s not without challenges. The biggest problem that cancer research is facing right now, according to Dr. Schreiber, is determining the best direction for research given all of these new advances. “We suffer from too many riches right now,” Dr. Schrieber says, “How do you decide which therapeutic combination to focus on? Who should be doing this work, academic investigators or pharmaceutical companies? What is the best model for the two groups to work together?”

“Academics are particularly good at doing the type of fundamental research that produce insights that could lead to novel disease therapies,” Dr. Schreiber explains. “Pharmaceutical companies are particularly well positioned to do the developmental research that drive novel insights into novel therapies. Recently there has been a lot more openness and interaction between these two groups of scientists, which is a big plus, but there has to be more.”

Another problem is that right now, there is still a big jump between testing new therapies in small animals like mice and rats, and testing these therapies in humans. “We need some kind of intermediate testing system,” Dr. Schreiber says, “that will help us span the therapeutic trial gulf that currently exists.”

Some of these issues could be resolved, Dr. Schreiber says, if more research funding were available. “When you look at the amount of money that the government is spending on immunotherapy clinical trials, it's pathetic. It’s 3 percent of the entire NCI [National Cancer Institute] budget. The most fast-moving research program sponsored by the NCI is having remarkable effects on cancers which have very few effective treatments – immunotherapy is in fact providing new and effective opportunities to treat such cancers. However, federal support for immunotherapy trials will support treatment of only a minimum percentage of such cancer patients. You would think everyone would want to jump on this opportunity!”

Immunotherapy and the Cancer Moonshot

This past May, Dr. Schreiber was named as a member of one of the subcommittees on the Cancer Moonshot Initiative, an effort headed by Vice President Joe Biden to bring about a concerted effort to find a cure – or at least a much more effective treatment – for cancer. Dr. Schreiber was on the cancer immunology, immunotherapy, and prevention subcommittee together with about 20 other experts in various areas of immunology.

“So many smart people in one room,” Dr. Schreiber described the experience. “The first couple of meetings were a bit disperse, with each of us speaking based on our different experiences and backgrounds. Over time, however, particular themes that made sense began to emerge, and the committee members began to get behind each of these themes and refine them.”

Two major suggestions have come out of this subcommittee that will hopefully inform and promote development of more effective cancer immunotherapies. “Our job was to focus our efforts on common deliberation and emerge with ideas that would drive this exciting and productive field forward,” he said. “Hopefully our recommendations will be supported by Congress and funded.”

“NCI, Vice-President Biden, and President Obama have all heard our suggestions,” Dr. Schreiber said. “Now, hopefully the new Congress and the new Administration will take them into account as well. The feedback we’ve gotten is that there is support across congressional aisles for these good ideas. Hopefully this support will translate into increased governmental support and funding for this critical work.”