“Researchers have realized that the immune system is in some ways like a dial that can be ‘turned up’ to fight cancer, or, conversely, ‘turned down’ to fight autoimmunity,” said Robert Plenge, senior vice president, Translational Medicine (TM) and Immunology, Cardiovascular, & Fibrosis Thematic Research Center (ICF TRC).
This is just one of the insights driving the cutting edge of discovery at BMS today.
A realization leading to exploration
Historically, immunology had been focused on autoimmunity – the immune system as a bad actor turning against the body. But the first immuno-oncology research opened up a new understanding of the immune system’s role in treating disease--the idea that the body’s immune system could turn against cancer by “turning up” the immune system, taking the “brakes” off of T cells.
“There are very few instances in drug discovery and development where you have an invention in medicine that’s truly transformational, and the advent of immuno-oncology a decade ago is one of those examples,” said Plenge.
In the decade since then, advances in immuno-oncology have brought hope for a longer life to certain patients with cancer, particularly those with metastatic disease. Research is now progressing into earlier stages of disease, aiming to intervene before the disease has spread and when the immune system is stronger and more likely to respond to treatment.
Research is also progressing with translational insights – that is, an understanding of disease biology –that have been used to identify segments of patients who are most likely to benefit from certain medicines or combinations of medicines.
“We’ve been successful at translational work in oncology, though we still have a long way to go. In autoimmunity, there is a lot of ongoing translational work, but it’s in its infancy. We hope to take the learnings in oncology and apply them in the context of autoimmunity to better identify patient segments,” said Plenge. “Ideally, the goal is precision medicine –finding the right medicine for the right patient at the right time.”
Promising insights from hematologic cancers also show potential to augment immunology research. For example, B cells provide a common ground between hematologic and immunologic diseases. There are certain hematologic diseases that involve mutated B cells, while in autoimmunity, certain diseases are characterized by autoreactive B cells that act against the body.
“In some of the hematologic diseases, we can use CAR T cell therapy to go after the malignant cancer cells. We’re trying to take that same concept in autoimmunity and flip the paradigm and use cell therapy to kill the autoreactive autoimmune cells, but we are in the very early stages of discovery,” said Plenge.