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Your Immunity System & Cancer
Jonathan Cebon
Austin Health, Olivia Newton-John Cancer Research Institute
&
Olivia Newton John Cancer & Wellness Centre
Cancer immunosurveillance theory
1967
Tumours can be recognized and
eliminated by the immune system.
Macfarlane Burnet (1899–1985).
Melanoma in donor renal graft - 16 years
after initial resection
Melanoma in donor renal graft - 16 years
after initial resection
MacKie NEJM. 2003
Case 1
Mrs R
• Past: Crohn’s disease
– In remission
1998
• Primary melanoma diagnosed
– Abdominal wall, high risk, stage IIC
June 99
• 1st recurrence: skin nodules
July 99
• 2nd recurrence: Brain tumour
– Treated with radiotherapy
August 1999
Admission to hospital with Crohn’s disease flare
– Spontaneous regression of
– Multiple subcutaneous metastases
– 3cm liver metastasis
Case 1
June 1999 Feb 2000
Case 1
May 2001
• 3rd melanoma recurrence: R proximal humerus
– Resection + prosthesis
May-Jun 2001
– Vitiligo gradually developed over face, trunk, arms
Dec 2001
Gall bladder surgery
pigmented masses
No live melanoma
Melanin-laden immune
cells (macrophages)
Case 1
• Last clinical review Jun 2014
– Alive & well
– No evidence of melanoma
Tumor infiltrating lymphocytes: association with improved survival
Melanoma
Summary
• Stage 4 melanoma: metastatic disease in brain, liver,
bone, skin, mucosal surfaces
• Median survival 7 months
• Spontaneous remission associated with
autoimmunity Crohn’s colitis
• Discussion point: can autoimmunity be harnessed as
a therapeutic tool?
Immune Checkpoint Blockade
Ribas NEJM June 2012
T-cell receptor: Antigen-MHC
CD28: B7
CTLA-4: B7
Feb 2014 June 2014
Melanoma in Liver
Response to Yervoy
Immune Checkpoint Blockade
Ribas NEJM June 2012
LUDWIG CANCER RESEARCH
September 2013 April 2014
Anti-PD-1 Malignant Melanoma
Pulmonary metastases
70y M
Combination anti-CTLA4 & anti-PD-1
Wolchok et al June 2013
Slide 18
Presented By Jedd Wolchok at 2013 ASCO Annual Meeting
Cancer Risk following Renal Transplant
ANZ Dialysis & Transplant register 1997 8618 patients
Cancer Number Risk Ratio
CNS Lymphoma 17 >1000
Ureter 10 250
Parathyroid 2 200
Kaposi Sarcoma 18 86
Vulva/Vagina 40 43
Penis 7 24
Cervix 65 17
Bladder 54 7
Kidney 8 7
NH Lymphoma 83 7
Liver 8 6
Colon 50 2
Breast 42 1
PD-1 inhibitors
Active in multiple cancer types (response rates reported at June 2015)
• Melanoma (17-40%)
• Lung (10-30%)
• Kidney (12-29%)
• Bladder (25%)
• Ovarian (6-23%)
• Head & Neck (14-20%)
• Hodgkins Lymphoma (87%)
• Gastric
• Triple-ve breast
• Mesothelioma
• HCC
• Cancers with mismatch repair gene defects
Summary & Conclusions
• Cancer responds to immune attack
• Understanding the underlying science has
enabled effective new therapies to be
developed
• Clinical trials are underway to evaluate
these treatments in many different cancer
types

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Your immune system and cancer - Jonathan Cebon - BreaCan 5 August 2015

  • 1. Your Immunity System & Cancer Jonathan Cebon Austin Health, Olivia Newton-John Cancer Research Institute & Olivia Newton John Cancer & Wellness Centre
  • 2.
  • 3. Cancer immunosurveillance theory 1967 Tumours can be recognized and eliminated by the immune system. Macfarlane Burnet (1899–1985).
  • 4. Melanoma in donor renal graft - 16 years after initial resection Melanoma in donor renal graft - 16 years after initial resection MacKie NEJM. 2003
  • 5. Case 1 Mrs R • Past: Crohn’s disease – In remission 1998 • Primary melanoma diagnosed – Abdominal wall, high risk, stage IIC June 99 • 1st recurrence: skin nodules July 99 • 2nd recurrence: Brain tumour – Treated with radiotherapy
  • 6. August 1999 Admission to hospital with Crohn’s disease flare – Spontaneous regression of – Multiple subcutaneous metastases – 3cm liver metastasis Case 1 June 1999 Feb 2000
  • 7. Case 1 May 2001 • 3rd melanoma recurrence: R proximal humerus – Resection + prosthesis May-Jun 2001 – Vitiligo gradually developed over face, trunk, arms Dec 2001 Gall bladder surgery pigmented masses No live melanoma Melanin-laden immune cells (macrophages)
  • 8. Case 1 • Last clinical review Jun 2014 – Alive & well – No evidence of melanoma
  • 9. Tumor infiltrating lymphocytes: association with improved survival Melanoma
  • 10. Summary • Stage 4 melanoma: metastatic disease in brain, liver, bone, skin, mucosal surfaces • Median survival 7 months • Spontaneous remission associated with autoimmunity Crohn’s colitis • Discussion point: can autoimmunity be harnessed as a therapeutic tool?
  • 13. Feb 2014 June 2014 Melanoma in Liver Response to Yervoy
  • 15. LUDWIG CANCER RESEARCH September 2013 April 2014 Anti-PD-1 Malignant Melanoma Pulmonary metastases 70y M
  • 16. Combination anti-CTLA4 & anti-PD-1 Wolchok et al June 2013
  • 17. Slide 18 Presented By Jedd Wolchok at 2013 ASCO Annual Meeting
  • 18. Cancer Risk following Renal Transplant ANZ Dialysis & Transplant register 1997 8618 patients Cancer Number Risk Ratio CNS Lymphoma 17 >1000 Ureter 10 250 Parathyroid 2 200 Kaposi Sarcoma 18 86 Vulva/Vagina 40 43 Penis 7 24 Cervix 65 17 Bladder 54 7 Kidney 8 7 NH Lymphoma 83 7 Liver 8 6 Colon 50 2 Breast 42 1
  • 19. PD-1 inhibitors Active in multiple cancer types (response rates reported at June 2015) • Melanoma (17-40%) • Lung (10-30%) • Kidney (12-29%) • Bladder (25%) • Ovarian (6-23%) • Head & Neck (14-20%) • Hodgkins Lymphoma (87%) • Gastric • Triple-ve breast • Mesothelioma • HCC • Cancers with mismatch repair gene defects
  • 20. Summary & Conclusions • Cancer responds to immune attack • Understanding the underlying science has enabled effective new therapies to be developed • Clinical trials are underway to evaluate these treatments in many different cancer types