PracticeUpdate Oncology February 2019

EXPERT OPINION 20

Combination of Immune Checkpoint Blockade and Tumor Vaccine for HPV+ Cancer

Interview with Barbara Burtness MD by Tyeese L. Gaines DO

Dr. Gaines: Massarelli and colleagues recently reported data on the combination of nivolumab with an HPV vaccine for patients with HPV-positive tumors. What was the rationale of exploring this therapeutic combination? Dr. Burtness: So, we know that in each HPV-associated head and neck cancer that viral antigens are being expressed by the tumors, by the tumor cells, and yet, the immune system can sometimes be exhausted in the presence of those viral antigens. If you’re giving an immune checkpoint inhibitor like nivolumab, you still need the immune system to have antigens to react against, and so, the idea was to up-regulate the response to the viral antigens. And this is a very interesting vaccine because it covers, it has nine different sequences in it covering most of the viral oncoproteins, and they observed a much higher response rate for the combination of vaccine with nivolumab, suggesting that their hypothesis was strong. Dr. Gaines: Were there any safety concerns with this combination? Dr. Burtness: It did not appear to be that there was anything different than what we’re already familiar with nivolumab. Dr. Gaines: And what are the next steps for the development of this vaccine in the man- agement of HPV-positive disease? Dr. Burtness: I think that we want to see vaccines come much earlier into the course. We know that about 14–15% of people with HPV-associated oropharynx cancer and locally advanced disease who are treated for curable ultimately develop metastases. And so, I think the idea of mounting a very good immune response to the cancer at the time of definitive treatment is very appealing. So, I hope that we’ll be seeing those studies mov- ing forward. www.practiceupdate.com/c/75527

" …we want to see vaccines come much earlier into the course. We know that about 14–15% of people with HPV-associated oropharynx cancer and locally advanced disease who are treated for curable ultimately develop metastases. "

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