Cancer
Study identifies how ovarian cancer protects itself, paving way for new drug
Researchers have discovered a way that ovarian cancer tumours manipulate their environment to resist immunotherapy and identified a drug target that could overcome that resistance.
The study used a cutting-edge spatial genomics technology and preclinical animal models, with tumour specimens from ovarian cancer patients further validating the findings.
The researchers found that ovarian cancer cells produce a molecule called Interleukin-4 (IL-4), which is typically associated with asthma and the skin condition eczema, also known as atopic dermatitis.
The study went on to find that the cancer cells used IL-4 to create a protective environment that kept away killer immune cells, making the tumours resistant to immunotherapy. A drug, dupilumab, which blocks IL-4’s activity, has been approved by the Food and Drug Administration (FDA) and is already used to treat asthma and eczema.
This new study suggests dupilumab or similar drugs could be repurposed to enhance immunotherapy for ovarian cancer.
The study was carried out by the Icahn School of Medicine at Mount Sinai and published in Cell.
Ovarian cancer
Ovarian cancer is one of the most deadly cancers; 50 per cent of patients die within five years of diagnosis.
While immunotherapy drugs such as pembrolizumab, which target the PD-1 molecule, have demonstrated efficacy in treating melanoma and lung cancer, they have not significantly improved survival rates in ovarian cancer.
This is partly because ovarian tumours have fewer mutations, making them harder for the immune system to recognize. Additionally, research suggests that these tumors may resist immunotherapy by creating barriers that prevent immune cells from infiltrating their borders.
The critical question, say the investigators, has been: how do tumours establish these protective environments?
To address this question, the research team, led by Alessia Baccarini, PhD, Assistant Professor of Immunology and Immunotherapy, and Brian D. Brown, PhD, Director of the Icahn Genomics Institute at Icahn Mount Sinai, used a novel genomics technology known as Perturb-map.
Perturb-map enhances traditional gene-editing CRISPR screening—where hundreds of genes are simultaneously “perturbed”—by incorporating state-of-the-art spatial imaging. This enables each gene’s role in controlling the tumor environment to be elucidated. Their experiments revealed that removing the IL-4 gene from ovarian cancer cells rendered the tumours susceptible to anti-PD-1 therapy.
“Surprisingly, the IL-4-deficient cancer cells were eliminated by the immune system even when mixed within tumours containing IL-4-producing cancer cells, a phenomenon known as intratumoural heterogeneity, which also contributes to drug resistance in cancer,” says Dr. Brown, who is Mount Sinai Professor of Genetic Engineering and senior author of the study.
The researchers then tested a combination of anti-PD-1 and IL-4 receptor-blocking drugs in mice with aggressive metastatic ovarian cancer and found that this combination treatment significantly extended their survival.
Additional preclinical studies demonstrated that ovarian cancer uses IL-4 to program macrophages, a type of immune cell, into protectors of the cancer cells. The IL-4-programmed macrophages prevented T cells from killing the cancer cells. However, when IL-4 was blocked, the local environment surrounding the cancer cells changed, and this left the malignant cells susceptible to being eliminated by the immune system.
To further validate their findings, the team examined specimens from human ovarian tumour resections and saw that the patients’ cancer cells also produced IL-4. Moreover, analysis of single-cell RNA sequencing data from patient tumours—which examines how genes are expressed in cells—revealed that the macrophages displayed a strong IL-4 signature, suggesting that IL-4 is playing a similar role in human ovarian cancer and may be one of the reasons patients have not benefited from immunotherapy.
“Ovarian cancer has almost been written off as non-responsive to existing immunotherapy, so it was quite stunning to us that by just blocking this one molecule, IL-4, and altering the tumour’s microenvironment, we could make these difficult-to-treat tumours more treatable,” adds Dr. Brown.
“This is further evidence that targeting the tumour’s neighbourhood, not just the cancer cells, can be beneficial.”
While these findings are encouraging, the investigators stress that clinical trials are essential to determine whether targeting IL-4 can enhance patient outcomes. Given that dupilumab is already FDA-approved for asthma and eczema, there is potential for swift clinical testing alongside immunotherapy to enhance survival in ovarian cancer patients.
Thomas Marron, MD, PhD, Director of the Early Phase Trial Unit at Mount Sinai and a colleague of Drs. Brown and Baccarini, has already been running a clinical study to test whether dupilumab can improve anti-PD-1 immunotherapy in patients with lung cancer, and several patients have shown beneficial responses.
“Ovarian cancer is a disease that’s so hard to catch early and once diagnosed, it’s often too late. I am excited that these findings may make a difference in patients’ lives. The IL-4 pathway is already targeted for diseases like eczema, and I am hopeful that if we target it in ovarian cancer, we can help women facing this terrible disease,” says Dr. Baccarini.
A vaccine trial will test whether an mRNA jab can help stop precancerous cells developing into bowel and ovarian cancer in people with Lynch syndrome.
The first stage is due to launch this summer and will assess whether the jab can train the immune system to recognise and eliminate precancerous cells before cancer develops.
Around 175,000 people in England have Lynch syndrome, but only five per cent, or around 10,000 people, know they have it.
The inherited condition increases the risk of developing bowel cancer by 80 per cent and is linked to around 1,100 bowel cancer cases each year.
Lynch syndrome is also linked to a far higher risk of bowel, womb and ovarian cancer, alongside other types including stomach, pancreatic, kidney and skin cancer.
While the syndrome does not directly cause cancer, the genetic changes can lead to more abnormal cells developing, which then multiply and increase the risk of cancers such as bowel, prostate and endometrial cancer.
It is caused by an alteration in a mismatch repair gene. Carriers do not have any symptoms.
The new Intercept-Lynch trial is part of a scientific collaboration between the University of Oxford and Moderna, while Cancer Research UK has backed the vaccine’s development.
Once patients receive the new mRNA-4194 jab, experts will analyse their immune responses, assess the best dose and check whether the jab is safe.
The second phase of the study will include multiple centres across the UK, including Oxford, and is expected to begin in 2027.
The aim of the trial is to train the immune system with a vaccine to recognise abnormalities and stop them developing into cancer.
Professor David Church, Cancer Research UK senior cancer research fellow in the University of Oxford’s centre for human genetics and lead investigator of the trial, said: “People with Lynch syndrome are at risk of cancers over their entire lives.
“So, it’s very common, for instance, a woman to have a first cancer of her womb, and then some years later have a bowel cancer, or vice versa.
“The targets we’ve chosen for the vaccine were chosen based on their sharedness across multiple cancer types in Lynch syndrome, so we think they should provide broad protection, if the vaccine works.”
In people with Lynch syndrome, mutations can build up, making the cells containing them more likely to turn into cancerous cells.
However, those mutations can be made visible to the immune system and, with enough stimulation, the immune system can attack the abnormal cells and stop cancer from forming.
Professor Church said the mRNA jab acts as “an instruction manual” for the body to attack precancerous cells.
He added that, as with many vaccines, patients may need a booster jab at some stage.
On whether similar approaches could help prevent cancers not caused by Lynch syndrome, Professor Church said: “In terms of proof of principle that we can train the immune system to recognise these cancer-associated alterations and enhance the immune response against them to prevent these pre-cancers or prevent the progression of pre-cancer to cancer, that proof of principle should give us insights that are generalisable.”
David Berman, chief development officer at Moderna, said: “By applying mRNA technology earlier in the patient journey, we aim to harness the immune system when it can have the greatest impact.
“We are proud to bring this innovation to the UK, building on our long-standing collaboration with leading UK institutions to advance mRNA research and development.”
Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.
The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.
Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:
He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.
“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.
“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”
Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.
At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.
Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.
While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.
The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.
It found that breast cancer could change the structure of a network that supports the lymph nodes.
Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.
Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.
Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.
They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.
The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.
Chemotherapy uses medicines to kill cancer cells or slow their growth.
The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.
Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.
A new ovarian cancer drug has been approved for NHS use in England, offering hundreds of women with hard-to-treat disease a life-prolonging treatment.
Elahere is the first new drug for chemotherapy-resistant ovarian cancer to be approved by the NHS for more than 20 years.
Ovarian cancer is the 18th most common type of cancer globally, affecting more than 300,000 women a year.
More than three-quarters of patients are diagnosed at an advanced stage, making the disease harder to treat.
Prof Ruth Plummer, national clinical lead for cancer drugs at NHS England, said: “This represents the most significant breakthrough in NHS treatment for these hard-to-treat ovarian cancers in over two decades – and we’re delighted it will now offer hundreds of women much-needed hope of precious extra time with their loved ones.”
Standard treatment for ovarian cancer usually involves surgery and chemotherapy, but about 80 per cent of patients with advanced disease relapse and most eventually develop resistance to chemotherapy.
According to the National Institute for Health and Care Excellence, patients with folate receptor-alpha-positive platinum-resistant epithelial cancers have until now had limited options when their tumours stop responding to standard chemotherapy.
Now NICE has approved mirvetuximab soravtansine, also known as Elahere, for patients with epithelial ovarian, peritoneal or fallopian tube cancer that has become resistant to platinum-based chemotherapy and whose tumours contain the FRα protein that the drug targets.
FRα is a protein found on the surface of some cancer cells.
NHS England said up to 400 women a year in England could benefit, in what it described as a major milestone for treatment.
Mirvetuximab soravtansine is given through a drip once every three weeks.
A global clinical trial involving eight NHS hospitals found that the treatment delayed cancer progression and prolonged survival by an average of four months, compared with chemotherapy alone, with more manageable side-effects.
Cancer progression means the disease is growing, spreading or worsening.
In 37 per cent of patients, tumours shrank by at least 30 per cent, compared with 16 per cent of those given chemotherapy.
The drug, made by AbbVie, combines a “homing” antibody, which seeks out the FRα protein on the surface of cancer cells, with a cancer-killing molecule that destroys the cell from within.
Experts said the decision was a seminal moment and could significantly improve the quality of life of affected patients.
Rachel Downing, head of policy and external affairs at Target Ovarian Cancer, said: “This is a hugely important moment for women with platinum-resistant ovarian cancer and their families, who have faced limited effective treatment options for far too long. Today’s announcement offers real hope of improved quality of life.”
Victoria Clare, chief executive of the charity Ovacome, said: “Today marks a landmark moment. Being told that platinum-based chemotherapy is no longer working can bring anxiety and uncertainty, particularly when the disease is at an advanced stage, where time and options are limited.
“This recommendation is the first in over 20 years to offer the ovarian cancer community an additional choice at a critical stage, with the potential to make a real difference to patients and their families.”
Helen Knight, director of medicines evaluation at NICE, said: “We heard clearly from patients and clinicians about the very limited options available at this stage of the disease and the substantial burden that chemotherapy places on women’s lives.
“We are pleased that, following a robust process and a new commercial arrangement with AbbVie, we are now able to recommend this treatment for NHS use.”
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