CHEAT SHEET: Cancer Immunotherapy

Remember the good old days, when professors let you bring to an exam one 8.5″x11″ single-sided cheat sheet crammed with your tiniest scrawled notes about what you expected could be on the test? The landscape of immuno-oncology is changing so rapidly that in January I longed for a “cheat sheet” to keep up with the conversation. The problem is that nothing helpful was found through googling. So, I stayed up all night using my brain (and this list of FDA approvals) to create a simple one-page summary to visualize it all together.

This “cheat sheet” may be useful for others too, so I am sharing it with you. Download the printable PDF here and see my note about crowdsourcing updates below.

This selection of immunotherapy products was gathered through reading some reviews and painstakingly searching through FDA approvals from January 2010 through through December 2017. I include bi-specific antibodies, adoptive cell therapies, checkpoint modulators, cytokines, oncolytic virus therapies, and vaccines.

Key take-aways

Color corresponds to manufacturers (n = 14) in the game right now. Their products (n = 20) are connected to the indications approved by the FDA through December 2017. Some products have many indications; some cancers have several immunotherapy products. The overview lets me quickly identify which cancers have more than one immunotherapy product available and eyeball how many manufacturers are currently competing in that market.

immuno-oncology drugs stimulate the patient’s own immune system to respond to the cancer

Notice the dynamics over time. Ipilimumab was groundbreaking in 2011, and it cost other companies years of lag time to catch up with that class of innovation. I find it interesting to observe companies marketing a single product with many indications (added over time) as compared to other companies that continue to innovate new products (with fewer added indications per product, so far). I read a report from PhRMA showing more than 240 immuno-oncology products in clinical trials.

The trend leads me to suspect that there was a spillover benefit from a breakthrough in knowledge in 2011. Spillover benefits occur when society or third parties benefit from the actions of others. Whether or not Bristol-Myers Squibb has been, or will be in the future, adequately rewarded for their innovation could be a hot debate.* Considering the high list prices at launch, I understand the huge incentive for pharmaceutical companies to invest in this area.

The trick to immunotherapy nomenclature

Dr. Elizabeth Duke at the Fred Hutchinson Cancer Research Center taught me her trick for extracting some meaning from the crazy names assigned to these immunotherapy products. The nomenclature gives us a clue about how the product is derived.

Suffix	Meaning (“the product is derived from…”)
-mumab	mouse
-zumab	humanized
-xizu-	chimeric/humanized
-u	human

Crowdsourcing updates

It is hard to find a comprehensive and frequently updated list of immuno-oncology products online, and it would be impossible for me to keep this resource updated alone. I invite you to post a comment below if you have a correction, suggestion, or resource to contribute. If there is interest, I will periodically update data and and re-post the figure.