Immune system T cells attack cancer cells.Research round-up
Highlights from
research. By Laura
Vargas-Parada
reflect the clinical benefit of a
treatment. The highest priced
drugs were not consistently
the most effective treatments.
The team compared the clinical
value of a drug, as defined by
the American Society of Clinical
Oncology (ASCO) and the
European Society for Medical
Oncology (ESMO) criteria,
to its monthly cost in each
country. It found no significant
association between price and
clinical benefit in four of the
countries, but in France an
association was seen with the
ASCO criteria. However, the
team note that final prices in
England might differ from those
used in its study, because the
National Health Service receives
discounts on certain drugs that
are not made public.
Vokinger suggests that
forming coalitions between
countries could improve
alignment of pricing and benefit.Lancet Oncol. 21 , 664–670 (2020)Drug cost does not
reflect benefit
A cost–benefit analysis
led by Kerstin Vokinger at
the University of Zurich,
Switzerland, suggests that the
prices paid for cancer drugs
do not reflect the compounds’
clinical benefit. Vokinger
and colleagues evaluated the
monthly treatment cost of 65
oncology drugs in the United
States and 4 European countries.
The average cost in the United
States (US$13,179) was more
than double that of European
nations ($6,202 in England,
$5,696 in Switzerland, $5,121 in
Germany and $4,866 in France).
This is probably because,
unlike in the United States, the
governments of the European
countries commonly negotiate
on price with manufacturers.
However, the analysis also
revealed that the prices set
in each country, whether
negotiated or not, did notor heterogeneous levels of
immune-cell infiltration had
significantly lower levels of
neoantigens than did those
with low immune activity,
suggesting that tumours
respond to immune surveillance
with strategies to minimize
neoantigen expression as a self-
protection strategy.
The researchers identified
several mechanisms by which
tumours achieve this, including
epigenetic alteration of
promoters of genes that contain
neoantigenic mutations. In
each case, the changes were
more common in tumours
with high levels of immune
activity. People with tumours
with a limited capacity for
immune evasion were found
to survive significantly longer.
This information could be used
to forecast clinical outcomes,
and help clinicians to plan
immunotherapy interventions.Nature 567 , 479–485 (2019)Immune cells drive
tumour evolution
Rachel Rosenthal at the Francis
Crick Institute, London, and her
team have provided the clearest
picture yet of how the immune
system influences the genetic
evolution of lung-cancer cells.
By analysing a collection of
adenocarcinoma and squamous-
cell carcinoma samples, the
researchers detailed a strong
correlation between the
emergence of mechanisms that
tumours use to evade immune
attack and infiltration of the
tumour by immune cells.
The researchers analysed
258 samples from 88 untreated
early-stage tumours, collecting
data on tumour DNA, RNA and
epigenetic factors. Based on
the immune infiltration of the
tumour microenvironment, the
team identified three distinct
groups of tumours: those with
uniformly high levels of immune
activity, those with uniformly
low levels and those with
different levels of infiltration in
different parts of the tumour.
In the heterogeneous
tumours, regions with different
levels of immune activity were
also different at a genetic level.
To assess the extent to which
the immune microenvironment
drives changes in tumour
genetics — a phenomenon
known as immunoediting
— the researchers looked at
the ‘neoantigens’ present
in a tumour. These newly
formed antigens arise from
altered proteins produced by
tumours and help the immune
system to identify malignant
cells. Tumours with high
SPECTRAL-DESIGN/GETTYS2 | Nature | Vol 585 | 24 September 2020
Precision oncology
outlook
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2020
Springer
Nature
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2020
Springer
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Limited.
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reserved.