As a postdoc in Thomas Gajewski's lab in Chicago at the start of this millennium, Christian Blank was captivated by research into checkpoint inhibitors. He thought it was extraordinarily elegant that one's own immune system could be taught to fight cancer. He never quite lost track of the idea that checkpoint inhibitors, discovered several years earlier, could be the key to that. "My life's work is to show that immunotherapy with checkpoint inhibitors is applicable as a treatment for many cancer types," he said. The good news is that Blank, thanks to the help of many, has come a long way at age 50.
Over the past two decades, Blank and others have shown that it is possible to prevent immune cells from being turned off by tumor cells, so they can "just get on with their tasks of recognizing and destroying tumor cells. This can be achieved by blocking the stop signals that tumor cells transmit. Checkpoint inhibitors prevent the tumor's "little hands" from pressing these "switches" on the immune cells. As a result, the tumor stops growing and, in many cases, dies.
Blank's research group at the Netherlands Cancer Institute aims to personalize this therapy for melanomas so that more and more tumors can be destroyed and side effects for patients are reduced. About 20 to 30 agents are currently in development, all of which block a different stop signal sent out by tumor cells.
Blank discovered that the results of this form of immunotherapy in melanomas are much better when the treatment is offered prior to surgery rather than after tumor removal. Neoadjuvant treatment gives the immune system the opportunity to recognize all of the cancer cells, leading to a better immune response.
He aims to develop the same therapy for eye melanomas at LUMC with Ellen Kapiteijn. "I started working with melanomas because they are difficult to treat. As chemotherapy and radiation have little effect, so I didn't have to compete with other therapies. But the treatment can be used for other solid tumors. And we see that happen more and more."
Many years of research preceded these developments, but all things considered, things moved relatively quickly. "The underdog's good luck," he calls it. Hardly anyone was engaged in research on checkpoint inhibitors. And those that did know how to find each other easily and shared their findings with each other. "That openness creates a pleasant work climate and allows you to build momentum together. We were a small and fast team." They're hardly small nowadays, but their speed remains. Even with their current number of peers, all collaborations run smoothly.
The results are impressive. Within a decade, the community of melanoma physicians was able to cure 50 percent of patients with late-stage melanoma. But not only has the survival rate increased; with the latest neoadjuvant treatments, the duration of the treatment can also be shortened significantly – for many patients to only six weeks. Invasive surgeries can also be omitted from the treatment plan for half of the patients. And treatment is a lot cheaper at €16,000 per patient instead of €60,000. And, also very important, patients don't have to feel like "patients" as long, so they can pick their lives back up and return to work more quickly.
In 10 years, he hopes to be able to cure 95 percent of early-stage melanoma patients. "We can currently cure between 85 and 90 percent of these patients. That's already a high number, but those last 10-15 percent are always the most difficult. That's what we will be focusing on in the coming years. That, and the way patients undergo their treatment. If many people are cured of cancer, the treatment should just be a six-week-long life event, preferably in a hotel-like setting with daily aftercare through an advanced app at home."
He doubts that he will be at the helm of this research himself by then. In about five years, he would be happy to pass the baton to young, talented researchers. By then, he would focus on a different rare tumor for which little research has been done.
And who knows, maybe one day he will get involved in health care policies, preferably in an advisory role. He has been politically engaged since he was young and feels more affirmed in his ideology now than when he was 18: neoliberalism does not work – at least not in the crucial sectors. And certainly not in health care. As an example, he points out how the Electronic Patient Record hinders important innovations in healthcare. And then there is the overly dominant role of the pharmaceutical industry. It is difficult to conduct innovative clinical research without collaborating with the pharmaceutical industry. He has managed to convince them to get involved, but there is still a lot of research that gets discontinued if a product that is still among the expensive drugs loses its patent.
But maybe that's something for later in life. First, he wants to make sure that many patients can consider treatment of stage III disease (a tumor with metastasis in the lymph nodes) "just" a six-week-long life event, which will allow them to return to their daily lives more quickly.
Watch Christian Blank's Inaugural Lecture on Friday, October 14, at 16.00 live through the Leiden University website.