Christian Blank and his team have been awarded this prize because of their innovative and internationally leading role in demonstrating the power of neoadjuvant immunotherapy: a treatment in which immunotherapy is given prior to surgery. In close collaboration with the Netherlands Cancer Institute’s fundamental researchers, they are taking steps towards a form of immunotherapy that is tailored to the patient's own molecular tumor profile.
The basic hypothesis behind neoadjuvant immunotherapy – which Blank and cancer immunologist Ton Schumacher hatched together in 2014 – is that the immune system's response will be broader – and better – if the wide variety of tumor cells found in the tumor are still present in the patient's body. Other advantages are that the effects of immunotherapy on the tumor tissue can be studied more easily and that the method allows for the use of less invasive procedures because the tumor has already shrunk.
That same year, Christian Blank set up an investigator-initiated study in melanoma patients at the NKI: the OPACIN study, the results of which were published in 2018. In it, he demonstrated that it is feasible to give immunotherapy before surgery. Moreover, the pathological response rate was high at 80%. Blank also showed that there is no recurrence observed in patients who do respond well to the therapy. In the OPACIN-neo study, which immediately followed his previous work, he managed to significantly reduce the side effects.
This led to further melanoma studies looking into, among other things, whether surgery could be omitted entirely in certain circumstances. Meanwhile, neoadjuvant immunotherapy has become an important line of research at the Netherlands Cancer Institute, where many of the studies looking into colorectal cancer, head and neck cancer, breast cancer, and renal cell cancer have already led to publications.
Neoadjuvant immunotherapy in cancer treatment is not a standard treatment yet. One important step in this direction is the NKI-led international phase three study in stage III melanoma (NADINA) which started in 2021. This study compares neoadjuvant immunotherapy to adjuvant immunotherapy (immunotherapy after surgery). Another quality that makes the NADINA study unique is that it systematically monitors the quality of life of all participants.
Blank set up an international consortium, the International Neoadjuvant Melanoma Consortium (INMC), together with two other major melanoma centers in Australia and the US. This consortium now has 1,500 members, including representatives from the pharmaceutical industry. This allows them to develop innovations and reach patients more quickly.
The jury picked the neoadjuvant immunotherapy project from a total of nine entries of exceptional quality, says medical director Jacqueline Stouthard. The jury stated that the neoadjuvant immunotherapy project stood out because it scored highly across the board. Neoadjuvant immunotherapy is based on new scientific insights, tackles a major burden that patients face, opens the door for less invasive procedures, and closely collaborates with fundamental researchers to discover the right combination of therapies for each patient. Its ultimate goal is to shorten the time in which patients are patients whenever possible, by intervening at a very early stage and working towards tailor-made treatment for each patient. In addition, there is a strong drive to collaborate internationally.