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‘Cancer treatment should be a six-week life event’

When internist Christian Blank made his very first discovery, his field of immunotherapy was the underdog of cancer research. Now, over 20 years later, Blank has been appointed Professor By Special Appointment of Internal Medicine for his clinical research into immunotherapy and will give his inaugural lecture on 14 October.

The chair, which was installed by the Netherlands Cancer Institute in 2020, proves, says Blank, that faith in immunotherapy has been restored. In his inaugural lecture ‘A cycle of life of T Cell Activation’ he will focus at length on his life’s work: checkpoint inhibitors.

As a postdoc in Thomas Gajewski’s lab in Chicago at the start of the millennium, Christian Blank was gripped by the research into checkpoint inhibitors. The idea that our immune system can be taught to fight cancer seemed supremely elegant to him. And the notion took hold that checkpoint inhibitors, which had been discovered a few years before, could be the key. ‘My life’s work is showing that checkpoint inhibitor therapy can be used for many cancers.’ The good news is that at the age of 50, Blank – with the help of many others – has made a lot of progress.

In the past two decades, Blank and others have shown how to prevent tumour cells from switching off immune cells so that the body can carry on ‘as usual’ identifying and attacking tumour cells. This can be done by blocking the stop signs tumour cells produce. Checkpoint inhibitors ensure that the tumour’s ‘hands’ can’t flip the ‘switches’ of the immune cells. The cancer stops growing and in many cases dies.

Blank’s research group at the Netherlands Cancer Institute focuses on personalising this therapy for melanoma so the body can attack increasing numbers of tumours and patients experience fewer side effects. Some 20 to 30 drugs are now in development, each of which blocks a different stop sign from tumour cells.

Better immune response

Blank also discovered that this form of immunotherapy produces a much better result with melanoma if it is administered before an operation rather than after the tumour has been removed. Because this ‘neoadjuvant’ treatment gives the immune system the opportunity to identify the whole range of cancer cells and thus provide a better immune response.

He wants to do this for eye melanoma too in the future, with Ellen Kapiteijn at the LUMC. ‘I ended up choosing melanoma because they are the most difficult tumours and chemotherapy and radiation had little effect on them. So I didn’t have to compete with other therapies. But it can be used for all types of solid cancer. And that is happening more and more often.’

Underdog’s luck

This obviously took many years of research, but it was still relatively quick. ‘That was underdog’s luck,’ he says. Hardly anyone was doing research into checkpoint inhibitors at the time. And those who were knew how to find each other and share their results. ‘Not only is this openness a really nice way to work but it also means you really can build up the momentum together. We were small and fast.’ Small no longer applies but fast certainly does. Although he now has lots of colleagues, he still works together with them a lot.

The results are impressive. Within a decade, the melanoma-doctor community was able to cure 50 per cent of patients with late-stage melanoma. But it wasn’t only the survival rate that increased. With the latest neoadjuvant treatments, the therapy has drastically reduced to six weeks for many patients. And disfiguring surgery is no longer necessary for half of the patients. The treatment is also much cheaper, at 16,000 euros per patient instead of 60,000. And, also very important, it’s much quicker until the patient is no longer a patient and can resume their life and work once again.

Ninety-five per cent cured

In ten years’ time, he hopes to cure 95 per cent of early-stage melanoma patients. ‘Now it’s between 85 and 90 per cent. That’s high already but that last 10 to 15 per cent is always the hardest. We’ll focus on that in the coming years and on the way the patient undergoes the treatment. If lots of people are cured of cancer, the treatment should be turned into a six-week life event, preferably in a hotel-like setting. And with daily aftercare through a sophisticated app at home.’

He doubts whether he will still be at the helm of this research by then. He wants to pass the baton to talented young researchers in about five years’ time. Then he would like to focus for a while on a rare tumour for which very little research has been done.

Neoliberalism in healthcare

And who knows, maybe he’ll get stuck into healthcare policy one day, preferably in an advisory role. He has been politically involved from a young age and can see his convictions being confirmed even more strongly now than when he was 18: namely, that neo-liberalism doesn’t work. At least not in the essential sectors. And definitely not in the health sector. He points to the Electronic Health Record, which stands in the way of important innovation in healthcare. And to the over-dominant role of the pharmaceutical industry. It is difficult to do innovative clinical research without the cooperation of the pharmaceutical industry. He has managed to convince the industry, but a lot of research no longer goes ahead if, for example, the patent runs out on a product that is classed as an expensive drug.

But that might be something for later in life. He first wants to make sure that for many patients treating a stage III disease (a tumour that has spread to the lymph nodes) is ‘just’ a six-week life event. Which will mean they can get back to their normal lives much faster.

Text: Marijn Kramp

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