I guess for a long time we’ve recognised that there’s some sort of interaction between cancer and the immune system and immunity is regulated, there are on-switches and off-switches, there are ways of winding things up and winding things down. Understanding how to manipulate that has given us some great opportunities to treat cancer. The recognition of cancer by the immune system is something that people have talked about but now we’ve found out how to manipulate therapy in order to take advantage of that.

Because you’ve changed the target, you’ve stopped making antibodies against cancer cells, is that right?

Right. So we’ve made antibodies which regulate immunity. The immune system is capable of recognising the cancer cells more often than not. There are still plenty of clinical trials to be done and using vaccines to enhance that recognition is still something which is a hot topic so I don’t think we’ve seen the end of vaccines. There are other approaches which enhance the immune recognition as well – oncolytic viruses and other approaches that somehow enhance the way the tumour presents its antigens to the immune system will need to be explored. It may well be the treatments that we’ve used for years like radiation have had more of an impact on the immune system than were previously given credit for.

So the immunotherapeutics, including anti-PD1 and anti-PDL1 are very exciting because the clinical trials are showing clinical benefit. That clinical benefit is not just objective responses but long-term survival, durable survival in a significant number of patients. Initially it was in melanoma and then lung cancer and renal cancer and now we’re seeing other cancer types as well are benefitting from this approach and that includes Hodgkin’s disease, it includes head and neck cancer, it includes liver cancer. There’s a variety of cancer types, gastric cancer, bladder cancer, where the early clinical data is showing clear signs of benefit.

Next?

After this? So the next approach is going to be to figure out how to optimise the benefit. We’re seeing signals of activity, those signals of activity are coming from single agents and just as we found combining chemotherapeutics was something which gave much better results the early signs are that combining immunotherapeutics is going to enhance outcomes as well. Figuring out which drugs to combine in which indications and how to do it, how to schedule it, how to combine them, how to sequence things, that’s all wide open. There is some information coming through from the pre-clinical models but a lot of this is going to have to be tested in the clinic.

Thank you very much indeed, that’s first class.