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Michele Ardolino
Scientist, OHRI
Ass. Prof., University of Ottawa
Canadian Cancer Survivor Network
May, 2nd 2019
Tumor immunology and Cancer Immunotherapy
@QFKC

@ArdolinoLab

@OttawaHospital

@uOttawaBMI
@ArdolinoLab
Outline
Cancer and the Immune System
The Immunotherapy Revolution
Conclusions
The Hallmarks of Cancer

The Immune System

Cancer Immunoediting
Taking off the breaks

Educating the immune response

A little help from…. a foe
Where are we at and where are we going?
In Canada, cancer is the first cause of death
Cancer
What is cancer?
-Epithelial origin: CARCINOMAS (e.g. lung,
prostate, breast)
-Hematopoietic origin: LEUKEMIAS,
LYMPHOMAS, MYELOMAS
-Mesodermal origin: SARCOMAS (e.g.
bones, muscles)
Cancer
https://www.medicalnewstoday.com/articles/323448.php
Cellular transformation is a multistep process
Normal cells become cancer cells after a process of
CELLULAR TRANSFORMATION
Oncogenes: genes that make cells replicate without control
Non functional tumor suppressor genes: genes that should
suppress tumor growth but do not work anymore
 
Cancer
Kotecha, et al., Oncotarget, 2016
http://beatricebiologist.tumblr.com/post/100165993576/cancer-gene
Several agents promote cellular transformation
Cancer
Hyndman, Cancer Microenvironment, 2016
Many cancer types
Cancer is not a disease: it is a COLLECTION of diseases
Cancer
Cancer and the immune system
What makes cancer a cancer?
The HALLMARKS of cancer from 2000
Hanahan D. and Weinberg R.A.

Cell, 2011
no immunologyHanahan D. and Weinberg R.A.

Cell, 2011
Cancer and the immune system
What makes cancer a cancer?
The HALLMARKS of cancer from 2000
What makes cancer a cancer?
The HALLMARKS of cancer from 2000 to 2011
Hanahan D. and Weinberg R.A.

Cell, 2011
Cancer and the immune system
Hanahan D. and Weinberg R.A.

Cell, 2011
Ability of escaping the
immune response is
now recognized as an
hallmark of cancer
What makes cancer a cancer?
The HALLMARKS of cancer from 2000 to 2011
Cancer and the immune system
What is the Immune System?
Cancer and the immune system
https://www.stemcellimmuneregenerative.com/what-is-the-immune-system
Cancer and the immune system
Insult
Sensing
Response
Communication
All cells in the body communicate with
immune cells. 

Immune cells patrol the body and are
continuously exposed to
environmental clues.

If something is wrong, the immune
cells can detect it.
Cancer cells acquire aberrant features
that can be recognized by many
immune cells that then react!
Cancer and the immune system
Great cytotoxic capacity
Kill dangerous cells
Probe the target cells to detect signs of abnormalities
T and NK cells
T and NK cells do not kill healthy cells
T/NK
Healthy
cell
spared
by
T and NK cells
Cancer and the immune system
Tumor cell
T and NK cells specifically kill dangerous cells
T/NK
Killed
by
T and NK cells
+
Healthy cell
Cancer and the immune system
NK cell
Tumor cell
T cells, NK cells and other immune cells are often present
in human and mouse tumors
T cell
B cell
????
Why don’t they kill tumor cells?
Cancer and the immune system
Many to discover!!!!
Cancer has many ways to hide from the Immune System
Immunoediting
Outline
Cancer and the Immune System
The Immunotherapy Revolution
Conclusions
The Hallmarks of Cancer

The Immune System

Cancer Immunoediting
Taking off the breaks

Educating the immune response

A little help from…. a foe
Where are we at and where are we going?
Can we use the Immune System to fight cancer?
IMMUNE SYSTEM
Many cancer types
Cancer is not a disease: it is a COLLECTION of diseases
Cancer Immunotherapy
As such, there is no ONE FITS FOR ALL solution

Immunotherapy can provide the ultimate personalized therapy by harnessing the patient
own’s immune system against cancer
Cancer cell
Cancer Immunotherapy
“Traditional” cancer treatments (chemo and radiotherapy) activate the immune system
Cancer cell
Cancer cell
Cancer cell
Radiotherapy
Chemotherapy
DC
CTL
!!!!!!
?????
Well done
mate
Exclusion
Lack of recognition
Suppression
How do the Cancer evade the immune response?
Exclusion
Lack of recognition
Suppression
Different cancer immunotherapies target
different angles of immune-evasion
How do the Cancer evade the immune response?
Cancer Immunotherapy
Cancer cell
Cancer cell
Cancer cell
Cancer cell
VACCINATION
ADOPTIVE CELL
TRANSFER
ANTIBODIES ONCOLYTIC VIRUSES
Cancer Immunotherapy
Cancer cell
Cancer cell
Cancer cell
Cancer cell
VACCINATION
ADOPTIVE CELL
TRANSFER
ANTIBODIES ONCOLYTIC VIRUSES
Cancer Vaccines
Vaccines are the “go-to” strategy for immunologists

The idea is to elicit a strong immune response against tumors

Problem: for pathogens, vaccines are PROPHYLACTIC not THERAPEUTIC
Cancer Vaccines
Vaccines are the “go-to” strategy for immunologists

The idea is to elicit a strong immune response against tumors

Problem: for pathogens, vaccines are PROPHYLACTIC not THERAPEUTIC
Prevent cancer to form in the first place

e.g.: HPV vaccine prevents cervical
cancer
Cancer Vaccines
Vaccines are the “go-to” strategy for immunologists

The idea is to elicit a strong immune response against tumors

Problem: for pathogens, vaccines are PROPHYLACTIC not THERAPEUTIC
Prevent cancer to form in the first place

e.g.: HPV vaccine prevents cervical
cancer
Cure cancer in patients: harder to
achieve because the tumor is already
there!
Cancer Vaccines
Dendritic Cell Vaccines
Cancer Immunotherapy
Cancer cell
Cancer cell
Cancer cell
Cancer cell
VACCINATION
ADOPTIVE CELL
TRANSFER
ANTIBODIES ONCOLYTIC VIRUSES
Cellular Therapy
Ca
Ca
Ca
Ca
Adoptive cellular therapy is based on the idea that T cells are capable of fighting tumors
Ca
Ca
Ca
Ca
T cells with
different
specificity
Expand T cells
specific for the
tumor
Re-infuse
tumor specific
T cells into the
patient
T cell transfer works!
Cellular Therapy
Zacharakis N. et al, Nat Med., 2018
Before therapy 22 months after therapy
Tumor
Cellular Therapy
Ca
Ca
Ca
Ca
Adoptive cellular therapy is based on the idea that T cells are capable of fighting tumors
Ca
Ca
Ca
Ca
T cells with
different
specificity
What if there
was a way to
make all the T
cells reactive
against
cancer?
CAR T cells: engineering T cells to fight cancer
Cellular Therapy
June et al.

Science 2018CARs MAKE ALL T CELLS REACTIVE AGAINST TUMOR CELLS
Cellular Therapy
Ca
Ca
Ca
Ca
Adoptive cellular therapy is based on the idea that T cells are capable of fighting tumors
Ca
Ca
Ca
Ca
Instagram: whiteheadfdn

http://emilywhiteheadfoundation.org/
Cancer Immunotherapy
Cancer cell
Cancer cell
Cancer cell
Cancer cell
VACCINATION
ADOPTIVE CELL
TRANSFER
ANTIBODIES ONCOLYTIC VIRUSES
Antibodies are Y-shaped molecules
produced by B cells.

Antibodies bind with high specificity to
their antigen. 

Antigens are usually microbial products,
but in the lab we can produce antibodies
that bind to molecules present in the
body for therapeutic purposes.
Antibodies
https://www.labce.com/spg813210_antigenantibody_interaction.aspx
Antibodies are Y-shaped molecules
produced by B cells.

Antibodies bind with high specificity to
their antigen. 

Antigens are usually microbial products,
but in the lab we can produce antibodies
that bind to molecules present in the
body for therapeutic purposes.
Antibodies
https://www.labce.com/spg813210_antigenantibody_interaction.aspx
For example: we can use antibodies that
activate immune cells against cancer by
TAKING OFF THE IMMUNOLOGICAL BREAKS
Inhibitory receptors regulate immune cell activation
Antibodies
The activation of immune cells,
including T cells, is regulated by
POSITIVE and NEGATIVE signals.

This balance is important to
prevent auto-immunity…

… but tumors often exploit the
NEGATIVE signals provided by the
INHIBITORY CHECKPOINT
RECEPTORS to escape the
immune response.
Antibodies
Ca
Ca
Ca
Ca
Checkpoint blockade removes the break from the immune system
Ca
Ca
Ca
Ca
T cells and
NK cells kill
tumor cells
Antibodies blocking checkpoint
receptors re-activate immune
cells against cancer
Ca
Ca
Ca
Ca
T cells and
NK cells are
inhibited by
checkpoint
receptors
Ca
Ca
Ca
Ca
Ca
Ca
Ca
Ca
Taking off the breaks from the immune system has a therapeutic effect!
Hodi F.S. et al.,

New Engl. J. Med. 2010
Ipilimumab
Antibodies
Topalian S. L. et al.,

New Engl. J. Med. 2012
Tumor
COMBINATION COMBINATION COMBINATION
Antibodies
ENDLESS
COMBINATION
Cancer Immunotherapy
Cancer cell
Cancer cell
Cancer cell
Cancer cell
VACCINATION
ADOPTIVE CELL
TRANSFER
ANTIBODIES ONCOLYTIC VIRUSES
Oncolytic Viruses
Let’s give cancer a cold…
…a made in Ottawa story
Dr. John Bell

OHRI/uOttawa

Oncolytic Virus pioneer
Oncolytic Viruses
Adapted from Nature Reviews Drug Discovery
Antiviral responses are extremely complex
and require many molecular components.

Cancer cells often accumulate mutations that
alter these pathways and make tumor cells
more sensitive to viral infection.
Oncolytic Viruses
Let’s give cancer a cold…
HEALTHY CELLS ELIMINATE THE VIRUS
CANCER CELLS CANNOT
ELIMINATE THE VIRUS BY KILLING THE TUMOR,
THE VIRUS ALSO
STIMULATES THE IMMUNE
SYSTEM
Oncolytic viruses in the clinic
Before
After
Parker et al., 2008, Lancet Oncology
Oncolytic Viruses
Outline
Cancer and the Immune System
The Immunotherapy Revolution
Conclusions
The Hallmarks of Cancer

The Immune System

Cancer Immunoediting
Taking off the breaks

Educating the immune response

A little help from…. a foe
Where are we at and where are we going?
Conclusions
Immunotherapy revolutionized the clinical approach to cancer and provided hope to patients
with previously incurable diseases
HOWEVER
There is still A LOT to do
Conclusions
Immunotherapy revolutionized the clinical approach to cancer and provided hope to patients
with previously incurable diseases
HOWEVER
Therapy does not work or last in many patients: what can we do to improve the
response?
There are many immunotherapies available: how do we choose what is the best therapy
for every patient?
Safety is an issue for some immunotherapies: how do we reduce toxicity without
compromising efficacy?
Conclusions
Immunotherapy revolutionized the clinical approach to cancer and provided hope to patients
with previously incurable diseases
HOWEVER
Therapy is not efficacious or durable in many patients: what can we do to improve the
response?
There are many immunotherapies available: how do we choose what is the best therapy
for every patient?
Safety is an issue for some immunotherapies: how do we alleviate toxicity without
compromising efficacy?
RESEARCH IS THE ANSWER
1750 Courtwood Crescent, Suite 210

Ottawa, ON K2C 2B5

Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca 
Pinterest: http://pinterest.com/survivornetwork/
Many thanks:
lab
Honorary member
Karen Jardine
Marie-Claude Bourgeois-Daigneault
Surgical Equipe
Carolyn Nessim
James Villeneuve
Stephanie Johnson-Obaseki
Rebecca Auer
Joan Sealy Trust
Lab members
Cynthia Chan
Denis Qeska
Jonathan Hodgins
Lysanne Desharnais
Maria Park
Serena Cortés-Kaplan
Shaad Hasim

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Tumor Immunology and Cancer Immunotherapy

  • 1. Michele Ardolino Scientist, OHRI Ass. Prof., University of Ottawa Canadian Cancer Survivor Network May, 2nd 2019 Tumor immunology and Cancer Immunotherapy @QFKC @ArdolinoLab @OttawaHospital @uOttawaBMI @ArdolinoLab
  • 2. Outline Cancer and the Immune System The Immunotherapy Revolution Conclusions The Hallmarks of Cancer The Immune System Cancer Immunoediting Taking off the breaks Educating the immune response A little help from…. a foe Where are we at and where are we going?
  • 3. In Canada, cancer is the first cause of death Cancer
  • 5. -Epithelial origin: CARCINOMAS (e.g. lung, prostate, breast) -Hematopoietic origin: LEUKEMIAS, LYMPHOMAS, MYELOMAS -Mesodermal origin: SARCOMAS (e.g. bones, muscles) Cancer https://www.medicalnewstoday.com/articles/323448.php
  • 6. Cellular transformation is a multistep process Normal cells become cancer cells after a process of CELLULAR TRANSFORMATION Oncogenes: genes that make cells replicate without control Non functional tumor suppressor genes: genes that should suppress tumor growth but do not work anymore   Cancer Kotecha, et al., Oncotarget, 2016 http://beatricebiologist.tumblr.com/post/100165993576/cancer-gene
  • 7. Several agents promote cellular transformation Cancer Hyndman, Cancer Microenvironment, 2016
  • 8. Many cancer types Cancer is not a disease: it is a COLLECTION of diseases Cancer
  • 9. Cancer and the immune system What makes cancer a cancer? The HALLMARKS of cancer from 2000 Hanahan D. and Weinberg R.A. Cell, 2011
  • 10. no immunologyHanahan D. and Weinberg R.A. Cell, 2011 Cancer and the immune system What makes cancer a cancer? The HALLMARKS of cancer from 2000
  • 11. What makes cancer a cancer? The HALLMARKS of cancer from 2000 to 2011 Hanahan D. and Weinberg R.A. Cell, 2011 Cancer and the immune system
  • 12. Hanahan D. and Weinberg R.A. Cell, 2011 Ability of escaping the immune response is now recognized as an hallmark of cancer What makes cancer a cancer? The HALLMARKS of cancer from 2000 to 2011 Cancer and the immune system
  • 13. What is the Immune System?
  • 14. Cancer and the immune system https://www.stemcellimmuneregenerative.com/what-is-the-immune-system
  • 15. Cancer and the immune system Insult Sensing Response Communication All cells in the body communicate with immune cells. Immune cells patrol the body and are continuously exposed to environmental clues. If something is wrong, the immune cells can detect it. Cancer cells acquire aberrant features that can be recognized by many immune cells that then react!
  • 16. Cancer and the immune system Great cytotoxic capacity Kill dangerous cells Probe the target cells to detect signs of abnormalities T and NK cells
  • 17. T and NK cells do not kill healthy cells T/NK Healthy cell spared by T and NK cells Cancer and the immune system
  • 18. Tumor cell T and NK cells specifically kill dangerous cells T/NK Killed by T and NK cells + Healthy cell Cancer and the immune system
  • 19. NK cell Tumor cell T cells, NK cells and other immune cells are often present in human and mouse tumors T cell B cell ???? Why don’t they kill tumor cells? Cancer and the immune system
  • 20. Many to discover!!!! Cancer has many ways to hide from the Immune System Immunoediting
  • 21. Outline Cancer and the Immune System The Immunotherapy Revolution Conclusions The Hallmarks of Cancer The Immune System Cancer Immunoediting Taking off the breaks Educating the immune response A little help from…. a foe Where are we at and where are we going?
  • 22. Can we use the Immune System to fight cancer? IMMUNE SYSTEM
  • 23. Many cancer types Cancer is not a disease: it is a COLLECTION of diseases Cancer Immunotherapy As such, there is no ONE FITS FOR ALL solution Immunotherapy can provide the ultimate personalized therapy by harnessing the patient own’s immune system against cancer
  • 24.
  • 25.
  • 26. Cancer cell Cancer Immunotherapy “Traditional” cancer treatments (chemo and radiotherapy) activate the immune system Cancer cell Cancer cell Cancer cell Radiotherapy Chemotherapy DC CTL !!!!!! ????? Well done mate
  • 27. Exclusion Lack of recognition Suppression How do the Cancer evade the immune response?
  • 28. Exclusion Lack of recognition Suppression Different cancer immunotherapies target different angles of immune-evasion How do the Cancer evade the immune response?
  • 29. Cancer Immunotherapy Cancer cell Cancer cell Cancer cell Cancer cell VACCINATION ADOPTIVE CELL TRANSFER ANTIBODIES ONCOLYTIC VIRUSES
  • 30. Cancer Immunotherapy Cancer cell Cancer cell Cancer cell Cancer cell VACCINATION ADOPTIVE CELL TRANSFER ANTIBODIES ONCOLYTIC VIRUSES
  • 31. Cancer Vaccines Vaccines are the “go-to” strategy for immunologists The idea is to elicit a strong immune response against tumors Problem: for pathogens, vaccines are PROPHYLACTIC not THERAPEUTIC
  • 32. Cancer Vaccines Vaccines are the “go-to” strategy for immunologists The idea is to elicit a strong immune response against tumors Problem: for pathogens, vaccines are PROPHYLACTIC not THERAPEUTIC Prevent cancer to form in the first place e.g.: HPV vaccine prevents cervical cancer
  • 33. Cancer Vaccines Vaccines are the “go-to” strategy for immunologists The idea is to elicit a strong immune response against tumors Problem: for pathogens, vaccines are PROPHYLACTIC not THERAPEUTIC Prevent cancer to form in the first place e.g.: HPV vaccine prevents cervical cancer Cure cancer in patients: harder to achieve because the tumor is already there!
  • 35. Cancer Immunotherapy Cancer cell Cancer cell Cancer cell Cancer cell VACCINATION ADOPTIVE CELL TRANSFER ANTIBODIES ONCOLYTIC VIRUSES
  • 36. Cellular Therapy Ca Ca Ca Ca Adoptive cellular therapy is based on the idea that T cells are capable of fighting tumors Ca Ca Ca Ca T cells with different specificity Expand T cells specific for the tumor Re-infuse tumor specific T cells into the patient
  • 37. T cell transfer works! Cellular Therapy Zacharakis N. et al, Nat Med., 2018 Before therapy 22 months after therapy Tumor
  • 38. Cellular Therapy Ca Ca Ca Ca Adoptive cellular therapy is based on the idea that T cells are capable of fighting tumors Ca Ca Ca Ca T cells with different specificity What if there was a way to make all the T cells reactive against cancer?
  • 39. CAR T cells: engineering T cells to fight cancer Cellular Therapy June et al. Science 2018CARs MAKE ALL T CELLS REACTIVE AGAINST TUMOR CELLS
  • 40. Cellular Therapy Ca Ca Ca Ca Adoptive cellular therapy is based on the idea that T cells are capable of fighting tumors Ca Ca Ca Ca Instagram: whiteheadfdn http://emilywhiteheadfoundation.org/
  • 41. Cancer Immunotherapy Cancer cell Cancer cell Cancer cell Cancer cell VACCINATION ADOPTIVE CELL TRANSFER ANTIBODIES ONCOLYTIC VIRUSES
  • 42. Antibodies are Y-shaped molecules produced by B cells. Antibodies bind with high specificity to their antigen. Antigens are usually microbial products, but in the lab we can produce antibodies that bind to molecules present in the body for therapeutic purposes. Antibodies https://www.labce.com/spg813210_antigenantibody_interaction.aspx
  • 43. Antibodies are Y-shaped molecules produced by B cells. Antibodies bind with high specificity to their antigen. Antigens are usually microbial products, but in the lab we can produce antibodies that bind to molecules present in the body for therapeutic purposes. Antibodies https://www.labce.com/spg813210_antigenantibody_interaction.aspx For example: we can use antibodies that activate immune cells against cancer by TAKING OFF THE IMMUNOLOGICAL BREAKS
  • 44. Inhibitory receptors regulate immune cell activation Antibodies The activation of immune cells, including T cells, is regulated by POSITIVE and NEGATIVE signals. This balance is important to prevent auto-immunity… … but tumors often exploit the NEGATIVE signals provided by the INHIBITORY CHECKPOINT RECEPTORS to escape the immune response.
  • 45. Antibodies Ca Ca Ca Ca Checkpoint blockade removes the break from the immune system Ca Ca Ca Ca T cells and NK cells kill tumor cells Antibodies blocking checkpoint receptors re-activate immune cells against cancer Ca Ca Ca Ca T cells and NK cells are inhibited by checkpoint receptors Ca Ca Ca Ca Ca Ca Ca Ca
  • 46. Taking off the breaks from the immune system has a therapeutic effect! Hodi F.S. et al., New Engl. J. Med. 2010 Ipilimumab Antibodies Topalian S. L. et al., New Engl. J. Med. 2012 Tumor
  • 48. Cancer Immunotherapy Cancer cell Cancer cell Cancer cell Cancer cell VACCINATION ADOPTIVE CELL TRANSFER ANTIBODIES ONCOLYTIC VIRUSES
  • 49. Oncolytic Viruses Let’s give cancer a cold… …a made in Ottawa story Dr. John Bell OHRI/uOttawa Oncolytic Virus pioneer
  • 50. Oncolytic Viruses Adapted from Nature Reviews Drug Discovery Antiviral responses are extremely complex and require many molecular components. Cancer cells often accumulate mutations that alter these pathways and make tumor cells more sensitive to viral infection.
  • 51. Oncolytic Viruses Let’s give cancer a cold… HEALTHY CELLS ELIMINATE THE VIRUS CANCER CELLS CANNOT ELIMINATE THE VIRUS BY KILLING THE TUMOR, THE VIRUS ALSO STIMULATES THE IMMUNE SYSTEM
  • 52. Oncolytic viruses in the clinic Before After Parker et al., 2008, Lancet Oncology Oncolytic Viruses
  • 53. Outline Cancer and the Immune System The Immunotherapy Revolution Conclusions The Hallmarks of Cancer The Immune System Cancer Immunoediting Taking off the breaks Educating the immune response A little help from…. a foe Where are we at and where are we going?
  • 54. Conclusions Immunotherapy revolutionized the clinical approach to cancer and provided hope to patients with previously incurable diseases HOWEVER There is still A LOT to do
  • 55. Conclusions Immunotherapy revolutionized the clinical approach to cancer and provided hope to patients with previously incurable diseases HOWEVER Therapy does not work or last in many patients: what can we do to improve the response? There are many immunotherapies available: how do we choose what is the best therapy for every patient? Safety is an issue for some immunotherapies: how do we reduce toxicity without compromising efficacy?
  • 56. Conclusions Immunotherapy revolutionized the clinical approach to cancer and provided hope to patients with previously incurable diseases HOWEVER Therapy is not efficacious or durable in many patients: what can we do to improve the response? There are many immunotherapies available: how do we choose what is the best therapy for every patient? Safety is an issue for some immunotherapies: how do we alleviate toxicity without compromising efficacy? RESEARCH IS THE ANSWER
  • 57. 1750 Courtwood Crescent, Suite 210
 Ottawa, ON K2C 2B5
 Telephone / Téléphone : 613-898-1871 E-mail: jmanthorne@survivornet.ca or info@survivornet.ca Website: www.survivornet.ca Twitter: @survivornetca Facebook: www.facebook.com/CanadianSurvivorNet Instagram: @survivornet_ca  Pinterest: http://pinterest.com/survivornetwork/ Many thanks: lab Honorary member Karen Jardine Marie-Claude Bourgeois-Daigneault Surgical Equipe Carolyn Nessim James Villeneuve Stephanie Johnson-Obaseki Rebecca Auer Joan Sealy Trust Lab members Cynthia Chan Denis Qeska Jonathan Hodgins Lysanne Desharnais Maria Park Serena Cortés-Kaplan Shaad Hasim