Cancer drugs are notorious for offering slim odds of helping patients live longer, while guaranteeing they’ll suffer some unhappy side effects. Lots of scientists are searching for clues in the genome for how to select people most likely to benefit from a drug, while sparing everyone else. Boston-based Immuneering thinks there’s a better place to look—the immune system.
Immuneering popped on my radar at last week’s XSITE event at Boston University, where I met CEO and founder Ben Zeskind. He’s 27, with a list of accomplishments that puts him in boy wonder territory. He’s got a bachelor’s in electrical engineering and computer science from MIT, a Ph.D in bioengineering from the Whitehead Institute, and an MBA from Harvard Business School. Zeskind didn’t tell me about his background, but got my attention when he said he’s recruited Bob Carpenter to be his chairman and mentor. Carpenter is 64, a 30-year biotech entrepreneur who once sold a company to Genzyme (NASDAQ: GENZ) for $1 billion, and since then has spent 15 years on the Cambridge, MA-based biotech giant’s board of directors.
This mentor-and-protege team has its sights on making a fundamental change in cancer treatment. Immuneering wants to take blood and tumor biopsy samples, look at whether the patient has immune cells with the right characteristics to produce a powerful, long-lasting immune response against tumors, and run those readouts through a proprietary mathematical model to predict the odds that a patient will respond to a drug. This fundamental understanding should also offer suggestions for how to boost the odds of success, explain why some drugs work for individuals and not others, and do it for virtually every type of cancer with a few tweaks to the model, Carpenter says.
Since the global market for cancer drugs was worth $66 billion in 2008, and is expected to grow to $84 billion by 2012, governments and health insurers are going to continue putting a lot of pressure on drugmakers to justify all that cost, largely through tools that can predict whether a drug will actually work or not.
“Nobody that we know of is taking this kind of approach,” Carpenter says. “Maybe it’s because I was a computer scientist in the early days, but I love the precision of the mathematical modeling. This is the way to go to understand how drugs interact with the immune system, so we can make better predictions on which drugs will work.”
Immuneering is starting out by trying to solve one of the classic prescribing problems for oncologists. Patients with kidney cancer or melanoma that has spread through the body can get Novartis’ interleukin-2 (Proleukin), a drug that offers about a one-in-10 chance of providing a long-lasting remission, while putting patients through nasty side effects that often end up putting them in an intensive care unit, Carpenter says. The drug costs $60,000, so insurers understandably would like to see some solid evidence it will work before they start writing reimbursement checks.
The Immuneering model looks at all kinds of variables in blood and tissue samples to get a handle on the probability a patient will be one of those success stories. It looks at ligand proteins on the surface of a type of immune cell known as Natural Killer cells. The Immuneering test examines whether a Natural Killer cell has characteristics that make it likely to be activated by a drug, but it accounts as well for whether the tumor has some of the sneaky traits that undermine the tumor-killing ability of Natural Killer cells. It also takes into account other factors, such as how many inflammatory proteins are in the blood with the potential to be activated against tumors, Carpenter says. It might even be useful for predicting how patients will respond to treatment for autoimmune diseases, in which the immune system goes haywire and starts attacking healthy tissues. The research underpinning all this has its roots in the MIT lab of Doug Lauffenburger.
This whole concept still needs proof, and the proof is going to require some money. About $2 million in venture capital, to be precise, Carpenter says. That amount is needed to pay for a study of 60 patient samples, which looks backward in time to see whether this test would have successfully predicted who responded, and who didn’t, to a course of interleukin-2 treatment. The study has already received approval by the patient safety monitoring board of Kaiser Permanente, Carpenter says.
A future study, a prospective one that makes predictions upfront and then follows patients over time to see how accurate those predictions really are, will be done later to pass tougher muster with the statisticians.
If that test and subsequent studies are successful, Carpenter says he envisions building a business in which a company lab offers a service, at $5,000 to $6,000 per test, that offers physicians far greater confidence that, say, a $60,000 drug is going to be effective. The doctor would get the answer in 2-3 weeks, Carpenter says. This service could be ready for commercialization in about two years, he says.
Carpenter’s role in all of this is to help “refine” the Immuneering business plan, open doors for Zeskind with venture capitalists, and help make the company pitch to investors about one or two days a week, he says. He was introduced to this idea during the Harvard Business School Business Plan competition, when he was serving as an alumni judge, and a classmate of Zeskind’s brokered a meeting. Carpenter says he and Zeskind hit it off right away. “I was extremely impressed,” Carpenter says. “He’s a brilliant guy.”
Then Carpenter did what experienced mentors do, helping form a connection for Zeskind with Mara Aspinall, the former president of Genzyme Genetics, who agreed to sign on with Immuneering as a business advisor. (For readers who live outside Boston, this is the part where you can get jealous, and see why having a critical mass of talent in a biotech cluster is so important to starting companies.)
Zeskind sounds like the partnership he’s formed with Carpenter is helping him pick up a lot of things you can’t learn at Harvard Business School.
“Bob brings the wisdom that comes from decades of startup experience and a fantastic track record,” Zeskind says. “Bob has devoted his entire career to improving human health, and is passionate about Immuneering’s approach for harnessing the immune system to fight cancer and autoimmune disease. We work closely on a daily basis, and he is an excellent mentor. I think anyone who has heard our pitch would agree that we make a great team.”
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