Cancer cases could rise by 50 % by 2020, with 15 million new cases every year in the world (1). Surgical operation is not a sufficient solution for long-term remission and many cancers are not operable. For example, only 20% of patients with pancreatic cancer have surgically resectable tumors at the time of diagnosis. Among these 20% patients, the vast majority will experience recurrence within the first 2 years (2).

Cytotoxic chemotherapy is the most available treatment for cancer. Unfortunately, the efficacy of chemotherapy is limited and cures are rarely achieved, in particular for solid tumors (3). Little improvement has been made for overall survival with chemotherapy alone. In particular, most chemotherapies kill target cells by triggering a process of programmed cell death and this mode of cell death can be tolerogenic for cancer (3). Second, lymphocyte depletion is a common side effect of many anti-cancer drugs.

In 2013, immunotherapy was awarded « breakthrough of the year » by Science (4). This consists of inducing the immune system against cancer cells. It is now administered in first line or combined to chemotherapy to overcome its potential immunosuppressive effect. On the contrary of chemotherapy, it can provide a durable effect with improved survival (5).

Two strategies are employed in immunotherapies : active and passive. Passive immunotherapy is based on external immunity effectors delivered to the patient, like monoclonal antibodies or cytokines delivery. Their main advantage is that they do not rely on the immune system, for immunocompromised patients for example. In addition, they offer an immediate protection. However, this first generation of immunotherapies do not provide a long-lasting protection and their efficiency is limited by a lack of specificity toward the patient tumor antigen. The objective of active immunotherapy is to break this tolerance by eliciting a CD8+ response against specific tumor antigens. Advantages of it include the induction of a long immune response with an immunological memory, and many vectors available for induction according to the cell type targeted. Active Immunotherapies are essentially targeted therapies, but they are not personalized to the patient tumor antigen. The main limitation for personalized active immunotherapy are development costs. One of the first immunotherapy approved against melanoma, Yervoy, cost in average 40,000$ a month and is not specific (6). Immunotherapies more specific and based on dendritic cells (DC), like Provenge®, are even more expensive with 93,000$ for each treatment (7), because DCs induction is an ex vivo labor-intensive process. In the case of Provenge®, patients must match the prostate tumor antigen PAP in order to qualify for this therapy.High production costs prevent these active immunotherapies to be adapted to the patient features, limiting the therapeutic outcome.

To cut down costs and production time while improving efficiency, we created a yeast targeting dendritic cells in vivo, based on the non-pathogenic baker yeast S. cerevisiae. Our living chassis takes advantage of the synthetic biology approach to make personalized medicine a reality, with a scalable cancer therapy. The standardized chassis targeting DC is personalized to the patient tumor antigen introduced in the form of plasmid in the chassis.

Antigen prediction

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Surface display

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In vitro and in vivo

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Tumor environment modulation

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Hypoxia Biosensor

Hypoxic resistant cancer cells are still able to evade the immune response. To detect these hypoxic cancer cells that can resist both chemotherapy and radiotherapy, we created a yeast bio-sensor for hypoxia. Upon detection of hypoxic tumor environment, S. cerevisiae releases perforin and granzyme B to trigger cell apoptosis. The proof of concept was established with RFP production under control of our bio-sensor and a hypoxic gradient.

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References

1. Le monde », online article of 12/12/2013 : http://www.lemonde.fr/sante/article/2013/12/12/hausse-du-nombre-de-cancers-le-constat-alarmiste-de-l-oms_4333500_1651302.html

2. K D. Forinash, S Pilon-Thomas and G M. Springett, Immunotherapy Combined With Chemotherapy for Pancreatic Cancer: A Game Changer? OncLive, Friday, September 5, 2014

3. Van der Most G, WS Robinson, A Lake, Combining Immunotherapy With Chemotherapy to Treat Cancer, Discovery Medicine, 5(27):265-270, 2005

4. Cancer Immunotherapy, Science, Vol. 342 no. 6165 pp. 1432-1433

5. Hodi, F. S. et al. Improved survival with ipilimumab in patients with metastatic melanoma, 2010, N. Engl. J. Med. 363, 711–723

6. Ledford H, Immunotherapy’s cancer remit widens, Nature, 28 May 2013

7. Dr. Len, Medicare Decides To Pay For Provenge, Leaving The Battle Over Cost And Value To Be Fought Another Day, American cancer society blog, mars 30, 2011