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Skip to 0 minutes and 11 seconds GARY MIDDLETON: Hello, my name is Gary Middleton. I’m a professor of Medical Oncology at the University Hospital, Birmingham. And I’ve also got a contract with the University of Birmingham as well, in the Institute of Immunology and Immunotherapy. So my two main sort of clinical interests are colorectal cancer and lung cancer, two big killers still. And still two diseases where we’ve still not got great treatments for it. And so I’m very interested in pushing forward research in these two areas. In particular pre-clinical and translational interests, again really in immunobiology. Particularly in understanding what sort of cells stop the immune system from working.

Skip to 0 minutes and 44 seconds I’m also very interested in how the genetics of a cancer, the various mutations and the genetic abnormalities, determine the immunological substrate of the tumours themselves. So we’ve been thinking about the immune system and cancer for over 25 years now. It’s been a very frustrating 25 years, really. We’ve tried many sorts of ways of trying to harness the immune system to fight cancer, often using things like cancer vaccines, and it’s been very difficult. But the last three years there’s been a complete revolution in the way we’ve thought about this. In particular, the use of drugs, which we call the immune checkpoint inhibitors, have totally transformed the way we treat cancer.

Skip to 1 minute and 20 seconds I remember sitting in the audience it’s our main American meeting in 2012 when the first stage was presented, and I was blown away by this. These were patients where we were using treatments to block something that stops the immune system from working in cancer. And we were seeing some really amazing results. Not just in tumors where we usually think there might be an immune reaction, like melanoma and renal cancer, but in ones where we thought there was no immune reaction at all, lung cancer, the great killer.

Skip to 1 minute and 47 seconds To see patients with lung cancer, who we’d always thought had a completely switched off immune systems, responding to a treatment that was just activating their own immune cells to kill their own cancer was amazing. And this was based on pre-clinical work that had been going on over several years. And to actually see this start to translate into the clinic was phenomenally exciting. I first started treating patients with these agents in 2013, and was completely bowled over. Not every patient responds to this. But the ones that do respond to it, often they’re very deep responses which are very long lasting. It’s this long lasting response that’s most important.

Skip to 2 minutes and 22 seconds When we think about chemotherapy, or even targeting therapy, we get some responses in patients, but they’re short lived. What we’re seeing with these patients that respond to these immune checkpoint inhibitors– remembering the only thing that’s really driving these responses is the patient’s own immune system– we’ve seen patients go into complete remission and stay there. I have three patients who are literally dying of their lung cancer, who were treated in late 2013, early 2014, who are in complete remission from their cancer. Completely and utterly well, having a great, fulfilling, excellent quality of life. You’re never going to see that with personalised medicine. You’re never going to see that with standard chemotherapy. It is quite unique.

Skip to 3 minutes and 0 seconds This idea that you could take a single drug with an excellent side effect profile, give it to the patient to allow their own immune cells to finally see their own cancer and kill their own cancer cells, is phenomenally exciting. And we really here in Birmingham, this is something we’re very, very keen on not only understanding why patients respond, but particularly why they don’t respond. We want to unpick why patients don’t respond to these agents so they combine it with drugs that can make them then respond to that. This is what we’re all about here.

Checkpoint blockade – an oncologist's perspective

In this video, Gary Middleton, Professor of Medical Oncology at the Queen Elizabeth Hospital, Birmingham, reflects on how novel immunotherapies called ‘Checkpoint Blockade’ are having dramatic effects in patients with cancer.

Make sure you watch the animation later on in Step 3.5 to understand how these therapies work.

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This video is from the free online course:

Cancer Immunotherapy: a Step Change in Cancer Treatment

University of Birmingham