followed army soldiers into war zones. Every unnecessary tool was a burden, so he tracked what his group used, how they used it, and what could and couldn’t be left behind. Peoples and his team also established standards—which they later wrote and published books about—on topics such as when to operate on wounded fighters and when to send them away on a transport.
Atul Gawande wrote about that work in a 2004 article published in the New England Journal of Medicine. Gawande is now a famous physician at Boston’s Brigham and Women’s Hospital and author, but when he first met Peoples, Gawande was a surgical intern at that same hospital in the 1990s. In the NEJM article, Gawande wrote that during Peoples’ service, the death rate among injured U.S. soldiers was the lowest among any prior wars the U.S. was involved in. (NPR interviewed them both.)
“I know of no one in medicine I hold in higher esteem,” Gawande wrote in a recommendation letter.
Peoples had an interest in vaccines throughout his career. He had published some 17 papers on vaccines by the time Gawande met him, and has the same number of patents under his name for his vaccines work, dating back to 1994. In 2000, he started an Army program to encourage research collaborations on cancer vaccines, both in the military and elsewhere. NeuVax was originally developed at MD Anderson, and Peoples helped develop it before it was licensed in 2004 by the company that eventually became Galena.
Peoples retired from the army in 2014 as a colonel and turned his full attention to oncology research. That year, he started a contract research organization, Cancer Insight, focused on cancer immunotherapy. He is aiding a nonprofit, the Metis Foundation, that aims to help military researchers gain federal and private funding for medical research. And he is the chief medical officer of a San Antonio startup, Rapamycin Holdings, which has an experimental treatment for cancer.
Cancer Vaccines: Past Failures And New Hope
Peoples’ transition to oncology has been a tough one, now headlined by the stinging failure of the breast cancer vaccine NeuVax. The vaccine, which has long had skeptics, made it all the way to Phase 3 testing before Galena disclosed that NeuVax failed badly. It performed worse than a placebo at preventing the recurrence of tumors in breast cancer patients, causing independent data monitors to recommend to Galena in June to halt the study. The trial was officially closed on Aug. 10, and Peoples says he is still having trouble making sense of what happened.
NeuVax isn’t alone, however. Several experimental cancer vaccines have flopped in trials run by a variety of drug developers, from GlaxoSmithKline to Merck to Celldex Therapeutics. The only cancer vaccine to win FDA approval was Dendreon’s sipuleucel-T (Provenge), and it had such a disappointing launch that Dendreon filed for bankruptcy in 2014 and later sold itself to Valeant Pharmaceuticals.
Nonetheless, investments in cancer vaccines have continued, as they’re one of many tools that researchers and biotech companies are trying to use in concert to spur the immune system to fight cancer. Likewise, Peoples says he remains invested and is moving forward, even if he questions his decision to make cancer research his sole focus.
“I’m still not sure it’s the exact right decision,” Peoples says about the decision. “Nevertheless, unfortunately, it’s somewhat of a necessary one.”
What’s next?
Peoples began dissecting the what he might do were NeuVax to fail, even before the data was released. Harkening back to the same questions he might have during a surgery or at war, he wondered, what’s working, and what’s not? The answer he’s come up with is a popular sentiment regarding cancer immunotherapy: combination therapy looks like the key to better results.
A cancer vaccine’s goal is to stimulate an immune response against a tumor. And NeuVax, specifically, was meant to train T cells—the immune system’s attack dogs—to seek out and kill cells expressing a specific protein, HER2, that helps cancer cells grow. The hope was this strategy would help prevent breast cancer from recurring after treatment with chemotherapy or surgery, making both more effective.
That idea—making a good therapy better—got Peoples to consider another question: What other therapies, especially other immunotherapies, might also work well with vaccines? The answer he came to was checkpoint inhibitors.
Checkpoint inhibitors are immunotherapy drugs that help T cells see tumors that they otherwise wouldn’t. The ‘checkpoints’ themselves are proteins that tumors can mask themselves with; by blocking checkpoints, these drugs reveal tumors’ true identity.
Over the past five years, four checkpoint inhibitors from
