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May 7, 2025 • 17 mins

This week on BioTech Nation, we explore a new approach to cancer treatment that could help patients manage pain without compromising their care. Dr. Lorin Johnson, CSO of Glycyx Therapeutics explains how a new once-daily pill could help patients manage pain without blocking their treatment.

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Episode Transcript

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Dr. Moira Gunn (00:11):
On average, over half of cancer patients suffer
with significant pain, and forthat pain, they are primarily
prescribed opioids. But nowthere is scientific evidence
that opioids may in factinterfere with the very
immunotherapy they are takingfor their cancer. Today's

(00:32):
interview is about one company'sbig idea now beginning clinical
trials to enable both theimmunotherapy and the opioids to
be effective. Doctor. LorinJohnson is the Chief Scientific
Officer of Glycyx Therapeutics.
Doctor. Johnson, welcome to theprogram.

Dr. Lorin Johnson (00:52):
Thank you, Moira.

Dr. Moira Gunn (00:53):
Now I remember when immunotherapy for cancer
came on the scene and it's beenbasically a decade now and there
was so much hope for it. Inreality, the response rate has
been about fifteen to twentypercent. And if that works for
you, that's fantastic, but thatleaves a lot of people out. Now

(01:13):
with all that tremendous hope inthe beginning, we've all
wondered, you know, why doesn'tit work better? And then I see a
paper from late last fall, lastNovember, in a well respected
peer reviewed British medicaljournal, the Journal for
Immunotherapy in Cancer.
And doctor Johnson, your namewas one of the some dozen

(01:34):
scientists who together authoredthat paper. How does morphine
that a cancer patient takes forpain work against the
immunotherapy that same cancerpatient is taking?

Dr. Lorin Johnson (01:48):
-Well, that has been a puzzle, and as you
know, a lot of cancer patientstake opioids for pain, up to
fifty percent, and in studies oncheckpoint inhibitors now,
immunotherapy, in over onethousand patients, Patients
taking opioids have been shownto not respond as well and to

(02:10):
actually die about twice as fastas patients not taking opioids.
So we wanted to test this in ananimal model, and that's what
the paper's about.

Dr. Moira Gunn (02:22):
So we knew it in humans already, and we went back
to test it in I think it wasmice. I think he went back and
tested it in mice. It usuallygoes the other way. We see it in
mice, let's test it in humans.But you said, We're seeing this
in humans, let's see if we canreproduce it.

Dr. Lorin Johnson (02:39):
-Yes, and this was very key. Our
collaborators at UPMC hadalready published on head and
neck cancer, and they had foundthat in their head and neck
cancer patients on immunotherapyand opioids, the immune cells
did not invade the tumor. So wethought maybe we could reproduce

(03:00):
this in an animal model and seewhat the mechanism is.

Dr. Moira Gunn (03:03):
And it did. It worked, or it didn't work, as
the case may be.

Dr. Lorin Johnson (03:07):
-We reproduced the clinical effect
the animal model, yes.

Dr. Moira Gunn (03:12):
Wouldn't it be terrific if we already had a
pain pill among so many that wehave that didn't interfere with
the immunotherapy, or at leastbe close on a pain pill, and
that's where Glycic comes in.

Dr. Lorin Johnson (03:28):
Well, that's right. As you know, opioids work
in the brain, but what a lot ofpeople don't know is they work
all over the body also. So theysuppress pain in the brain, but
they have multiple effectsoutside of the brain, on the
immune system, on the GI system,and some of these are very

(03:49):
deleterious. In fact, what weknow is they suppress the immune
system. So what Glysix has is adrug that antagonizes, that
stops opioids from workingoutside of the brain.
Our drug does not go into thebrain, and it blocks opioid

(04:09):
actions outside of the brain.And it turns out this is the way
to block the opioid effect onthe immune system.

Dr. Moira Gunn (04:17):
Okay, so now, of course, this isn't easy or we
would have done it yesterday oryears ago. This has to be
tested. But you said to me awhile back that our bodies
produce natural opioids,endorphins, that can interfere
with immunotherapy, and that thetumors themselves can produce

(04:38):
opioids. Wouldn't this have anadverse reaction anyway?

Dr. Lorin Johnson (04:44):
-Yes. In fact, the tumors that produce
opioids, and melanoma is onethat's well known to do so,
suppress the immune system fromattacking them. And this is one
of the reasons why they are ableto thrive in the body.

Dr. Moira Gunn (05:00):
-We know that we're taking the opioids to
suppress the pain, but why dothey suppress the immune system?

Dr. Lorin Johnson (05:08):
-Well, Moira, the whole opioid system evolved
as part of essentially a woundhealing process. So back in
evolution, our genes encodedwhat we know as endorphin. When
we have a wound, we have a tigerbite in the Serengeti, we have

(05:34):
to deal with that, and opioidshelp produce the growth of new
blood vessels into the wound,the, new connective tissue, and
it keeps the immune system fromoverreacting to the wound. So

(05:54):
it's a mechanism of woundhealing. And cancer cells Cancer
has figured out that's just away to bypass everything and
stay under detection of theimmune system.

Dr. Moira Gunn (06:06):
So actually, natural opioids have a really
sophisticated and very positivefunction. It's just that the
synthetic ones we take for painhave really That is a bad turn
here.

Dr. Lorin Johnson (06:22):
Yes, yes. The natural opioids are produced
every night in your body. It's awave that comes through in the
middle of the night, but theydon't stay constant. They come,
they go, they come, they go. Butwhen we take medicinal opioids,

(06:43):
they're active the whole time,and that just pushes the system
into the completeimmunosuppressive side.

Dr. Moira Gunn (06:51):
We can block what the opioids you're taking
are doing. Can it also block thenaturally occurring opioids and
the ones that the tumor isproducing?

Dr. Lorin Johnson (07:04):
In fact, we do. In fact, some of the first
preclinical studies we performedwere in animal models where
there were no opioids given, nomedicinal opioids given, and in
fact, we showed that we couldenhance the effect of
immunotherapy even in theabsence of medicinal opioids. We

(07:28):
were blocking the naturalopioids.

Dr. Moira Gunn (07:31):
-Okay, so this is very good news. And I think
some people out there aresaying, Well, why don't you just
tell these cancer patients notto take the pain pills?

Dr. Lorin Johnson (07:42):
-Well, unfortunately, pain is a very
specific kind of pain. It hasinput at the tumor site, it has
input at the metastasis sites,bone metastasis are quite
painful, and it's a combinationof central pain, neuropathic

(08:03):
pain, and there are noalternatives to opioid therapy
for cancer pain, yet. Obviouslythat would be a great place for
research. But until there's away to do that, our best
approach is to block the effectsof opioids outside of the brain.

Dr. Moira Gunn (08:23):
So the idea is take your immunotherapy, which
is our standard of care, takeyour opioids for the pain that
originates in the brain, andblock it in the rest of the
body. Correct. Got it. That's atall order, but I understand
that you've got well, you've gotfour different cancers that

(08:46):
you're working on. You know,head and neck, lung cancer,
melanoma, and you've gotpancreatic cancer.
And in the the first three thatI mentioned, you've got a phase
two b. That's an advanced studythat you're just about ready to
get going on here. Tell us aboutthat. Who are the cancer

(09:07):
patients? What do they do?
How long will it last?

Dr. Lorin Johnson (09:11):
So the combination therapy of our drug
with immunotherapy will belooked at in head and neck
cancer, lung cancer, as yousaid, and melanoma. The head and
neck cancer study will take acouple of years to complete,

(09:33):
lung and melanoma, probablythree years. And again, that's
with the combination therapy.The pancreatic cancer study that
you referred to is actually inend stage patients, end stage
cancer patients, includingpancreatic cancer patients, that
are taking opioids to survive tothe end of their life. And we

(09:58):
know that the side effects ofopioids on the immune system and
other actions in the body arecontributing to their shortened
survival.
That study is gonna start inAugust. We're ready to go with
that.

Dr. Moira Gunn (10:10):
What we're talking about there is getting
that up and running. How longwill that study take?

Dr. Lorin Johnson (10:16):
That study will dose patients for about a
year. It'll probably take abouteighteen months to fully
recruit.

Dr. Moira Gunn (10:23):
So that's what they do there. Now, let me ask
you about the other ones. Howdifferent in terms of pain are
people with head and neckcancer, lung cancer, and
melanoma?

Dr. Lorin Johnson (10:36):
Well, that's a really enlightening question,
because head and neck is verypainful. You can imagine
patients with cancers in theirmouth or their throat, where
they can't swallow, they can'teat. And so up to seventy
percent and greater of head andneck cancer patients take

(10:59):
opioids, exogenous opioids forpain, medicinal opioids. Lung
cancer is about fifty percent,so it's in the middle. And
melanoma is lower, maybe twentyto thirty percent, but melanoma
patients in those cancers, thoseare the ones that are producing

(11:19):
high amounts of endorphinthemselves.
So that's why melanoma is stilla really strong target for us.

Dr. Moira Gunn (11:28):
Well, this is really interesting in the
melanoma case because theirmelanoma is producing these
natural opioids, it's not aspainful. And it's like, Wait a
minute, we really need to get toyou. We really need to do this.

Dr. Lorin Johnson (11:48):
That's correct. Most of melanoma pain
comes when there are metastases.So they've gone to other
tissues. Melanoma does thisbecause the gene in the human
body that makes melanocytesstimulating hormone is in a big

(12:09):
complex gene that also includesbeta endorphin, so it's all in
one big gene product, andmelanoma cells are driven by
melanocyte stimulating hormone,that's their normal feel good
hormone, and it happens to endup producing endorphin at the
same time and suppressing theimmune system. So it's evolved

(12:34):
for melanoma as a way to thriveand get around the immune
system.
It's quite remarkable, actually.

Dr. Moira Gunn (12:42):
I know you guys wanna start all of these trials
tomorrow afternoon, if nottomorrow morning. You know? It's
like, I really wanna get onthis. And there are all of
these, you know, reasons to togo go deliberately here. And so
there's a there's a lot to beit's going to get pushed by by
what's available and resourcesavailable and people available.

(13:06):
But there's a real commonalitybesides the treatment that you
have, the once daily pill thatyou have. And that is that
you've gotta figure out what areyou gonna measure with these
patients when they're takingthis drug? What are you going to
measure? -:

Dr. Lorin Johnson (13:24):
We have to abide by what FDA uses for
approval of cancer drugs, andthose endpoints are progression
of the tumor. So does the tumorgrow? Does it stay the same or
does it shrink? And thenultimately, survival. And this
is why cancer studies take along time, because just getting

(13:47):
a tumor to stop growing doesn'tmean that it ultimately saves
the patient's life.
So the first phase of all ofthese studies is always to ask,
what did we do to the tumor? Didwe cause it to stop growing?
That's great. That shows thatour response rate has gone up.
But ultimately, we keep thepatients on the drug all the way

(14:10):
out the end of their life, andthat's where we get final
approval.
We also look at quality of lifein these patients. There are
other opioid side effects thatare very troublesome for these
patients, including commonlyknown, like constipation. We
know this drug alleviates thoseissues. We know we will produce

(14:35):
a benefit for quality of life,but unfortunately, cancer drugs
aren't approved just for qualityof life measures. We hopefully
will see a survival benefit.
Earlier, I talked about tumorprogression, but I should also
say that part of what will getmeasured are the appearance of
new metastases, And from ourprevious animal studies, we know

(15:00):
we have an effect on the abilityof cancers to metastasize, and
that is also driven by opioids.We mentioned previously that
opioids cause the growth of newblood vessels, and tumor cells
use this aspect to metastasizeand grow new tumors at new

(15:24):
sites. So we expect that as partof the suppression of the immune
system and the slowing of tumorprogression, we should also be
able to see an effect on tumormetastasis.

Dr. Moira Gunn (15:39):
Well, I have to say, this is very unusual to
have four clinical trials allready to go. Usually, it's like,
well, we we'll go to anotherindication and get the go ahead
to start studying that. You'reall ready to go. You pick
pancreatic cancer first, andthat's gonna start in August. So

(16:03):
good luck to you.
This is very exciting to notonly to see this be a real
possibility of hope for theimmunotherapy drugs, but also
that we're not asking people tobe in pain.

Dr. Lorin Johnson (16:18):
That's correct. So ultimately, it is
all about quality of life. Theycan take the opioid, they can
have their pain reduced, andthey can live longer.

Dr. Moira Gunn (16:30):
Well, thank you, Doctor. Johnson. Please come
back, keep us updated.

Dr. Lorin Johnson (16:34):
I will, and Moira, thank you for bringing
science to everybody.

Dr. Moira Gunn (16:38):
Doctor. Lorin Johnson is the Chief Scientific
Officer of Glycyx Therapeutics.More information is available at
glycyx.com. That's glycyx,glycyx Com.
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