The next big advance in cancer treatment could be a vaccine.
After decades of limited success, scientists say research has reached a turning point, with many predicting more vaccines will be out in five years.
These shots aren’t the traditional vaccines which prevent diseases, but instead shrink tumours and keep cancer at bay. These experimental treatments are aimed at breast cancer and lung cancer. This year, there have been improvements reported for skin cancers melanoma or pancreatic cancer.
” We’re making something work. Now we need to get it to work better,” said Dr. James Gulley, who helps lead a center at the National Cancer Institute that develops immune therapies, including cancer treatment vaccines.
More and more, scientists are able to understand the way cancer can hide from our immune system. Cancer vaccines, like other immunotherapies, boost the immune system to find and kill cancer cells. And some new ones use mRNA, which was developed for cancer but first used for COVID-19 vaccines.
In order for a vaccine’s immune system T cells to be trained to see cancer as dangerous in the first place, Dr. Nora Disis, of UW Medicine’s Cancer Vaccine Institute, Seattle, explained. Once trained, T cells can travel anywhere in the body to hunt down danger.
“If you saw an activated T cell, it almost has feet,” she said. “You can see it crawling through the blood vessel to get out into the tissues.”
Patient volunteers are crucial to the research.
Kathleen Jade, 50, learned she had breast cancer in late February, just weeks before she and her husband were to depart Seattle for an around-the-world adventure. Instead of sailing their 46-foot boat, Shadowfax, through the Great Lakes toward the St. Lawrence Seaway, she was sitting on a hospital bed awaiting her third dose of an experimental vaccine. The vaccine is being given to her in order to determine if the treatment will reduce her tumor prior surgery.
“Even if that chance is a little bit, I felt like it’s worth it,” said Jade, who is also getting standard treatment.
Progress on treatment vaccines has been challenging. The first, Provenge, was approved in the U.S. in 2010 to treat prostate cancer that had spread. The patient must be able to process their own immune cells and then receive them via IV. There are also treatment vaccines for early bladder cancer and advanced melanoma.
Vaccin research for early cancer failed because cancer was able to outwit and outlast patients’ weakened immune systems. This is according to Olja Finn, vaccine researcher at University of Pittsburgh School of Medicine.
“All of these trials that failed allowed us to learn so much,” Finn said.
As a result, she’s now focused on patients with earlier disease since the experimental vaccines didn’t help with more advanced patients. Her group is planning a vaccine study in women with a low-risk, noninvasive breast cancer called ductal carcinoma in situ.
More vaccines that prevent cancer may be ahead too. Hepatitis B vaccinations have been used for decades to prevent liver cancer, and HPV vaccinations introduced in 2006, are effective against cervical cancer.
In Philadelphia, Dr. Susan Domchek, director of the Basser Center at Penn Medicine, is recruiting 28 healthy people with BRCA mutations for a vaccine test. Those mutations increase the risk of breast and ovarian cancer. The idea is to kill very early abnormal cells, before they cause problems. She likens it to periodically weeding a garden or erasing a whiteboard.
Others develop vaccines for people who have precancerous lungs nodules or other inherited cancer-risk conditions.
“Vaccines are probably the next big thing” in the quest to reduce cancer deaths, said Dr. Steve Lipkin, a medical geneticist at New York’s Weill Cornell Medicine, who is leading one effort funded by the National Cancer Institute. “We’re dedicating our lives to that.”
People with the inherited condition Lynch syndrome have a 60% to 80% lifetime risk of developing cancer. According to Dr. Eduardo Vilar Sanchez, MD Anderson Cancer Center, Houston, who leads two government-funded trials on cancer vaccines, recruiting them has been easy.
“Patients are jumping on this in a surprising and positive way,” he said.
Drugmakers Moderna and Merck are jointly developing a personalized mRNA vaccine for patients with melanoma, with a large study to begin this year. These vaccines can be customized for each patient based on their specific cancer tissue mutations. This personalized vaccine can teach the immune system how to search for cancer cells with mutations and destroy them.
Todd Pieper, 56, from suburban Seattle, is participating in testing for a vaccine intended to shrink lung cancer tumors. His cancer spread to his brain, but he’s hoping to live long enough to see his daughter graduate from nursing school next year.
“”I’ve got nothing to loose and everything to gain – either for myself or other people in the future,” Pieper explained his decision to become a volunteer.
One of the first to receive the ovarian cancer vaccine in a safety study 11 years ago was Jamie Crase of nearby Mercer Island. Diagnosed with advanced ovarian cancer when she was 34, Crase thought she would die young and had made a will that bequeathed a favorite necklace to her best friend. Now 50, she has no sign of cancer and she still wears the necklace.
She doesn’t know for sure if the vaccine helped, “But I’m still here.”
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