Cancer Treatment Next Major Advance could be Vaccine

The next significant development in cancer treatment may be a vaccine. After decades of limited success, researchers have reached a turning point, with many predicting the release of additional vaccines within five years.

These are not traditional disease-preventative vaccines, but rather injections to shrink tumors and prevent cancer from returning. In addition to breast and lung cancer, melanoma and pancreatic cancer have also shown improvement this year.

“We’re getting something to 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 than ever, scientists comprehend how cancer conceals itself from the immune system of the body. As with other immunotherapies, cancer vaccines stimulate the immune system to locate and destroy cancer cells. And some of the newer ones utilize mRNA, which was originally developed for cancer but was first used in COVID-19 vaccines.

For a vaccine to work, it needs to teach the immune system’s T cells to recognize cancer as dangerous, said Dr. Nora Disis of UW Medicine’s Cancer Vaccine Institute in Seattle. 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 critical to the study.

Kathleen Jade, 50, was diagnosed with breast cancer in late February, just weeks before she and her husband were to go on an around-the-world trip. Instead of sailing their 46-foot boat, Shadowfax, over the Great Lakes into the St. Lawrence Seaway, she sat in a hospital bed, waiting for her third injection of an experimental vaccination. She’ll get the vaccine to test if it shrinks her tumor before surgery.

“Even if that chance is a little bit, I felt like it’s worth it,” said Jade, who is also getting standard treatment.

The development of therapeutic vaccines has proved difficult. The first, Provenge, was licensed in the United States in 2010 to treat advanced prostate cancer. It entails preparing a patient’s own immune cells in a lab and administering them via IV. Treatment vaccinations are also available for early bladder cancer and metastatic melanoma.

Cancer outwitted and outlasted patients’ weakened immune systems, according to Olja Finn, a vaccine researcher at the University of Pittsburgh School of Medicine.

“All of these trials that failed allowed us to learn so much,” Finn said.

As a result, because the experimental vaccines did not assist more advanced patients, she is now focusing on people with early disease. Her group is developing a vaccination research in women with ductal carcinoma in situ, a low-risk, noninvasive breast cancer.

More cancer-prevention vaccines may also be on the way. Hepatitis B vaccines, which have been around for decades, prevent liver cancer, while HPV vaccines, which were launched in 2006, protect cervical cancer.

Dr. Susan Domchek, director of the Basser Center at Penn Medicine in Philadelphia, is seeking 28 healthy patients with BRCA mutations for a vaccination test. These mutations raise the risk of developing breast and ovarian cancer. The goal is to eliminate aberrant cells at an early stage, before they cause issues. She compares it to tending a garden or erasing a blackboard on a regular basis.

Others are working on vaccines to prevent cancer in persons who have precancerous lung nodules or other hereditary cancer risk factors.

“Vaccines are probably the next big thing” in the fight to minimize cancer fatalities, according to Dr. Steve Lipkin, a medical geneticist at New York’s Weill Cornell Medicine who is leading one National Cancer Institute-funded effort. “We’re dedicating our lives to that.”

People who have Lynch syndrome have a 60% to 80% lifetime risk of acquiring cancer. According to Dr. Eduardo Vilar-Sanchez of MD Anderson Cancer Center in Houston, who is directing two government-funded research on vaccines for Lynch-related cancers, recruiting people for cancer vaccine trials has been very easy.

“Patients are jumping on this in a surprising and positive way,” he said.

Moderna and Merck are working together to develop a tailored mRNA vaccine for melanoma patients, with a big research set to begin this year. The vaccines are tailored to each patient’s cancer tissue, which has many mutations. A vaccination that has been tailored in this way can train the immune system to look for and kill cancer cells that have a mutation fingerprint.

However, such vaccines will be prohibitively expensive.

“You basically have to make every vaccine from scratch. If this wasn’t personalized, the vaccine could probably be made for pennies, just like the COVID vaccine,” said Dr. Patrick Ott of Dana-Farber Cancer Institute in Boston.

The vaccines being developed at UW Medicine are intended to benefit a large number of people rather than a single patient. Early and advanced breast cancer, lung cancer, and ovarian cancer are all being studied. Some results could be available as early as next year.

Todd Pieper, 56, of Seattle’s suburbs, is taking part in clinical trials for a vaccination designed to decrease lung cancer tumors. Although his disease has progressed to his brain, he hopes to survive long enough to watch his daughter graduate from nursing school next year.

“I have nothing to lose and everything to gain, either for me or for other people down the road,” Pieper said of his decision to volunteer.

Jamie Crase of adjacent Mercer Island was among the first to receive the ovarian cancer vaccination in a safety study 11 years ago. Crase, who was diagnosed with severe ovarian cancer at the age of 34, assumed she would die early and left a treasured necklace to her best friend in her will. She is now 50 years old, cancer-free, and still wears the necklace.

She doesn’t know for sure if the vaccine helped, “But I’m still here.”

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