A cancer vaccine is a concept that seems torn from the plot of a futuristic sci-fi movie, or from the pages of a utopian novel from decades ago.
But the miracle of science exists today. And while much work remains to be done, he has been preventing cancer and saving lives for more than four decades.
“If you take a poll and ask people, ‘Do we have a vaccine against cancer?’ people will say no,” Karen Knudsen, CEO of the American Cancer Society, told fortune
“They really don’t know that we know.”
Pharmaceutical giants BioNTech and Moderna recently made headlines for exploring the potential of an mRNA vaccine, first used with COVID, to treat cancer. The vaccine uses different, lab-made messengers that teach the body how to mount an immune response.
But clinical trials have long been conducted using more traditional vaccine technology — and participants have received cancer vaccines, many of them personalized. Some vaccines have received approval from the US Food and Drug Administration. And vaccines to prevent cancer have been around since the 1980s.
If this is news to you, you are not alone. Doctors don’t always prescribe cancer-preventing vaccines or cure cancer to patients—due to lack of knowledge, or bias toward certain racial, gender, or age groups.
“Patients have to advocate for themselves,” said Dr. Nina Bhardwaj, director of immunotherapy in the Vaccine and Cell Therapy Laboratory and co-director of the Cancer Immunology Program at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York City.
We tend to think “the doctor is right,” he said. “But that’s not always the case, by any means.”
What is a cancer vaccine?
Cancer vaccines are not very different from vaccines for infectious diseases like flu, measles, mumps, and COVID, Dr. Keith Knutson, a professor of immunology at the Mayo Clinic who researches and develops cancer vaccines, said. fortune
Vaccines stimulate the immune system to fight a target—usually a virus. But in this case, the target is cancer.
Today, many cancer vaccines are therapeutic—used to treat patients who have developed advanced cancer, often in conjunction with other interventions such as chemotherapy, surgery, or radiation. Two are currently approved by the FDA, according to the Cancer Research Institute: one for early-stage bladder cancer, and the other for prostate cancer.
But there is also a vaccine for cancer survivors. It’s given to people in remission at high risk of relapse, Knutson said. He led a Department of Defense-funded study testing vaccines to prevent recurrence of triple-negative breast cancer.
Then there is a vaccine that can prevent all cancers. There are four FDA-approved: three for HPV, or human papillomavirus, and one for Hepatitis B. All work to prevent infections that can cause cancer down the road. The HPV vaccine is recommended for boys and girls around age 11 or 12, but can be given as early as age 9, and age 26. The Hep B vaccine is recommended for everyone age 59 and younger, and adults 60 and older. at risk for infection.
While there are only a few approved cancer vaccines, they have a far greater impact. The HPV vaccine led to a 65% decrease in cervical cancer for women in their early 20s from 2012-2019, according to data released last month by the American Cancer Society. Such women will be the first to receive the vaccine, which was approved by the FDA in 2006.
Similar reductions should be seen in other cancers caused by HPV that typically occur later, such as head, neck, oral, rectal, and vulvar cancers, according to Knudsen.
“This is a major victory for science,” he said, referring to new data on the vaccine’s success. “We really can end cervical cancer as we know it for everyone, if vaccination happens” – and the same should apply to other HPV-related cancers.
Another target that many researchers are looking at: breast cancer. Laboratories around the world, including Knutson’s, are particularly interested in developing a vaccine that can prevent the world’s most common cancer—or at least prevent it from returning in survivors.
Knutson’s lab is working on a vaccine that targets six attack points often found in breast cancer. Fortunately, many are also found in lung, ovarian, and pancreatic cancers.
“We may have produced an immune system that targets breast cancer specifically, but we think that immunity can also protect against other cancers,” he said.
How cancer vaccines work
Currently, vaccines that treat cancer are in active trials, with some exceptions. However, it’s not a cure – and getting it is more complicated than going to the pharmacy and getting a COVID or flu vaccine.
Personalized cancer vaccines are common in clinical trials. But developing it is a long process. And as Dr. Phillip Febbo, chief medical officer at the biotechnology company Illumina, said, “Cancer does not wait.”
Febbo calls personalized cancer vaccines “specialized therapies.” For each patient, the specialist must determine the tumor that can be removed through biopsy. Then the patient has to undergo a biopsy and the tumor cells are genetically sequenced by a company like Illumina. The sequence is analyzed to determine the most effective vaccine composition for a given patient. Then a personalized vaccine must be produced and delivered to the patient.
Each step can take weeks, if not months—usually about six months in total, according to Knutson. Time is “something we struggle with every day,” he said.
Illumina provides genetic sequencing capabilities to Moderna for a melanoma prevention vaccine, which is given to people who have been diagnosed and have had their tumors removed, Febbo said.
Patients who took the new vaccine and Merck’s Keytruda, a monoclonal antibody therapy that helps immune cells kill cancer cells, were 44% less likely to die or have their cancer return, compared to a group that took only Keytruda, the company announced in December. The drug is moving into Phase 3 trials, the last before FDA approval.
Febbo’s company has reduced the time it takes to sequence a genome to about a day, instead of weeks, he said — a move that facilitates faster delivery of specialized vaccines.
Knudsen, Knutson, and others are intrigued by the success of Moderna’s cancer vaccine. They hope that mRNA technology is the key to speeding up the process of making a personalized cancer vaccine – one that has far more resistant side effects than chemo.
“Now we’re in a new era, just looking at mRNA vaccines,” Knudsen said. “Is mRNA vaccine technology a new frontier for us? This is still an open question.
How to get a cancer vaccine
The future of cancer vaccines is bright, experts say — but it may not be so bright for everyone.
All experts fortune said he worries that new medical technologies like cancer vaccines could disproportionately benefit the privileged — and out of reach for many marginalized members of the population.
This is a trend seen in clinical trials in general, and one that is not new to health care, Bhardwaj said.
“Poor or underserved populations are less likely to be included,” he said.
Bias, unconscious and otherwise, is often against patients who are not white, women, and the elderly. Because of this, doctors may not recommend clinical trials or some treatments, and “patients have to advocate for themselves,” he said.
Case in point: Black men are about twice as likely to die from prostate cancer as white men. “Some of that is because we don’t know enough about the genetics of risk,” he said. “But some lack access to treatments and clinical trials,” which offer “the most advanced forms of treatment.”
If a patient is interested in a possible vaccine for cancer—approved or in clinical trials—they shouldn’t wait for an oncologist to suggest the possibility, experts say. fortune.
“Ask, ‘Am I eligible? What are the benefits and concerns? What are my treatment options?'” Knudsen advises. “Get a second opinion when you can.”
How close is it to widespread availability of a cancer vaccine?
Most of the current cancer vaccines are for people with advanced disease. It’s an “advancement of natural medicine” to start with those who need it most, Febbo said. “We make progress, then take that progress and progress earlier and earlier” in the disease stage.
Knutson predicts an increasing number of therapeutic cancer vaccines will be developed over the next decade. There are many Phase 2 clinical trials and few such Phase 3 clinical trials, which means more help needs to be done soon, he said — with an emphasis on “must.”
Sometimes, the problem is not a lack of successful new treatments, but a lack of funding to carry them through to the finish line.
“Part of the problem is, and continues to be – in all realms, whether it’s cancer vaccines or other treatments – there are people who have to take (the cost of) higher-level clinical studies,” like Phase 3 trials, he said.
“An academic like me might be able to go through Phase 1 or 2 and show promising results, but the landscape is competitive and popular among investors and what doesn’t determine whether there is a Phase 3 clinical trial.”
“There’s no question there are a lot of missed opportunities” over the years, Knutson said. In a worst-case scenario, his team develops a successful cancer vaccine but cannot secure the resources for Phase 3 trials, which are required for FDA approval.
In such a situation, they can encourage that future researchers will be able to build on the progress made by the team by reading the published findings.
“Although it may be uncomfortable if I don’t get to see this particular vaccine or that vaccine move forward, I will know that I have contributed to the scientific base that guides the future,” he said.