New vaccines tailor-made to fight a patient's tumour could revolutionise cancer care: We speak to...
One year ago, Adrian Taylor received a heartbreaking diagnosis: he had an untreatable form of cancer in his lungs, and if left untreated, there was an absolute certainty that it would lead to his death, possibly in a matter of months.
However, at present, due to a pioneering experiment testing a cancer vaccine in the UK, he expresses that 'the feeling of hope has replaced despair. I am not succumbing to cancer, I am thriving with it and experiencing an immense sense of well-being'.
Adrian, a supply chain expert at the age of 54, received a diagnosis of head and neck cancer in December 2021.
Following enduring months of arduous chemotherapy and radiotherapy, a CT scan conducted in June 2022 indicated the absence of cancer in his head and neck. However, the scan also unveiled a 9mm tumor in his right lung, signaling that the cancer had metastasized and was now considered untreatable.
Adrian, residing in Wallasey, Merseyside alongside his wife, Karen, 61, and their three daughters and son, expressed that he had managed to cope with his initial encounter with cancer. However, the recent revelation was utterly devastating.
Adrian, a 54-year-old individual (shown in the photo), received a diagnosis of head and neck cancer in December 2021.
At that moment, the advisor expressed, 'Let me phrase it like this, Mr. Taylor: if you don't undergo the necessary medical care, there's a complete guarantee that you will succumb to this illness.' Instantly, I shifted into a mindset focused on survival. Thoughts of my kids, spouse, and loved ones raced through my mind. I felt compelled to stay alive and take care of them. It was a greatly humbling experience.
Adrian went back to his original cancer specialist to have a conversation about the choices he had. Unfortunately, chemotherapy and radiotherapy were no longer viable solutions since the cancer had progressed significantly. Additionally, scans revealed multiple tumors scattered throughout his lung, rendering surgery unsuitable.
According to him, one of the growths had expanded from 9mm to 25mm in just a few months, indicating that it was an extremely fast-developing cancer.
I found myself in a desperate situation, confrontating my mortality head-on. The only glimmer of hope I had left was to take part in a experimental study for a novel therapy.
Afterwards, in September of the previous year, he received a great opportunity - to participate in an experimental test for a cancer immunization, an innovative method that has the potential to completely transform the way the ailment is managed.
The experiment, taking place in Liverpool's Clatterbridge Cancer Centre, is aimed at individuals suffering from HPV-16-induced head and neck carcinoma, which corresponds to approximately one-third of all head and neck cancer cases. As a component of this trial, patients are additionally provided with pembrolizumab, an innovative medication referred to as a checkpoint inhibitor that aids in enabling the immune system to combat cancerous cells.
The aspiration is that the vaccine will trigger fresh immune cells that will additionally eliminate the cancer cells, efficiently enhancing the immune reaction to the tumor.
Cancer immunizations and checkpoint inhibitor medications belong to the category of immunotherapy, which are forms of treatment that operate by utilizing the immune system. James Spicer, a professor in experimental cancer medicine at King's College London, explains that these therapies focus on distinct facets of cancer biology.
Adrian's consultant recommended him to be a part of the trial group. 'After a couple of weeks, I met with them and they confirmed my suitability. I received the initial dose in November, and now I return every three weeks for additional doses and undergo scans every eight weeks,' he explains.
A CT scan conducted prior to the commencement of the trial revealed the presence of a minimum of six tumors spread across the right lung, ranging in width up to 25mm. Additionally, it was observed that these tumors were exhibiting rapid growth.
In the month of May, I had a meeting with a cancer specialist. He examined the most recent scan, expressing astonishment by shaking his head and uttering, "This is extraordinary." He proceeded to display the images to me - previously, there was a substantial grey area in my lung, an indication of cancer, but now it appeared to be free from it. It was an overwhelmingly surreal experience. The scan from last week revealed that only a small portion of cancer remained - the biggest tumor, measuring 25mm, had significantly diminished to just 4.6mm.
Cancer vaccines and checkpoint inhibitor medications fall under the realm of immunotherapy, which involves utilizing the immune system to combat diseases.
I feel like a brand-new person now, and I am carrying out activities that I never believed I could accomplish before: I accompanied my daughter as she walked down the aisle and got married in November, and I have witnessed the graduation ceremonies of two of my children within the last year. I am filled with an overwhelming sense of joy and optimism for what lies ahead in my life once again.
Adrian will continuously get immunized as long as he is simultaneously undergoing treatment with pembrolizumab; at present, this timeframe is limited to a maximum of two years.
He is among the initial recipients in the United Kingdom to experience the advantages of a cancer immunization.
In contrast to vaccines administered to prevent contagious illnesses like Covid, cancer vaccines primarily function as therapies, aiming to halt the recurrence of the disease for patients already afflicted by it.
The vaccinations have two options: ready-made (check out the story on the side) or customized specifically for the patient to combat their specific cancer, depending on its genetic configuration.
Once administered, the concept is that these vaccines prime the immune system to identify particular proteins in cancerous cells in order to eliminate them.
Professor Christian Ottensmeier, an expert in cancer treatment and the head of clinical research at Clatterbridge Cancer Centre, who provided care to Adrian, explains: 'In the case of a vaccine, it's similar to the process of training a sniffer dog to detect a specific smell. You would present the dog with a cloth carrying that scent and instruct it to locate it.'
A vaccine serves as a means to educate our brand new immune T cells, which can be likened to our trusty sniffer dogs. It is truly extraordinary to observe how Adrian's training has yielded such great results, as his cancer has significantly reduced in size.
I am pleasantly surprised by the level of progress he has made - we are all filled with joy and offering our support. This kind of achievement has a significant impact on my perspective regarding the potential and transformative power of a vaccine.
This form of cancer treatment is still in its initial stages and not everyone will experience such an extraordinary response to it. Nevertheless, we are extremely enthusiastic about the potential it holds.
Experts in the field of oncology have informed Good Health that the potential for cancer vaccines is vast, encompassing the ability to potentially address all forms of cancer.
At present, in addition to head and neck cancer, there are ongoing vaccine experiments taking place in the United Kingdom for prostate and colorectal cancers, as well as melanoma (a type of skin cancer). Furthermore, a forthcoming trial focusing on lung cancer is imminent.
At Clatterbridge, there are currently six ongoing trials for cancer vaccines. The United Kingdom has the opportunity to excel in cancer vaccine research, thanks to a collaboration between the government and BioNTech. This partnership aims to facilitate trials for personalized vaccines, intended to benefit 10,000 patients by 2030. This exciting announcement was made in July.
A newly developed cancer vaccine launching platform, created by NHS England, will aid in the recruitment of patients for these trials. This national hospital network aims to identify eligible patients for vaccination and ensure their access to these trials, regardless of the hospital where they are receiving treatment.
It has been reported that various other organizations are engaged in discussions regarding conducting cancer vaccine trials in the United Kingdom, such as Moderna and Merck.
Dr. Renato Baleeiro, a prestigious honorary senior research fellow at the Barts Cancer Institute, Queen Mary University of London, working on creating a vaccine for triple negative breast cancer, enthusiastically reveals that the recent financial support and agreement between BioNTech and the Government will facilitate the launch of additional clinical trials to evaluate personalized cancer vaccines. Furthermore, Dr. Baleeiro highlights that the United Kingdom is at the forefront of this revolutionary research field, with numerous ongoing and planned trials underway.
So what is the mechanism behind cancer vaccines? The fundamental technique is the identical cutting-edge mRNA method utilized amidst the pandemic to offer us the Moderna and Pfizer-BioNTech Covid-19 vaccinations.
Messenger RNA (mRNA) serves as the molecular blueprint that provides guidance to cells in producing proteins within our bodies.
Regarding Covid, the mRNA vaccine provided guidance to cells in order to produce the spike protein, which is detected on the external layer of the virus. Following immunization, cells commence the production of the spike protein, consequently "educating" the immune system to identify and generate cells that combat it. Subsequently, in the event of a future Covid infection, these immune cells become armed and prepared to combat it.
In the case of cancer, if researchers are aware of the specific protein responsible for its development, they have the option to employ a readily available mRNA vaccine. This vaccine provides instructions to cells, guiding them to produce the said protein. Alternatively, scientists can create a customized vaccine tailored to target the unique tumor of an individual patient.
Initially, an examination is conducted on a patient's tumor specimen to detect any alterations in the genetic makeup of the proteins accountable for its proliferation.
Next, a specifically designed molecule of the mRNA is manufactured to direct cells in producing the particular tumor protein, referred to as a neoantigen.
This substance is introduced into the individual, triggering the production of fresh cells that generate these tumor proteins. Consequently, these proteins educate novel immune cells, stimulating a reaction. The hypothesis implies that the immune system is subsequently prepared to acknowledge and eliminate the cancer.
According to Professor Spicer, the idea of immunizing against cancer has been present for many years, but it hasn't yielded remarkable outcomes up until this point.
There are numerous research studies that indicate vaccines can trigger a measurable immune reaction in the bloodstream. However, this has not been demonstrated to subsequently result in the reduction of tumors.
Over the last ten years, advancements in technology, like the analysis of genetic information and enhanced comprehension of the immune system's functioning in identifying and eliminating cancerous growths, have resulted in the development of improved vaccines.
According to Professor Spicer, we are now progressing from the theoretical aspect, which implies understanding the potential of training the immune system to identify and eliminate cancer cells, to a stage where it has practical significance and can actually provide advantages for patients.
Professor Ottensmeier concurs and asserts that the introduction of novel immunotherapy medications has imparted a significant impetus to the realm of cancer vaccines.
Medications like nivolumab and pembrolizumab excel at stimulating the immune cells that possess the ability to combat cancer. However, they do not educate fresh cells to perform the same task. This is when the vaccines play a crucial role, as stated by him.
According to Professor Spicer, if we stick to the strict definition, we should not refer to mRNA cancer vaccines as vaccines. Instead, he suggests labeling them as 'RNA therapeutics'. He explains that a conventional vaccine prepares the immune system to respond to an invader, such as the Covid virus, before it actually enters the body. However, in the case of cancer, we are stimulating the immune response to target something that is already present in the body, assisting it in fighting against a threat it previously couldn't handle.
As an illustration, let's consider individuals who underwent a surgical procedure to treat colorectal cancer. The tumor has been successfully removed, yet there exists a substantial probability of its recurrence owing to the presence of minuscule metastatic cells that remain in the body.
Rather than anticipating its growth, we will now choose to extract the tumor, decipher its genetic coding, produce an mRNA vaccine that generates the irregular proteins, and administer it to individuals. This way, the immune system can familiarize itself with and combat that particular protein if it comes across it anew.
'That's the ultimate goal in cancer treatment - and it's entirely personalized for every individual.'
According to Professor Spicer, this treatment strategy could potentially benefit individuals with any type of cancer since all cancers rely on genetic mutations to invade cells, thrive, and disseminate.
Several trials for custom-made cancer vaccines have shown positive outcomes thus far. At the American Association for Cancer Research conference earlier this year, it was revealed that over 75% of melanoma patients with high-risk conditions who received a personalised vaccine alongside immunotherapy experienced 18 months of living without recurrence. This surpassed the 62.2% recurrence-free survival rate observed in patients receiving immunotherapy alone.
According to a report by the journal Nature in May, a test that involved an mRNA vaccine for pancreatic cancer, which is known to be highly aggressive, took place at the Memorial Sloan Kettering Cancer Center in New York. The results indicated that approximately 50% of the 16 participants experienced either a prevention or a delay in the recurrence of the disease. Currently, there is an ongoing trial involving 260 patients to further explore the potential of this vaccine.
Robert Jones, a liver surgeon at Liverpool University Hospitals NHS Foundation Trust, is spearheading the groundbreaking research on colorectal cancer in the UK. According to him, they have made remarkable progress in this field. At present, they are capable of removing a tumor, analyzing the genetic code within the cancer cells, pinpointing the specific mutations, and developing a personalized vaccine for the patient, all within a timeframe of approximately seven weeks.
The vaccinations are administered through a quick injection. Various studies are exploring various approaches; while some administer two, three, or multiple shots of a particular vaccine post-surgery and chemotherapy (the 165 participants in the Liverpool-led trial for colorectal cancer, spanning 12 centers across the UK, will receive 12 shots), others follow a more continuous regimen. In addition to being customized to the individual's cancer, another benefit is that these vaccines do not cause the adverse effects typically associated with standard chemotherapy and radiotherapy.
Professor Ottensmeier clarifies: 'When we administer radiotherapy, the beams must pass through multiple layers including skin, muscle, bone, and other tissues. Unfortunately, it cannot distinguish between cancerous and healthy cells, thus causing equal harm to all cells it encounters. The use of chemotherapy presents a similar dilemma. By targeting dividing cells, it acts as a toxin that leads to the death of numerous cells, resulting in side effects like mouth sores, diarrhea, and low blood cell count. These toxic substances lack selectivity. In contrast, vaccines successfully prevent the occurrence of these adverse reactions.'
Adrian's personal account attests to this fact: 'The processes of chemotherapy and radiotherapy were incredibly challenging for me, both in terms of my physical and emotional well-being. I had to take a break from my job for a duration of eight months due to my damaged saliva glands, which prevented me from consuming any food or beverages. As a result, I experienced a dramatic weight loss of 4-6 stone.'
However, when it comes to the cancer vaccine, the process is uncomplicated and effortless. I arrive, they insert a thin tube called a cannula into my hand, and then I simply remain seated for approximately two hours as they observe and evaluate my condition.
I may require paracetamol to regulate my body temperature, however, other than that, there are no adverse effects. I feel perfectly alright afterward, and I have consistently remained productive.
Up until now, cancer vaccines have shown limited disadvantages, according to specialists. Professor Ottensmeier explains, "Due to the utilization of the mRNA method throughout the pandemic, we are aware of potential complications - the primary adverse effects include tenderness at the injection site and a slight increase in body temperature, which are normal immune responses." He further adds, "This approach is groundbreaking - typically, we claim to be capable of managing the disease temporarily, but the journey might become challenging due to the side effects of chemotherapy."
Now we can confidently claim that we can generate positive clinical outcomes without causing any negative health impacts. This allows you to continue living your life without any worries. It's truly remarkable to express such a statement.
There are potential discussions about investigating if a cancer immunization could eventually hinder the initial occurrence of cancer. However, in line with his comparison to detection dogs, Professor Ottensmeier states that the obstacle lies in the fact that 'not all cancers have the same scent'.
According to him, individuals with a heightened probability for cancer recurrence or those possessing a genetic anomaly that may induce cancer are anticipated to be the primary beneficiaries. Nonetheless, if it proves successful, there is potential for future opportunities to initiate trials and explore its efficacy as a preemptive vaccine.
Professor Spicer also states: 'Suppose we discover a single key gene that is powerful in preventing and eradicating a particular type of cancer, let's say breast cancer. We can then investigate whether it is feasible to distribute the vaccine to the entire population in order to determine if it reduces the overall occurrence of the disease. It's hard to predict, but given the pace of advancements we've witnessed, it's possible that I may witness this development during my lifetime.'
One of the obstacles that we will encounter is the planning and execution of distributing it on a larger scale - as Professor Spicer elucidates: 'It is feasible but more intricate than a typical pharmaceutical.'
Dr. Lennard Lee, a cancer vaccine research expert at the University of Oxford, holds a positive outlook. According to him, our nation has demonstrated the ability to efficiently distribute vaccines during the pandemic. While developing customized vaccines requires some additional steps, we are already making progress and have successfully done so in other personalized treatments.
The customized vaccines will be pricier due to the need for genetic sequencing and various procedures involved in creating a personalized vaccine for every individual. However, Dr. Lee emphasizes that this may not pose a significant obstacle since other recently developed cancer therapies also come with a high cost but are still utilized.
Meanwhile, Adrian expresses profound gratitude towards the Clatterbridge team. He states: 'I am filled with pride and honored to be involved in a scientific investigation that may revolutionize the way we treat cancer.'
Ready-made edition for individuals diagnosed with breast cancer
Researchers are actively working on creating two distinct kinds of cancer vaccines. These include custom-made vaccines, which are designed specifically for a particular patient's unique type of cancer using their genetic information (as explained in the main article), and pre-made vaccines that can be readily used without any customization.
Dr. Lennard Lee, an associate professor in the field of cancer vaccine research at Oxford University, sheds light on the development of pre-made immunizations that utilize the proteins responsible for the majority of instances of a specific cancer type.
"Both kinds of vaccines will play a part," he includes.
According to James Spicer, an expert in studying cancer at a prestigious university in London, it seems highly likely that in the near future, we will have readily available vaccines for melanoma and stomach cancer. This is because our research has allowed us to pinpoint the frequently mutated proteins in these specific types of cancer, which are present in a significant number of cases.
Jennifer Davis, a 46-year-old nurse residing in Ohio and a mother of three, received a readily available vaccine for triple negative breast cancer in October 2021.
Pre-made alternatives are both adaptable and convenient since they can be mass-produced similarly to pharmaceuticals, ensuring their availability for immediate use by patients. On the other hand, customized vaccinations involve an additional level of intricacy as they need to be tailored to each individual, resulting in a waiting period of weeks or even months. In certain cases, this delay becomes critical since some patients simply can't afford to wait for their specific vaccines.
On the other hand, a ready-made vaccine is not customized, and therefore, it is uncertain whether it will be effective or not.
In reality, there are initial indications that readily available vaccines may be effective for certain individuals, at the very least.
Jennifer Davis, a nurse from Ohio and a mother of three, aged 46, was administered a readily available vaccine for triple negative breast cancer in October 2021.
She had received a diagnosis three years ago and underwent cancer treatment involving chemotherapy, radiation therapy, and a surgical procedure called a double mastectomy.
She shared with Good Health that she was informed about the cancer's rapid growth and aggressive nature. Generally, triple negative breast cancer is known to be more forceful, difficult to treat, and has a higher probability of recurrence compared to other forms of breast cancer.
Once her treatment was completed, she vividly remembers that it became a game of anticipation, wondering if the condition would resurface.
During a subsequent check-up, a nurse practitioner brought up a newly developed vaccine tailored for her specific breast cancer type, which holds promising potential in preventing any future recurrence.
However, the testing process was still confined to the laboratory, and it wasn't until September 2021 that it reached a stage where it could be carried out on humans. Jennifer's eligibility for enrollment was confirmed based on a recent scan that revealed no evidence of the ailment reoccurring, which was one of the prerequisites for participation in the study.
She inquires: 'I inquired: 'On how many occasions did they witness mice perishing or experiencing dreadful responses following the injection? Additionally, of those who were administered the vaccine, what percentage observed the reoccurrence of cancer?'
The response to both inquiries was a resounding zero. Consequently, in October, I was administered the initial of three measures, spaced out by a span of two weeks each. Notably, I experienced no adverse effects whatsoever; the experience resembled nothing more than a routine inoculation.
The concept is that getting three doses of the vaccine offers lifelong defense. Initial findings that were revealed in April showcased that all 14 females who received this vaccine generated an immune reaction. This implies that their bodies were potentially fortified to recognize and eliminate the tumor if it reappeared.
Jennifer states that she is now approaching the five-year mark since her recovery, and she happily asserts that she is leading an ordinary existence.
The vaccination she received is developed using findings from the Cleveland Clinic's investigation, which unveiled a protein known as alpha-lactalbumin. This protein is commonly found in various types of breast cancer, including triple negative breast cancer.
George Thomas Budd, a professor of medicine at the Cleveland, elucidated the study's core focus on the 'retired protein hypothesis'. This hypothesis aims to identify proteins that are typically active only during specific periods in normal tissues, but unexpectedly become active at irregular intervals in certain cancer types.
In simpler terms, the protein called alpha-lactalbumin is only present in breasts that are producing milk, like when a woman is breastfeeding. It can also be found in cases of breast cancer. Professor Budd explains that focusing on this protein has shown promising results in mice models, as it seems to slow down and potentially stop the growth of cancer.
In the latest research, the majority of patients displayed immunologic reactions. This indicates that the protein is being recognized by the immune system and triggering a response. Currently, we are determining the appropriate dosage for upcoming experiments.