Cancer vaccines given as treatment for the disease have moved a step closer after promising results in a landmark trial of skin cancer patients.
The treatment, developed by Moderna and Merck, is based on mRNA, the same technology used to make Covid vaccines. It was given to patients with high-risk melanoma who remained free of cancer after surgery to remove their tumour.
The manufacturers have not yet said exactly how much the treatment reduced cancer return but said it was a “clinically meaningful improvement”. Results from a previous smaller study found the treatment halved cancer recurrence.
Independent experts hailed the results. “This is an important moment for a field that scientists have been working towards for many years,” said Dr Lennard Lee, an oncologist at the University of Oxford, who was not involved in the research.
“This is the first positive [large] trial of an individualised mRNA-based cancer treatment.”Professor Marco Gerlinger, an oncologist at Barts Cancer Institute in London, said the results were positive for cancer patients beyond just those with melanoma.
“It provides proof of principle that personalised cancer vaccines work,” he said. “This is important as they can be designed against many different cancer types.”
Moderna is already making other mRNA vaccines against tumours including those of the breast, bladder and lungs, while German firm BioNTech is making cancer vaccines in partnership with the UK Government.
Dr Yin Wu, a Wellcome Trust career development fellow at King’s College London said the results were significant, but said a more detailed breakdown of the results was needed.
Potential for patients to be cancer free for longer
The vaccine, which is called Intismeran, is personalised to each patient’s tumour. It is used along with another cancer drug already prescribed by the NHS, Keytruda.
In the latest trial, 1,137 people received either nine injections of Intismeran every three weeks alongside Keytruda, or Keytruda alone. The companies said the results met their initial goals.
The combination treatment “has the potential to establish a new treatment paradigm, helping patients remain cancer-free for longer,” said Professor Georgina Long, the study’s principal investigator and medical director of Melanoma Institute Australia.
The treatment could be at least a year or two from being used within the NHS. Manufacturers Moderna and Merck first need to file for approval of their treatment with the UK Medicines and Healthcare products Regulatory Agency.
Then, the financial body Nice would need to decide if the treatment could be given through the NHS in England, if it determines it to be cost-effective. Its decisions are usually also followed in Wales and Northern Ireland, while Scotland has a similar organisation for approval, Sign.
“The companies will engage with regulators on filing submissions for Intismeran in combination with Keytruda,” a spokesperson for Moderna and Merck said. Shares in both companies surged in New York following the results.
How cancer vaccines work
While vaccines are usually seen as tools for preventing disease, when it comes to cancer they can also be used as treatments, given after the disease has already begun.
Cancer vaccines have long been seen as holding great promise, because the immune system can sometimes naturally recognise cancer cells and destroy them before the person even notices a lump. Unfortunately, as cancers grow they may develop mutations that let them escape this immune response.
Intismeran works by revving up the immune system so it is better able to recognise the unique proteins made by the cancer cells’ mutated DNA.
Treatment involves surgically removing the patient’s cancer, then genetically sequencing the tumour cells. This lets scientists create strands of mRNA – a similar molecule to DNA – that encode instructions for making those cancer proteins.
The mRNA is then injected into the person’s body, and their cells start producing the cancer proteins in small amounts.
This trains the person’s immune cells to react more aggressively to the cancer cells – in a similar way to how a flu vaccine trains the immune system to attack cells infected with the flu virus.
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