Achi news desk-
Around 60 to 70 patients are being recruited at eight sites in the UK, including Edinburgh, for a treatment known as the “cordon bleu” of cancer medicine – and one of the most exciting developments for decades.
It could hardly come at a better time.
In Scotland, melanoma rates are predicted to increase by 52% by the end of the 2030s – with an even steeper increase of 75% for men.
On current forecasts, by 2038-40 there will be more than 2,500 new diagnoses of melanoma skin cancer each year compared to 1,400 at present.
The hope is that vaccines, tailored specifically for each melanoma patient, can destroy the cancer cells and prevent the disease from coming back.
The Phase Three clinical trial – which aims to enroll around 1,100 patients globally – is being led by the University of London Hospitals NHS Foundation Trust (UCLH) following positive results for Phase Two participants.
The Phase Two findings, published in the Lancet in February this year, compared the outcomes of patients with severe high-risk melanoma who received up to nine 1mg doses of the vaccine over a 27-week period in addition to the immunotherapy drug, Keytruda, in versus those who received only Keytruda plus a placebo vaccine.
The randomized control study, which was double-blind – meaning neither the patient nor the clinician knew which patients were getting the actual vaccine – found that those in the vaccinated group were 49% less likely of dying or having their cancer return over the following three. years.
The melanoma vaccine, developed by pharmaceutical giants Moderna and MSD (Merck Sharp and Dohme), uses the same mRNA technology first used during the Covid pandemic.
Unlike traditional vaccines, which use dead or weakened viruses and take months to ramp up, mRNA vaccines are produced quickly once the genetic sequence for a pathogen has been obtained.
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They act as a “messenger”, delivering an instruction manual to our cells on how to recognize a virus, bacterium, or – in this case – cancer.
The immune system uses this information to produce antibodies that can attack the real thing, if it is detected again.
In the case of the melanoma vaccine, scientists custom-build it for each patient by taking a tissue sample from their tumor after it has been removed during surgery.
From this, they extract his unique DNA signature and an artificial intelligence program designs a vaccine that can target the specific proteins – known as neoantigens – that are expressed on the surface of the cancer cells.
The vaccine can encode up to 34 of these neoantigens, meaning it can respond to a wide range of different mutational combinations.
The idea is that it trains the body’s immune system to recognize and destroy melanoma tumor cells, and prevent the cancer from recurring.
It simply cures the patient of their cancer – permanently.
Dr Heather Shaw, consultant medical oncologist and UK national co-ordinating investigator for the trial, told the Guardian the jags were “one of the most exciting things we’ve seen in a very long time”.
He added: “This is a very finely honed tool.
“To be able to sit there and tell your patients that you’re offering something that’s effectively the Fat Duck in Bray versus McDonald’s – that level of cordon bleu is coming to them.”
Steve Young, a melanoma patient from Stevenage in Hertfordshire, is among the first to be enrolled in the Phase Three trial.
The 52-year-old was diagnosed after a melanoma growth was removed from his scalp in August last year.
Although scans show no sign that the tumor has spread, cancer cells may be floating around undetected in his body.
Mr Young described his participation in the trial as “an opportunity to get involved in putting on some boxing gloves and squaring up to him”.
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Lawrence Young, professor of molecular oncology at the University of Warwick – who is not involved in the trial – said it was “one of the most exciting developments in modern cancer therapy”.
He added: “Interest in cancer vaccines has been rekindled in recent years by a deeper understanding of how the body controls immune responses and by the advent of mRNA vaccines which make vaccine development based on the immune profile of a patient’s own tumor is much simpler. .”
There is already hope that the method can be extended to other cancers such as the lungs, kidneys, and bladder.
BioNTech, whose Pfizer Covid mRNA vaccine has been administered more than any other worldwide – 665 million doses to date in the EU alone – is among those in the race to reorganize the technology towards cancer.
Birmingham University Hospitals NHS Foundation Trust (BIP) is currently leading a randomized control trial sponsored by BioNTech which will recruit 10,000 patients across the UK to test its colorectal cancer vaccine.
As with the melanoma study, patients with high-risk stage two or three bowel cancer who have already had surgery will receive multiple doses of a personalized vaccine and be followed over three years.
The aim is to measure whether their survival rates are higher than those in the “watchful waiting” group – where patients are regularly scanned for signs of recurrence, but receive no other intervention.
The first patient to be treated as part of the clinical trial received his jag in April.
It comes just a few months after research in Scotland revealed the effect of HPV vaccination on cervical cancer.
Since the rollout began in 2008, there have been no known cases of the disease among females aged 12 to 13 who were immunized.
In the past, cervical cancer was highest among women aged 25 to 39; on current trends it could be almost entirely wiped out within a generation.
In the 20th century, vaccines transformed the threat of infectious diseases. In the 21st century, they may do the same for cancers.
