By Lisa Jarvis / Bloomberg Opinion
A study published last month in Nature underscores the potential for a new personalized pancreatic cancer vaccine to keep the disease from coming back. The trial was tiny, just 16 patients, but it’s eliciting a sentiment not normally associated with this brutal disease: hope.
Pancreatic cancer is notorious for the swiftness with which is kills. So, when researchers offer data suggesting a personalized vaccine might be able to keep the cancer at bay for years, it’s worth paying attention to; even when the results are in just a handful of people.
It also should be a call to action. Progress has been too slow for this patient group and their families. They deserve better options. The only way to get there is to keep investing in the kind of foundational research that, through decades of painstaking work, becomes the basis for breakthroughs.
Even with slow and steady progress over the last decade toward improving survival rates, just 13 percent of people are alive five years after they are diagnosed with pancreatic cancer. That poor prognosis has made it the third deadliest cancer in the U.S., behind lung and colon cancers.
Finding better treatments has been exceptionally difficult. People don’t typically experience symptoms and there are no simple tests for the disease. By the time it’s detected, it usually has spread to nearby organs; a point when even the best treatments, if they existed, would make success unlikely.
This new round of data is for a vaccine that delivers strands of mRNA — the same material used in the covid vaccines — encoding the recipes for a long list of proteins specific to a patient’s tumor. The idea is to teach the immune system to recognize and destroy those tumor bits whenever it comes across them.
The concept might sound straightforward, but until data started to emerge from this small trial, few expected the immune system could be turned against pancreatic cancer. Vaccines typically work best when a tumor is riddled with mutations, as in melanoma, where Moderna’s bespoke mRNA vaccine has shown promise.
That’s what made earlier data from this study so stunning: The vaccine revved up the immune response against this typically tough tumor in half of the 16 participants.
But researchers didn’t know whether the cancer-fighting immune cells called T-cells generated by the vaccine would stick around; and, even if they did, whether they would keep doing their job.
Now, we know those immune cells can last for years, for some people, maybe even sticking around for life. Even better, they seem to retain the functions believed to be necessary for preventing a recurrence, says Vinod Balachandran, the pancreatic cancer surgeon at Memorial Sloan Kettering Cancer Center who led the study. Just two of the eight patients with a strong T-cell response saw their cancer come back. (The disease returned in seven of the eight people whose immune systems didn’t respond to the vaccine.)
The approach has its limits. In order to make the bespoke vaccine, doctors need to sequence a sample of the patient’s tumor, yet only the 20 percent or so of pancreatic cancer patients are eligible for surgery.
Barbara Brigham, a grandmother whose doctors found her pancreatic cancer in September 2020, is one of the lucky ones experiencing a years-long response to the vaccine. Routine scans have shown no sign of her cancer since she completed treatment with her personalized vaccine and chemotherapy in fall 2021. That’s allowed her to experience college graduations, attend her granddaughter’s wedding, and witness the birth of her eighth grandchild last December. All of those are “things that I didn’t think I would be around for,” Brigham told me.
And while she still is being monitored every six months for signs her cancer has returned, she’s starting to check some goals off her life list. She’s always wanted to take a cruise down the Rhine to visit her family’s hometown in Germany and thinks 2026 is her year. “I’m crossing my fingers and saying, I’m finally going to do it,” she says.
Of course, many more questions need to be answered before the vaccine is ready for prime time. Patients are now being enrolled in a larger study that should help researchers better grasp the mechanism of the immune response. Crucially, that trial should tell us whether the vaccine does a better job than conventional chemotherapy at preventing cancer from coming back.
Still, this initial success against such a recalcitrant tumor has broader implications for using personalized mRNA vaccines to target other common tumors that have so far been resistant to other kinds of immunotherapy, Balachandran says. It’s helping him and other researchers draw a better blueprint for designing cancer vaccines that actually work as promised.
Pushing that work forward with the urgency it deserves will require coordinated effort and significant investment from the government, biotech companies and philanthropy. Yet given the current environment at the National Institutes of Health, which helped fund the foundational work to develop the vaccine (not to mention foundational work to develop mRNA technology), it’s hard not to worry momentum could be lost.
What a colossal failure that would be. This cancer has stolen so much from so many families. If there’s a possibility for more people to benefit, we should be moving as quickly as possible to realize that potential.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry.
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