September 7, 2020

Technology Series

Cancer vaccines

BY Soyon Park, Preston Llewellyn

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( 3 mins)

What it is

Cancer vaccines enable people’s immune systems to target cancer cells, instead of an infectious agent, such as a virus or bacterium. They aim either to prevent cancer or to cure it. 1

How it works

Vaccination is probably the most successful public health intervention in history, and has enabled the near-erradication of many human diseases, and the effective control of many more. 2

Commonly, vaccination works by administering either part of a pathogen, or a whole pathogen in a live or weakened state to a patient, whose immune system then mounts a response against it. 3 Thereafter, when the pathogen is again encountered, the patient’s immune response is more effective, and the pathogen is unable to cause disease. 4

Cancer vaccines apply the same logic, using molecules commonly found on the surface of cancer cells, 5 or by vaccinating against viruses known to cause cancer, such as the Human Papillomavirus (HPV) 6 or Hepatitis B. 7

Approaches

There are a number of contrasting approaches to cancer vaccination:

  • Treatment vs. Prevention. Live BCG virus itself is currently used as a treatment for established bladder cancer, 8 and the HPV vaccine to prevent human papillomavirus infection, which causes cervical cancer. 9
  • Personalised vs. Generalised Vaccines. Cancer Vaccines can be designed as bespoke treatments for an individual’s cancer, 10 or as an off-the-shelf preparation designed to recognise common cancer targets. 11
  • Tumour Antigens vs. External Antigens. Antigens are the molecules that are recognised by immune cells. Antigens that are either found more frequently, or exclusively on tumours, make good targets for vaccines. 4 Equally, vaccinating against external antigens such as viruses known to cause cancer has been demonstrated to be effective. 5,6
  • Live Cell Vaccines vs. Oncolytic Viruses. Live cell vaccines involve removing immune cells from the patient’s blood and mixing them with cancer antigens before re-injecting them. 12 Oncolytic Viruses are viruses that have been altered to specifically infect cancer cells. 13

Implications and issues

The current paradigm in cancer medicine is one of diagnosis and treatment. While improvements in early diagnosis can help in this paradigm, it remains expensive, and disease often recurrs. Although currently-available cancer vaccines are focussed on treatment rather than prevention, a shift to prevention would represent a true paradigm shift in the ability to combat cancer. 14

  1. Only a handful of cancer vaccines are currently approved for use worldwide.15
  2. However, there are comparable numbers of cancer vaccine clinical trials ongoing compared to other immunotherapeutic approaches, such as CAR-T cell therapy and Checkpoint Inhibitors.16
  3. Preventing, rather than treating, cancer could bring greater benefit to the developing world.17
  4. Cancers are highly heterogeneous: finding common antigens between them has made developing off-the-shelf vaccines difficult. There are many candidates, but translating these into the clinic has proved difficult.
  5. The falling cost of DNA sequencing has made the development of personalised vaccines more accessible. While still expensive, this approach has met with notable success. 18
  6. The use of cancer vaccines in combination with immunotherapies, 19 in particular checkpoint inhibitors, has been shown to be more effective than a single therapy alone. 20

The ability to prevent rather than treat cancer presents the opportunity to save countless lives. Depending on the approach taken, there is also the opportunity to make the treatment of cancer cheaper, extending these gains to a wider population. 

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