Ask a group of oncologists what the next big thing in cancer therapeutics is, most will tell you personalised mRNA vaccines. Why such consistency? Well, the answer lies in the confluence of several disparate technologies and the relatively disappointing progress of getting durable responses with many of the new and costly tyrosine kinase inhibitors, with a few notable exceptions.
The change came in 2015 when the FDA-approved nivolumab for metastatic non-small lung cancer in patients who had failed on platinum-based doublet chemotherapy. Although remarkable and long-lasting responses can occur, most patients relapse within 2 years. And predicting responses by measuring tumour mutations or identifying tumours with high PD1 or PDL1 levels is relatively haphazard.
But it is the bespoke vaccines created for individual patients that are most likely to have the greatest success and revolutionise the field, and certainly capture the imagination. In June last year, startling data were presented at the American Society of Clinical Oncology annual meeting in Chicago. Sixteen pancreatic cancer patients were given a personalised vaccine around 9 weeks after surgery at Memorial Hospital, New York.
Unlikely
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