Pancreatic Cancer Vaccine Shows Promise, But When Will It Be Ready?
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Fact checked by Nick Blackmer
Researchers have developed personalized mRNA vaccines for patients with pancreatic cancer, which have shown safe and feasible outcomes in a small trial.
The customized vaccines work by delivering instructions to certain cells, telling them to produce a protein that triggers an immune response and attacks cancer cells in the pancreas.
Despite the promising early results, experts say that could be many years before the vaccines are available to patients.
A new vaccine that uses mRNA technology and that can be customized for patients with pancreatic cancer has shown promising results in a small new study.
Pancreatic cancer is one of the deadliest forms of cancer, killing about 88% of people who are diagnosed with it. Pancreatic cancer is also one of the most challenging types of cancer to treat; even after surgery, around 90% of patients have a relapse within seven to nine months.
However, the future of pancreatic cancer treatment—and even prevention—might be brighter. A group of researchers and scientists from BioNTech have demonstrated that custom-made mRNA vaccines may offer hope in the fight against this deadly form of cancer.
Learn More:What Are the Symptoms of Pancreatic Cancer?
According to the small study, which was published in the journal Nature, the vaccines caused an effective and lasting immune response in 8 out of the 16 participants. The patients’ immune systems learned how to recognize and fight off cancer cells.
“The key finding is we have evidence that there might be the ability to target neoantigens in pancreatic cancer using vaccination,” Benjamin Greenbaum, PhD, corresponding author of the study and Associate Attending in the Computational Oncology Service at Memorial Sloan Kettering Cancer Center, told Verywell. “Five to ten years ago, it was a disease often thought to be difficult to target using immune-based therapies, but now it’s not impossible.”
Even though Greenbaum and his colleagues have proven that their mRNA vaccine is safe and feasible to develop and administer to patients with early-stage pancreatic cancer after surgery, experts who were not involved in the study say that it could be many years before it becomes available.
“They will need to prove efficacy in larger groups of patients, possibly randomizing some patients to the treatment and others not to prove that it is the vaccine which is contributing to the benefit,” James Farrell, MD, director of the Yale Center for Pancreatic Disease and a professor of medicine and surgery at the Yale School of Medicine, told Verywell. “This could take several years to get to an approval stage.”
Learn More:Who Gets Pancreatic Cancer?
How the Vaccine Works
The mRNA vaccines are made by BioNTech, a biotechnology company based in Germany. If the name sounds familiar, it’s the same company that helped make the mRNA vaccines for COVID-19.
While the tech is similar, Greenbaum said that the biggest difference between the mRNA vaccines is that the ones his team developed are custom-made for each patient’s specific tumor.
“This is a personalized vaccine, which means it’s created from the specific mutations in that patient’s tumor which create new proteins in the tumor that potentially the immune system can see,” said Greenbaum.
To make the vaccines, the researchers from New York first took out each patient’s tumor and shipped samples of them to Germany. From there, the scientists at BioNTech analyzed the DNA and RNA in the tumors to find unique proteins called neoantigens.
“This is not a one size fits all,” said Farrell. “These patients’ tumors have been taken out and analyzed at a DNA and RNA level. Then, the investigators have chosen sequences of DNA and RNA that correspond to what is known as neoantigens.”
These exciting results indicate we may someday be able to use vaccines as a therapy against pancreatic cancer.
The scientists could then create an mRNA vaccine specific to the neoantigens, which Farrell said are coated in tiny particles that help protect and transport their genetic material to the patient. In the study, the vaccine was given to the patients through an IV injection over nine separate doses.
According to Farrell, when the vaccine is administered to the patient, it is taken up by special cells in the immune system called dendritic cells. The cells use the vaccine’s mRNA genetic material to make neoantigen proteins that are similar to the ones seen on a patient’s original tumor.
Once the proteins are released into the bloodstream, Farrell said they travel around the body and eventually get detected by the immune system. They signal the immune system to “activate” and strengthen its response.
The immune system’s activated cells, called T cells, recognize these proteins as markers of cancer cells. Then, the T cells multiply and target the tumor cells that have neoantigens on them, attacking and potentially destroying them.
Farrell said that when it’s used along with an immune checkpoint inhibitor drug to “rev up the immune system,” the vaccine “teaches the immune system to recognize and fight tumor cells, which express these types of proteins.”
Learn More:How Is Pancreatic Cancer Staged?
A Small But Exciting Study
The researchers included 16 patients in the study, which started in December 2019. All of the patients were White and had early-stage disease which could be surgically removed (resected).
In addition to the vaccine, all the patients got chemotherapy and a checkpoint inhibitor drug, which works in conjunction with the vaccines to boost immune responses.
Half of the 16 patients analyzed responded to the vaccine. As a result, their immune systems learned how to recognize and fight off the cancer cells. The patients also showed no signs of relapse of their pancreatic cancers for the 18 months they were tracked.
In a press release for the research, Vinod Balachandran, MD, a pancreatic cancer surgeon who led the first clinical trial, said that these “exciting results indicate we may someday be able to use vaccines as a therapy against pancreatic cancer.”
Learn More:Are There Any Vaccines for Cancer?
How Close Are We to Cancer Vaccines?
While the trial showed promising results in a small group of patients, other experts who were not involved in the study caution that there could be factors like chemotherapy and other treatments contributing to why some patients responded well to the vaccine.
“One has to be cautiously optimistic, but also take note of the fact that the patients did get other therapies,” Anirban Maitra, MBBS, professor of pathology and translational molecular pathology and scientific director of the Sheikh Ahmed Pancreatic Cancer Research Center at UT MD Anderson Cancer Center, told Verywell. “They got another immunotherapy that was given in conjunction with a vaccine, and they got chemotherapy as well, which is typically given as a standard of care to all patients after surgery.”
Five to ten years ago, it was a disease often thought to be difficult to target using immune-based therapies, but now it’s not impossible.
Since there are still many unanswered questions about the effectiveness of the vaccine, such as how much of the effect is because of chemotherapy compared to getting the vaccine alone, Maitra said that it could be several years before an mRNA vaccine for pancreatic cancer is available.
“We really don’t have full clarity on that,” he said. “But this is a phase one trial, and the most important two questions in a phase one trial are safety and feasibility.”
According to Maitra, future trials (including the second trial) will have to include more patients who will get multiple therapies and other patients who will get those therapies plus the vaccine. This will allow the researchers to compare the effects of the vaccine to not having the vaccine.
“It’s going to take some time to do the phase 2 trial and then phase three if that success happens,” he said. “We are some ways from that because, at this point, we have to see what the bigger trials show in terms of efficacy and that could take anywhere between three to five years or more.”
According to the researchers, a larger, randomized clinical trial is set to open which will involve patients at multiple sites in various countries. The research team at Memorial Sloan Kettering Cancer Center expects to start enrolling patients for the study this summer.
Learn More:Coping With a Pancreatic Cancer Diagnosis
What Pancreatic Cancer Treatments Are Available Right Now?
We may not have pancreatic cancer vaccines yet and it might be years before they’re available, but we do have some treatments for pancreatic cancer. If you’ve been recently diagnosed, know that the treatment that’s right for you will depend on the stage of your cancer, your overall health, and the recommendations of your healthcare team.
Surgery: Depending on the stage of the cancer and the location of your tumor, your provider may recommend surgery. This option aims to remove all cancerous tissue, which can involve taking out any tumors, parts of the pancreas, or other affected organs.
Radiation therapy: This treatment uses radiation to target and kill cancer cells. It’s also called adjuvant therapy and is typically an option that is given after surgery as a way to prevent cancer from coming back. It may help some patients live longer. Radiation can also be used before surgery to shrink tumors.
Chemotherapy: This treatment option uses drugs that destroy cancer cells or slow their growth. It can be given before or after surgery and can be paired with other treatments such as radiation therapy.
Immunotherapy: This treatment is also called targeted therapy, and it uses the body’s immune system to recognize and attack cancer cells. Immunotherapies can be used either alone or with other cancer treatments. Recent research has suggested that immunotherapies could be useful in prolonging survival in people with stage IV pancreatic cancer compared with standard care.
A personalized mRNA vaccine has shown early promise in fighting pancreatic cancer, but experts say it will be many years before this type of vaccine is widely available. For now, surgery, radiation, chemotherapy, and immunotherapies are among the options for patients with this often hard-to-treat cancer.
