“This has been a turning point” for the testing of anti-cancer vaccines, “but it is not a turning point that has started now. Messenger RNA vaccines were, even before Covid, on the radar of oncology research”. In “3-4 years” the first fruits of the ongoing experiments could be reaped. “Let's say that I see the future positively. As I say at the end of the conferences, the best is yet to come”. Word of the oncologist Paolo Ascierto, director of the Department of Melanoma, Oncological Immunotherapy and Innovative Therapies of the National Cancer Institute Irccs Fondazione Pascale of Naples, who tells Adnkronos Salute about this turning point that oncology research is building and which could materialize in the future storm not too far from today.
2023 was certainly marked by the results of trials featuring mRNA anti-cancer vaccines. The journey began a long time ago. And, Ascierto recalls, “already in 2017, to give an idea, I was discussing it with experts from the BioNTech company who at the time were experimenting with a vaccine, still under investigation, both for lung tumors and melanoma. Then it was Covid has arrived and we all know the story. We know that the mRna vaccine has proven effective” against Sars-CoV-2 and therefore this platform “has been cleared with regard to the possibility of inducing an important immune response”. Then “the first studies of the Moderna vaccine with pembrolizumab arrived which demonstrated how these vaccines can actually make a greater contribution than classic immunotherapy, with what are called 'checkpoint inhibitors', the anti-PD-1”.
And, continues the oncologist, “in this preliminary study in melanoma – which is a trailblazer for all types of cancer – we have seen how this combination reduces the risk of recurrence by a further 44% and the risk of relapse by as much as 66%. distant metastases. These are very important data. So much so that we are now in the Phase 3 study, which is underway. We have also opened it in Italy. In Naples we were the first and now there are also other centers” in the field . “We have already started treating patients. 4 have been started” on the path, “and they will receive the vaccine shortly, because this treatment begins with classic immunotherapy, the time needed to prepare the vaccine, which is then added. And 'a personalized vaccine because it is obtained from a tumor sample.”
How the vaccine works
It works like this: “The sample” of the tumor “is sent to the laboratory and is processed – explains Ascierto – There the famous neoantigens are isolated, which are mutated proteins typical of the tumor which are therefore recognized as foreign by our immune system. Of all these antigens – there are hundreds, if not thousands – an algorithm that is in the hands of the company that then produces the vaccine, in this case Moderna, selects the 34 most immunogenic, that is, capable of giving a greater immune response and from the DNA of these antigens the messenger RNA is then constructed. This mRNA of the 34 neoantigens becomes the vaccine which is inoculated under the skin, like a classic vaccine.”
It is a treatment, continues the oncologist, “which is carried out for a year, both pembrolizumab and this vaccine (of which 9 administrations are given). And therefore it is a personalized vaccine because it is done on a single individual's tumor sample. If this strategy proves useful and therefore confirms what we saw in the previous study, a path will open up. Because it is clear that this approach can be applied to melanoma as to all other types of cancer. They are already there ongoing trials on the lung and so we'll see.” The results? “The CEO of Moderna said maybe they will be available in 2025, usually it takes two or three years. The 2030 horizon is realistic, I am convinced so – he reflects – I would say let's wait 3-4 years and we will be able to reap the fruits, then it could be that they arrive sooner. It all depends on the data, whether it will be mature.”
At the moment there are “different lines of research. At the moment the strategy is a strategy in the adjuvant modality, that is, after surgery, and there are also studies in metastatic disease. There is a whole line that can be developed, always in combination with 'checkpoint inhibitors'. How do I see the future? For melanoma we have already made giant strides, we manage to cure 50% of patients in the metastatic phase, we need to increase this share. We are going into the earliest phases, let's say that I see the future with optimism”, he concludes.
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