This finding led to two classes of approved therapies: drugs that lift molecular brakes on T cells so they can intensify their anticancer attack, and T cells engineered to home in on cancer cells. Decades later, researchers discovered that immune cells called T cells could recognize tumor antigens as foreign and attack cancers. In the 1890s, physician William Coley reported that injections of bacterial toxins-a vaccine of sorts-sometimes shrank patients’ tumors, apparently by stimulating the immune system. It’s a stepwise approach.”Įfforts to harness the immune system to fight cancer have a long history. “We are a long way from a general vaccine” to prevent cancer, says medical oncologist Shizuko Sei of the National Cancer Institute’s Division of Cancer Prevention. If the idea works to prevent one or a few cancers, it could be extended to meet an ambitious goal suggested by President Joe Biden: developing a vaccine that could prevent many types of cancer, modeled on the messenger RNA (mRNA) vaccines that have helped fight the COVID-19 pandemic. The best approach is unclear, and developers also face the difficult challenge of measuring success without waiting decades for healthy people to develop cancers.Įarly trials are yielding glimmers of promise. Some deploy just a single antigen whereas others use a large number, in a bid to broadly shield against cancer. The Lynch vaccine instead targets “neoantigens,” a potent type of antigen only found on tumor cells. Some use so-called tumor antigens, molecular markers that are scarce on healthy cells but plentiful on cancer cells. Researchers are trying out several vaccine strategies. Their efforts have been propelled by new insights into the genetic changes in early cancers, along with the recognition that because even nascent tumors can suppress the immune system, the vaccines should work best in healthy people who have never had cancer. The editorial called the goal an “objective that science cannot yet deliver.” But now, a few teams-including one funded by the same advocacy group, the National Breast Cancer Coalition (NBCC)-are poised to test preventive vaccines, in some cases in healthy people at high genetic risk for breast and other cancers.
A decade ago, a Nature editorial dismissed a prominent breast cancer advocacy group’s goal of developing a preventive vaccine by 2020 as “misguided,” in part because of the genetic complexity of tumors. The concept isn’t new, and it has faced skepticism. The idea is to deliver into the body bits of proteins, or antigens, from cancer cells to stimulate the immune system to attack any incipient tumors.
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The Lynch vaccine trial will be one of the first clinical tests of a vaccine to prevent nonviral cancers. But most cancers are not caused by viruses. They target viruses: hepatitis B virus, which can trigger liver cancer, and human papillomavirus, which causes cervical and some other cancers. Vaccines to prevent certain types of cancer already exist. If it works, Dave Dubin says, “it could be huge.” “It is a big psychological burden.” In hopes of easing that strain, Vilar-Sanchez will soon lead a clinical trial of a vaccine to prevent or at least delay Lynch-related cancers. “There is a lot of anxiety in this patient population,” says oncologist and geneticist Eduardo Vilar-Sanchez of the MD Anderson Cancer Center. He and his family in Haworth, New Jersey, launched a nonprofit, AliveAndKickn, to promote research and awareness of Lynch syndrome, which affects an estimated 1.1 million people in the United States. The disease also turned him into an activist. Nobody enjoys it,” Dave Dubin says-not the 2-day colonoscopy prep and procedure, nor the worrying about possible tumors. His eldest son, Zach Dubin, 26, inherited the DNA repair mutation and also regularly gets checked for cancer. The disease, Lynch syndrome, comes with up to a 70% lifetime risk of cancer.ĭubin, 55, gets annual colonoscopies, endoscopies, and imaging scans, which caught a third cancer, in his kidney.
Genetic testing finally found an explanation for his family’s trials: a mutation in a DNA repair gene that lets genetic errors pile up in dividing cells. He had surgery and chemotherapy, but his cancer came back 10 years later. “It was almost the Dubin way, and we just went on,” Dubin says. His grandfather and father had both survived the disease. When Dave Dubin learned at age 29 that he had colon cancer, it wasnt a big surprise.
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