Personalized cancer vaccines: this is the closest future of the fight against cancer

Vaccines are one of the best inventions of the last centuries. An estimated 1.5 billion lives have been saved since they were implemented. Now, after the flourishing of genomics, they are again postulating themselves as a solution to one of humanity's most feared diseases: cancer.

Since 2008, the possibility of using our own immune system against this endless number of pathologies has raised the hope of defeating it once and for all. In fact, Bill Gates himself stressed at the beginning of the year the importance of this application of vaccines, pointing it out as one of the great advances that will mark the near future.

Cancer is not a disease, it is millions of them

Cancer is not itself a disease but a huge group of them. It appears because of a cell that begins to function incorrectly and, instead of self-destructing, which is what it is programmed for, it continues to divide and spread without control. By its nature, cancer is very complex and there is no single solution to stop it.

This is because there are literally thousands of factors causing such catastrophic changes in the cell. These changes, in turn, manifest themselves in millions of different and completely different ways, but with only one result. In short: cancer is not, and cannot be treated, like a disease, because it is, in fact, millions of them.

If there is a system prepared to solve millions of diseases, it is our immune system. This, by its nature, is capable of changing and adapting. In this way, it "learns" to recognize a danger, attacking it and mitigating its negative effects on the body immediately. And why is this system, as sophisticated as it is, unable to recognize the problem that developing tumors cause?

The answer lies in physiological mechanisms dedicated, specifically, to protecting ourselves from our own defenses. An exacerbated immune system is capable of causing an autoimmune disease equal to or more dangerous than cancer. The latest discoveries in this regard, however, are leading us to develop techniques, and remedies, that we would never have imagined.

A vaccine against cancer?

In October 2018, the Nobel Prize in Medicine and Physiology was awarded to James P. Allison of the University of Texas and Tasuku Honjo of the University of Kyoto. These researchers discovered the cellular function by which our immune system restrains itself when attacking tumor cells.

Tumor cells manage to go unnoticed using some of the basic molecular mechanisms responsible for protecting our own bodies. While Allison worked with the CTLA-4 protein, Honjo discovered how the PD-1 protein works. Both work by braking the system, although through different mechanisms. By blocking the expression of these proteins, the system attacks tumors. In other words, they opened the door to a cancer "vaccine".

What do you mean a vaccine? A vaccine for injection is a solution specifically designed to "teach" the immune system where the danger is. In this case, the vaccines are not for use, as they are not prepared with attenuated pathogen residues. However, they do have the purpose of leading the way to the immune system. This is done by "releasing the brakes", blocking the expression of these proteins, roughly, to allow the system to attack misguided cells.

In this way, it is the system itself that cleans, without side effects, in principle, without chemotherapy (at best) and in a totally effective way. At the moment, "cancer vaccines" have been terribly effective, when they have been effective, which has well justified the Nobel Prize we were talking about.

If they already exist, why do we talk about the future?

The road has been long, and these kinds of treatments have been talked about for quite some time. In 2017, BioNTech presented its first clinical study, after years demonstrating the possibilities of using personalized cancer vaccines. In 2018 the first results began to appear. Novartis also joined this war almost simultaneously with BioNTech. The world of cancer vaccines has been brewing for some time, but not so long.

For a pharmacological treatment to be released, it usually takes between 10 and 15 years, and several billions of euros. Although basic discoveries take time in the research heritage, the way to go is still long and complicated. If all goes well, this year we could see new clinical trials leading to the first commercial vaccines in three years.

There are still some important questions to resolve. These types of vaccines, for example, are personally designed. That is, each one is made for only one person, from their cellular material. The immune system is very delicate and exquisite. Each body is different. And every cancer, inside every body, too. These vaccines are called "personalized" for this reason: they are like sniper bullets, aimed exclusively at specific cells of a specific person.

This design, and its effectiveness, is one of the first questions to solve. At the moment the clinical results are being very positive. But you have to optimize the process to make it affordable, something that will still take a while. On the other hand, we cannot forget about possible side effects. At best the worst case scenario, the vaccine will not work.

In the most dramatic, it can cause severe diseases, related to autoimmune diseases, with very diverse neurological and physiological manifestations. This type of therapy, due to its complexity, requires extreme technique and patience. Despite that, its development is going extremely fast, and right now there are many avenues open about it.

Who are the protagonists in the search for a cancer vaccine?

Right now there are several types of cancer that are treatable with this type of vaccine. Specifically, the T-cell immunotherapy technique, CAR, which refers to these types of white blood cells "trained" thanks to the vaccine, is capable of treating childhood acute lymphoblastic leukemia, non-hodgkin lymphoma, and multiple myeloma. There are also good results in referring prostate cancer or kidney cancer.

More and more, as we learn new things about tumors that affect us. There are currently several dozen large companies working on new vaccines. From the aforementioned BioNTEch and Novartis, pioneers in this field, to Genentech, another of the great actors in this scenario, with various techniques for the development of personalized vaccines to their credit. The several times sold Dendreon, author of the prostate cancer vaccine and who has reached levels in the several hundred million dollars. In short, there are many and quite established, despite the relatively short time that this sector has.

It is clear that the promise of a personalized vaccine to treat cancer is very valuable. Hence the stakes are high. In fact, in addition to the commitment of large "pharma" such as Novartis and powerful companies such as Genentech or BioNTEch, such important institutions as the American Society of Oncology, or the Spanish Society of Medical Oncology are committed to a future in which vaccines against Cancer will be one of the main treatments of choice. We can also point out that progress is being fast and effective. And if you manage to solve this amalgam of pathologies, we will admit that it has been worth such a rush. And it really seems that we are facing one of the greatest discoveries in our history.

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