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  • Writer's pictureThe San Juan Daily Star

After giving up on cancer vaccines, doctors start to find hope

Dr. Elizabeth Jaffee, deputy director of the Sidney Kimmel Cancer Center at Johns Hopkins University, speaks in New York, Jan. 15, 2019. Encouraging data from preliminary studies are making some doctors feel optimistic about developing immunizations against pancreatic, colon and breast cancers.

By Gina Kolata

It seems like an almost impossible dream — a cancer vaccine that would protect healthy people at high risk of cancer. Any incipient malignant cells would be obliterated by the immune system. It would be no different from the way vaccines protect against infectious diseases.

However, unlike vaccines for infectious diseases, the promise of cancer vaccines has only dangled in front of researchers, despite their arduous efforts. Now, though, many hope that some success may be nearing in the quest to immunize people against cancer.

The first vaccine involves people with a frightening chance of developing pancreatic cancer, one of the most difficult cancers to treat once it is underway. Other vaccine studies involve people at high risk of colon and breast cancer.

Of course, such research is in its early days, and the vaccine efforts might fail. But animal data are encouraging, as are some preliminary studies in human patients, and researchers are brimming with newfound optimism.

“There is no reason why cancer vaccines would not work if given at the earliest stage,” said Sachet Shukla, who directs a cancer vaccine program at MD Anderson Cancer Center in Texas. “Cancer vaccines,” he added, “are an idea whose time has come.” (Shukla owns stock in companies developing cancer vaccines.)

That view is a far cry from where the field was a decade ago, when researchers had all but given up. Studies that would have seemed like a pipe dream are now underway.

“People would have said this is insane,” said Dr. Susan Domchek, principal investigator of a breast cancer vaccine study at the University of Pennsylvania.

Now, she and others foresee a time when anyone with a precancerous condition or a genetic predisposition to cancer could be vaccinated and protected.

“It’s super aspirational, but you’ve got to think big,” Domchek said.

A less grim prognosis

Marilynn Duker knew her family tree was dotted with relatives who had cancer. So when a genetic counselor offered her testing to see if she had any of 30 cancer-causing gene mutations, she readily agreed.

The test found a mutation in the gene CDKN2A, which predisposes people who carry it to pancreatic cancer.

“They called and said, ‘You have this mutation. There really is nothing you can do,’ ” recalled Duker, who lives in Pikesville, Maryland, and is CEO of a senior living company.

She began having regular scans and endoscopies to examine her pancreas. They revealed a cyst. It has not changed in the past several years. But if it develops into cancer, treatment is likely to fail.

Patients such as Duker don’t have many options, said Dr. Elizabeth Jaffee, deputy director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University. A person with more-advanced cysts could avoid cancer by having their pancreas removed, but that would immediately plunge them into a realm of severe diabetes and digestive problems. The drastic surgery might be worthwhile if it saved their lives, but many precancerous lesions never develop into cancer if they are simply left alone. Yet, if the lesions turn into cancer — even if the cancer is caught at an early stage — the prognosis is grim.

But it also offers an opportunity to make and test a vaccine, she added.

In pancreatic cancer, Jaffee explained, the first change in normal cells on the path to malignancy almost always is a mutation in a well-known cancer gene, KRAS. Other mutations follow, with six gene mutations driving the cancer’s growth of pancreatic cancer in the majority of patients. That insight allowed Hopkins researchers to devise a vaccine that would train T cells — white blood cells of the immune system — to recognize cells with those mutations and kill them.

Their first trial, a safety study, was in 12 patients with early-stage pancreatic cancer who already had been treated with surgery. Although their cancer was caught soon after it had emerged and despite the fact that they were treated, pancreatic cancer patients typically have a 70% to 80% chance of having a recurrence in the next few years. When pancreatic cancer returns, it is metastatic and fatal.

Two years later, those patients have not yet had a recurrence.

Now, Duker and another patient have been vaccinated to try to prevent a tumor from starting in the first place.

“I am really excited about this opportunity,” she said.

The vaccine seems safe, and it has elicited an immune response against the common mutations in this cancer.

“So far, so good,” Jaffee said.

But only time will tell if it prevents cancer.

Preempting a precancer

Dr. Mary Disis, director of the Cancer Vaccine Institute at the University of Washington, wants to prevent breast cancer in women with gene variants that put them at high risk. Her initial hopes, though, are more modest.

One goal is to help women who have ductal carcinoma in situ, which doctors call a precancer. Surgery is the standard treatment, but some women also have chemotherapy and radiation to protect themselves from developing invasive breast cancer. “Ideally, a vaccine would replace those treatments,” she said.

She began by looking at breast cancer stem cells. These cells, found in early cancers, are resistant to chemotherapy and radiation, and they can metastasize. They drive recurrences of breast cancers, said Disis, who has received grants from pharmaceutical companies and is a founder of EpiThany, a company that is developing vaccines.

Disis and her colleagues found a number of proteins in these stem cells that were normal but produced at a much higher level in cancer cells than in noncancerous cells. That offered an opportunity to test a vaccine that produced some of those proteins.

Their vaccine was tested in women with advanced cancers that were well established. It did not cure the cancers but demonstrated that the vaccine could provide the sort of immune response that might help earlier in the course of the disease.

Disis plans to try vaccinating patients with ductal carcinoma in situ or another precancerous condition, atypical ductal hyperplasia. Her group has a vaccine they developed to target three proteins produced in abnormally high amounts in these lesions.

The hope, she said, is to make the lesions shrink or go away before the women have surgery to remove them.

“This would be proof the vaccine has a cleansing effect,” she said. If the vaccine succeeds, women may feel comfortable forgoing chemotherapy or surgery.

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