The opportunity posed by cancer vaccines

How Covid helped to unlock the door to faster trials and new vaccine technologies...
25 October 2024

Interview with 

Leonard Lee, University of Oxford

VACCINE

A needle and bottle of the COVID-19 vaccine.

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One treatment that is fast gaining momentum in the cancer therapy world is vaccination; I don't mean initiatives like the incredibly successful cervical cancer vaccine programme, which prevents infection with the human papilloma virus that causes cervical and some head and neck cancers. Actually, I'm referring to the approach where scientists can now identify characteristic markers on cancer cells that are unique to the tumour and not present on healthy cells. By targeting the immune response at these signatures using new approaches like the mRNA vaccine technologies road tested for the first time in humans during the COVID pandemic, great strides might be made in stopping a person's cancer coming back. As he explains to Chris Smith, oncologist Leonard Lee, from Oxford University, has identified in the healthcare system a list of strengths we can capitalise on and some missing elements that we need to reinforce to make the most of the opportunity that this new technology can offer...

Len - Vaccines prevent disease and in many ways cancer patients have the same issue. You want to stop the cancer coming back. One way you can think about this is that, for people who've had cancer and it's been cut out, you would hope that, if you vaccinate them, the cancer may not come back or their chances reduce. It basically is a way of promoting the immune response to help you recognise that cancer to control it.

Chris - One of the first recommendations you lay out is to say, let's build on what we learned about vaccines from the pandemic. Are you specifically pointing to mRNA vaccine technology with that?

Len - Yes, definitely. So that was a technology which we didn't know we could have, or use, or would be effective, and that within a year had gone from being on people's drawing boards to being given to hundreds of millions of people across the world and it gave people freedoms which we didn't expect, but it worked. When we think about leveraging the confidence of this success, it's really in two ways. The first one is, take your technology, you know you can update it from an alpha to beta vaccine really quickly, now change the little bit in the middle and put a cancer epitope there, or something that cancer looks like so the body can recognise that cancer. The second bit is, you know you can develop products very quickly, take that confidence, all the streamlined processes, and deploy it in the cancer world now and see how quickly discoveries can be made and products can be tested. Because at the end of the day, if you take that confidence of speed and all these modern ways of doing trials now, you can get an answer a little bit quicker than you thought you might have done. So that's really important.

Chris - I wondered if you would go there because that was the thing that really surprised a lot of people during the pandemic, wasn't it? The fact that we went from literally a drawing board concept to needles going into people's arms and liberating them from the shackles of Covid in months. And people were saying, look, this would normally take years of trials. Where have the corners been cut? So it was presumably a streamlining process that went into that and you are saying, well we need to make sure we don't lose sight of that and go back to the bad old days.

Len - That's the thing, isn't it? If you believe what was said before 2020, you would believe that it takes 10 years to get anything through, maybe 20 years. In fact, if you had a drug now it should take until around the 2040s before you can help a patient. Really the thinking has now changed, because actually trials and discoveries are made as quickly as people are entered into trials and patients want to take part. And actually it's the streamlining of the processes, but also greater participation and awareness that enables you to go faster.

Chris - One of the other things on your list of recommendations is the infrastructure, and how we approach doing trials. Presumably, the fact that we are now into an era where the electronic patient record is very much the mainstay of how we operate medically, it gives us much better control of the data. And then you can bring in other insights like AI to begin to pick through all those data points and you go from trials that would've had thousands of people in them to trials with billions of data points. That must make things more agile?

Len - It does indeed. That's the strength of what we created in the UK because all nations were tested, but actually the ones which can use the electronic patient records the best were the ones which were able to make greater strides. The world looks at the UK as being the place where, every month, discoveries were made. And you've got to think about why that is. I think it's probably because of the NHS. We've got the data systems so you can work out when they needed scans, what did the scans show, what happened, and ultimately what their outcomes were. That sort of trials infrastructure, based around modern healthcare records, is the way forward and, really, ones we should be investing more in to try and get the greatest benefit.

Chris - Whose desk do you hope these recommendations land on? In other words, who are they actually arguing at or hopefully influencing so that these sorts of things can be achieved?

Len - Good question, Chris. This was written to target a broad audience actually because, at the end of the day, if people want an agenda to succeed, and patients put themselves forward and doctors offer them trials and the hospitals open up, that is all that's required. Hospitals, patients, and their doctors. I think ultimately it's an awareness piece. But at the end of the day, if we do the small things, which is what everyone can do, which is that if you are a cancer doctor to open the trial, if you are a member of the public to be aware of this and support this and mention it and talk about it amongst friends, and, for hospitals, to open up, then that will happen. And actually early indications show we've ended up doing really, really well. Some of our fantastic centres are opening up very, very quickly now with the confidence that they could succeed. We are gradually growing up that recruitment global charts. We've become actually a very good centre for cancer vaccine research, if not the best.

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