2023-12-20 08:36:24
by Vera Martinella
The enrollment of patients operated on for this type of skin cancer has also started in Italy, which has already paved the way for another revolution in the treatment of tumors: immunotherapy. But they are not like virus vaccines
The scientific community is eagerly waiting for the definitive results of the trials on large mRNA anti-cancer vaccines.
They are needed by patients with cancer
At the moment there are over 40 (produced by various pharmaceutical companies) tested, some of which have already reached the advanced study stages, starting with melanoma, the first to arrive. Why is it often talked about? Is this such significant news? Who is interested in this news? First of all, a fundamental premise: they are called vaccines, but they do not make you “immune” from cancer, they are not like the anti-flu or anti-chickenpox ones – specifies Paolo Ascierto, director of the department of melanoma oncology, oncological immunotherapy and innovative therapies of the National Institute of Tumors IRCCS Pascale Foundation of Naples —. They are needed by patients with cancer, not healthy people, and for them they represent an important progress. The fact that the topic is addressed frequently is also due to the fact that, at various scientific conferences and on numerous occasions, new data are gradually collected and this translates into a continuous dissemination of news.
Attack cancer more effectively
So, to start, what are mRNA cancer vaccines? They are drugs that make use of messenger RNA (mRNA), a sort of “postman” that transmits important information to the cells – explains Ascierto, one of the leading Italian specialists and president of the Immunotherapy and Melanoma Bridge conference, an international event recently held in Naples —. They are based on the same technology adopted for vaccines against Covid, that is, they use synthetic mRNAs designed to “instruct” the immune system to recognize specific proteins (called neoantigens), which are the expression of genetic mutations that have occurred in cancerous cells. The aim is not to prevent the disease, but to help and support the patients’ immune system to recognize and attack the tumor more effectively. Personalized mRNA cancer vaccines are therefore “custom” designed with the aim of triggering the immune system to selectively and exclusively kill tumor cells in that patient and in patients whose tumors express the same mutation.
Melanoma leading the way?
Are they already available for the sick? Yes, but only within trials, it is an important opportunity for patients who do not benefit from standard therapies – clarifies the oncologist -. Currently, over 40 clinical trials on mRNA-based vaccines are underway in the world in various cancers: prostate, non-small cell lung cancer, triple-negative breast, colorectal cancer. And for melanoma, which has reached the most advanced phase of study, the third, the last before the definitive approval and entry into the market of a new drug. The enrollment of patients began at Pascale a few days ago, we are among the first centers in the world.
44% reduction in relapse
And what do the data say about the melanoma vaccine? The trials were performed on 157 patients diagnosed with melanoma (stage 3 or 4) who had already undergone radical surgery. Some of them were given nine doses of the experimental cancer vaccine (made by Moderna) along with the immunotherapy drug pembrolizumab every three weeks for a year. Others received only pembrolizumab. Data two years after administration show a 44% reduction in the risk of relapse or death in those who received the combination with the vaccine. It will still take a few years before we have the results of this last phase of the clinical study, but we hope to be able to give a new and more effective therapeutic option to as many patients as possible.
Immunotherapy
Melanoma has already paved the way for another revolution in cancer treatment: immunotherapy… It was 2011 when the first data in patients with metastatic cutaneous melanoma were announced – recalls Ascierto -: only one patient in four with a advanced melanoma was still alive a year after diagnosis, life expectancy in the presence of metastases was around six months, today almost half of sufferers exceed seven and a half years. Immunotherapy, which stimulates the immune system to react against cancer, has proven to be an effective strategy in the last decade for many cancers for which there was little hope and which are difficult to treat. And now melanoma (which, diagnosed in the initial stage, almost always heals and surgical removal alone may suffice) continues to dictate the path to follow, indicating that the future of immuno-oncology is in the combination of various molecules and (this is the latest front of research, from which we await definitive answers) in its administration before surgery, not after as is done today.
70 immunotherapy drugs under study
So, in addition to mRNA vaccines, is research also continuing on immunotherapy? Certainly – concludes AScerto -. There are as many as 70 immunotherapy drugs under study, both in the preclinical (on laboratory guinea pigs) and clinical phases and in Italy alone there are around 200 ongoing trials, of which 51 with active enrollment, which represent in all respects a new opportunity therapy for patients. And the indications for drugs already in use are expanding. For example, pembrolizumab, a monoclonal antibody against PD-1 (i.e. aimed at undermining one of the “brakes” of the immune system), first approved for melanoma and since last September also authorized for other tumors: metastatic kidney, metastatic triple-negative breast and post-operative, advanced endometrium and cervix, esophagus, colon and some gastric cancers. There are also combinations of immunotherapeutics as in the case of nivolumab and ipilimumab approved and reimbursed by the National Health Service from 2022 for the treatment of metastatic non-small cell lung cancer, for advanced renal cancer in the first line, for advanced esophagus with chemotherapy progression, pleural mesothelioma in first line and in some colorectal cancers. We have also had approval for the use of bispecific antibodies such as tebentafusp in patients diagnosed with metastatic or unresectable uveal melanoma who present a particular antigen.
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December 20, 2023 (changed December 20, 2023 | 07:36)
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