The New Cancer Immunotherapy Era, Part 1
(Innovative Personalized Cancer Vaccines)
Cancer Immunotherapy is a very broad term. This is a two part series we will discuss, and part 1 is an overview of how we have been using immunotherapy to treat cancer.
Most of you know that I am involved in cancer immunotherapy and supporting the host immune system in the cancer patient for 30 years. We have developed a breast cancer vaccine and received a patent on that in 1994. Our cancer vaccine has been used in patients with a depressed immunity to their own breast cancer after receiving standard of care treatment. We published a paper on that in 2013 showing that definitely improved disease specific survival. Several years ago, I published an editorial that host immunity in clinical oncology was ignored in the United States.
In the last 4-5 years there has been a big interest in the immune system where cancer is concerned and a big push to develop personalized cancer vaccines, DNA vaccines and what they call check-point inhibitors which have gotten publicity lately. Now the oncology community is realizing that the immune system plays a very important role in how the patient deals with their cancer and how they survive their cancer. It is also recognized that some chemotherapy which is immunosuppressant used in the proper setting can be complemented by immunotherapy and that they are at times synergistic. A new era for cancer immunotherapy is evolving and that is a great thing. In my practice, I have decided to concentrate on innovative, personalized cancer vaccines.
Cancer vaccines can be divided into two groups –
- personalized cancer vaccines
- therapeutic cancer vaccines
Personalized Cancer Vaccines
What are the indications for personalized cancer vaccines? they should be used in the adjuvant setting (after chemo, surgery, and radiation). That means that this type of vaccine should be used in patients who have been treated for their cancer with standard of care treatment and they should have their immune system evaluated. Since surgery, chemotherapy, and radiation all affect the immune system, the immune system should be evaluated around 12 weeks after any of these modalities are used. If patients have depressed lymphocyte specific immunity to their own cancer, they should be considered for a vaccine in the adjuvant setting to decrease their risk of recurrence.
We already have proof of principle in breast cancer with the vaccine that we have developed. This adjuvant vaccine theory should be applied to all solid epithelial tumors and possible soft tissue tumors such as colon, lung, breast, prostate and melanoma. It is also possible with further experience and research that this type of vaccine could possibly be preventive if directed to its target.
In the Part 2 of this series we will discuss therapeutic cancer vaccines and when to use personalized or therapeutic vaccines.
Respectfully your friend and physician,
Robert L. Elliott M.D., Ph.D., D.Sc.