World’s-first mRNA vaccine can stop pancreatic cancer in its tracks

Recently, mRNA vaccines have captured the medical spotlight, playing a pivotal role in combating the COVID-19 pandemic. However, long before the pandemic emerged, researchers at the Memorial Sloan Kettering Cancer Center were diligently exploring the potential of mRNA vaccine technology in the battle against cancer.

Spearheading this groundbreaking endeavor is Dr. Vinod Balachandran, a physician-scientist affiliated with the David M. Rubenstein Center for Pancreatic Cancer Research, a member of the Human Oncology and Pathogenesis Program, and the Parker Institute for Cancer Immunotherapy.

Dr. Balachandran's pioneering work has led to the development of a clinical trial that examines the use of mRNA vaccines to treat pancreatic cancer, offering a glimmer of hope to patients facing this formidable adversary.

At the heart of this innovative approach lies the concept of neoantigens, proteins found within pancreatic tumors that serve as alarm bells, alerting the immune system to the presence of cancer cells. These neoantigens play a pivotal role in rallying the immune response to keep pancreatic cancer at bay.

Unlike traditional vaccines, which are one-size-fits-all, these mRNA vaccines are tailored to each individual, with the aim of stimulating the production of specific immune cells known as T cells. These T cells are trained to recognize and target pancreatic cancer cells, reducing the risk of cancer recurrence following surgical removal of the primary tumor.

Intriguingly, the results of this groundbreaking research have shown remarkable promise. Among the 16 patients studied, eight experienced activation of T cells that recognized their own pancreatic cancers.

Importantly, these patients demonstrated delayed recurrence of their pancreatic cancers, providing tantalizing evidence that the T cells activated by the vaccines may be effectively holding the cancer at bay.

Dr. Balachandran's work in pioneering mRNA vaccines for pancreatic cancer received a significant boost through collaboration with BioNTech, the company responsible for developing the Pfizer-BioNTech COVID-19 vaccine.

When asked about the inspiration behind using a vaccine to combat pancreatic cancer, Dr. Balachandran explained, "There has been great interest in using immunotherapy for pancreatic cancer because nothing else has worked very well. We thought immunotherapy held promise because of research we began about seven years ago."

This research, spanning seven years, revealed that a select group of pancreatic cancer patients managed to defy the odds and survive after tumor removal surgery. Upon close examination, it was observed that these tumors harbored an unusually high number of immune cells, particularly T cells.

These immune cells were drawn to the tumors by signals emitted from within. These signals, as it turned out, were neoantigens—proteins that T cells recognize as foreign invaders, prompting an immune system assault on the cancer.

Even more intriguing was the discovery that T cells recognizing these neoantigens persisted in the bloodstream of these fortunate patients for up to 12 years after tumor removal.

This sustained immune response resembled an autovaccination, with T cells retaining a memory of the neoantigens as a threat, akin to the way vaccines confer long-term protection against pathogens. This finding sparked the idea of artificially inducing a similar effect in other pancreatic cancer patients.

To understand how mRNA vaccines can combat pancreatic cancer, one must delve into their intricate mechanisms. Dr. Balachandran and his team published their findings on immune protection in long-term pancreatic cancer survivors in the prestigious journal Nature in November 2017. During this time, they were also exploring methods to deliver neoantigens to patients in the form of vaccines, with a particular focus on mRNA vaccines.

Unlike traditional vaccines, which introduce weakened or inactivated pathogens into the body, mRNA vaccines leverage a piece of genetic code known as messenger RNA (mRNA).

This genetic code instructs cells in the body to produce a specific protein, thus triggering an immune response. Coincidentally, BioNTech's co-founder and CEO, Uğur Şahin, expressed interest in the research conducted by Dr. Balachandran's team, initiating a collaboration that would prove pivotal.

In late 2017, Dr. Balachandran and his team journeyed to Mainz, Germany, where BioNTech is headquartered. Over dinner, they discussed the potential of mRNA vaccines in the context of pancreatic cancer treatment. This marked the beginning of a journey that held immense promise for cancer patients worldwide.

The intricacies of designing an effective cancer vaccine are manifold. Given that cancer arises from the body's own cells, distinguishing proteins in cancer cells as foreign entities is a formidable challenge for the immune system. Nevertheless, advances in cancer biology and genomic sequencing have paved the way for the design of vaccines capable of discerning the difference.

Dr. Balachandran's team, in conjunction with BioNTech and Genentech, capitalized on these advances, recognizing the critical role played by tumor mutations in triggering immune responses. Their optimism in the potential of mRNA vaccines for pancreatic cancer was well-founded, setting the stage for their groundbreaking research.

The personalized nature of mRNA vaccines for pancreatic cancer is a testament to their efficacy. After a patient undergoes surgical removal of a pancreatic tumor, the tumor is genetically sequenced to identify mutations that generate optimal neoantigen proteins—those that appear most foreign to the immune system.

Subsequently, an mRNA vaccine is meticulously crafted, containing the genetic code specific to these neoantigens present in the individual's tumor.

During the vaccine production process, patients receive a single dose of a checkpoint inhibitor drug. This combination is intended to enhance the immune response to tumors. Once the mRNA vaccine is administered into the bloodstream, it prompts dendritic cells—an essential component of the immune system—to produce the neoantigen proteins.

These dendritic cells simultaneously educate other immune system components, including T cells, to recognize and attack tumor cells bearing the same neoantigen proteins. With T cells primed to seek out and destroy cells displaying these proteins, the chances of cancer recurrence are diminished.

The road to realizing personalized mRNA vaccines for pancreatic cancer was fraught with challenges, not least of which was the complexity of the manufacturing process. Unlike mass-produced vaccines like those for COVID-19, the mRNA cancer vaccine had to be custom-made for each patient based on the unique characteristics of their tumor.

This necessitated an intricate series of steps, including the surgical removal of the tumor, shipping the tumor sample to Germany for sequencing, manufacturing the vaccine, and returning it to New York—all within a tight timeframe.

Thankfully, Dr. Balachandran's team and their collaborators rose to the occasion, successfully enrolling the target total of 20 patients nearly a year ahead of schedule. Their unwavering dedication and meticulous planning ensured that the personalized mRNA vaccines could be provided to those in dire need.

As if the hurdles of personalized vaccine production weren't enough, the emergence of the COVID-19 pandemic added an unprecedented layer of complexity to the clinical trial. Dr. Balachandran and his team recognized the urgency of adapting swiftly to ensure that patients were not adversely affected.

Under the leadership of Cristina Olcese and with the unwavering support of individuals such as Department of Surgery Chair Jeffrey Drebin and Hepatopancreatobiliary Service Chief William Jarnagin, the team orchestrated the logistics required to maintain the trial's momentum.

Remarkably, what was initially estimated as a two-and-a-half-year trial was completed in a mere 18 months. The tireless efforts of Dr. Drebin, Medical Oncologist Eileen O'Reilly, Physician-Scientist Jedd Wolchok, Biologist Taha Merghoub, Computational Biologist Ben Greenbaum, and the support from Stand Up 2 Cancer/Lustgarten Foundation were instrumental in making this trial a reality amidst the challenges posed by the pandemic.

The recent findings from this pioneering research offer a beacon of hope for patients grappling with pancreatic cancer. Dr. Balachandran affirms that "an mRNA vaccine can trigger the production of T cells that recognize pancreatic cancer cells."

The prospect of personalized vaccines enlisting the immune system in the fight against pancreatic cancer—a disease in dire need of improved treatments—holds tremendous promise. Moreover, these developments may extend their impact to other forms of cancer as well.

Looking ahead, Dr. Balachandran and his team are committed to further analyzing the data obtained from the clinical trial. This analysis will provide valuable insights into the factors that facilitate the vaccine's efficacy in patients. Armed with this knowledge, they aim to refine the vaccines to make them more effective and applicable to a broader spectrum of pancreatic cancer patients.

In a testament to the forward-thinking vision of the Memorial Sloan Kettering Cancer Center, this pioneering work exemplifies their commitment to bringing cutting-edge treatments to cancer patients.

Through their partnership with BioNTech and Genentech, and with the support of Stand Up 2 Cancer/Lustgarten Foundation, a larger study is already in the pipeline, aiming to test personalized mRNA vaccines in a more extensive cohort of pancreatic cancer patients.

As Dr. Balachandran notes, they were at the forefront of mRNA vaccines before their popularity surged, leveraging scientific discoveries to make a tangible impact on patients' lives. The future indeed looks brighter for those facing the formidable challenge of pancreatic cancer, thanks to the relentless pursuit of innovation in the field of mRNA vaccines.

Note: Materials provided above by the The Brighter Side of News. Content may be edited for style and length.

Like these kind of feel good stories? Get the Brighter Side of News' newsletter.