For those of us in our late 60s and navigating Sniper’s Alley, recent news about an experimental cancer vaccine to prevent the recurrence of colon cancer is encouraging.
Not because this vaccine will save many lives – it is only a trial – but because it is a harbinger of good news, especially about cancer.
Cancer vaccines are the latest and greatest example of a wave of new therapies that promise to turn most cancers into just another disease that can be treated and survived.
A few weeks ago, an experimental cancer vaccine was shown to halve the death rate among melanoma patients.
For five decades, since Richard Nixon declared a “war on cancer” in 1971, progress in the fight against this most insidious of foes has been disappointing.
While death rates from heart disease, infections, accidents and other causes fell sharply, death rates from cancer remained stubbornly high.
As cancer increases with age, it is the leading cause of death in the UK
Contrary to popular belief and the beliefs of many doctors, cancers are not primarily the wages of sin: they are the wages of age. Smoking, sunburn, and some aspects of diet aside, there is little you can do to prevent the exponentially increasing risk of cancer as you get older.
Cumulative random mutations are “the largest contributors to cancer in general, often more important than hereditary or environmental factors,” as one study put it.
As cancer increases with age, it has become the leading cause of death for my generation and the most common cause of death in Britain.
Yet the tide is slowly turning — and there is much reason for optimism. More and more people who get cancer are staying in remission for longer and longer periods. The “age-standardized mortality rate” from cancer — a statistical tool that allows comparisons between populations with different age structures — has been falling steadily for 40 years, as better diagnosis, surgery and treatment come to the rescue.
The three biggest causes of death – lung, bowel and breast cancer – have almost halved the number of deaths per 100,000 age-standardised population in the UK since 1980.
In the case of lung cancer, the decline in smoking, accelerated by the rise of vaping, has been a major factor. But prevention through lifestyle changes has proven much harder for other cancers.
Prostate and pancreatic cancer, the two leading causes of death, both kill slightly more people per 100,000 than in 1980, even when standardized for age.
Time and again, the promise of miracle cures for all forms of cancer fails. The reason for this is that cancers develop ways to neutralize the weapons sent against them.
Until recently, even when cancer was treatable, treatment was often brutal. In addition to surgery, months of radiotherapy and chemotherapy made patients’ lives almost as bad as the disease itself.
That is now changing, as new and kinder generations of treatment methods come onto the market.
There are promising new drugs, including antibody drug conjugates, or ADCs. These combine an antibody that targets cancer cells with a chemical that kills them.
Then there is the growing excitement about “checkpoint inhibitors” that turn off the mechanism that stops the immune system from attacking its own body. Otherwise, your immune system doesn’t have permission to kill your cancer because it thinks the tumor is part of you. Hence the recently announced melanoma trial, run by Merck and
Moderna combines a checkpoint inhibitor called pembrolizumab (brand name Keytruda) with a vaccine that prompts the immune system to attack specific antigens (a type of protein) on the tumor.
Early results from the clinical trial involving 157 patients showed that this combination increased the survival rate of treated patients from 56 percent to 75 percent in almost three years.
It is these cancer vaccines that perhaps show the greatest promise, and their history is a classic example of how difficult it is to take new ideas seriously.
Katalin Kariko, the Hungarian-American biochemist who began developing cancer vaccines based on the messenger RNA molecule in the 1990s, had to overcome extreme skepticism within the scientific community.
Because her experiments failed time and again, she faced pay cuts, demotions, and termination of her tenure, but she still won the Nobel Prize last year, along with her colleague Dr. Drew Weissman.
It was Covid, not cancer, that ultimately made the mRNA vaccines famous – and infamous.
Two companies, Moderna in Boston (USA) and BioNTech in Mainz (Germany), used Dr. Kariko’s ideas and developed them into an unprecedentedly fast way to make vaccines against the spike protein of the SARS-CoV-2 virus.
It has revolutionized the slow world of vaccine development. Especially in the elderly, these Covid vaccines have saved many lives. But governments have over-claimed the Covid vaccines, falsely claiming they would prevent transmission of the virus, and have tried to make vaccination passports a condition of employment in various professions.
This has led to a disastrous backlash against all vaccines, and mRNA vaccines in particular. This is worrisome, because it is against cancer that mRNA vaccines will really make their mark, as Dr. Kariko and Dr. Weissman originally intended.
It would be wrong to raise the expectations of people with cancer today too high. Many advances will take years to bear clinical fruit. Others will end in disappointment.
Nobel Prize-winning biochemist Katalin Kariko had to overcome the skepticism of the scientific community when she decided to create cancer vaccines from the molecule messenger RNA
But in an age of almost mandatory pessimism, it’s easy to forget how much better our lives are still getting every day. The things that dominate our news media – wars in Ukraine and Gaza, China’s authoritarianism, Britain’s economic stagnation – cannot and will not stop the steady improvement of our lives through innovation.
In the biomedical field, Britain has an extraordinary record. It was here that natural selection, the structure of DNA, DNA sequencing, IVF, genetic fingerprinting and cloning were first discovered or invented.
With its global lead in genomics, Britain could play a leading role in the cancer vaccine revolution. The NHS and Genomics England have set up a Cancer Vaccine Launch Pad to bring cancer vaccine clinical trials to the UK. Trials have begun on colorectal, lung, liver, kidney and pancreatic cancer vaccines. Former vaccine tsar Dame Kate Bingham points out that cancer vaccines will be cheaper than continuing to treat patients with advanced cancer with drugs.
“Cancer vaccines can be used therapeutically after surgery and after chemo. But ultimately we can use cancer vaccines prophylactically, like we do with childhood vaccines against infectious diseases,” she says.
“For example, we could do a blood biopsy to detect circulating tumor DNA before the lesion can be visualized. Then we could vaccinate immediately.”
Ultimately, perhaps all middle-aged people could be vaccinated against the five most common forms of cancer.
However, Dame Kate has warned that the NHS is not making the most of this opportunity. Speaking at The Great National Cancer Vaccine Summit in May, she said there had been a 40 per cent decline in new clinical trials since 2017.
But as a recent analysis by Macmillan Cancer Support shows, Britain lags behind most comparable countries in five-year survival rates for common cancers. This is largely because we ration healthcare here through delay: the gap between seeing a GP and seeing a specialist or having a biopsy is longer in the NHS than in most health systems. Every day counts with cancer.
But a not-invented-here mentality doesn’t help either. A series of proton beam imaging and treatment centres, developed by Professor Karol Sikora with private money, have been largely boycotted by the NHS.
The genomic knowledge we have at our disposal today is extraordinary, like turning on a light in a library. Beating cancer is therefore very possible. As long as we apply that knowledge wisely, the possibilities are immense.