How COVID vaccines could actually help scientists find a cure for cancer

The new coronavirus could help us cure cancer. Well, certain cancers.

The COVID pandemic has given the pharmaceutical industry the push it needs to finally complete the development of messenger RNA technology so that companies such as Moderna and Pfizer can use the technology for its COVID vaccines.

Today, the pharmaceutical industry uses the same mRNA platforms to cancer vaccines. Dozens of these new vaccines are in development, and experts say there’s a chance they’ll lead to the biggest decrease in cancer mortality in decades.

Of note is a key difference between mRNA injections for COVID and mRNA injections for cancer. mRNA vaccines to prevent COVID. They will not prevent cancer. Instead, they go treat cancer after you caught it. In this sense, “vaccine” – even though that is the accepted term – is somewhat of a misnomer when it comes to mRNA applications for cancer. “Therapy” might be a better term.

Either way, mRNA cancer vaccines have been in the works for a few years now, but the first tangible sign of real progress only appeared last week. On Dec. 13, Massachusetts-based Moderna and its partner Merck, the New Jersey-based pharmaceutical giant, announced top results from the first-ever randomized human trial for an mRNA cancer vaccine.

The two companies recruited 157 people with advanced melanoma for the trial. The volunteers received either Keytruda antibody therapy or Keytruda combined with a new vaccine called mRNA-4157. Adding mRNA-4157 reduced the risk of recurrence or death by 44%, the companies reported.

The key to mRNA-4157, and any other mRNA cancer vaccine, is that it can be tailored to an individual patient. As the name suggests, “messenger RNA” is just a means that communicates a message. The message is a piece of genetic material – RNA – that tells a person’s immune system to produce a particular disease-fighting protein.

Developers can encode mRNA to produce a wide range of proteins. To, say, prevent COVID or shrink different cancerous tumors. “Flexibility is extraordinarily attractive,” Elias Saytour, a University of Florida neurosurgeon whose RNA engineering lab works on cancer vaccines, told The Daily Beast.

But the flexibility that makes an mRNA vaccine so attractive is also a problem. How do you know exactly which RNA to add to a particular patient’s vaccine? “Not all cancers are the same,” Sayour explained. “To overcome this, prediction algorithms are used to identify unique information in an individual’s cancer that will be recognized by their immune system.”

mRNA had been in development for nearly 50 years before COVID finally forced governments to pump money into the effort, helping industry finally complete the first mRNA vaccines two years ago. The basic platform for an mRNA cancer vaccine is actually quite old. It’s the algorithms which are new.

“The manufacturing process begins with the identification of genetic mutations in a patient’s tumor cells that could give rise to neo-antigens,” explained the US National Cancer Institute. Neoantigens are proteins that form on cancer cells. “Computer algorithms then predict which neo-antigens are most likely to bind to T-cell receptors and stimulate an immune response,” the institute added.

In theory, an mRNA maker could produce a personalized cancer vaccine in as little as four weeks, Sayour said. In practice, we need many more mutation detection algorithms and many more tests before mRNA vaccines are ready for routine use in cancers.

Sayour pointed out that mRNA will likely work better for some cancers than others. Not all cancers are “immunogenic”, which means they trigger an immune response. Without an immune response, we might not know which protein to encode in an mRNA jab. “mRNA vaccines are likely to work in cancers like melanoma that are considered immunogenic,” Sayour explained. Moderate your expectations for other cancers.

There are other possible limitations to mRNA as a cancer cure. Henry Wang, a chemical engineering professor who studies vaccine production at the University of Michigan, told The Daily Beast he was worried about production.

You can’t produce mRNA injections for cancer the same way you get mRNA injections for COVID. How do you scale and manage the production of a drug that requires such careful and detailed individualization? “It creates an entirely different set of [quality-control] and manufacturing issues,” Wang said.

There is also the issue of cost. Because these are essentially boutique products, each vaccine would be designed for one or a few people and made in small quantities. This means that mRNA cancer pits can end up being really dear. It is possible that mRNA works very well against some or many cancers, but is too expensive for most people. “Somebody has to solve the problem of cost versus benefit,” Wang said.

Sayour, for his part, said he is optimistic. Even allowing for customization and production issues, mRNA appears to be our best short-term pharmaceutical tool for reducing cancer deaths. “It seems to have the best balance between commercialization and personalization.”

If pharmaceutical developers can write a multitude of algorithms, carry out large-scale trials, understand production processes and thread the cost-benefit needle, cancer vaccines could be viable and save many lives.

Even if they can not, and mRNA bites for cancer fall flat, the core technology could still have a bright future. Moderna is already working on mRNA stings for about two dozen diseases, including herpes and Zika. The German company BioNTech SE is even working on mRNA for multiple sclerosis.

ARNM got its start in preventing COVID. Treating the cancer could be the next step. It’s a safe bet that neither disease will be the last to face this particular technology.

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