Hope on the horizon: Recent advances in brain cancer immunotherapy

Modern immunotherapy is making strides to improve the odds for brain cancer patients.

Many people may remember that Senator Edward (Ted) Kennedy was diagnosed with brain cancer in May, 2008, and died from it about 15 months later, in August of 2009. For me, Kennedy's cancer progression was one of those news cycles that intersected with the personal life, because my mother was diagnosed with brain cancer around the same time, in the summer of 2009, and she died from it half a year later, in January of 2010.

One of my lasting memories about Kennedy's death is the pessimistic tone of commentary from media personalities at the time. As they commented on the almost hopeless odds that Kennedy was facing, I was - of course - thinking about how their commentary applied to my own mother. And it turned out that they were right. My mom tried surgical treatment and chemotherapy, but in the end it didn't seem to make much difference. In a mere few months, she went from a healthy and vibrant retiree traveling around the country to a wheelchair bound cancer patient, and even that stage passed quickly. In a few more months, she was gone at the relatively young age of 61.

As a result of this experience, it always catches my attention when I come across news about advances in the treatment of brain cancer. This week, my RSS feed contained some news of this nature. The articles, New Vaccine For Deadly Brain Cancer Shows Incredible Results in Clinical Trial and Brain cancer in children is notoriously hard to treat – a new mRNA cancer vaccine triggers an attack from within describe some promising results from a clinical trial of a new vaccine for brain cancer. Both of those articles are commentaries on newly published research from Cell, RNA aggregates harness the danger response for potent cancer immunotherapy.

As with the treatment covered in my recent article, Revolutionary Canine Cancer Vaccine Shows Promising Results: A Ray of Hope for Man's Best Friend, the product is called a vaccine, but it is only used after a cancer diagnosis. This is explained in Nature's YouTube video, below:

In the ScienceAlert article, we learn that a personalized vaccine has extended the lives of four patients in clinical trials. With standard treatments, the article says that glioblastoma patients can expect roughly 6 months (on average) with no progression of the disease. With this vaccine, the article reports that two patients experienced 8 or 9 months of "progression free survivorship". The article reports that a third patient - with "recurrent glioblastoma" survived for 9 months, whereas the median survivorship would have been expected at 5-8 months. All of this follows a canine study where the median survival rate for dogs with brain tumors was extended from 35 days to 139 days.

As seen in the above YouTube video, the article suggests that the "tumor microenvironment" (TME) normally suppress the immune system response by killing immune cells that attack the tumor, but the vaccine uses a customized protocol to defeat that behavior. Using mRNA technology that is similar to the COVID-19 vaccines along with a sample of the tumor, itself, the researchers are able to reprogram the immune cells to circumvent the TME's defenses and attack the tumor. Elias Sayour is quoted as saying,

In less than 48 hours, we could see these tumors shifting from what we refer to as 'cold' – immune cold, very few immune cells, very silenced immune response – to 'hot,' very active immune response

The team is now working to optimize doses and frequencies for the best balance of safety and effectiveness. As with last month's post about a cancer vaccine in dogs, Sayour also suggests that this treatment can be combined with others.

The second article was written by two of the researchers, Christina von Roemeling and John Ligon. This article points out the unique difficulties of treating brain cancers in children.

First, brain cancers are notoriously difficult to treat because traditional treatments are unable to penetrate the blood/brain barrier. Second, children's brains are less well studied than adult brains. Finally, traditional treatments can afflict the patient with life-long side effects.

According to this article, modern immunotherapy builds on a seminal work in 1991, A Gene Encoding an Antigen Recognized by Cytolytic T Lymphocytes on a Human Melanoma, which was the first time that a tumor antigen was identified. Building on that foundation, much of today's immunotherapy work is focused on using messenger RNA (mRNA) to create a blueprint for the body to make its own tumor antigens. The team that published the Cell article has been exploring the use of mRNA cancer vaccines for about 10 years.

Problems that have emerged with cancer vaccines include the fact that some vaccines don't trigger a strong enough immune response, and also that tumors are not made of a single type of cell. To circumvent those problems, the team uses the patient's own tumor cells to create the vaccine, and they layer specialized lipid nanoparticles in order to maximize the amount of mRNA that can be delivered.

Describing their current accomplishments and plans for the future, the article says,

We administered our mRNA-based vaccine to four adult patients with glioblastoma who had relapsed after previous treatment. All patients survived several months longer than the expected average survival at this advanced stage of illness. We expect to treat children with a type of brain tumor called pediatric high-grade glioma by the end of the year.

Importantly, mRNA vaccines can be developed to treat any kind of cancer, including childhood brain tumors. Our Pediatric Cancer Immunotherapy Initiative focuses on developing new immune-based therapies for children afflicted with cancer. After developing an mRNA vaccine for glioma in chidren, we will expand to treat other kinds of pediatric brain cancers like medulloblastoma and potentially treat other kinds of cancers like skin cancer and bone cancer.

Overall, I'd say that these results all sound promising, but I'd also say that the ScienceAlert headline oversells it when they describe it as "incredible". A survival increase from - say - 6 months to 9 months is a 50% increase, so it is noteworthy and I'm sure that every day matters to the patient. But, 9 months is still a pretty short survival period. To me, it seems like this is probably a significant step in the direction that we need to go, but a lot more progress is still needed in order to qualify as "incredible". Also, I want to see results in more than 4 people before I have much confidence in the results. Finally, I didn't see anything about cost and scaling in either of the articles, so even if these treatments pan out, it's not clear to me how long it will be until the general public can gain access to them.

Overall, I am pleased to see progress in this area, and I hope it continues. The faster the better.

Related

• UF-developed mRNA vaccine triggers fierce immune response to fight malignant brain tumor
• ‘Real hope’ for cancer cure as personal mRNA vaccine for melanoma trialled
• Cancer vaccines are having a renaissance
• The effort to make a breakthrough cancer therapy cheaper

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Thank you for your time and attention.

As a general rule, I up-vote comments that demonstrate "proof of reading".

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Steve Palmer is an IT professional with three decades of professional experience in data communications and information systems. He holds a bachelor's degree in mathematics, a master's degree in computer science, and a master's degree in information systems and technology management. He has been awarded 3 US patents.

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^{Pixabay license, source}

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