Tag Archive for: cancer treatment

What are Cancer Vaccines?

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Approved Cancer.Net Editorial Board, 08/2020

Vaccines are medicines that help the body fight disease. They can train the immune system to find and destroy harmful germs and cells. There are many vaccines that you receive throughout your life to prevent common illnesses. There are also vaccines for cancer. There are vaccines that prevent cancer and vaccines that treat cancer.

Are there vaccines that prevent cancer?

There are vaccines that can prevent healthy people from getting certain cancers caused by viruses. Like vaccines for the chicken pox or the flu, these vaccines protect the body from these viruses. This type of vaccine will only work if a person gets the vaccine before they are infected with the virus.

There are 2 types of vaccines that prevent cancer approved by the U.S. Food and Drug Administration (FDA):

HPV vaccine. The vaccine protects against the human papillomavirus (HPV). If this virus stays in the body for a long time, it can cause some types of cancer. The FDA has approved HPV vaccines to prevent:

HPV can also cause other cancers the FDA has not approved the vaccine for, such as oral cancer.

Hepatitis B vaccine. This vaccine protects against the hepatitis B virus (HBV). This virus can cause liver cancer.

Are there vaccines that treat cancer?

There are vaccines that treat existing cancer, called treatment vaccines or therapeutic vaccines. These vaccines are a type of cancer treatment called immunotherapy. They work to boost the body’s immune system to fight cancer. Doctors give treatment vaccines to people who already have cancer. Different treatment vaccines work in different ways. They can:

  • Keep the cancer from coming back
  • Destroy any cancer cells still in the body after treatments end
  • Stop a tumor from growing or spreading

How do cancer treatment vaccines work?

Antigens, found on the surface of cells, are substances the body thinks are harmful. The immune system attacks the antigens and, in most cases, gets rid of them. This leaves the immune system with a “memory” that helps it fight those antigens in the future.

Cancer treatment vaccines boost the immune system’s ability to find and destroy antigens. Often, cancer cells have certain molecules called cancer-specific antigens on their surface that healthy cells do not have. When a vaccine gives these molecules to a person, the molecules act as antigens. They tell the immune system to find and destroy cancer cells that have these molecules on their surface.

Some cancer vaccines are personalized. This means they are made for just 1 person. This type of vaccine is produced from samples of the person’s tumor that are removed during surgery. Other cancer vaccines are not personalized and target certain cancer antigens that are not specific to an individual person. Doctors give these vaccines to people whose tumors have those antigens on the surface of the tumor cells.

Most cancer vaccines are only offered through clinical trials, which are research studies that use volunteers. In 2010, the FDA approved sipuleucel-T (Provenge) for people with metastatic prostate cancer, which is prostate cancer that has spread. Sipuleucel-T is tailored to each person through a series of steps:

  • White blood cells are removed from the person’s blood. White blood cells help the body fight infection and disease.
  • The white blood cells are altered in a laboratory to target prostate cancer cells.
  • Next, the doctor puts the altered cells back into the person through a vein. This is similar to a blood transfusion. These modified cells teach the immune system to find and destroy prostate cancer cells.

Another vaccine uses a weakened bacteria called Bacillus Calmette-Guérin (BCG) that is injected into the body. This weakened bacteria activates the immune system to treat early-stage bladder cancer.

What are the challenges of using treatment vaccines?

Making treatment vaccines that work is a challenge because:

Cancer cells suppress the immune system. This is how cancer is able to begin and grow in the first place. Researchers are using adjuvants in vaccines to try to fix this problem. An adjuvant is a substance added to a vaccine to improve the body’s immune response.

Cancer cells start from a person’s own healthy cells. As a result, the cancer cells may not “look” harmful to the immune system. The immune system may ignore the cells instead of finding and fighting them.

Larger or more advanced tumors are hard to get rid of using only a vaccine. This is 1 reason why doctors often give a cancer vaccine along with other treatment.

People who are sick or older can have weak immune systems. Their bodies may not be able to produce a strong immune response after they receive a vaccine. That limits how well a vaccine works. Also, some cancer treatments may weaken a person’s immune system. This limits how well the body can respond to a vaccine.

For these reasons, some researchers think cancer treatment vaccines may work better for smaller tumors or cancer in its early stages.

Vaccines and clinical trials

Clinical trials are key to learning more about both cancer prevention vaccines and cancer treatment vaccines. Researchers are testing vaccines for many types of cancer, including:

Bladder cancer. Researchers are testing how well a vaccine made from a virus altered with the HER2 antigen works. These antigens or molecules live on the surface of some bladder cancer tumors. The virus may help teach the immune system to find and destroy these tumor cells. Researchers also want to know which works better: standard bladder cancer treatment or standard treatment with a vaccine.

Brain tumors. There are many studies testing treatment vaccines aimed at certain molecules on the surface of brain tumor cells. Some focus on newly found brain cancer. Others focus on cancer that has come back, or recurred. Many of the studies include children and teens.

Breast cancer. Many studies are testing treatment vaccines for breast cancer, given alone or with other treatments. Other researchers are working to get vaccines that prevent breast cancer into clinical trials.

Cervical cancer. As explained above, the FDA approved HPV vaccines that prevent cervical cancer. Research continues on vaccines that help treat each stage of cervical cancer.

Colorectal cancer. Researchers are making treatment vaccines that tell the body to attack cells with antigens thought to cause colorectal cancer. These antigens include carcinoembryonic antigen (CEA), MUC1, guanylyl cyclase C, and NY-ESO-1.

Kidney cancer. Researchers are testing many cancer vaccines to treat kidney cancer. They are also testing vaccines to prevent kidney cancer in its later stages from coming back.

Leukemia. Studies are looking at treatment vaccines for various types of leukemia, such as acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). Some are meant to help other treatments, such as a bone marrow/stem cell transplant, work better. Other vaccines made from a person’s cancer cells and other cells may help the immune system destroy the cancer.

Lung cancer. Lung cancer treatment vaccines in clinical trials target antigens.

Melanoma. Researchers are testing many melanoma vaccines, given alone or with other treatments. Destroyed melanoma cells and antigens in the vaccines tell the immune system to destroy other melanoma cells in the body.

Myeloma. There are many clinical trials looking at vaccines for people with multiple myeloma who are near remission. This means doctors can no longer find the cancer in the body and there are no symptoms. Researchers are also testing vaccines in people with smoldering myeloma or who need to have an autologous bone marrow/stem cell transplant.

Pancreatic cancer. Researchers are working on many treatment vaccines designed to boost the immune system’s response to pancreatic cancer cells. The vaccine may be given as the only treatment or along with another treatment.

Prostate cancer. As noted above, sipuleucel-T is a vaccine that doctors can use to treat people with prostate cancer that has spread. Now studies are looking to see if the vaccine can help people with prostate cancer at earlier stages.

Learn more about the latest research for specific cancers in this website’s guides and finding a clinical trial.

Questions to ask your health care team

If you want to learn more about joining a cancer treatment vaccine clinical trial, talk with your health care team. You may want to ask these questions:

  • Is there a clinical trial testing a vaccine for my type and stage of cancer?
  • Where is the clinical trial located?
  • What is the vaccine and how does it work?
  • How is the vaccine made? Will I need blood cells or tumor tissue removed to make the vaccine? How will you remove it?
  • How will I receive the vaccine and how often?
  • How long will I need the vaccine?
  • What side effects could occur?
  • Can I receive the vaccine with other treatments such as radiation therapy or chemotherapy?
  • What are the other treatment options for this cancer?

Related Resources

Getting Treatment in a Clinical Trial

Making Decisions About Cancer Treatment

Clinical Trials

Podcast: Should People With Cancer Be Tested for Hepatitis B?

More Information

National Cancer Institute: Cancer Treatment Vaccines

What is SCOR?

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“SCOR helps facilitate the connection between SCOR institutions (hospitals, medical centers and private practices), patients and the clinical trials patients seek, thereby allowing SCOR members to provide “state-of-the-art” and innovative cancer treatments to these patients.”  -Dr. Judith Hopkins, Oncologist and SCOR Principal Investigator, Winston-Salem, NC

Drug Discovery and Development

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Approved by the Cancer.Net Editorial Board, 08/2018

Doctors and scientists are always looking for better ways to care for people with cancer. To do this, they create and study new drugs. They also look for new ways to use drugs that are already available.

A drug goes from being an idea in the lab to something that a doctor prescribes. To do this, it must go through a long development and approval process. During this process, researchers make sure the drug is safe for people to take and effectively treats cancer. This process often takes many years and significant resources. But the actual amount of time and money needed depends on the drug.

There are 3 main steps in finding and developing a new drug:

  • Preclinical research, which is when the drug is found and first tested
  • Clinical research, which is when the drug is tested in people
  • Post-clinical research, which takes place after the drug is approved

Drug discovery and initial testing

The discovery of new cancer drugs can happen in different ways:

Accidental discovery. In the early 1940s, an explosion exposed sailors to poisonous mustard gas. Doctors found that these sailors had low white blood cell counts. So they began using nitrogen mustard, or mechlorethamine (Mustargen) to treat Hodgkin lymphoma. This is a cancer of the lymphatic system involving the white blood cells. Nitrogen mustard is still a cancer treatment used today. But accidental discoveries such as this are rare.

Testing plants, fungi, and animals. Paclitaxel (Taxol) treats several types of cancer. This was first found in the bark of the Pacific yew tree. More recently, a primitive animal called a sea sponge was used to create the drug eribulin (Halaven). The National Cancer Institute (NCI) has samples of thousands of plants, marine organisms, bacteria, and fungi. These are collected from around the world in the hopes of finding new cancer treatments.

Studying the biology of cancer cells. Most cancer researchers start by comparing both the genes found in DNA and growth patterns of cancer cells to healthy cells. This identifies important steps in the cancer growth process that a drug could fix.

For example, researchers learned that about 20% of all breast cancers have an abnormal amount of a certain protein. It is called HER2 and controls the growth and spread of cancer cells. Five drugs were created to target HER2: trastuzumab (Herceptin), lapatinib (Tykerb), pertuzumab (Perjeta), ado-trastuzumab emtansine (Kadcyla), and neratinib (Nerlynx). Now, a person with breast cancer has the tumor tested to check for HER2. It will show if these drugs can treat the cancer. Learn more about these targeted treatments.

Understanding the chemical structure of a drug target. Scientists may use computers to mimic how a potential drug interacts with its target. This is similar to fitting 2 puzzle pieces together. Researchers can then make chemical compounds that interact with the specific drug target.

After drugs are created, researchers test them on human tumor cells in the lab. They see if the drugs stop the growth of cancer cells. Next, they test the drug in animals to find out if it is still effective at treating cancer. Researchers test the drug in 2 or more animal species. They learn how the body uses the new drug. They also learn what side effects the drug may cause and what dose of the drug to test in people.

Drug developers and sponsors

The U.S. Food and Drug Administration (FDA) does not develop or test drugs. Instead, medical research universities, government agencies such as the NCI, and drug companies find and test new drugs. The sponsor is the group that develops a drug. It does the research needed for the FDA to approve the drug.

Biosimilars

Drug developers are creating different types of biologic medicines to treat cancer. One kind of biologic medicine is called biosimilars.

Biosimilars are a variation of drugs already approved by the FDA. They offer a growing number of new treatment options for people. They also often cost less than similar drugs.

The FDA requires a biosimilar drug to be compared with an existing one. The existing drug is called a reference drug. The biosimilar must be highly similar in structure and function and have no large differences compared to the reference drug.

Biosimilars have to meet a strict approval process by the FDA to make sure it is a safe and effective treatment option. Talk with your health care team to find out if biosimilars could be a part of your treatment plan.

Clinical research

Before new drugs are tested in people, the sponsor must submit an Investigational New Drug (IND) application to the FDA. The IND provides information about past and future research plans, such as:

  • Preclinical studies done in the lab and in animals
  • Plans for clinical trials in people
  • How the new drug is made

The FDA approves potential drugs for testing in people under certain conditions:

  • The research shows that the drug is likely to work and be safe.
  • The proposed clinical trials must be designed correctly.
  • The drug can be made the same way every time.

Clinical trials are research studies involving volunteers. They are used to find out if a new drug is safe, effective, and better than the standard treatments. Each phase involves a larger number of people than the previous phase. It also provides more detail about the new drug’s safety and effectiveness.

Clinical trials may involve hundreds or thousands of people. They usually take years to complete. But sometimes, if a small clinical trial shows very promising results, the process may be sped up.

Early phases of clinical trials focus on safety, dosing, and how the body processes the drug. Later phases center on how well the drug works. Learn more about clinical trials.

Clinical review and FDA approval

If the clinical trials are successful, the drug sponsor submits a New Drug Application (NDA) to the FDA. The NDA requests approval for the drug to be prescribed by doctors. The request includes:

  • Results from the preclinical and clinical studies.
  • Details about how the drug will be made and labeled.
  • The drug’s possible side effects and any interactions with food or other drugs.

The FDA may approve the drug if the evidence shows it is effective and safe for use. No drug is completely safe or free from side effects. But a drug is approved if there are more benefits than risks.

After FDA approval

A drug is ready for the market when it receives FDA approval. This means it can be prescribed by doctors and sold to people. But the FDA may require that the sponsor conduct more clinical trials. These are called phase IV clinical trials.

Phase IV clinical trials look for other possible side effects or confirm the benefits of the treatment. They may study the drug in different doses, new combinations, or in different schedules. They may also study the treatment in new groups of people, such as older adults or children. Or they may assess the drug’s long-term effects.

Some drug makers may conduct their own phase IV clinical trials. They may do more research to get FDA approval to use the drug in a new way, such as for another type of cancer.

The FDA also monitors the safety of drugs currently on the market. They do this to make sure that drug makers report any new or serious side effects. The FDA may withdraw a drug from the market if new research shows it is not safe or effective.

Immunotherapy to Treat Cancer

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Immunotherapy is a type of cancer treatment that helps your immune system fight cancer. The immune system helps your body fight infections and other diseases. It is made up of white blood cells and organs and tissues of the lymph system.

Immunotherapy is a type of biological therapy. Biological therapy is a type of treatment that uses substances made from living organisms to treat cancer.

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors don’t contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:

  • Have genetic changes that make them less visible to the immune system.
  • Have proteins on their surface that turn off immune cells.
  • Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.

Immunotherapy helps the immune system to better act against cancer.

What are the types of immunotherapy?

Several types of immunotherapy are used to treat cancer. These include:

  • Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.Learn more about immune checkpoint inhibitors.
  • T-cell transfer therapy, which is a treatment that boosts the natural ability of your T cells to fight cancer. In this treatment, immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein.T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.Learn more about T-cell transfer therapy.
  • Monoclonal antibodies, which are immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so that they will be better seen and destroyed by the immune system. Such monoclonal antibodies are a type of immunotherapy.Monoclonal antibodies may also be called therapeutic antibodies.Learn more about monoclonal antibodies.
  • Treatment vaccines, which work against cancer by boosting your immune system’s response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.Learn more about cancer treatment vaccines.
  • Immune system modulators, which enhance the body’s immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.Learn more about immune system modulators.

Which cancers are treated with immunotherapy?

Immunotherapy drugs have been approved to treat many types of cancer. However, immunotherapy is not yet as widely used as surgery, chemotherapy, or radiation therapy. To learn about whether immunotherapy may be used to treat your cancer, see the PDQ® adult cancer treatment summaries and childhood cancer treatment summaries.

What are the side effects of immunotherapy?

Immunotherapy can cause side effects, many of which happen when the immune system that has been revved-up to act against the cancer also acts against healthy cells and tissues in your body.

Learn more about immunotherapy side effects.

How is immunotherapy given?

Different forms of immunotherapy may be given in different ways. These include:

  • Intravenous (IV)
    The immunotherapy goes directly into a vein.
  • Oral
    The immunotherapy comes in pills or capsules that you swallow.
  • Topical
    The immunotherapy comes in a cream that you rub onto your skin. This type of immunotherapy can be used for very early skin cancer.
  • Intravesical
    The immunotherapy goes directly into the bladder.

Where do you go for immunotherapy?

You may receive immunotherapy in a doctor’s office, clinic, or outpatient unit in a hospital. Outpatient means you do not spend the night in the hospital.

How often do you receive immunotherapy?

How often and how long you receive immunotherapy depends on:

  • Your type of cancer and how advanced it is
  • The type of immunotherapy you get
  • How your body reacts to treatment

You may have treatment every day, week, or month. Some types of immunotherapy given in cycles. A cycle is a period of treatment followed by a period of rest. The rest period gives your body a chance to recover, respond to the immunotherapy, and build new healthy cells.

How can you tell if immunotherapy is working?

You will see your doctor often. He or she will give you physical exams and ask you how you feel. You will have medical tests, such as blood tests and different types of scans. These tests will measure the size of your tumor and look for changes in your blood work.

What is the current research in immunotherapy?

Researchers are focusing on several major areas to improve immunotherapy, including:

  • Finding solutions for resistance.
    Researchers are testing combinations of immune checkpoint inhibitors and other types of immunotherapy, targeted therapy, and radiation therapy to overcome resistance to immunotherapy.
  • Finding ways to predict responses to immunotherapy.
    Only a small portion of people who receive immunotherapy will respond to the treatment. Finding ways to predict which people will respond to treatment is a major area of research.
  • Learning more about how cancer cells evade or suppress immune responses against them.
    A better understanding of how cancer cells get around the immune system could lead to the development of new drugs that block those processes.
  • How to reduce the side effects of treatment with immunotherapy.
Find more information about immunotherapy clinical trials near you HERE.

Immunotherapy to Treat Cancer was originally published by the National Cancer Institute.

The Importance of Cancer Treatment Research

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Research on the treatment of cancer is fundamental to improving outcomes for all patients affected by the disease. Despite the tremendous progress made in recent decades in treating many types of cancer, effective therapies are still lacking for some forms of the disease, including liver cancer, pancreatic cancer, and certain types of adult and pediatric brain cancer. More than 600,000 people are projected to die from cancer in the United States in 2020.Also, too many patients whose cancer has been successfully treated experience long-term adverse effects of the disease and its treatment, including increased risk of a second cancer. Therefore, cancer treatment research includes developing ways to prevent or lessen the side effects of treatment. More research is needed to ensure that all patients with cancer have safe and effective therapies and the highest possible quality of life.

Thanks to NCI-funded research, patients with cancer have a greater number of more-effective and less-toxic therapeutic options than ever before. NCI has played a vital role in cancer drug discovery and development for more than 50 years. NCI’s support for cancer treatment research extends from studies of the fundamental biology of cancer, the development of treatments that target cancer cell abnormalities, and the testing of new cancer therapies in clinical trials.

NCI’s contributions are reflected in the fact that:

  • Approximately half of the drugs currently used to treat patients with cancer were discovered and/or developed by NCI-supported researchers. These include imatinib (Gleevec), the first small-molecule molecularly targeted therapy; ipilimumab (Yervoy), the first immune checkpoint inhibitor; and tisagenlecleucel (Kymriah), the first genetically engineered cell-based immunotherapy.
  • In 2019 alone, 11 new cancer treatments were approved by the Food and Drug Administration, and NCI-funding contributed to the development and/or testing of most of them.
  • A study published in 2019 showed that nearly half of the phase 3 clinical trials conducted by the SWOG Cancer Research Network, one of five National Clinical Trials Network clinical research groups, were associated with changes in cancer clinical practice guidelines or new drug approvals.

The Future of Cancer Treatment Research

Breakthroughs in molecularly targeted therapies and immunotherapy have revolutionized the cancer treatment landscape for patients. Additional cancer treatment innovations are on the horizon. For example, recent research is creating optimism that, one day, there may be targeted treatments for so-called “undruggable” cancer targets, including the oncoproteins RAS and MYC, and for restoring the tumor-suppressor function of proteins such as p53 and PTEN. Although more development and clinical testing are needed, the availability of these targeted treatments will be a hallmark of unprecedented progress for patients who have few therapeutic options.

Many other important research opportunities exist to improve the care and treatment of the individual patient. One day, not only will it be possible to molecularly characterize a patient’s cancer cells, but the cellular components of their tumor—and even the composition of their intestinal or tumor microbiome—will inform treatment decisions. With this information, doctors will select therapies, or combinations of therapies, for each patient and avoid ones that will have unacceptable side effects. This future will only be possible through additional research investment.

Vision

All patients with cancer will have safe and effective treatments.

Approach

Additional investments in cancer treatment research will further improve the outlook for both adults and children with cancer. Fully realizing the potential to identify, study, and test new cancer therapies requires additional research to achieve the following goals:

1) Discover and develop new cancer therapies, including those that involve molecularly targeted therapies and immunotherapies, as well as treatment combinations

Treatments that target the molecular changes in a person’s cancer and immunotherapies that unleash the power of the immune system against the disease are revolutionizing the potential of cancer care. Because these newer therapies provide durable clinical benefits to only a small proportion of patients, new or revised therapeutic approaches must be developed. Among our major objectives of this research are:

  • Identifying and characterizing new targets for cancer treatment, such as abnormal proteins that are responsible for cancer cell survival, growth, and spread
  • Developing new ways to leverage the rapid progress in cancer immunotherapy to benefit more patients, including identifying predictive biomarkers of efficacy or toxicity, developing novel immune targets, and combining therapies
  • Understanding the mechanisms of drug resistance, a major cause of treatment failure in patients, and developing strategies that target these mechanisms, including the use of combination therapies
  • Identifying and developing additional biomarkers to monitor treatment benefits and harms and to aid clinicians in selecting the most appropriate treatments for patients

2) Improve traditional cancer treatment approaches, including surgery, radiation therapy, and chemotherapy

Surgery, radiation therapy, and chemotherapy remain important options for cancer treatment. NCI funds research to improve the effectiveness and use of these treatments. We must learn to use them more precisely and minimize their side effects. NCI’s major objectives include:

  • Understanding how to combine therapies, including different types of treatment (for example, radiotherapy with immunotherapy)
  • Tailoring treatments to avoid overtreatment and avoidable toxic side effects (for example, by conducting de-escalation studies)
  • Advancing the development of precision radiotherapy to target tumors more precisely and spare the surrounding normal tissue from radiation damage
  • Supporting innovations in cancer surgery, including approaches to minimize the impact on normal tissues

Cancer Treatment Research was originally published by the National Cancer Institute.  Updated August 30, 2020.