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Success of lung cancer vaccine brings hope of a breakthrough

By Nigel Hawkes
Patients with advanced tumours lived more than twice as long as expected after a series of injections

November 02 - A VACCINE for treating lung cancer has shown very promising results in a trial, according to results presented yesterday. The trial adds to optimism that vaccines against cancer will work and that one day they will be used alongside surgery, chemotherapy and radioherapy as standard tools in the cancer clinic.

In the new trial, more than half the patients with advanced disease that had not spread to other organs were alive two years after treatment with a vaccine designed to enhance the body's own ability to fight cancer.

On average, such patients would be expected to survive for just over a year, so the results, announced yesterday at the European Society for Medical Oncology meeting in Vienna, are a big advance.

“Breakthrough is not a word I use, but this comes close,” said Håkan Mellstedt, from the Karolinska University Hospital in Stockholm, commenting on the trial. “I have been involved in cancer vaccines for 20 years, and scientists are always cautious. But these are very exciting results.”

This year three teams reported good results from trials of vaccines to treat prostate cancer. Success has also been reported recently with a more conventional vaccine, developed by GlaxoSmithKline to prevent cervical cancer by combating the sexually transmitted virus that triggers most cases of the disease.

The new study, carried out in Canada and four centres in the UK — Guy’s Hospital and St George’s Hospital in London, Western General Hospital in Edinburgh and Clatterbridge Centre for Oncology in the Wirral — involved 171 patients with non-small-cell lung cancer, the commonest form of the disease.

Half were given standard treatment, while the other half were also given the new vaccine.

Overall survival was 13 months in the normally treated group, and 17.4 months in those given the vaccine, a slightly disappointing result as the team had been hoping for better.

But in a subset of the patients — those with tumours too advanced for surgery, but that had not spread to any other organs — 60 per cent of those given the vaccine were still alive after two years, compared with 36.7 per cent of the unvaccinated group. One survivor has been taking the vaccine for 3½ years.

Charles Butts from the Cross Cancer Institute in Edmonton said that these results had been good enough to take the vaccine, developed by Biomira Inc, a Canadian company, and the drug company Merck, into larger trials. These will involve 1,000 patients from across the world, he said yesterday, and would last at least two years. The US Food and Drug Administration has granted the drug “fast-track” status and the new trial should start next year.

The vaccine works by stimulating the body’s immune system to attack the tumours more vigorously. A sugar- protein molecule that is found on the surface of many cells in the body is slightly altered in cancer cells, making it more visible to the immune system.

The vaccine, given weekly by injection for eight weeks and then at six-weekly intervals, is designed to alert the immune system to the target protein and increase the intensity of attacks, while leaving normal cells unaffected.

Professor Mellstedt said that several cancer vaccines were showing signs of progress. “We are seeing encouraging results in colorectal and kidney cancer and in malignant melanoma (skin cancer),” he said.

“This trial in lung cancer is very promising, and an attractive feature is that the vaccine may also work for a lot of other tumours, including pancreatic and colorectal tumours.”

Some cancer vaccines are made by taking extracts of an individual’s tumour and modifying them to create a personalised vaccine. But the Biomira vaccine could be produced in large scale by a pharmaceutical company and used for all patients with a particular disease, he said. The trial had also shown that the vaccine treatment is active in advanced disease after chemotherapy, where the majority of patients still had visible tumours.

“There is now no doubt that the non-toxic vaccine treatment concept will be incorporated into the therapeutic arsenal of cancer drugs,” Professor Mellstedt said.

Bernard Ehmer of Merck said that the results “offered a potentially meaningful benefit to patients”.

Every year 31,000 cases of lung cancer are diagnosed in the UK, 19,000 in men and 12,000 in women. Four fifths are non-small-cell lung cancer.
Deaths, at 27,000 a year, are almost as high as the incidence, reflecting the fact that treatments for lung cancer are poor, and survival rates have not improved much since the 1970s. Smoking is the main cause of lung cancer.


Three cancers have been the subject of vaccine trials

Lung cancer: the greatest killer in men, with 31,000 cases diagnosed in Britain every year, 19,000 in men and 12,000 in women. Four fifths are non-small-cell lung cancers. Deaths, at 27,000 a year, are almost as high as incidence, reflecting the fact that treatments for lung cancer are poor and survival rates have not improved much since the 1970s

Prostate cancer: the top male cancer, with 27,000 new cases every year. Much better treatments exist than for lung cancer, so survival is higher, but the disease still accounts for almost 10,000 deaths a year. Five-year survival is now almost two thirds, but better treatments would still be welcome

Malignant melanoma: the cancer with the fastest- growing number of new cases. There are 7,000 a year, 4,000 in women and 3,000 in men. Survival depends on the stage of development of the tumour at the time of detection. Five-year survival in patients with thin tumours is now more than 90 per cent, while in those with thicker tumours it is only 40 per cent in men and 54 per cent in women.

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