Personalized mRNA cancer vaccines are not yet routine care.
During one of my insomnia fits last week, I stumbled onto an emerging technology in an area I've always tried to follow for personal reasons—and somehow, I'd completely missed it. I hope I'm just a moron here.
(Hold the laughter and nodding agreement.)
Because I suspect some of you already know more about this than I did. What caught my attention was personalized mRNA cancer vaccines. And I use the word personalized very intentionally.
I lost my dad after a long, heroic battle with cancer. From 1987 to 1990, I watched him go through brutal chemotherapy while also dealing with shingles and a skin condition called mycosis fungoides. He lost an enormous amount of weight. He lost all his hair. And eventually, we lost him.
None of that is new to anyone who has watched someone they love fight serious cancer. If you've been there, you have my sincere sympathy. And to those of you who have beaten that fucker: A tremendous cheer for you. I've watched too many people come up short. That's why personalized mRNA cancer vaccines grabbed me. Full disclosure: the technical science behind this is way outside my league.
So I did what I usually do when something grabs my curiosity. I started digging. I spent two and a half hours bouncing between research papers, scientific literature and articles. I've collected papers I still need to work my way through. I've talked with a research scientist I've known personally for several years, and I'm going to talk with a surgeon friend as well. I'm not anywhere close to being ready to tell you what all of this means. That's actually the point. I want to understand it first—and then, if I can, explain it to you in plain English. Some of the medical and scientific professionals I've talked with have given me what my now-deceased wife Kim used to call her "Virtual Children's Pop-Up Book for Adults."
Kim, a highly intelligent woman, wasn't suggesting that people who understood complicated subjects were smarter or better than everyone else.
Quite the opposite.
She believed that if you understood something other people didn't, you had an obligation to try to explain it. It was probably one of the reasons Kim loved watching and listening to Dr. Neil deGrasse Tyson. Technology. Law, Art. History. Politics. Science. Medicine. Anything. Don't talk down to people. Don't bury them in jargon. Open the damn book. Turn the pages. And if it takes a hypothetical pop-up dragon, a few pretty pictures and whatever else you can dream up to keep someone's attention long enough for them to work through a complicated concept, then by God, use the pop up dragon. Keep turning those pages until they finally look at you and say:"Oh, yeah. I totally get that."
That was the whole point. So that's what I'm going to try to do here. I'm going to take what I learn from people who actually understand this stuff, dig through the research myself, and build my own little virtual pop-up book for the Kim's Warriors campfire. Because if this technology lives up to even some of its promise, it could become something very important someday. And I want to understand exactly what that promise is—and how close we actually are to it.
Let's start with the alphabet soup. mRNA stands for messenger RNA. It's essentially a short-lived set of instructions that tells cells how to make a particular protein or protein fragment. With a personalized cancer vaccine, doctors can study a sample of a patient's tumor and compare its genetic characteristics with the patient's healthy cells. They're looking for mutations—genetic changes—that help distinguish the cancer from normal tissue. Some of those changes can produce targets called neoantigens. Scientists can then design an individualized vaccine around selected targets. And here's an important distinction: The vaccine doesn't contain the patient's cancer cells. And it doesn't rewrite the person's DNA.
The basic idea is to give the immune system information it can use to recognize particular features of the cancer. Which brings us to the really interesting part.
Think about your immune system as an enormous security operation. Cancer can be difficult for that security system to identify because cancer cells originated from your own cells. They aren't necessarily wearing a giant sign saying: "HELLO. I'M CANCER." Personalized mRNA vaccination is an attempt to give the immune system a much more specific set of instructions about what to look for. Instead of simply saying: "Find cancer." the goal is closer to: "Here are some unusual characteristics found in this particular person's tumor. Learn them. Look for cells displaying them." Those instructions can help activate an immune response, including T cells, which play a major role in identifying and attacking abnormal cells. That's the promise. Not a magic bullet. Not a guaranteed cure. A more precise target.
The basic process looks something like this:
That's the theory. And increasingly, researchers are getting evidence that parts of that theory can work in actual patients. But—and this is a very important but—there is a huge difference between "this works in a clinical trial" and "this is ready for your doctor's office. "We're not there yet.
The thing that makes scientists so interested in personalized cancer vaccines is precision. We all know. Cancer isn't one disease. Even two people diagnosed with the same type of cancer can have tumors with very different genetic characteristics. A personalized approach attempts to use those differences rather than treating every tumor as if it were identical. That's a pretty big conceptual shift. Instead of asking: "What works for this kind of cancer?" researchers are increasingly asking: "What makes this particular patient's cancer vulnerable?" That doesn't mean the approach will always work. It doesn't mean every mutation makes a useful target. And it certainly doesn't mean we're looking at a universal cancer vaccine. But the underlying idea is damn interesting.
Here's where reality walks into the room and ruins the party. Personalized medicine is complicated. A patient's tumor has to be obtained and analyzed. Potential targets have to be identified. A vaccine has to be designed and manufactured specifically for that person. That takes time. And cancer doesn't necessarily give a damn about our manufacturing schedule. For aggressive cancers, even weeks can matter. There are also enormous logistical and financial challenges involved in producing individualized treatments at scale. So even if the science continues to succeed, another question remains: Can we make these treatments quickly enough, reliably enough and affordably enough for ordinary people to actually receive them? That's not a side issue. That's part of the science too.
Because cancer has a nasty habit of eventually becoming personal. Maybe it's your father. Your mother. Your spouse. Your kid. Your brother. Your sister. Your best friend. Or you. I remember watching a baseball game last summer where an entire stadium participated in a tribute to people who had been lost to cancer. Fans held up signs bearing the names of people they loved. The announcers participated too. Thousands of people standing together, holding up names.
It was one of those moments when you realize that cancer isn't an abstract medical term. It's people. It's empty chairs at Thanksgiving. It's phone calls nobody wants to make. It's hospital rooms. It's birthdays somebody doesn't get to see. And it's also survivors. People we should all hug and cheer for who beat the bastard. That's why advances in cancer research matter to all of us. Maybe personalized mRNA vaccines become one of the important tools in the fight. Maybe the technology changes. Maybe something better comes along. That's how science works. We learn something.We test it. We discover what we got wrong. We improve it. Then we test it again. And sometimes, eventually, somebody gets to live because of what we learned.
Fair enough. Personalized mRNA cancer vaccines are an attempt to create highly individualized instructions for the immune system. Scientists study a patient's tumor, identify features that distinguish the cancer from healthy cells, and design a vaccine intended to help the immune system recognize those features. The hope is that this could eventually provide a more precise way to attack cancer—and perhaps help prevent some cancers from returning. But we're not at the finish line. There are still questions about effectiveness, timing, manufacturing, cost, accessibility and which cancers will benefit most. So I'm not here to tell you that the cure for cancer has arrived. It hasn't. I'm here because something potentially important is happening, and I want to understand it. And then I want to open Kim's little virtual pop-up book, sit down around the campfire with you, and turn the pages. One at a time. No medical degree required. Just curiosity.
* If you have questions, want to add something you know, or have a story about cancer—someone in your family, someone you love, something you've been through yourself, or something you're going through right now—for any reason, talk to me. Share your story. Share what you've learned. Share what you know. This is important. And around this campfire, there's room for all of it.