These results are preliminary, but if validated in a larger, more conclusive clinical trial, the result could be “a new paradigm” for cancer care, says study co-author Elias Sayour, MD, PhD, associate professor of neurosurgery and principal investigator of the RNA Engineering Laboratory at the University of Florida School of Medicine in Gainesville.
“It’s really exciting,” says Tanya Evans, MD, a dermatologist and medical director of the skin cancer program at the melanoma clinic at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., who was not involved in the research.
How long did people live?
Researchers analyzed records of more than 1,000 patients with advanced lung or skin cancer who were receiving immunotherapy at the University of Texas MD Anderson Cancer Center at Houston. Simply put, immunotherapy drugs work by teaching a patient’s immune system how to recognize and attack cancer cells.
The analysis of lung cancer patients compared two groups: a group of 180 people with advanced lung cancer who received an mRNA COVID-19 vaccine within 100 days of starting immunotherapy, and a group of 704 patients who received the same immunotherapy drugs but did not receive the vaccine.
Researchers found that people with advanced lung cancer who received the vaccine nearly doubled their survival time, from 20.6 months (on average) to 37.3 months.
Among patients with advanced melanoma, the deadliest form of skin cancer, 43 received the COVID-19 vaccine within 100 days of starting immunotherapy, while 167 did not receive the vaccine. Researchers found that those who received the vaccine saw their survival time increase from 26.7 months to 40 months. Some melanoma patients were still alive when researchers collected the data, suggesting the vaccine’s impact could be even greater.
“These results are important because they suggest that widely available mRNA vaccines designed to target COVID-19 could help patients’ immune systems kill their cancer,” says Adam Grippin, MD, PhD, senior author of the study and senior resident in radiation oncology at the University of Texas MD Anderson Cancer Center.
How do mRNA vaccines work?
Importantly, when researchers looked at medical records, they observed no change in survival times when patients received pneumonia or flu vaccines, which are not mRNA vaccines.
This suggests there is something special about mRNA vaccines, says Nilesh Vora, MD, a medical oncologist and medical director of the Todd Cancer Institute at Long Beach Medical Center in Long Beach, California.
Why does vaccination help cancer patients live longer?
Scientists are still studying why mRNA COVID-19 vaccines might fight cancer. But there is a theory. “MRNA vaccines increase the likelihood that conventional immunotherapy will work,” says Dr. Sayour. “This happens through the triggering of cellular alarms that mobilize immune cells to recognize the tumor as foreign.”
Dr. Vora calls this response an “enhancement” of the body’s immune system. “When you add lung cancer immunotherapy, you get an even greater response,” he says.
Dr. Grippin describes the COVID-19 mRNA vaccine as a “siren” that activates the immune system to kill cancer cells. “Tumor cells counter this immune attack by expressing [making] “Immune checkpoints” – proteins that turn off the immune system,” he says. “When we combine mRNA vaccines with immune checkpoint inhibitors, we block these proteins and unleash the power of the immune system to kill cancer.”
Dr. Evans expands on this idea. “In a sense, the vaccine grows the tumor cells and the immune therapy keeps them in place for a stronger response,” she says. “This is great news for melanoma and lung cancer, as well as other cancers.”
Why results matter
This study focused on patients with certain types of cancer who used the mRNA COVID-19 vaccine, but oncologists say the findings have even bigger implications. “This fuels the idea that the immune system plays a huge role in the progression of cancer,” says Vora. “It appears that an mRNA vaccine administered around the same time as immunotherapy may enhance the immune response. »
The findings also support the development of universal cancer vaccines to “wake up” the immune system before people undergo immunotherapy, says Sayour.
Additionally, the results suggest that future mRNA vaccines could be tailored to target specific cancers, says Evans. “Instead of presenting instructions for making a spike protein, you can give instructions for making antigens for cancer,” she explains. (Antigens are any substance that triggers the immune system to produce antibodies.) “Then the body can make antibodies that attack the cancer directly. »
What happens next?
The study was observational (meaning the researchers looked at existing data that was not originally collected for this purpose) and will require a randomized, controlled trial to see if the results can be replicated. But the research team is already planning a phase 3 clinical trial which should start before the end of the year.
“We hope that RNA-based therapies could not only help patients who are already considering receiving immune therapy, but also extend the benefits of immune therapy to patients with immune-resistant tumors,” says Grippin.
Ultimately, Vora says this is a big step in the right direction. “It’s very exciting,” he said.
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