EVERETT — A skin cancer vaccine utilizing messenger RNA, known medically as mRNA, is the biggest treatment breakthrough in 10 years, according to an oncologist at Everett’s Providence Regional Medical Center who has been evaluating an encouraging new study just released by Merck and Moderna.
Dr. Graham Unis, medical oncologist at Providence Everett, says the new study by Merck and Moderna, described as a personalized cancer vaccine, could be a “similar leap forward” in fighting cancer when immunotherapy improved on chemotherapy treatment 10 years ago.
“I would say that similar to when immunotherapy was built 10 years ago, it changed the field not just for melanoma, but many different cancer types. I suspect that this is a similar leap forward in terms of revolution,” Dr. Unis forsees.
Chemotherapy treatment kills both healthy and cancerous cells. Immunotherapy stimulates the immune system to fight cancer cells. This new study on mRNA hinges on training the immune system to specifically target mutations found only on a person’s tumor.
Messenger RNA is the single‑stranded RNA molecule transcribed from a DNA template that carries genetic instructions from the nucleus to a ribosome, where its codon sequence is read to build a protein.
Dr. Unis says the mRNA platform is already being applied to other types of cancer, “We know that many tumor types are very sensitive to immunotherapy. And it’s likely not long before we start to see these therapies developed in other tumor types.” Merck and Moderna already have trials under way to study this method of treating lung, bladder, kidney cancer, pancreatic and stomach cancers with results expected in the next year or two, according to Moderna President, Stephen Hoge.
Merck and Moderna’s study of 1000 patients said their vaccine helped prevent the return and spread of melanoma.
Unis tells the EverettPost.com that the sample size is a significant part of the breakthrough. “The more samples that we have or the more patients that take place, the more confident we are in the therapy. That shows a difference is actually a real difference, rather than just due to random chance,” he says.
“In general, there’s kind of three major clinical trial types starting from phase one, phase two, and phase three,” Dr. Unis continues, saying, “Phase 3 clinical trials are kind of the last step before submitting for full FDA approval, and so this is the first time that that I’m aware of that a phase three clinical trial has demonstrated a significant benefit with an mRNA vaccine.”
For skin cancer patients, Dr. Unis says, “Melanoma, traditionally, had a very poor prognosis. It didn’t respond very well to therapy and for patients who had recurrent disease or metastatic disease, the overall survival, was measured in two years.”
To improve that survival rate and treatment, Providence’s oncologist says, “They developed a few immunotherapies that came out at the same time almost 10 years ago. And these revolutionized treatments for melanoma.” Survivability rates increased.
Flash forward to Merck and Moderna’s newly released results and Dr. Unis explains, “Now, we have messenger RNA, which is a type of molecule that we use for synthesizing proteins. But we found that for vaccines, it can be a very potent stimulatory signal for the body’s immune system. And so there’s been a lot of effort to develop ways that we can make immunotherapy effective for patients who may not be responding,” to previous forms of non-mRNA treatment.
“Because mRNA is such a strong stimulatory factor it was very effective at being able to recruit the body’s immune system,” Dr. Unis says, which isolates the treatment on the tumor and not other healthy parts of the patient’s body.
“So, with the MRNA vaccines, now, we’re able to personalize the treatment. We take samples of this tumor type, and we develop vaccines that target the melanoma. And then we use that to then stimulate the body’s immune system,” Unis chronicles.
That targeted stimulus means, “The hope is that eventually our body develops its own memory cells,”Dr. Unis continues, referring to the immune system knowing how to fight the cancerous cells specifically. “And these mRNA vaccines then can lead to a long-lasting remission of the disease. Or, completely eliminate it entirely, which is kind of our goal here.”
Asked if this new mRNA personalized melanoma vaccine will be beneficial for all or most skin cancer patients, Dr. Unis is very optimistic, telling the EverettPost.com, “The trial reported that that the response was consistent over many different kind of subgroup analysis. We’ll have to wait and see what the final data shows, but overall, based on what hat they’ve reported so far, it’s likely to be beneficial across the board” for melanoma patients.
Dr. Unis is mindful of what this means for patients in north Snohomish County and the North Sound who might otherwise be required to go to Seattle hospitals for cancer treatment. “mRNA vaccines appear to be relatively easy to administer and relatively safe to administer. So I think that this will likely be able to reach many of the patients in the community setting who would otherwise have to be traveling to major academic centers for more advanced therapies.”
For Providence Everett, the vaccine availability would mean, “There’s less of a barrier,” to a patient’s treatment location Dr. Unis advises, “and I think that that likely following its approval we’ll be implementing and developing plans here (at Providence Everett) pretty quickly.”
That creates a practical as well as medical benefit for treating cancer patients. “We’re at a very important (geographic) area, because there’s a lot of patients who live to the north of Everett. Any kind of comprehensive cancer care, and it’s something that we’ve really grown to develop,” at Providence Everett, the oncologist emphasizes, “I think the Providence program’s only going to go up,” in treating cancer patients.
A win-win.
“Absolutely,” Dr. Unis concludes. “I’m pretty excited about it.”