Breakthrough in mRNA vaccines for melanoma

A new ‘personalised’ mRNA cancer vaccine in combination with pembrolizumab (sold as Keytruda) significantly improves recurrence-free survival from melanoma, Moderna and Merck have announced.
 
The combination of the mRNA vaccine and pembrolizumab, an immunotherapy drug, was given as adjuvant treatment to patients with stage III/IV melanoma following complete resection as part of the KEYNOTE/mRNA trial, which showed it reduced the risk of recurrence or death by 44% compared to pembrolizumab alone.
 
Associate Professor Jeremy Hudson, Clinical Director of the North Queensland Skin Centre, told newsGP he is delighted by the news.
 
‘My congratulations to the researchers, as this is a good step forward in the fight against melanoma,’ he said.
 
There were 157 patients in the trial, including Australians. Serious adverse events occurred in 14.4% of patients who received an mRNA vaccine and pembrolizumab, slightly more than the 10% rate in those who received the immunotherapy drug alone.
 
Melanoma is Australia’s most fatal skin cancer and Australia has the highest per capita incidence rate in the world.
 
Approximately 17,000 Australians are diagnosed with melanoma each year, with 1400 dying from it annually.
 
The research is yet to be peer-reviewed or published in a journal. However, experts are excited, with Professor Georgina Long of the Melanoma Institute of Australia telling the ABC that it may be ‘the penicillin moment’ in cancer therapy.
 
Meanwhile, Associate Professor Jason Luke, Director of the Cancer Immunotherapeutics Center in Pittsburgh, told the Washington Post ‘it really sounds like science fiction. But I really do think that’s the world we’re moving into’.
 
Personalised mRNA vaccines are made to specifically match each patient’s cancer fingerprint. They train the body’s immune cells to recognise the cancer fingerprint proteins so that they can launch an immune response against the malignant cells.
 
Both pembrolizumab and the mRNA vaccine were administered over one year, with the mRNA vaccine administered nine times and pembrolizumab given every three weeks, up to 18 cycles.
 
Associate Professor Hudson, also Chair of RACGP Specific Interests Dermatology, says he sees great potential in mRNA therapy.
 
‘What we have today is meaningful evidence that mRNA vaccines can improve survivability in melanoma,’ he said.
 
‘Technologically, this is also important as it is a validation of mRNA synthesis and use against cancers, which is a much more individualised treatment from a biological perspective.
 
‘Interestingly enough, mRNA research into cancers has been going on for about a decade now and it was this groundwork that allowed the COVID mRNA vaccines to be rolled out quickly.’
 
The results are the first demonstration of efficacy for an investigational mRNA cancer treatment in a randomised clinical trial and the next steps are to initiate a Phase III study in 2023 before expanding to additional tumour types.
 
According to Associate Professor Hudson, the technology could be useful for an array of other conditions.
 
‘There are certainly a lot of other cancers that could be treated with mRNA vaccines, which is a hopeful prospect,’ he said.
 
‘As long as the skin cancer has a specific protein we can target, it’s fair game. The first skin cancer that springs to mind is Merkel cell, which has a very aggressive metastatic rate.’
 
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