Clinic Conversation of the Week: How to Talk With Patients About Personalized Neoantigen Vaccines for Renal Cell Carcinoma

Bradley McGregor, MD: Welcome to this Clinic Conversation of the Week, a series where we discuss the latest groundbreaking research with patients in the clinic. My name is Brad McGregor, and I’m a Medical Oncologist from Dana-Farber Cancer Institute in Boston, Massachusetts. Today, I’ll be discussing ongoing research exploring neoantigen therapy in kidney cancer and how I explain this to patients in the clinic. There was some really exciting data published in the past few weeks, looking at this idea of a personalized neoantigen therapy or vaccine.

Here’s What I Would Say

“So, the idea of using vaccines to treat cancer has been around for a while. In kidney cancer, we’ve tried using sort of generalized vaccines, and it’s really had disappointing results, so I was very fortunate to participate in what was called the NeoVax trial. This trial enrolled patients who had kidney cancer that was resected and had very aggressive disease, with stage III or higher.

What we did is we took their tumors and analyzed them, and we made a personalized vaccine. It was a protein-based vaccine. We gave this vaccine alone without any intravenous (IV) treatment to our patients over a period of time after surgery, and we recently published results. Of the first nine patients, over a couple years of follow-up, none of the patients had their cancer come back.

The primary end point was looking at how the blood was affected. What we saw overall is that we can make a vaccine in all these patients. When we looked at the blood of the patients after the vaccine, the blood showed that they had responded to the vaccine, and they were activated against the tumor. It’s really, really exciting results. It’s the idea that we can treat and prevent kidney cancer from coming back, not by just taking off the brakes of the immune system, but by steering the immune system to where it needs to go through this personalized vaccine.

So, that was a very complex trial where we used a protein-based vaccine. It was hard to make, but we now know from our experience with COVID that we can do different approaches. We have mRNA approaches where instead of having to make the protein itself, we say, “Hey, this is what we want the body to go after.” We can use mRNA to give the recipe.

Subsequently, in the follow-up study of this, which has just completed accrual, we gave everyone immunotherapy with pembrolizumab, which sort of releases the brakes of the immune system to try to let the immune system go and attack the cancer at the same time. Patients are randomized to receive either a placebo or this new vaccine based on their tumor. We’re giving the vaccine to try to steer the immune system to go against the kidney cancer.

It’s a really, really exciting idea where patients who’ve had their kidney cancer removed, can we prevent recurrences not by just giving immunotherapy to attack the cancer, but trying to say, “Hey, we need immunotherapy, attack the cancer,” and really try to drive that immune system into the right space. I think it’s a really exciting way to think about how we treat cancer, specifically kidney cancer, but also other cancers. The idea is that as we further explore treatments, not only are we just going to do this generalized activation immune system, but using these personalized neo antigen therapies, we can really try to ensure that the immune system is going to go after the specific cancer cells. And so, it’s really the next step in how we want to treat cancer. And hopefully this is one of many trials that will lead to further improvements for our patients.”

About Dr. McGregor

Bradley McGregor, MD, is a Medical Oncologist and the Director of Clinical Research at the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute. He is also an Assistant Professor of Medicine at Harvard Medical School. Dr. McGregor is an active investigator for clinical trials researching combination immunotherapies for genitourinary cancers, including kidney and bladder cancer.