How to build a cancer vaccine, and whether they will work this time
Grateful to Benjamin Vincent and Alex Rubinsteyn for our many conversations on this topic, and comments on drafts of this essay!Introduction When most people hear of “cancer vaccine,” they’ll think of normal vaccines. Perhaps they’ll even think of what ostensibly is a cancer vaccine: the HPV vaccine. These vaccines—and those akin to them—are not the subject of this essay, as those are preventive vaccines against an infectious cause of cancer. When you inject one of those, you are vaccinating against a virus. The virus causes cancer. Prevent the virus, prevent the cancer. This is standard vaccinology applied to an oncogenic pathogen, and amongst the approved ones, they work decently well, but are not, in any meaningful sense, what oncologists mean when they talk about cancer vaccines.Typical cancer vaccines are vaccines given to you when you have cancer.These have been worked on for forty years, and have largely failed.It’s a grim field. I’ve talked with a fairly high number of biology folks at this point, and ‘cancer vaccines don’t work, right?’ is a common sentiment amongst them, even those who have never touched the area. Of course, the researchers who actually work in this specific domain will include some nuance as to why things aren’t so cut and dry, but the point is clear: this stuff is challenging. It’s not like people aren’t trying either. There have been many, many attempts to make cancer vaccines work, and each result has left an increasingly bitter taste in their mouths.But there is something in the air these days. If you really try, you can feel it too. There is optimism afoot in cancer vaccines. Really, there may be optimism afoot in cancer at large. Sid’s stories and Rosie’s story have lit something of a fire underneath many people’s feet, and all sorts of eyes are being directed here. Is it time? Have we arrived? Are genuine cancer vaccines on the horizon?Maybe. But let’s not get ahead of ourselves, and ensure that we understand the science here.The im