Manel Juan
Head of the Immunology Service
This abstract and the forthcoming article are nothing more than a step forward (backed by data) in the communication strategy for something they had already announced (without data) on 24 August. It is undoubtedly a commercial strategy to generate expectations and boost their market capitalisation, which had already risen significantly in August.
Whilst it is clear and evident, given the data, that this represents a step forward, at heart it is nothing complex. It is something that all immunologists knew was there (and not just in melanoma) but which, given the regulatory framework for clinical trials, is very expensive to bring to patients (large-scale studies requiring significant investment are needed) and is therefore left to the major pharmaceutical companies, such as Merck and Moderna.
It is not an anti-melanoma vaccine in the strict sense, as it does not prevent the onset of anything. It reduces recurrence—that is, the reappearance of the disease in a person who has already suffered from it. In fact, it is a fully personalised RNA vaccine (developed by Moderna), as it targets specific mutations in each patient’s melanoma tumour.
As for the ‘record-breaking vaccine’ developed in six years, I believe this is a clear failure of the system, as the concept was already evident from a wealth of previous experience (particularly from cases of post-immunisation remissions spanning over 100 years, the success of the necessary checkpoint inhibitors, and the existing knowledge regarding immunisation and the immune response). In fact, the preventive SARS-CoV-2 vaccines were launched because these mRNA-based immunisations had been under development for ten years using this anti-tumour model. They are now simply being publicised because the necessary investment of millions has been secured to demonstrate their efficacy in a large number of patients.
It is striking that we are being led to believe we are dealing with a single type of vaccine, when in fact it is a personalised vaccine that differs for each patient; yet we are attempting to apply the criteria for standardised products to what is, in reality, a heterogeneous immunisation procedure. However, it is the industry that provides the funding for products, not for procedures; and this means that, for this procedure to become their product, years must be invested in each study involving thousands of patients for each indication, as if they were standardised products for different cancers, when in reality they are a procedure with different components in which the true owner should be the patient—the owner of the tumour. In the meantime, we will miss out on opportunities to treat patients who could already benefit in almost all tumours where immunotherapies work thanks to spontaneous natural immunity, which will always benefit from induced immunity and vaccines. It is clear that the risk (adverse effects) will depend on the immunisation itself, which does not distinguish between induced and natural immunity.