Start Page / Reports / Tumor vaccination

Tumor vaccination

Report type: Alert
Published: 2003-01-14
Contact person SBU: Sofia Tranæus  E-mail: tranaeus@sbu.se

Findings by SBU Alert

Version: 1

Technology and target group

Cancer vaccines are intended to stimulate the patients own immune system to attack cancer cells. These vaccines can be used for both prophylactic and therapeutic purposes. The goal of prophylactic vaccination is to prevent cancer from appearing in the population. For the foreseeable future, prophylactic vaccines will probably be used only to a limited extent. Current research is targeted mainly at developing therapeutic vaccines that can reduce tumor volume or offer protection against relapse in patients who have had cancer already. The greatest progress in cancer vaccine research has been made in malignant melanoma, non-Hodgkins lymphoma, multiple myeloma, and colon cancer.

Patient benefit

To date, only few results have been reported from early clinical trials, often based on very few patients. Tumor reduction has been noted in patients with non-Hodgkins lymphoma, multiple myeloma, and chronic lymphatic leukemia. Tumors in some patients with non-Hodgkins lymphoma temporarily, but completely, disappeared after vaccination. A study of 38 patients with malignant myeloma showed a significant extension in the time to relapse, from 0.6 years to 1.6 years. Furthermore, the 3-year survival rate increased from 33% to 53% in the vaccinated group. A study of 254 patients with colon cancer showed in followup after 5 years that 20% of the vaccinated patients had relapsed compared to 32% in the control group.

Economic aspects

The costs for administering vaccines are estimated to be low since vaccination is delivered in ambulatory care settings. The initial prices for vaccines are estimated to be relatively high and will vary widely depending on the manufacturing process used. No information is available on the cost effectiveness of this method.

Scientific evidence

Tumor vaccination is an experimental treatment method under development and is used only within the framework of scientific studies. There is poor* documentation concerning the patient benefit of cancer vaccination. There is no* documentation describing the cost effectiveness of the method. No tumor vaccines have yet been approved for use in Sweden.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Håkan Mellstedt, Professor of Oncologic Biotherapy, Managing Director, CancerCentreKarolinska, Department of Oncology, Karolinska Hospital. It has been reviewed by Hans Olov Sjögren, Professor, Section for Tumor Immunology, Lund University.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

  1. Bendandi M, Gocke CD, Kobrin CB, Benko FA, Sternas LA, Pennington R et al. Complete molecular remissions induced by patient-specific vaccination plus granulocyte-monocyte colony-stimulating factor against lymphoma. Nat Med 1999;5(10):1171-7.
  2. Berd D, Maguire HC Jr, Schuchter LM, Hamilton R, Hauck WW, Sato T et al. Autologous hapten-modified melanoma vaccine as postsurgical adjuvant treatment after resection of nodal metastases. J Clin Oncol 1997;15(6):2359-70.
  3. Bystryn JC, Zeleniuch-Jacquotte A, Oratz R, Shapiro RL, Harris MN, Roses DF. Double-blind trial of a polyvalent, shed-antigen, melanoma vaccine. Clin Cancer Res 2001;7(7):1882-7.
  4. Kirkwood JM, Ibrahim JG, Sosman JA, Sondak VK, Agarwala SS, Ernstoff MS et al. High-dose interferon alfa-2b significantly prolongs relapse-free and overall survival compared with the GM2-KLH/QS-21 vaccine in patients with resected stage IIB-III melanoma: results of intergroup trial E1694/S9512/C509801. J Clin Oncol 2001;19(9):2370-80.
  5. Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB et al. A controlled trial of a human papillomavirus type 16 vaccine. N Engl J Med 2002;347(21):1645-51.
  6. Livingston P. The unfulfilled promise of melanoma vaccines. Clin Cancer Res 2001;7(7):1837-8.
  7. Ruffini PA, Neelapu SS, Kwak LW, Biragyn A. Idiotypic vaccination for B-cell malignancies as a model for therapeutic cancer vaccines: from prototype protein to second generation vaccines. Haematologica 2002;87(9):989-1001.
  8. Takahashi S, Rousseau RF, Yotnda P, Mei Z, Dotti G, Rill D et al. Autologous antileukemic immune response induced by chronic lymphocytic leukemia B cells expressing the CD40 ligand and interleukin 2 transgenes. Hum Gene Ther 2001;12(6):659-70.
  9. Vermorken JB, Claessen AME, van Tinteren H, Gall HE, Ezinga R, Meijer S et al. Active specific immunotherapy for stage II and stage III human colon cancer: a randomised trial. Lancet 1999;353(9150):345-50.
  10. von Mehren M, Arlen P, Gulley J, Rogatko A, Cooper HS, Meropol NJ et al. The influence of granulocyte macrophage colony-stimulating factor and prior chemotherapy on the immunological response to a vaccine (ALVAC-CEA B7.1) in patients with metastatic carcinoma. Clin Cancer Res 2001;7(5):1181-91.