I'd like vaccines for Cancer, Nazis, and Neo-McCarthyism

The world would be more lovely if our immune system could distinguish between healthy cells and cancer cells.

Imagine a successful immune response to a potentially malignant cellular mutation the moment it occurs—cancer would be no more threatening than the common cold. Unfortunately our immune systems don't see anything wrong with cancer cells, so most often, they let them be.

Little surprise though that this, an aspect of personalized medicine, is an emerging area of research; a search of 'cancer AND vaccine' at Clinicaltrials.gov unearthed over 1000 hits. Finding ways to employ our own immune systems to attack cancer has loads of cachet and enormous promise.

Consequently, I have high hopes for BiovaxID, Accentia and Biovest's highly-touted, patient-specific cancer vaccine against follicular lymphoma, almost a quarter-century in the making.

But is BioVest pulling a bit of a fast one on us by hyping it as a vaccine?

VACCINES DEFINED

We have to start somewhere so let's start here: Dictionary.com defines 'vaccine' as:

"Any preparation used as a preventive inoculation to confer immunity against a specific disease, usually employing an innocuous form of the disease agent, as killed or weakened bacteria or viruses, to stimulate antibody production."

This is how we understand a vaccine: something that you receive that protects you against getting a specific illness. However, there are three common types of vaccines, and BioVaxID falls into the C category[1]:

• A. Attenuated (live but weakened virus or bacteria)
• B. Inactivated (whole, dead strains of virus or bacteria)
• C. Subunit (pathogen fragments which provide a targeted antigen)

VACCINES IDEALLY IMAGINED

So what are the properties of an ideal vaccine? Three have been identified[2]:

• One, it has to be safe
• Two, it has to bring about effective immunity
• Three, it has to prevent the targeted disease in all vaccinated persons

According to these properties, there are several vaccines considered ideal or damn near close, including those for hepatitis A and Hib and, in the case of cancer vaccines, those for hepatitis B and human papillomavirus (HPV).

How about BiovaxID? (pronounced, by the by, 'bye-o-vax-idd')

HOW BIOVAXID WORKS

As mentioned, cancer cells don't alert our immune system the way foreign antigens do because the system can't find anything on the surface of the cancer cell that screams, 'kill me'. So BioVest artifiically creates this surface alert. Here's how it works in a non-scientific nutshell:

• 1. A person with FL undergoes a node biopsy
• 2. Cancer cells are harvested
• 3. A surface marker unique to that cancer (an 'idiotype') is identified
• 4. BioVest then replicates the idiotype
• 5. Attaches it to an immune system stimulant
• 6. And gives it back to you.

If all goes right, once inside your body the reconstituted idiotype is recognized by the immune system as foreign, and an attack is launched.

But wait! BioVaxID's Phase III clinical trial contains a couple caveats. The first is that the patient must undergo a chemotherapy regimen prior to administration of the vaccine.

The second is that in order for this vaccine to have any value to you, you must first have the disease that the vaccine is targeted to prevent—not normally what you expect from a vaccine. Thus in reality, BioVaxID is an anti-cancer treatment no more or less than chemo or radiation, but by invoking the immune system, it can call itself a vaccine and enjoy all the privlidges of the term.

So this is not the kind of vaccine that we'll soon see as part of the CDC's childhood immunization schedules.

BIOVAXID'S BENEFITS

Thus far, BioVaxID has not conferred immunity on its recipients. Despite this criticism, initial results of phase III trials reported by Biovest in 2009 showed that BioVaxID "significantly prolonged disease-free survival in follicular non-Hodgkin's lympoma" on average by over a year—44.2 months compared to 30.6 months. In other words, patients getting the vaccine were found to be in remission for about a year longer than those not getting the vaccine. Furthermore, with a median follow-up of 4.7 years, those getting the vaccine had "a 38% lower risk of disease recurrence" compared to the control group.

In this respect it doesn't really fulfill any of the properties of an ideal vaccine (its long-term safety remains to be determined, even if approved by the FDA), but if the treatment itself proves to be both bearable and affordable*, what FL patient would pass up the chance to extend their time disease-free?

* [If you laughed at the word 'affordable' you're a fun-loving cynic. You KNOW this shit's gonna be expensive, like worse than Gleevec-expensive, more like Zevalin-expensive, or even worse …]

THE FUTURE OF CANCER VACCINES

BioVaxID appears headed for FDA approval. It won't be alone, and it may not be the first for blood cancers. But this direction gives me hope and shivers.

The very fact that cancer treatment is headed in the direction of personalized medicine should scare the shit out of us, because it suggests that cancer is fully heterogeneous—one person's lung cancer shares nothing in common with another person's lung cancer beyond anatomy. Considering all the work and money and sweat and toil—and all the patient suffering—that's been put into the likes of developing site-specific combination chemotherapy regimens, and more … to imagine they've been barking up the wrong tree … it's too much to imagine.

ONE MORE THING ...

Jenny McCarthy I beg you please SHUT THE FUCK UP!

End Notes and Additional Reading
1. Garcon, Nathalie & Goldman, Michel. "Boosting Vaccine Power." Scientific American, October 2009. Print.
2. Spector, R. "Progress in the search for ideal drugs." Pharmacology. 2002 Jan;64(1):1-7. PMID: 11731716.
- Biovest's page on BioVaxID
- The National Cancer Institute: Personalized cancer care
- Spector, Reynold. "A Skeptic's View of Pharmaceutical Progress." Skeptical Inquirer, July/August 2010. Print.
- Offit, Paul. 2008. Vaccinated. Washington DC. Smithsonian Books.