From the lab to clinical trials – why a preventative lung cancer vaccine could soon be a reality
It’s the third most common cancer in the UK, causing tens of thousands of deaths annually. But what if the disease, often only diagnosed when it’s too late, could be stopped before it even begins?
Whether you have been touched by the effects of lung cancer or not, there are some hard truths you may already know about it. According to the NHS, more than 43,000 people are diagnosed with the disease every year – making it the third most common cancer in the UK. Worse still, it kills around 33,000 people annually, with only around one in 10 people surviving for 10 years or more after diagnosis. Lung cancer often hides in plain sight, with symptoms appearing late, when treatment options are limited. But this could all be about to change.
Thanks to scientific advances, we’re entering a new era when it comes to tackling lung cancer. Researchers are now preparing to begin clinical trials of a preventive vaccine that could reduce the risk of developing the disease. It’s been made possible with funding from Cancer Research UK, the world’s largest charitable funder of cancer research, whose research has already helped double cancer survival in the UK over the past 50 years.
Now, the organisation has partnered with Goalhanger on The Rest is Science podcast, hosted by the brilliant Hannah Fry and Vsauce creator Michael Stevens. A special episode, which is available to listen to now, explores some of the groundbreaking research – such as the lung cancer vaccine – helping to change the future of cancer medicine.
Looking ahead
Lung cancer is difficult to treat because it’s not a uniform clump, it’s made up of many different groups of cells that each behave differently, so a drug might affect only some of them. Tumours are like a diverse forest, the most resilient parts of which can survive challenging and changing conditions. Putting pressure on a tumour by treating it means the weakest parts might die off, but the strongest and most adaptable are left to regrow.
Lung cancer has an almost infinite ability to evolve over time, making it more difficult to treat at a later stage. And it’s more likely to grow back in a treatment-resistant form.
“The idea that cancer evolves under pressure isn’t theoretical – it’s shaping research that’s changing the future of cancer medicine,” says Lydia Bird, a Cancer Research UK science expert. “Our scientists are tracing those evolutionary paths in detail, helping us understand how cancers start, adapt, spread and evade treatment. And this means we can design ways to adapt to that change, rather than being overtaken by it, to spot cancer earlier and prevent the disease before it starts.”
This is where Cancer Research UK’s work comes in. It funded TRACERx, a £14m nine-year study – the largest of its kind – to map how lung cancers evolve. Its researchers have been piecing together the entire life story of lung cancer; how it begins, changes and outsmarts treatment. To do this, they crunched genetic data on an enormous scale – the equivalent of reading the complete works of Shakespeare around 50m times. The goal was to identify patterns and predict the disease’s next move to stay one step ahead.
“What makes the TRACERx project particularly powerful is that it treats tumours as ever-changing ecosystems made up of diverse cancer cell populations,” says lead investigator Prof Charles Swanton. “By looking at the tumour in its entirety, we can observe how these cell populations interact and even compete with one another. All this is helping us to glean valuable insights into the likelihood that a tumour will return and when this might happen. We can also observe how the tumour is likely to evolve over time, spread and respond to treatment, offering hope to millions of patients in the future.”
But while the TRACERx study has focused on the “coding” part of the genome – the genes that make proteins and build our cells – this is only a tiny fraction of our DNA. Besides those are the billions of letters of DNA that were once dismissed as “junk”, but are now known to shape our biology and influence diseases such as cancer. As such, the next chapter of TRACERx research, TRACERx EVO, is using whole-genome sequencing to study this. “Through this programme, we endeavour to bring a deeper biological understanding of lung cancer evolution, prevention, diagnosis and treatment to the clinic,” says Swanton, who is also lead investigator for the TRACERx EVO study.
Impact of research
TRACERx research showed that many lung cancers share some of the same early genetic mistakes in their development. This has paved the way for the world’s first vaccine designed to prevent lung cancer. LungVax works by training the immune system to identify the “red flag” signals that appear when lung cells first start to go wrong, caused by the common genetic errors. That means that when cells enter a precancerous state, they can be eliminated before cancer begins. Given the vaccine’s promise, the world’s first trial to test it in people will soon begin.
“We will be looking carefully at how it works in people at risk of their cancer returning after surgery or at high risk of developing a new cancer, how easy it is to deliver and who might benefit from it most in the future,” says Prof Mariam Jamal-Hanjani, clinician scientist and group leader at University College London, as well as the co-founder and chief investigator for the LungVax clinical trial.
The vaccine could have many positive effects. “We could reduce the number of people who go through the experience of receiving a cancer diagnosis, will have to go to hospital to have chemotherapy and all the stresses that brings to people and their families,” says Prof Sarah Blagden, professor of experimental oncology at the University of Oxford, who is co-founder of LungVax. “We are developing a series of cancer prevention vaccines in Oxford, LungVax is our first. Seeing people benefiting will be vitally important.”
The real-world impact of TRACERx research is already spreading even further. Its researchers are also developing a blood test that can detect cancer’s return after surgery, up to a year before the most sensitive scans are able to, and match people to the best treatment for their unique disease. It’s also shedding even more light on the disease – from the role of air pollution in causing cancer-triggering inflammation in the lungs, to showing which cancer-driving mutations could be targeted with drugs. The work is only just beginning.