ideasIdea
A randomised trial of a shared-antigen vaccine to prevent Lynch syndrome cancers
Lynch syndrome tumours share predictable mutations the immune system can target. A vaccine in early trials could be tested to see if it prevents polyps and cancers in carriers.
Nous-209, a frameshift peptide vaccine, has phase 1b data in Lynch carriers showing immunogenicity. Propose a randomised phase 2/3 with adenoma incidence at three years as primary and colorectal cancer incidence as secondary, on a background of aspirin.
Hypothesis
Vaccination reduces adenoma incidence in Lynch carriers by at least 30% over three years.
Rationale
Frameshift neoantigens in mismatch-repair-deficient tumours are recurrent and immunogenic, and carriers have high event rates that make trials feasible.
What would test it
600-carrier RCT.
Maturity
early clinical
Who has to act
industry
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks
- Inherited risk is mostly unidentified · Most people who carry a high-risk cancer gene do not know it until they or a relative gets cancer.
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.