Cancer Immunology, Immunotherapy

, Volume 61, Issue 1, pp 109–117 | Cite as

Endpoints, patient selection, and biomarkers in the design of clinical trials for cancer vaccines

Focussed Research Review

Abstract

Therapeutic cancer vaccines are an emerging and potentially effective treatment modality. Cancer vaccines are usually very well tolerated, with minimal toxicity compared with chemotherapy. Unlike conventional cytotoxic therapies, immunotherapy does not result in immediate tumor shrinkage but may alter growth rate and thus prolong survival. Multiple randomized controlled trials of various immunotherapeutic agents have shown a delayed separation in Kaplan–Meier survival curves, with no evidence of clinical benefit within the first 6–12 months of vaccine treatment. Overall survival benefit is seen in patients with lower disease burden who are not expected to die within those initial 6–12 months. The concept of improved overall survival without marked initial tumor reduction represents a significant shift from the current paradigms established by standard cytotoxic therapies. Future clinical studies of therapeutic vaccines should enroll patients with either lower tumor burden, more indolent disease or both, and must seek to identify early markers of clinical benefit that may correlate with survival. Until then, improved overall survival is the only clear, discriminatory endpoint for therapeutic vaccines as monotherapies.

Keywords

Cancer Immunotherapy Tumor growth kinetics Tumor volume Biomarkers CIMT 2011 

Notes

Acknowledgments

The authors thank Bonnie L. Casey for editorial assistance in the preparation of this manuscript.

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Copyright information

© Springer-Verlag (outside the USA) 2011

Authors and Affiliations

  1. 1.Laboratory of Tumor Immunology and Biology and Medical Oncology Branch, Center for Cancer Research, National Cancer InstituteNational Institutes of HealthBethesdaUSA
  2. 2.Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer InstituteNational Institutes of HealthBethesdaUSA

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