Medicine, Technology and the End of Cancer

This personal reflection is part of a series called Turning Points, in which writers explore what critical moments from this year might mean for the year ahead. You can read more by visiting the Turning Points series page.

Turning Point: The United States Food and Drug Administration gave full approval to an Alzheimer’s drug for the first time in two decades.

Decades ago, as rookie physicians in the cancer ward of a German university hospital, we often had to deliver a heartbreaking message to our patients: “There are no treatment options left to offer you.” Back then, the primary weapons against advanced cancer were chemotherapy and irradiation. Effective at times, they often were not the cure many hoped for.

Today, the landscape of cancer treatment has drastically changed. We have witnessed the emergence of new medicines targeting tumor growth with high precision. Some previously untreatable cancers, even in advanced stages, have now become controllable. Yet for the majority of patients with metastatic cancer, the elusive promise of a highly effective therapy remains just out of reach.

Why, despite billions of dollars being invested in cancer research annually, is a cure for patients with advanced cancer still an exception rather than a standard?

The answer lies in the nature of cancer itself. Cancer arises from random genetic changes, called mutations, within healthy cells, acquired over time. Mutations can be triggered by lifestyle choices, familial predispositions, existing long-term health conditions or even exposure to hazardous chemicals. As they accumulate, mutated cells transform into cancerous entities.

Two implications arise from this randomness. First, every cancer is as unique as the individual it afflicts, which means that even those diagnosed with the same type of cancer have only a fraction of shared mutations. Second, each tumor is an intricate tapestry of billions of distinct cells, constantly learning to adapt, to evade the immune system and to resist therapeutic strategies we throw at it.

But what if, to outmaneuver these elusive adversaries, we could harness the power of another intimately personal and constantly learning force: our own immune system?

The body’s defense mechanism consists of billions of cells with astounding capabilities. Among them, T cells stand out as nature’s vigilant sentinels, ceaselessly patrolling our body. Yet our immune system is evolutionarily programmed to tackle external threats, such as viruses and bacteria, rather than mutations from within. Consequently, only a tiny fraction of mutations garners the attention of our immune defenses.

Now, imagine a future where on-demand personalized cancer vaccines are available. They would be tailored to convey each patient’s unique cancer mutations with precision, acting like a “Wanted” poster for immune cells, instructing them to launch multifaceted attacks on the tumor.

What was once just a vision three decades ago, as we stood by our patients’ bedside, is now the focus of extensive clinical trials by us and others.

Compounded advancements in science and technology across various areas have provided the tailwinds.

Deciphering the genetic makeup of each patient’s cancer from a tiny biopsy in high resolution and within a few hours has become feasible by reading the DNA with next-generation sequencing technologies. New, broadly available computing power helps us process the vast amounts of data this sequencing creates. We apply advanced computing, and A.I. algorithms help to identify the mutations that we assess to be most relevant. They then become the basis for the “Wanted” poster, which is sent to the cells via the messenger RNA (mRNA) in the vaccine. RNA, our preferred vaccine platform, is nature’s most primordial messenger. It can be rapidly designed, customized and manufactured within weeks. After all, time is of the essence for cancer patients.

Personalized cancer vaccine candidates are currently undergoing rigorous testing, and access to them is limited to controlled clinical trials. These trials have shown the feasibility of a personalized approach in a smaller number of patients by activating and expanding T cells that are capable of recognizing tumor cells based on selected mutations — an important prerequisite for the immune system to fight cancer. Recent clinical trials in melanoma and pancreatic cancer have shown the potential utility of personalized mRNA vaccines in reducing the risk of metastatic relapse after surgery. Researchers are also currently conducting larger clinical trials on some cancer types to compare these personalized vaccines to the current therapeutic standard of care. The data from these trials in the coming years will inform on the safety and effectiveness of personalized cancer vaccines under development.

Advancements in technology and science often occur in parallel silos, but when they converge, the results can be groundbreaking. The merging of mRNA and artificial intelligence exemplifies such a confluence, laying the foundation for transformative patient-centric medical solutions and ushering in a new era for medicine.

We believe that A.I. will continue to play an increasingly pivotal role in the development of personalized cancer vaccines and medicines. A.I. algorithms can quickly analyze massive genome data sets and help identify patterns and correlations that traditional methods might overlook. This rapid, precise analysis is particularly useful when seeking to pinpoint the relevant cancer mutations among the many genetic variations of a patient’s tumor. As global cancer databases grow, the predictions for the selection of mutations and the vaccine design for each patient are likely to continuously improve.

Highly versatile mRNA can, by virtue of its molecular features, enable rapid yet scalable manufacturing in miniaturized, parallelized, automated manufacturing facilities. Parallelized production breaks up the traditional assembly line and allows for different products to be manufactured simultaneously. For us, these features of mRNA-based manufacturing are foundational for making truly personalized medicines broadly available one day, as well as putting scientific knowledge — developed with the help of A.I. — into practice in due time. The combination of these technologies could allow for rapid adjustments to personalized mRNA vaccines as a patient’s tumor mutation profile evolves.

We believe that in the realm of medical research, the marriage of technologies such as A.I. and mRNA is ushering in a transformative era with parallels to Moore’s Law on microchips. Just as Moore’s Law predicted the exponential growth of computing power, we are now witnessing a similar acceleration that may help to address urgent but unmet medical needs. There is some disparity, though: The speed at which new knowledge is uncovered and technological hurdles overcome is outpacing our ability to develop and approve new therapies within the traditional regulatory and procedural systems of current drug development, clinical practice and care paradigms.

Thus, there is a call to action for scientists, governments, public health sectors and societies to prevent a growing gap between what would be feasible based on our current knowledge and technological advancements, and what is actually offered as treatment options to patients.

With all this in mind, how far are we from a medical future of personalized cancer vaccines?

It is still early. As with any other novel treatment, personalized cancer vaccine candidates have to pass the prescribed stages of clinical development and to prove a superior efficacy over existing therapies. We anticipate that the initial approval and adoption of such therapies will occur for selected cancer types by 2030. The decade after that could see a technology-driven transformation that will make personalized therapies widely available and affordable.

Cancer is deeply personal, and it is high time its treatment become personal, too.

Dr. Ugur Sahin and Dr. Özlem Türeci are pioneers in the field of mRNA vaccines and personalized cancer immunotherapies, and are the scientific founders of BioNTech.