{"entity":{"id":"idea-bio2-mrd-triggered-neoantigen-vaccine","kind":"idea","name":"Personalised vaccines given only when the blood test turns positive","aka":[],"tldr":"Individualised mRNA cancer vaccines take weeks to manufacture and work best against minimal residual disease. Making the vaccine at surgery and giving it only when a blood tumour DNA test turns positive matches both facts and concentrates the cost on the minority who will relapse.","summary":"An individualised mRNA neoantigen vaccine produced immune responses and prolonged recurrence-free survival in a randomised phase 2 in ctDNA-positive resected pancreatic and colorectal cohorts, and adjuvant melanoma data support the setting. Manufacturing time is the practical constraint, which a manufacture-at-surgery, deploy-on-ctDNA-positivity design resolves, and it concentrates cost on the minority who will relapse.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Dormant cells and minimal residual disease): Tie et al., ctDNA analysis guiding adjuvant therapy in stage II colon cancer (NEJM 2022)","url":"https://doi.org/10.1056/NEJMoa2200075"}],"tags":[],"related":[],"cancers":["pancreatic","colorectal","melanoma"],"sections":[],"technologies":["neoantigen-mrna-vaccine","mrd-testing"],"targets":[],"drugs":["autogene-cevumeran","intismeran-autogene"],"companies":["biontech","moderna"],"institutions":[],"pathways":[],"terms":["neoantigen","mrd"],"trials":[],"people":[],"bottlenecks":["b-dormancy-mrd","b-drug-pricing","b-manufacturing-cell-therapy"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Vaccine manufactured at surgery and administered on first ctDNA positivity produces higher ctDNA clearance and longer relapse-free survival than vaccination of all resected patients, at a third of the cost per patient treated.","rationale":"Vaccine efficacy depends on low antigen burden and an intact immune system, both of which hold at the moment of molecular relapse. Deferring administration also avoids vaccinating the majority who are already cured.","test":"A three-arm randomised trial: vaccinate all, vaccinate on ctDNA positivity, or observe with standard care; endpoints are relapse-free survival, ctDNA clearance and cost per relapse prevented.","maturity":"early-clinical","actor":"industry","cost":"large","horizonYears":6},"route":"/ideas/idea-bio2-mrd-triggered-neoantigen-vaccine/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"melanoma","kind":"cancer","name":"Melanoma","route":"/cancers/melanoma/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"resectable-pdac","kind":"cancer","name":"Resectable pancreatic ductal adenocarcinoma","route":"/cancers/resectable-pdac/"}],"technology":[{"id":"mrd-testing","kind":"technology","name":"MRD / molecular residual disease testing","route":"/technologies/mrd-testing/"},{"id":"neoantigen-mrna-vaccine","kind":"technology","name":"Personalised neoantigen (mRNA) vaccines","route":"/technologies/neoantigen-mrna-vaccine/"}],"drug":[{"id":"autogene-cevumeran","kind":"drug","name":"Autogene cevumeran","route":"/drugs/autogene-cevumeran/"},{"id":"intismeran-autogene","kind":"drug","name":"Intismeran autogene","route":"/drugs/intismeran-autogene/"}],"company":[{"id":"biontech","kind":"company","name":"BioNTech","route":"/companies/biontech/"},{"id":"moderna","kind":"company","name":"Moderna","route":"/companies/moderna/"}],"term":[{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"},{"id":"neoantigen","kind":"term","name":"Neoantigen","route":"/terms/neoantigen/"}],"bottleneck":[{"id":"b-dormancy-mrd","kind":"bottleneck","name":"Dormant cells and minimal residual disease","route":"/bottlenecks/b-dormancy-mrd/"},{"id":"b-manufacturing-cell-therapy","kind":"bottleneck","name":"Manufacturing cost and time for living and radioactive medicines","route":"/bottlenecks/b-manufacturing-cell-therapy/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}]}}