{"entity":{"id":"idea-prev-lynch-frameshift-vaccine-rct","kind":"idea","name":"A randomised trial of a shared-antigen vaccine to prevent Lynch syndrome cancers","aka":[],"tldr":"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.","summary":"Lynch syndrome tumours share predictable frameshift neoantigens the immune system can target, so this idea runs a randomised phase 2/3 of the Nouscom frameshift peptide vaccine Nous-209 in carriers, on a background of aspirin, with adenoma incidence at three years as the primary endpoint and colorectal cancer incidence as secondary. Nous-209 has phase 1b immunogenicity data in Lynch carriers, and carriers have high event rates that make prevention trials feasible. The test is a 600-carrier RCT. At early-clinical maturity it addresses the bottlenecks Inherited risk is mostly unidentified and Prevention we already have is not deployed, and relates to Cancer interception vaccines for high-risk carriers.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Inherited risk is mostly unidentified): Childers et al., National estimates of genetic testing in women with breast or ovarian cancer (JCO 2017)","url":"https://doi.org/10.1200/JCO.2017.73.6314"}],"tags":[],"related":["idea-interception-vaccines"],"cancers":["colorectal","endometrial"],"sections":["prevention","immunotherapy"],"technologies":["shared-antigen-vaccine"],"targets":[],"drugs":[],"companies":["nouscom"],"institutions":[],"pathways":[],"terms":["msi","neoantigen"],"trials":[],"people":[],"bottlenecks":["b-hereditary-risk","b-prevention-adoption"],"keyPapers":["paper-childers-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"600-carrier RCT.","maturity":"early-clinical","actor":"industry","cost":"large","horizonYears":5},"route":"/ideas/idea-prev-lynch-frameshift-vaccine-rct/","neighbours":{"idea":[{"id":"idea-interception-vaccines","kind":"idea","name":"Cancer interception vaccines for high-risk carriers","route":"/ideas/idea-interception-vaccines/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"endometrial","kind":"cancer","name":"Endometrial cancer","route":"/cancers/endometrial/"},{"id":"msi-high-colorectal","kind":"cancer","name":"Mismatch-repair deficient (MSI-high) colorectal cancer","route":"/cancers/msi-high-colorectal/"}],"section":[{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"shared-antigen-vaccine","kind":"technology","name":"Off-the-shelf cancer vaccines","route":"/technologies/shared-antigen-vaccine/"}],"company":[{"id":"nouscom","kind":"company","name":"Nouscom","route":"/companies/nouscom/"}],"term":[{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"},{"id":"neoantigen","kind":"term","name":"Neoantigen","route":"/terms/neoantigen/"}],"bottleneck":[{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"}],"paper":[{"id":"paper-lynch-frameshift-vaccine-ccr-2020","kind":"paper","name":"First trial of a vaccine against the shared neoantigens of mismatch-repair-deficient cancers","route":"/key-papers/paper-lynch-frameshift-vaccine-ccr-2020/"},{"id":"paper-childers-j-clin-oncol","kind":"paper","name":"National Estimates of Genetic Testing in Women With a History of Breast or Ovarian Cancer","route":"/key-papers/paper-childers-j-clin-oncol/"}],"roadmap":[{"id":"prevention-roadmap","kind":"roadmap","name":"Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers","route":"/roadmaps/prevention-roadmap/"}]}}