Cancer interception vaccines for high-risk carriers

Vaccinate people with BRCA or Lynch mutations against the antigens their future cancers will express, before any cancer exists. Lynch syndrome tumours share recurrent frameshift neoantigens and BRCA1 tumours are basal-like with predictable antigens, so vaccination could reduce adenoma and cancer incidence in carriers whose immune systems are intact and tumour burden is zero. Nous-209 for Lynch syndrome and the alpha-lactalbumin vaccine for TNBC from Cleveland Clinic are in early trials, and prevention needs only modest efficacy to be cost-effective. The test is a randomised placebo-controlled trial in Lynch carriers with colonoscopic adenoma incidence as the endpoint. At early-clinical maturity it addresses the bottleneck Inherited risk is mostly unidentified.