Sep 7, 2017

The cancer scientists behind the HPV vaccine win top medical prize

Lazaro Gamio / Axios

Douglas Lowy and John Schiller, scientists from the National Cancer Institute, will be presented the prestigious Lasker Award on Sept. 15 for their research that led to the development of human papillomavirus (HPV) vaccines. They're hopeful their approach could be used to produce more vaccines against other viral infections that cause cancers.

Why it's important: HPV vaccines are given to teens in an effort to thwart infections of the virus that can cause cervical and other cancers. While HPV is linked to cancers in both men and women, cervical cancer is one of its biggest possible consequences. More than 250,000 women die each year from cervical cancer worldwide, with the majority of cases happening in developing countries.

Schiller and Lowy, who is the acting NCI director, talked to Axios about the vaccine's use in the U.S. and cancer prevention efforts.

Background: Scientists knew that infection from certain types of HPV, transmitted through sex, could lead to cancers of the cervix, vagina, penis, anus, and throat. Lowy and Schiller identified proteins on the virus that form particles that mimic the structure of HPV. They then used those particles to create a vaccine that stimulated the body's immune system and prevented the virus from infecting people.

Here are the highlights of the interview, condensed and in some cases paraphrased:

Could the HPV vaccine be used as a model for other cancers or diseases?

Lowy: Yes. The approach "could be used for other vaccines to prevent cancer if the cancer is caused by a virus infection."

One example: There's already a vaccine in development for the Epstein-Barr Virus, which causes nasopharyngeal carcinomas and some lymphomas.

Schiller: In animal models, we've been able to inactivate a protein called PCSK9 that is involved in regulating LDL cholesterol levels and lower cholesterol levels via vaccination. "If you had a vaccine that could do something like that [in humans], that you needed every few years, it would become logistically and economically more feasible. It's something that is still in the development phase but, we're pretty excited about it."

What are some of the outstanding questions about HPV and the vaccine?

Lowy: "In terms of trying to improve the vaccine, the approach is really to try to see if it can be delivered in a more cost-effective manner that can be logistically simpler." There's a new clinical vaccine trial underway in Costa Rica to see whether one dose would provide protection.

What about the new CDC study that showed 50% of girls and less than 40% of boys in the U.S last year received the recommended doses of the vaccine to be protected?

Lowy: "You're describing a glass being half-empty, and I certainly think of the glass being half-full. But what I saw from the data... [was] that the percentage of young boys and girls who are being vaccinated continues to go up, albeit slowly."

"What I see is that with that new recommendation and the need for fewer doses, I am actually expecting that there will continue to be an increase in the percentage of people who are going to be getting vaccinated."

Is there a set of traits common to different cancers?

Schiller: "There are some commonalities to cancers, but cancers really are extraordinarily heterogeneous. When you think about the different causes, there are many cancers that we actually don't know what causes them, whereas, there are others where there are clear environmental exposures, such as the HPV-associated cancers, which we can directly link as causes of cancer..."

"It's a constant moving target, and each cancer can almost be considered its own, separate little organism in its own, separate little species"

Lowy: "That doesn't mean that you can't find common treatments that will apply widely to a large number of cancers, but by looking at the changes that have occurred in the cancer cell in its environment, they're very heterogeneous."

There have been "tremendous advances" in clinical cancer research, but the decision to give the Lasker Award to the HPV vaccine shows that "the opportunities for making advancements in the prevention of cancer also are considerable."

"I hope that it will lead to more emphasis in the areas of cancer prevention, cancer screening, and also trying to understand better what causes cancer, because in those different areas, making progress means that we can [prevent] the development of cancer before it even starts."

Schiller: To put some numbers on that, the cancer arm of WHO [World Health Organization] came up with an estimate that the vaccines have already prevented about 400,000 future cancers just in the people who have been vaccinated, but not one of those women know that they're not going to get cancer because of the vaccine."

"There's a lot of opportunity for cancer prevention... [it] tends to be under appreciated even though it could have a huge public health impact."

(Disclosure: As a 19-year-old chemical engineering student interning at Merck, I worked on some of the processes for manufacturing their Gardasil HPV vaccine.)

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