We Just Got Two Steps Closer to Personalized Cancer Vaccines

Sriram Subramaniam, National Cancer Institute (NCI), Wikimedia Commons // Public Domain
Sriram Subramaniam, National Cancer Institute (NCI), Wikimedia Commons // Public Domain

Attempting to wipe out cancer can at times seem like a cruel, high-stakes game of Whack-a-Mole. Recurrence is common, and while treated tumors may disappear, new ones often appear in different parts of the body. But two new studies published today in the journal Nature may have found a better way: personalized vaccines that could kick the disease out for good.

Current forms of cancer treatment can be quite effective in knocking tumors out, but they can’t keep them from coming back. That’s partly because cancer is not one disease but many, each with its own unique combination of genetic mutations and accompanying antigens (immune-triggering molecules), and standardized treatments can’t reach them all.

But what if we could create targeted treatments for each combination? Two small clinical trials of skin cancer vaccines have attempted just that.

For the first study, researchers created a vaccine that targets specific antigens, alerting the body to their presence so it can fight back. Of the six people who were given the vaccine, four were still cancer-free after 25 months. While the remaining two people did have melanoma, their tumors were responsive to treatment and eventually completely disappeared.

The second study used patients’ RNA to create customized vaccines that targeted antigens called neo-epitopes. The scientists administered the vaccine to 13 people. Of those 13, eight were tumor-free 23 months later, and one person was declared tumor-free after the vaccination and regular treatment. Most importantly, the vaccine had done what it set out to do: all 13 participants had shown an immune response. Their bodies learned what to do to get rid of the cancer.

While these results are impressive, both studies were quite small. We’ll need more studies and larger clinical trials before we can say for sure that the vaccines work, and we’ll need to test them in other forms of cancer. But as first steps go, these are promising indeed.

Why Does Scratching Make Itching Worse?

iStock/champja
iStock/champja

It feels like a biological blooper: A persistent itch is made worse by scratching, the one thing that provides instantaneous relief. Evolutionary biologists have proposed that the relationship between scratching and itching developed when disease-carrying parasites and insects bit humans, causing itching skin; scratching brushed the bugs away. Anyone suffering from a mosquito bite can understand that connection.

There’s no simple answer for why skin that has just been scratched becomes even itchier, but researchers have identified some mechanisms behind the irritating phenomenon.

Why Scratching an Itch Doesn't Help

Our sensory neurons are constantly bombarded with stimuli, so some sensations take precedence over others. Sensory signals of one type can be overridden by signals of other types if the latter are strong enough. The overridden signals don’t even reach the brain—they’re stopped by specific neurons in the spinal cord. In this way, the pain caused by scratching is often sufficient to drown out the itch—but only temporarily.

Cells in the brain stem produce the neurotransmitter serotonin, which quells pain. But according to Zhou-Feng Chen, Ph.D., director of the Center for the Study of Itch at Washington University School of Medicine in St. Louis, Missouri, serotonin has an additional function. His group has found that as the serotonin spreads through the spinal cord, it can activate neurons that transmit itch signals to the brain, compelling us to scratch even more.

Each time we scratch, we put this cycle in motion. The increasing amount of serotonin may even make us scratch harder, until the urge to scratch becomes detached from any itch trigger on the skin. “It’s to try to suppress the itchy sensation, which occurs in your brain,” Chen tells Mental Floss. By this mechanism, itches can even become chronic.

Serotonin signaling isn’t the only way scratching worsens an itch; harm to the skin caused by scratching is another contributor. “When the skin barrier is irritated or further damaged, it releases certain pro-inflammatory factors that can directly aggravate itch by stimulating the sensory nerve fibers,” Brian Kim, M.D., co-director of the Center for the Study of Itch, tells Mental Floss. Those factors can also activate your immune system, and some types of immune cells around the affected area may produce chemicals that induce itch.

The very idea of scratching can also be a trigger. Chen’s research group reported last year that mice appear susceptible to scratching when they see other mice do the same. “Itching is actually contagious between people, between animals, and in your body itself,” Chen says. “When you scratch one place, you quickly want to scratch another area.” Scratching doesn’t just make itch more intense—it sometimes also causes the sensation to spread.

Relief for Itching

In mild cases, it may be possible to resist scratching through sheer force of will—but that’s not usually a long-term solution.

“I always feel bad because a lot of people say to patients, ‘Don’t scratch, don’t scratch,’ but that’s very challenging,” Kim tells Mental Floss. He says he tries to determine the cause of a person’s itchiness first. If it’s caused by an underlying medical problem, such as infestation with lice or liver disease, managing that issue may resolve the itch. Even if the underlying problem can’t be cured, there are medications that can calm itch in certain circumstances, such as antihistamines for allergy-induced itch and topical corticosteroids for itch caused by certain skin conditions, including eczema.

For now, drugs like these may be our best weapons against itching. “I think itch is often viewed as quirky, not serious, or embarrassing,” Kim says, which explains why there’s little research on itch despite its impact on our lives. Unfortunately, that coveted scratch in a bottle remains out of reach.

A Generic EpiPen Coming in Early 2019 Could Save You Money

Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Brand-name EpiPens at a Congressional hearing on the escalating cost of the drug in 2016
Alex Wong/Getty Images

For an incredibly common, life-saving medication, EpiPens (epinephrine auto-injectors) are surprisingly difficult for many consumers to get ahold of. Their cost has skyrocketed in recent years from less than $100 for a pack of two to more than $600. They’ve gotten so expensive that some EMTs have resorted to using syringes to manually administer epinephrine rather than purchasing the standard auto-injectors, which are almost exclusively made by the pharmaceutical company Mylan. Generic options have been slow to come to market, but according to Business Insider, a recently approved EpiPen rival is coming in the first few months of 2019, and it could save consumers a significant chunk of change.

The drug’s developers have had an unusually hard time getting the new EpiPen alternative, called Symjepi, onto store shelves. The drug was approved in 2017, but the company, Adamis Pharmaceuticals, had trouble finding investors. Now, Novartis, the Swiss-based pharmaceutical giant that manufactures drugs like Ritalin, is releasing the drug through its Sandoz division (perhaps most famous for it role in discovering LSD in the 1930s).

Symjepi will cost $250 out-of-pocket for a pack of two doses. That’s 16.6 percent less than the Mylan-authorized generic EpiPen or Teva’s generic EpiPen, which both sell for $300. It differs a bit from its rivals, though, in that it’s a pre-filled, single-dose syringe rather than a spring-loaded auto-injector. Auto-injectors are plastic, pen-like devices that keep the needle shielded until the moment of injection, and are specifically designed to help make it easier for untrained (even squeamish) people to use in an emergency. With this version, patients will need to remove a needle cap and inject the needle. Just like the EpiPen, though, it’s designed to be injected in the upper thigh, through clothing if necessary.

If you have health insurance, the difference in cost may not matter as much for you as a consumer, depending on your plan. (I personally picked up a two-pack of Mylan-authorized generic Epipens at CVS recently for $0, using a manufacturer’s Epipen coupon to knock down what would have been a $10 copay.) But it will matter considerably for those with high-deductible plans and to insurers, which, when faced with high costs, eventually pass those costs on to the consumer either through higher co-pays or higher premiums. It also affects agencies that buy EpiPens for emergency use, like local fire departments. And since EpiPens expire after just a year, the costs add up.

However, there’s currently a shortage of EpiPens on the market, according to the FDA, making it more important than ever to have other epinephrine drugs available to those at risk for serious allergic reactions.

[h/t Business Insider]

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