Using Vaccination to Treat Multiple Myeloma, with Dr. Nikhil Munshi

Is a vaccine for multiple myeloma feasible? DocWire News spoke with Nikhil Munshi, MD, Professor at Harvard Medical School and medical oncologist at the Dana-Farber Cancer Institute, about how vaccination is an exciting area of exploration in the multiple myeloma treatment space.

This is the third of a three-part conversation with Dr. Munshi. Watch part one, where he discusses multiple myeloma treatment selection and sequencing, and part two, where he explores mechanisms of resistance to immunotherapy.

Interview Transcript

DocWire News: A study presented at AACR 2021, presented a novel neoantigen peptide vaccine for solid tumors and multiple myeloma tested in a phase 1 trial. Could you discuss vaccination as an immunotherapeutic strategy for multiple myeloma?

Dr. Munshi: I think this is another area of great interest to us and me—to develop a vaccine for myeloma. Any myeloma-specific or myeloma-selective antigen can be theoretically utilized to target by immune cells. And the one presentation that you mentioned, it was not just for myeloma, it was a neoantigen vaccine or peptide based vaccine being developed to target any and a lot of cancers. And so basically what this study did was to do sequencing, [and] found the genes which are mutated. They are new in the body for the cancer cells and not of the other cells. And using those targets, develop peptides now [specifically] for the patient and those peptides could be utilized to induce an immune response. And it’s an interesting new area of work where this new antigen can be targeted. We also utilize similar approaches targeting some of the common well known myeloma-related and over expressed antigen.

We have peptides that have been developed against XBP1, we have peptide against CD138, we have peptide against CS1, we have peptide against B cell maturation antigen (BCMA), and these peptides can induce immune responses and provide a benefit. BCMA is a good example because it is still a very myeloma plasma cell–specific target. For inducing immune response against BCMA, that would have a very narrow activity and we know BCMA is a great target. I think there is a great interest in developing similar vaccination type of approaches for this patient. And we do believe that that kind of immune response could have a great potential as a longer term maintenance strategy. If you vaccinate patient with new antigen or any of these other non-myeloma related antigen, say post [hematopoietic cell transplant (HCT)] or post chimeric antigen receptor (CAR) T [cell therapy], then that immune response can be sustained to control the disease for longterm without needing to do something.

I think developing a vaccine has a great potential. Currently we know, with the real great research being done for the COVID-19 vaccine, there is so much more information that we can now repurpose from COVID to cancer—myeloma for our example—and use RNA-base in many other approaches to utilize these targets to develop cancer specific vaccine or myeloma specific vaccine. There’s great enthusiasm that we can use something good out of this terrible time we are in with COVID to benefit other patients.