Available: 2025 at the earliest
Potential applications: Melanoma, pancreatic cancer and possibly other cancers

Moderna and BioNTech had their moment of glory during the war against COVID. But let’s not forget that, before that, the two biotech companies had made cancer their priority. In fact, it was almost by chance that the pandemic validated their technology, which uses messenger RNA (mRNA) to stimulate the immune system. The modality basically works the same way, whether it is dealing with a virus or a tumour. With cancer, doctors take a biopsy of the tumour and then identify the specific proteins expressed by the cancer cells. Messenger RNA coding for these proteins is then produced and re-injected into the patient. The proteins trigger an immune response directed against the tumour.

And it seems to be working. In May 2023, the German company BioNTech published promising results in the journal Nature from a phase I trial, conducted with the Swiss firm Roche, of an mRNA vaccine targeting pancreatic cancer. Then in December 2023, Moderna announced that its vaccine, in combination with Merck’s blockbuster Keytruda, reduced the risk of recurrence by 44% and metastasis by 65% in melanoma cases. 

"These results are extremely encouraging," Olivier Michielin says. "Our immune system stays with us throughout our lives. If we can stimulate it to attack cancer, it will be working for us all the time. And therefore prevent the risk of relapse.” Moderna CEO Stéphane Bancel, stated that mRNA cancer vaccines could be on the market by 2025. Professor Michielin takes a more cautious stance, setting the timeline at four to five years.

Available: Since 2011 (in the United States)
Main applications: Lymphoma, melanoma, colorectal and lung cancer
Potential: More than 4,000 clinical trials under way in 2021

In medical circles, oncologists often say that cancer cells are smart. That’s quite true. These invaders should be recognised and destroyed by the patient’s immune system, but they manage to escape the body’s defences and proliferate. "The real revolution in immunotherapy was finding out how cancer cells block the immune system, and then removing these "brakes", says HUG Professor Olivier Michielin. "This discovery earned James P. Allison and Tasuku Honjo the 2018 Nobel Prize in Medicine for their work in immunotherapy." 

Basically, how it works is that some cancer cells have a protein on their surface called PD-L1 (for Programmed Death-Ligand 1). This protein is able to bind to another protein called PD-1 (Programmed cell death protein 1) present on the surface of immune cells, T lymphocytes. "The binding of PD-1 and PD-L1 inactivates T lymphocytes, meaning the cancer cells can escape the immune system," Olivier Michielin says. Pharmaceutical companies have therefore developed drugs that prevent PD-1 and PD-L1 proteins from binding, to restore T lymphocytes’ ability to destroy cancer cells. Such approaches are referred to as anti-PD-1 or anti-PD-L1 immunotherapy.

"These therapies have been shown to be effective in treating certain types of cancer, including lymphoma, melanoma, colorectal, lung and kidney cancer, and head and neck cancers," Olivier Michielin says. "And clinical trials are under way to evaluate their efficacy in treating other tumours." Many pharmaceutical companies have anti-PD-1 or anti-PD-L1 immunotherapy drugs in their portfolio, such as Merck & Co (with Keytruda) and Roche Tecentriq). "Immunotherapy, which has been in use for around 10 years, is showing strong growth," Rose Nguyen says. "And that trend is set to continue as it proves its effectiveness against more cancers."

Available: Since 2000 (in the United States)
Main applications: Breast cancer, urothelial carcinoma, multiple myeloma, lymphoma
Potential: In 2020, more than 110 ADC treatments were undergoing clinical trials

"Traditional chemotherapy causes a lot of side effects because it doesn’t only affect cancer cells. It also impacts healthy cells. ADC treatments are targeted therapies that destroy tumour cells while sparing healthy cells," Professor Olivier Michielin. explains "They have produced impressive results, especially in treating breast cancer." How does the technique work? Antibody-drug conjugate, or ADC, is composed of an antibody attached to a cytotoxic drug via a chemical linker. Once administered, the antibody recognises a target on cancer cells and attaches to it, so that the cytotoxic payload can then kill the cells.

A Markets & Markets report estimates that the global ADC market will reach $19.8 billion by 2028, up from $9.7 billion in 2023, for annual growth of 15.2% over the period. Leaders in the sector include Roche (with Kadcyla), AstraZeneca and Daiichi Sankyo (with Enhertu) and Pfizer (Padcev). "ADC treatments don’t work with all cancers," Professor Michielin points out, "because we don’t have a target for all tumours. I think ADC applications will increase as new targets are identified."

Available: Since 2017 (in the United States)
Main applications: Acute lymphoblastic leukaemia (ALL), lymphoma
Potential: Nearly 1,000 clinical trials with CAR-T cell therapy were in progress in 2023

Emily Whitehead has had an amazing journey. In 2012 as a young girl, she was diagnosed with leukaemia that was unresponsive to all conventional treatments. She would certainly not survive. As a last resort, doctors at the Children’s Hospital of Philadelphia in the United States offered to enrol her in a clinical trial to receive CAR-T cells. Less than a month later, she was cancer-free. How does this miracle called CAR-T cell therapy work? "It involves taking T lymphocytes (ed. note: a type of white blood cell essential to the immune system) from the patient, then genetically modifying them so that they express a protein called CAR," Olivier Michielin explains. "Once reinjected into the patient, the modified T lymphocytes become "CAR-T cells" and multiply, hunting down and destroying cancer cells, because the CAR protein acts like the homing head of a missile. Lymphocytes can then identify cancer cells and attach to them."

The consultancy firm Vision Research forecasts that the global market for CAR-T cell therapies could grow at a rate of nearly 30% per year between 023 and 2032. In other words, it is expected to reach $88.52 billion in 2032, up from $8 billion today. The companies poised to benefit the most from his growth include California-based Kite Pharma, a subsidiary of Gilead Sciences, and Swiss giant Novartis.

Available: Since 2009 (in Europe)
Main applications: Ovarian cancer, lymphoma, bronchial cancer
Potential: More than a hundred clinical trials under way

Another form of immunotherapy, bispecific antibodies (BsAb or BsMAb, for bispecific monoclonal antibody) are a synthetic protein capable of attaching itself to cancer cells and lymphocytes at the same time, enabling the lymphocyte to kill the cancer cell. A number of bispecific antibodies are already on the market, including Blincyto, developed by the US biotech company Amgen for the treatment of acute lymphoblastic leukaemia, and Rybrevant, from Johnson & Johnson subsidiary Janssen, authorised for the treatment of patients with non-small cell lung cancer (NSCLC). "Bispecific antibodies have produced noteworthy results in treating specific solid tumours and certain lymphomas,” Olivier Michielin says. “Their use could be extended to other tumours if we can identify targets on the cancer cells for the antibodies to bind to."