Colorectal cancer vaccines: Tumor-associated antigens vs neoantigens

Figure 2 Workflow: preparation of individualized vaccine (using neoantigen targets). The figure shows the possible work flow for individualized cancer vaccination. The colorectal cancer patient (tumor in pink) undergoes tumor resection surgery and biomaterial (tumor (red container) and matching normal (beige container) tissue) is collected. Next generation sequencing and comparative bioinformatics analysis of these biomaterials reveal (tumor-specific) neoantigens and selected peptides are synthesized under GMP conditions. The vaccine consists of synthesized peptides, peptide-loaded antigen-presenting cells, ex vivo expanded T cells or chimeric antigen receptor T cells and can be combined with adjuvants, immunogenic chemotherapeutics and/or immune checkpoint inhibitors to further enhance vaccine efficacy. The patient will receive first vaccine shots ideally even before chemotherapeutic intervention. Residual tumor cells (in the colon or circulating as well as micrometastases in other organs) should be eliminated hereby. Exact vaccination scheme will depend on vaccine type, medical facility, etc.