For cancer you are competing with some amazingly expensive existing treatments like complicated surgery. How does synthesizing a one-off mRNA compare with cutting open someone's brain?
Yup. Cutting out as much as possible is going to continue to be part of the standard of care for the foreseeable future, too.
But I don't think that synthesizing some custom mRNA per-patient is at all cost prohibitive.
Formulating a lot of different batches of mRNA in lipid nanoparticles made with different mRNA might be a little complicated now, but I don't think it's an intrinsically terrible manufacturing problem.
It'll be better if this kind of technique is turns out to be applicable to more cancers, because you need to reach enough doses for economies of scale and manufacturing optimization to really kick in.
The immune system reacts to molecules on the surfaces of cells, not macro-level properties.
And even if you can get the immune system to react to the tumor, it's better if you've removed 99% of it, so that there's less opportunity for the tumor to evolve away from the immune reaction.
(Or, in the likely case that you just slow down growth of the tumor a lot: better to start out at a 99% smaller size).
Not a doctor (or even a biologist), but I wouldn't be surprised if it was a heavy lift to expect the immune system to break down a fruit-sized lump, or the lymphatic system to transport it away. So you may want to remove most of the mass physically, and just leave the immune system to mop up the remainder so it doesn't regrow.
Yeah, I would imagine they would do the minimally invasive surgey to remove as much tumor as possible and then do the immune treatment after. Maybe it would make sense to a biopsy and just the immune treatment, but my guess is it would be mkre effective the first way. At least in my personal experience with this kind of thing I would think this could improve survival rates and reduce disabilities caused or worsened by surgery by not having to achive clean margin removal of the tumor. But who knows. Maybe in the future they can extract enough tumor DNA from blood draws to create the target.
The treatment is probably more effective if you capture most/all of the tumor you can. For one, maybe that alone is good enough. For two, theres the fact that many tumors are a heterogenous mixture of populations of cancer cells rather than one clonal mass of cells that are genetically identical. There is a chance you might "miss" and fail to capture a particularly malignant population that might be rare at the time of surgery but might have distant metastasis before long.
