Donna Gustafson is living a cancer patient's fantasy.
At 72, the retired accountant hikes, travels, lifts weights, and exchanges adoring glances with Ed, the husband she married 50 years ago. All these moments are happening while she shows zero evidence of the Stage II pancreatic cancer that was supposed to kill her years ago.
"I have had 100% quality of life; I am back to where I was prior," Gustafson says.
"She's better than that," her husband interjects. "She's sassier, and she's in the best shape of her life — there's no question about that."
Seven years ago, Gustafson became the world's first recipient of an mRNA vaccine designed to treat pancreatic cancer, a highly lethal disease diagnosed in about 70,000 Americans every year. There are few effective treatments for the disease, but Gustafson's was a personalized version, created using samples of her tumor, aiming to reprogram her immune cells — training them, essentially, to recognize distinctive mutant proteins on cancerous cells and kill them.
mRNA vaccines having a moment
It's been a big year for cancer vaccines using mRNA, especially after drugmakers Merck and Moderna released results last month from the first major successful trial of mRNA vaccines for skin cancer, showing a 42% reduction in recurrence and death over two years.
A combination of technologies using mRNA, genomics and AI, helped create these vaccines, which are also being tested on lung, kidney, bladder and brain cancers. But researchers don't yet understand why some trials have failed, while others show eye-popping results in the form of people like Gustafson.
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Gustafson, who splits her time between New Jersey and Florida, says she wasn't scared to be first to test this concept against pancreatic cancer. She credits her three grown daughters for finding and getting her into the trial. "It was a no brainer," she says. "I knew that statistically, the odds of my survival were low, and I was very happy to be offered some type of hope."
Gustafson received nine doses of the vaccine, along with surgery and chemotherapy. She was part of a small clinical trial involving 16 pancreatic cancer patients. The vaccine worked on half of the patients, and seven of those eight are still alive today.
For patients on these vaccines, treatment is also an easier option. It does not compare to chemotherapy, which requires hours of infusion and comes with after-effects that were "barbaric" for his wife, Ed Gustafson says with a shudder.
By contrast: The shots felt like nothing, Donna Gustafson says. "I had no symptoms, no side effects — to the point where I was actually worried that maybe it was not helping."
But it was. Very swiftly.
Surgeon and scientist Vinod Balachandran ran the trial at Memorial Sloan Kettering Cancer Center in New York City. The vaccine used in his research is made in an expansive lab made up of hallways of freezers, desks, centrifuges and cytometers. Patients' responses to the treatment are measured in the lab. The oncologists and mathematicians who work there are dedicated to decoding pancreatic cancer, then reverse engineering the mRNA necessary to fight it.
A research analyst pulls up a graph on her computer, showing dozens of superimposed green lines — each representing the number of times an immune cell reproduces, Balachandran explains.
Looking at the graph representing Donna Gustafson's immune cell count, Balachandran notes how the lines shoot up, then remain high and flat — "a 10,000-fold increase" — reflecting how her immune system mass produced cancer-attacking cells and sustained it, for years beyond her last shot. "It just tells us that this response lasts," Balachandran says.
Balachandran says it was the strength and durability of such responses in half of the patients that, for him, blew open the possibility of mRNA vaccines. "Well, if you could generate such a strong immune response in the toughest of cancers, could this similarly develop cancer vaccines for a broad array of human cancers?," he says.
Promising future
This technology is now at an inflection point — with patients, doctors, researchers and investors. The National Cancer Institute, for example, is working on a partnership with private companies to fast-track research and development of more mRNA cancer vaccines. Balachandran and Sloan Kettering are part of that, with plans to expand production of personalized vaccines for patients on site.
Donna Gustafson says she and her husband have felt overwhelmingly lucky over the past seven years.
"I saw two more grandchildren be born and grow, many birthdays, holidays and Christmases with my family," she says.
With her husband, she's created and ticked off many items off her bucket list: skydiving, summiting, celebrating their 50th anniversary with the expectation of many more to come.
"We've done so many things — we probably have done so much more," Ed Gustafson says, before his wife picks up his sentence, "...if we had not had this experience."
"We live so much more for the day now," Ed Gustafson says, looking at his wife.
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