Moderna, Merck cancer vaccine shows promise in late-stage trial

I asked Claude this:

Here's Claude's answer:

Good analogy to start with — same core technology, very different target and strategy.

COVID vaccine mechanism (as you described): One mRNA sequence, same for everyone, coding for the spike protein of the virus. Your cells make the spike, your immune system learns to recognize that specific viral protein, and you're primed to fight the actual virus later.

This melanoma drug (mRNA-4157, brand name intismeran autogene, developed by Moderna with Merck's Keytruda) works differently in a few key ways:

1. It's personalized, not generic. After a patient's melanoma tumor is surgically removed, doctors sequence its DNA and compare it to the patient's normal cells to find the specific mutations unique to that person's cancer. The mRNA is synthesized to code for up to 34 "neoantigens" — selected based on the mutational signature of that particular patient's tumor DNA, making each dose an individualized therapy. No two patients get the same shot.

2. The target is mutant tumor proteins, not a foreign pathogen protein. Cancer cells accumulate mutations that produce slightly abnormal versions of proteins — "neoantigens" — that don't appear on healthy cells. The mRNA instructs the patient's own cells to manufacture these neoantigen fragments, essentially presenting a "wanted poster" of the tumor's unique fingerprints to the immune system.

3. The goal is T-cells hunting cancer cells, not antibodies blocking a virus. Rather than triggering antibody production (as with a virus), the aim is to generate T-cell responses that can recognize and attack cells carrying these specific mutant proteins — i.e., train the immune system to identify and kill any remaining or recurring cancer cells bearing those same mutations.

4. It's combined with Keytruda (pembrolizumab). Keytruda is Merck's anti-PD-1 therapy — it works by blocking a "brake" that tumors use to hide from T-cells (the PD-1/PD-L1 checkpoint). So the combination is: the mRNA vaccine trains new T-cells to recognize the tumor's specific mutations, while Keytruda keeps those T-cells from being switched off when they encounter cancer cells. It's a one-two punch — recruit the right soldiers, then keep them in the fight.

5. It's given after surgery, not as prevention. Patients had high-risk stage IIB through IV melanoma that had already been surgically removed, and received up to nine doses of the vaccine plus Keytruda over about a year, aiming to mop up microscopic residual disease and prevent recurrence — more like an anti-recurrence therapy than a prophylactic vaccine.

The results just announced: the combination met the main study goal of significantly extending time without melanoma recurrence, and reduced the risk of the cancer spreading to distant sites, in a Phase 3 trial of over 1,100 patients — the first randomized late-stage trial success for this "neoantigen vaccine" approach.

Sounds very expensive, so I asked Claude about that, too.

The tl;dr version is that these bespoke treatments will never get past the death panels.

Claude says:

Yes — you're right to expect that, and it's a real concern in the oncology field right now. No official price has been announced (it's not yet FDA-approved), but a few things point toward high cost:

Why it's likely to be expensive:

• It's a "batch of one." Every dose is manufactured individually per patient — tumor DNA sequenced, up to 34 mutations identified, custom mRNA synthesized, made into a personalized vaccine. That's fundamentally different (and costlier) than a mass-produced drug, more like a manufacturing operation per patient than a pill off an assembly line. Moderna's CEO Stéphane Bancel has noted the personalized vaccine can be manufactured in roughly 30 days — fast for a bespoke product, but each turnaround is its own production run.
• It's stacked on top of Keytruda, which is already one of the most expensive cancer drugs on the market (list price in the tens of thousands of dollars per year), so this would be an add-on cost, not a replacement.
• Comparable personalized/cell therapies are very costly. Other individualized cancer treatments (CAR-T therapies, for example) often run $400,000–$500,000+ per course, partly for the same reason: custom manufacturing per patient.

What we do know about market expectations: Barclays analysts estimated the therapy could generate about $3 billion in revenue just for treating melanoma by 2035 — a figure that only makes sense if per-patient pricing is substantial, since the addressable patient population is a few thousand people a year in the relevant high-risk melanoma stages, not millions.

A few mitigating factors worth noting:

• It's given for about a year (up to 9 doses) rather than indefinitely, unlike some chronic therapies.
• If it becomes standard adjuvant care and prevents recurrence, insurers may treat it similarly to how they cover other approved immunotherapies — but that doesn't mean it'll be cheap, just that it'll likely go through normal oncology drug insurance/Medicare coverage pathways rather than being self-pay.
• Manufacturing costs for mRNA platforms have dropped substantially since COVID-era scale-up, which could help costs some, though personalization inherently limits economies of scale compared to an off-the-shelf vaccine.

Bottom line: no price tag yet, but given the personalized manufacturing model and its position alongside Keytruda, expect it to land in the "high five to six figures per patient" range that's become typical for personalized cancer immunotherapies, pending actual company disclosures when it nears approval.

Tough choice for a lot of us. Avoid melanoma, but get autism.

Moderna stock soared by 39%on the open with this news.
The anti-vaxxers will have a tough call if stricken with this type of cancer.

Great news for non-idiots that end up with advanced melanoma

Yet another attempt by Bill Gates to chip everyone! I advice ALL true MAGA folks to avoid this vaccine no matter what. Better to die than live with the mind controlling chip that is sure to be in this vaccine.

What Would Jesus Do? said:

Sounds very expensive, so I asked Claude about that, too.

The tl;dr version is that these bespoke treatments will never get past the death panels.

Claude says:

Yes — you're right to expect that, and it's a real concern in the oncology field right now. No official price has been announced (it's not yet FDA-approved), but a few things point toward high cost:

Why it's likely to be expensive:

• It's a "batch of one." Every dose is manufactured individually per patient — tumor DNA sequenced, up to 34 mutations identified, custom mRNA synthesized, made into a personalized vaccine. That's fundamentally different (and costlier) than a mass-produced drug, more like a manufacturing operation per patient than a pill off an assembly line. Moderna's CEO Stéphane Bancel has noted the personalized vaccine can be manufactured in roughly 30 days — fast for a bespoke product, but each turnaround is its own production run.
• It's stacked on top of Keytruda, which is already one of the most expensive cancer drugs on the market (list price in the tens of thousands of dollars per year), so this would be an add-on cost, not a replacement.
• Comparable personalized/cell therapies are very costly. Other individualized cancer treatments (CAR-T therapies, for example) often run $400,000–$500,000+ per course, partly for the same reason: custom manufacturing per patient.

What we do know about market expectations: Barclays analysts estimated the therapy could generate about $3 billion in revenue just for treating melanoma by 2035 — a figure that only makes sense if per-patient pricing is substantial, since the addressable patient population is a few thousand people a year in the relevant high-risk melanoma stages, not millions.

A few mitigating factors worth noting:

• It's given for about a year (up to 9 doses) rather than indefinitely, unlike some chronic therapies.
• If it becomes standard adjuvant care and prevents recurrence, insurers may treat it similarly to how they cover other approved immunotherapies — but that doesn't mean it'll be cheap, just that it'll likely go through normal oncology drug insurance/Medicare coverage pathways rather than being self-pay.
• Manufacturing costs for mRNA platforms have dropped substantially since COVID-era scale-up, which could help costs some, though personalization inherently limits economies of scale compared to an off-the-shelf vaccine.

Bottom line: no price tag yet, but given the personalized manufacturing model and its position alongside Keytruda, expect it to land in the "high five to six figures per patient" range that's become typical for personalized cancer immunotherapies, pending actual company disclosures when it nears approval.

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This is analagous to products like the CAR-T drugs. The science and the logistics around them are indeed pretty impressive. As to the cost/benefit and insurance coverage question, my sense is that these therapeutic approaches will never be justifiable based on n=1, and instead they will live or die based on whether the basic platform can support multiple products. In essence, this is much more of a capital investment in the traditional sense of the word, and if you can't amortize it, you'll be screwed.

Personally, I'm skeptical, both scientifically in terms of viable targets etc., and because, frankly, I think we're sorta moving on from cancer to things like metabolic diseases and dementia-oriented things that people now live long enough to experience. But then again, I remember being in the room with the president of an early biologics company on a friday afternoon when he matter-of-factly announced that they'd just run out of product in their supply chain, but we should just keep going with our meeting because -- not to worry -- it happened every week about that time.

I still think people are underestimating AI. And yes, I am aware of the outsized expectations.

I don't think we will ever "cure" cancer (in the next 50 years). However, I do think we will make it much more manageable.

My neighbor growing up died at the age of 17 from Leukemia. Today, I think childhood leukemia is cured at a rate of 90%+ or something crazy like that. Hopefully AI helps us keep making progress.

fatpiggy said:

I still think people are underestimating AI. And yes, I am aware of the outsized expectations.

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Oh I dunno I think this is precisely the kind of thing it can do well. More or less a math problem.

PROLLY CAWZS AWTIZM

LunchBox50 said:

PROLLY CAWZS AWTIZM

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GETZ SUM IVERMECTIN

Palmerhawk said:

Moderna stock soared by 39%on the open with this news.
The anti-vaxxers will have a tough call if stricken with this type of cancer.

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It’s up a lot more than 39%

RFK Jr will find a problem or two with it

I take CBD oil, COVID shots, Ivermectin, and see a chiropractor for any minor illness. I may need to add this new drug into the mix so I can live forever.

MTTiger19 said:

It’s up a lot more than 39%

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Correct...saw that moderna is up 152% this week!

Palmerhawk said:

Correct...saw that moderna is up 152% this week!

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Hoping my 401k had some

other1 said:

RFK Jr will find a problem or two with it

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^^^^^
100%