We Can Now Customize Cancer Cures, Tumor by Tumor

But can any company afford to manufacture one-off medical treatments?

A blood vessel formation providing cancer cells (whose nuclei are shown in blue) with oxygens and nutrients. Illustration: Alfred Pasieka/Science Library/Getty Images

By Adam Piore

The first time someone pitched Genentech’s senior leadership on a personalized cancer vaccine, it did not go well. “I thought there was going to be a riot,” Ira Mellman, then Genentech’s head of research oncology, recalls.

From across the table, he watched the scientific review committee grimly shaking their heads as his team member and longtime collaborator Lélia Delamarre made her case. Then he overheard the head of clinical development turn to the person sitting next to him and mutter, “Over my dead body. A vaccine will never work.”

That was in 2012. Cancer immunotherapy, which uses a person’s own immune system to attack tumors, is now one of medicine’s most promising fields, and one of the greatest breakthroughs in oncology in decades. But it took a long time to get there. Until the recent advent of a new class of blockbuster immunology drugs, the field was notorious for questionable science, hype, and spectacular disappointments.

And what Mellman and his team were proposing that day went further than turbocharging immune cells to make them better able to attack cancers. They were talking about a vaccine precisely tailored to…