Immune checkpoint inhibitors (ICIs) have revolutionized the management of patients with high-risk early-stage and advanced melanoma, however an important fraction of patients still progress and die of the disease after ICI therapy. Personalized vaccines designed to induce T cell responses against patient-specific tumor neoantigens could present an opportunity to improve response to ICIs.

As an example of an individualized treatment approach, in a study published in The Lancet, Weber et al. report the safety and activity of an mRNA-based neoantigen cancer vaccine, mRNA-4157 (V940), in combination with the anti-PD1 antibody pembrolizumab as an adjuvant treatment in patients with completely resected high-risk cutaneous melanoma. mRNA-4157 (V940) encoded up to 34 personalized neoantigens, the prediction of which was based on a bioinformatic pipeline integrating next-generation sequencing analysis of tumor and blood samples to assess the mutanome of each patient.