Dendritic Cell Therapy - Dendritic Cell Vaccine
A dendritic cell vaccine trains the immune system with cells from the patient's own blood. The idea is sound, and after thirty years of trials one vaccine is approved, in one country, for one cancer. This guide sets out what the prostate, glioblastoma and melanoma trials found, how to judge a clinic's offer, and what proven options remain.
About This Department
After thirty years of trials, one dendritic cell vaccine has won approval, in one country, for one cancer. Everything else offered under the name remains experimental.
Dendritic cell vaccines train the immune system with cells taken from the patient's own blood, and the idea is sound. The results have been mixed. Sipuleucel-T lengthened median survival in advanced prostate cancer by 4.1 months. A randomized trial in melanoma, reported in 2024, found no reduction in relapse. Clinics in several countries sell dendritic cell treatments for any cancer at high prices, and patients deserve to know what the evidence says before paying. Send us your diagnosis and treatment history, and a medical oncologist will tell you what the evidence supports for your cancer, whether a registered trial could offer you a dendritic cell vaccine, and which proven treatments remain available.
Dendritic cell-based immunotherapy is safe and can induce antitumor immunity, even in patients with advanced disease. However, clinical responses have been disappointing, with classic objective tumor response rates rarely exceeding 15%.Review of two decades of dendritic cell trials, Lancet Oncology, 2014
What dendritic cells do
The immune system's messengers
Dendritic cells patrol the tissues, pick up fragments of anything foreign, carry them to the lymph nodes and show them to T cells, which then learn to attack cells carrying those fragments. Without that step, T cells stay blind. Cancers exploit this by switching dendritic cells off or hiding from them. A dendritic cell vaccine tries to skip the problem by training the patient's own dendritic cells in a laboratory, loading them with tumor fragments, and injecting them back so that they teach the T cells directly.
Dendritic cells are a diverse group of specialized antigen-presenting cells with key roles in the initiation and regulation of innate and adaptive immune responses.Nature Reviews Immunology, 2019
- Collection. White cells are drawn from the blood, by a large blood sample or by leukapheresis, a two to four hour procedure that separates them through a machine.
- Culture. Precursor cells are grown in a laboratory for about a week with growth factors until they become dendritic cells.
- Loading. The cells are exposed to the tumor's antigens, from the patient's own tumor tissue, from manufactured proteins or peptides, or from tumor genetic material.
- Maturation and release. A final step activates the cells, and they are tested for sterility and quality before release.
- Injection. The vaccine is injected into the skin, a lymph node or a vein, in a series of doses weeks apart.
Where the evidence stands
Thirty years. Hundreds of trials.
The idea has been tested since the mid-1990s in trials that were, for the most part, small and uncontrolled, run in single centers with a few dozen patients each and a laboratory measure of immune response as their main result, which made them good at showing that the vaccines are safe and poor at showing whether anyone lived longer. Most were small and uncontrolled, and they showed that the vaccines are safe and can provoke an immune response against the tumor. Only a few randomized trials have asked whether patients live longer or relapse less, and their answers differ by cancer.
Prostate cancer, the one approved vaccine
Sipuleucel-T is made from the patient's own antigen-presenting cells, loaded with a prostate cancer protein and given as three infusions two weeks apart. In the IMPACT trial, 512 men with metastatic prostate cancer that no longer responded to hormone therapy were randomized to the vaccine or to placebo. Median survival was 25.8 months against 21.7, and 31.7 percent against 23.0 percent were alive at three years.
The tumor did not shrink and the time to progression did not change. The benefit showed only in survival, a pattern immunologists attribute to a slow immune effect. Chills, fever and headache were the common side effects. The United States approved the vaccine in 2010. Its European authorization was later withdrawn at the manufacturer's request, and it is not available in most countries today.
Glioblastoma and melanoma
Glioblastoma, a promising and contested result
DCVax-L, made from the patient's dendritic cells loaded with lysate of the removed tumor, was tested in 331 patients with glioblastoma. Median survival from randomization was 19.3 months against 16.5 in patients with newly diagnosed disease, and 13.2 against 7.8 in recurrent disease.
The comparison weakens it. Patients initially randomized to placebo were allowed to cross over to the vaccine, so the published analysis compared vaccine patients with external controls drawn from other trials. External controls can differ in ways that matter, and the result has not led to approval in the United States or the European Union. Neuro-oncologists regard it as a reason for further trials.
Melanoma, a well-designed negative trial
MIND-DC randomized 148 patients with stage IIIB or IIIC melanoma, after surgery, to natural dendritic cells injected into lymph nodes or to placebo. The vaccine produced specific immune responses in 67.1 percent of treated patients against 3.8 percent of controls and was well tolerated, with serious side effects in 5 percent.
It did not prevent relapse. Two-year relapse-free survival was 36.8 percent with the vaccine and 46.9 percent with placebo, a difference within chance. A measurable immune response, in other words, did not translate into clinical benefit, the lesson that runs through most of the field. For the same patients, adjuvant checkpoint inhibitors and targeted drugs have proven benefit.
Private clinics in several countries advertise dendritic cell therapy for almost any cancer, for prices that can reach tens of thousands, and sometimes in place of standard treatment.
Check before paying.
- A legitimate trial is registered, has an ethics approval and never charges for the product. A paid treatment outside a trial is not research, whatever it is called.
- Claims of years of added life, tumor disappearance or suitability for every cancer have no support in randomized trials.
- Cell products must be manufactured in a licensed facility under good manufacturing practice. Ask where, and ask for the licence.
- Advice to stop or delay chemotherapy, radiotherapy, surgery or approved immunotherapy in favor of a vaccine puts proven benefit at risk.
- A clinic that cannot name the published trial supporting its product for your cancer has none.
The trials at a glance
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| Cancer | Trial | Design | Result |
|---|---|---|---|
| Metastatic prostate cancer resistant to hormone therapy | IMPACT, 512 men, New England Journal of Medicine 2010 | Randomized against placebo | Median survival 25.8 against 21.7 months. No effect on progression |
| Glioblastoma | DCVax-L, 331 patients, JAMA Oncology 2023 | Crossover allowed, compared with external controls | Median survival 19.3 against 16.5 months, newly diagnosed. Design limits the conclusion |
| Stage IIIB and IIIC melanoma after surgery | MIND-DC, 148 patients, Nature Communications 2024 | Randomized against placebo | Two-year relapse-free survival 36.8 against 46.9 percent. No benefit |
What about safety, cost and travel?
Safety is the strong point.
Few cancer treatments have proved as gentle in trials as dendritic cell vaccines. Fever, chills, fatigue and soreness at the injection site are the usual effects, and serious side effects are rare, 5 percent in MIND-DC. The risk lies elsewhere, in money spent on an unproven product and, far more seriously, in weeks or months lost for a treatment that works, since a cancer that is still controllable when the vaccine is started may no longer be by the time its absence of effect becomes clear on a scan.
- The pathology report and the most recent scans.
- Every treatment received so far, with dates and response.
- Any offer of dendritic cell therapy you have received, with the clinic, the product and the price, so that it can be assessed.
The use of sipuleucel-T prolonged overall survival among men with metastatic castration-resistant prostate cancer. No effect on the time to disease progression was observed.IMPACT trial, New England Journal of Medicine, 2010
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| Dendritic cell vaccine | Checkpoint inhibitor, such as pembrolizumab | CAR-T cell therapy | |
|---|---|---|---|
| Regulatory status | Experimental, except sipuleucel-T in the United States | Approved for many cancers | Approved for some blood cancers |
| Made from | Patient's own dendritic cells | Ready-made antibody | Patient's own engineered T cells |
| Survival benefit in randomized trials | Shown once, in prostate cancer | Shown in many cancers | Shown in lymphoma and myeloma |
| Common side effects | Fever, chills, injection soreness | Immune inflammation of organs | Cytokine release, neurologic effects |
A file review needs no travel. A consultation with tests takes three to five working days in Istanbul, and the length of stay for any treatment that follows depends on what is recommended. A dendritic cell vaccine given within a registered trial requires the schedule the trial sets, several visits over months in most protocols. Flying poses no problem between vaccine doses, and a trial's dosing calendar sets visits every few weeks in most protocols, which suits a patient willing to return. Whether a trial fits is a question for the review.
Legitimate trials supply the product free. Approved treatments are quoted after the review. Your own figure follows the free review of your file.
One coordinator from the international patients team is assigned from your first message. The team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish and arranges interpreting in other languages on request. An invitation letter naming the hospital and the treating oncologist is sent ten days before travel, and the international patients office arranges the transfer and a hotel for you and a companion. Halal, vegetarian and diabetic meals are available, a prayer room is on site, and a request for a female doctor is passed to the department and met wherever the rota allows. Back home, the coordinator stays reachable on the same WhatsApp number.
Dendritic cell therapy FAQ
Does dendritic cell therapy work?
Is dendritic cell therapy approved?
Is it safe?
Why do some clinics charge for it?
What about DCVax-L for glioblastoma?
Can my family come with me?
References
- Kantoff PW, Higano CS, Shore ND, et al. Sipuleucel-T immunotherapy for castration-resistant prostate cancer. New England Journal of Medicine. 2010;363(5):411-422.
- Liau LM, Ashkan K, Brem S, et al. Association of Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination With Extension of Survival Among Patients With Newly Diagnosed and Recurrent Glioblastoma: A Phase 3 Prospective Externally Controlled Cohort Trial. JAMA Oncology. 2023;9(1):112-121.
- Bol KF, Schreibelt G, Bloemendal M, et al. Adjuvant dendritic cell therapy in stage IIIB/C melanoma: the MIND-DC randomized phase III trial. Nature Communications. 2024;15(1):1632.
- Anguille S, Smits EL, Lion E, van Tendeloo VF, Berneman ZN. Clinical use of dendritic cells for cancer therapy. Lancet Oncology. 2014;15(7):e257-e267.
- Wculek SK, Cueto FJ, Mujal AM, Melero I, Krummel MF, Sancho D. Dendritic cells in cancer immunology and immunotherapy. Nature Reviews Immunology. 2020;20(1):7-24.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Prof. Dr. Mustafa Teoman YANMAZ, Medical Oncology.
Medically reviewed by
Prof. Dr. Mustafa Teoman YANMAZ
Medical Oncology
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