Colorectal cancer vaccines: what we know and what we don't yet know.

Humans have a sophisticated immune system that functions to clear invading organisms and abnormal cells. However, cancers are able to arise despite this immune system. Vaccines have the potential of benefiting cancer patients by stimulating an immune response against tumor-associated antigens (TAA). Our enhanced understanding of how the immune system processes and presents antigens has allowed an array of vaccine modalities to be developed and tested. The TAA with the greatest number of vaccine platforms tested in colorectal cancer is carcinoembyronic antigen (CEA). Trials to date have demonstrated safety and evidence for the induction of an immune response against CEA. This article will review trials conducted with a variety of CEA vaccines. Most studies conducted are phase I or II in the metastatic disease setting, limiting our understanding of the role of the immune response in controlling colon cancers. Phase III trials conducted to date have conflicting data with respect to improvements in disease-free and overall survival. It is our challenge to determine if and which vaccines have sufficient benefit to warrant large-scale trials in the adjuvant and prevention settings.