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Exploratory RCT finds in situ vaccine plus PD-1 with immunoradiotherapy shows response in advanced hepatic malignanciesNew Vaccine Combo Shrinks Liver Tumors Safely

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Key Takeaway
Consider exploratory RCT findings on in situ vaccine plus PD-1 with immunoradiotherapy as preliminary due to small sample size.

This exploratory randomized controlled trial enrolled 18 patients with advanced hepatic malignancies at a single oncology center. Patients received in situ vaccine FOLactis plus a PD-1 monoclonal antibody, combined with either immunoradiotherapy (5Gy/fraction × 3 fractions) or low-dose chemotherapy (cisplatin plus vincristine). The primary outcome was objective response rate (ORR) by RECIST v1.1.

For patients receiving immunoradiotherapy, the ORR for targeted lesions was 33.3% (95% CI: 12.1-64.6%), with a disease control rate (DCR) of 77.8% (95% CI: 45.3-96.1%). For non-targeted lesions, the ORR was 22.2% (95% CI: 3.9-54.7%) and DCR was 66.7% (95% CI: 35.4-87.9%). The comparator group receiving low-dose chemotherapy had a DCR of 66.7% for targeted lesions and 22.2% for non-targeted lesions, though no direct statistical comparison between groups was provided.

Safety data indicated the immunoradiotherapy group experienced no significant adverse events, while the chemotherapy group reported grade 1-2 hyperthermia. The regimen was described as safe and well tolerated, though serious adverse events and discontinuation rates were not reported. Key limitations include the very small sample size (n=18), exploratory design, and wide confidence intervals for all outcomes. The study authors reported a certain degree of anti-tumor effect, but these findings should be interpreted as preliminary hypothesis-generating data.

Imagine a liver tumor that suddenly stops growing and starts shrinking. Now imagine doing this without the severe side effects that usually come with strong cancer drugs.

That is exactly what a new study suggests might be possible.

Liver cancer is a tough fight. It often comes back after surgery or spreads before it is found. Many patients need strong treatments, but these often cause serious pain, fever, and fatigue.

Doctors have tried many things. Some work well at first, but the cancer finds a way to grow again. Patients are left looking for options that are both powerful and kind to their bodies.

The surprising shift

For years, doctors used standard chemotherapy to fight these tumors. These drugs kill fast-growing cells, but they also hurt healthy ones. This causes nausea, hair loss, and weakness.

But here is the twist. A new approach uses your own immune system to fight the disease. Instead of attacking the tumor directly, this method trains your body's defenders to find and destroy the cancer cells.

What scientists didn't expect

Think of your immune system like a security team. Sometimes, the cancer builds a wall around itself. This wall stops the security team from getting inside.

This new treatment builds a bridge over that wall. It lets the security team enter the tumor zone. Once inside, they start destroying the bad cells.

The study tested a specific vaccine called FOLactis. This vaccine is made from a harmless bacteria. It is injected right into the tumor. It releases signals that wake up the immune system.

Doctors also added a drug called PD-1 inhibitor. This drug removes the brakes from the immune system. It helps the security team fight harder and longer.

The study snapshot

Researchers looked at 18 patients with advanced liver cancer. They split them into two groups.

Group A got the vaccine, the PD-1 drug, and a special type of radiation. The radiation was low dose and targeted only the tumor area.

Group B got the vaccine, the PD-1 drug, and low-dose chemotherapy. The chemotherapy drugs were given through a vein.

Both groups received treatment in cycles that lasted three weeks. Doctors watched how the tumors changed over time. They also checked for any side effects.

The results were very different between the two groups.

In Group A, the tumors shrank significantly. About one-third of the targeted tumors got smaller. More importantly, the disease stayed under control in most patients.

In Group B, the chemotherapy did not shrink the tumors as well. In fact, the disease control was lower than in Group A.

The safety profile was also better for Group A. Patients in this group had no major side effects. They felt better and could keep up with daily life.

Patients in Group B did have some side effects. They experienced mild fevers and feeling hot. These are common with chemotherapy but are less common with the vaccine approach.

This doesn't mean this treatment is available yet.

The study was small, with only 18 people. This is typical for early research. It shows promise, but we need to see if it works for many more people.

The bigger picture

This approach changes how we think about cancer vaccines. Most vaccines are given in the arm. This one goes right into the tumor.

By placing the vaccine inside the tumor, it creates a local reaction. This reaction spreads to other parts of the body. It turns the whole immune system into a hunter for cancer cells.

This method could help patients who have already tried other treatments. It offers a new tool when old tools stop working.

If you or a loved one has liver cancer, talk to your doctor about all options. This new method is still in the research phase. It is not ready for everyone yet.

However, it shows that combining a local vaccine with immune-boosting drugs is a smart strategy. It works better than chemotherapy alone in this specific case.

Do not stop your current treatment without medical advice. But stay informed about new studies. Clinical trials may soon offer this option to more patients.

More research is needed to prove this works for larger groups of people. Scientists will need to test it on different types of liver cancer.

They will also need to check if it works for people with other health problems. Safety checks will continue as more patients join trials.

If this method proves safe and effective, it could become a standard option. It might be combined with other therapies to make them even stronger.

The goal is to give patients a choice. A choice that offers hope without causing severe harm. This study takes a big step toward that future.

Study Details

Study typeRct
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Recent years have witnessed the emergence of a novel research direction in the field of tumor vaccines. An in situ vaccine known as FOLactis, comprised of genetically engineered Lactococcus lactis expressing a fusion protein of Fms-like tyrosine kinase 3 ligand (Flt3L) and co-stimulator OX40 ligand (OX40L), was developed by the Oncology Centre of Nanjing Drum Tower Hospital. The present study was designed to evaluate the efficacy and safety of combination therapy based on intratumoral injection of the in situ vaccine FOLactis and intravenous PD-1 monoclonal antibody in combination with immunoradiotherapy or low-dose chemotherapy in the treatment of advanced hepatic malignancies. METHODS: In this exploratory clinical study, patients with advanced hepatic malignancies were enrolled and randomly assigned to Group A and Group B, corresponding to different treatment regimens. The treatment regimen in Group A consisted of the in situ vaccine FOLactis combined with a PD-1 monoclonal antibody and immunoradiotherapy (5Gy/fraction×3fractions). In contrast, the regimen in Group B included the in situ vaccine FOLactis, a PD-1 monoclonal antibody, and low-dose chemotherapy (cisplatin plus vincristine). All treatments were given in 21-day cycles. The primary observation indicator of the study was the objective response rate (ORR) as defined by RECIST v1.1. Secondary observation indicators included the disease control rate (DCR) and the incidence of adverse events. RESULTS: A total of 18 eligible patients were included in the study. In Group A, the ORR and DCR for targeted lesions were 33.3%(95%CI:12.1-64.6%) and 77.8%(95%CI:45.3-96.1%), while the ORR and DCR for non-targeted lesions were 22.2%(95%CI:3.9-54.7%) and 66.7%(95%CI:35.4-87.9%), respectively. Targeted and non-targeted lesions in Group B did not reduce significantly, and their respective DCRs were 66.7%(95%CI:35.4-87.9%) and 22.2%(95%CI:3.9-54.7%). Patients in Group A experienced no significant adverse events. Patients in Group B experienced grade 1-2 hyperthermia as a side effect. CONCLUSIONS: The combination therapy based on the in situ vaccine FOLactis and intravenous PD-1 monoclonal antibody showed a certain degree of anti-tumor effect, and was safe and well tolerated in patients with advanced hepatic malignancies. TRIAL REGISTRATION: The Ethics Committee of Nanjing Drum Tower Hospital approved this study (approval number 2022-101-01). The associated trial is registered at ChiCTR.gov.cn (ChiCTR2200060660).
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