Yeah. One thing I like to keep in mind with regard to DCVax-L is that the immune system doesn't have to fight the whole cancer, just the tiny bit of it that's left behind after resection and radiation. DCVax-L simply bypasses/overcomes the down-regulation of immune response which allowed the cancer to grow from invisible (and asymptomatic) to operable in the first place. By the time most patients detect it, the cancer has indeed grown to relatively huge proportions that even a properly activated immune system might not be able to handle. However, modern day resection rates and techniques are absolutely amazing, so by the time DCVax-L steps up to the plate (er, into the blood), the job may be only 1% as large as it was before. That seems to me to be a lot more manageable.
The reason chemo doesn't benefit as much from this advantage is because it's so non-selective and toxic, you can't just stay on it. You either have to take so much hoping to catch every last cancer cell (along with a great many of your formerly healthy cells) that you're on your deathbed anyway from the treatment, or you stop after a more reasonable effort and the few remaining cancer cells stage a comeback shortly thereafter. Remember, even the original Stupp protocol only dared use TMZ for six "cycles" (essentially months, but the treatment and associated bioactivity is periodic not continuous). Some doctors and trials these days have extended that (e.g. to twelve cycles), but eventually you always do have to stop, and this occurs a lot sooner than is necessary with DCVax-L. You want 36 cycles or more of injections? Go for it! You need more because your cancer was further progressed than average and there are likely more peripheral cells that evaded resection? No problem, all that extra tumor makes it possible to produce all that extra vaccine, and if there aren't enough DCs, we'll just bring you in for a second blood draw in a few days!
That's also why I'm a little puzzled by the very conservative dosing strategy they've chosen for this trial, but based on everything I've read it was done to be close to the precedent trials that laid the ground for this one, so probably just regulatory pragmatism on the part of management. Also saving a lot of extra treatment enables them to maintain blinding with their "reboot" protocol (where regardless of whether you are on treatment or placebo, if you "progress," your dosing schedule starts over with the treatment). No doubt if successful there will be follow-up trials (much, much, much easier to finance once your blockbuster treatment hits the market) to optimize the dosing schedule and take advantage of improved production automation and so on.
I seem to have strayed off-topic - point was, immune system doesn't have to fight the whole cancer, just the minuscule leftovers of it.
