Background: Neoantigen-based vaccines have emerged as a promising strategy in cancer therapy due to their ability to elicit highly specific and personalized immune responses against tumors. Objective: To review the biological basis, design process, mechanisms of action, and technological platforms of neoantigen vaccines, and to discuss combination strategies, current challenges, and future perspectives.
Methods: A narrative review of literature on cancer therapeutic vaccines published from 2010 to 2024, searched in PubMed, Scopus, and Web of Science using keywords including “neoantigen vaccine”, “cancer therapeutic vaccine”, and “personalized cancer immunotherapy”. Figures were created with BioRender.com.
Results: Neoantigen vaccines exploit tumor-specific somatic mutations to induce robust T-cell responses, particularly CD8⁺ cytotoxic T lymphocytes. The design process involves sequencing, epitope prediction, immunogenicity evaluation, and selection of platforms such as mRNA, DNA, peptide, dendritic cell, or viral vector vaccines. Combination with immune checkpoint inhibitors has shown encouraging early-phase efficacy (e.g., KEYNOTE-942, autogene cevumeran), although outcomes depend on cancer type, tumor mutational burden, HLA repertoire, vaccine platform, and combination regimen.
Conclusion: Despite several challenges, neoantigen vaccines hold substantial potential. Advances in sequencing, artificial intelligence, and combination strategies are expected to accelerate clinical translation toward effective and durable personalized cancer treatment.