From Neoantigen Discovery to Immune-Checkpoint Synergy: Peptide Cancer Vaccines as Precision Tools for Personalised Cancer Therapy

The diagnosis, management and potential eradication of cancer depend on tumour type, stage, extent and anatomical location. While surgery, chemotherapy and radiotherapy remain central, advances in molecular oncology have shifted treatment toward personalised approaches. Identification of tumour-specific molecular abnormalities and biomarkers has enabled targeted therapies that eliminate malignant cells while limiting damage to normal tissues. Cancer immunotherapy has emerged as a promising, non-invasive strategy that activates the immune system to recognise and attack tumour-specific antigens. Preventive vaccines based on weakened or inactivated viruses have achieved notable success in reducing virus-associated cancers. Therapeutic vaccines targeting tumour-associated antigens (TAAs) and patient-specific neoantigens aim to elicit strong cytotoxic and helper T-cell responses against established tumours. Advances in genomic sequencing, bioinformatics-driven neoantigen prediction and single-cell profiling now enable accurate identification of tumour-specific targets. This review highlights progress in cancer vaccine research, focusing on strategies targeting TAAs, neoantigens and delivery platforms such as dendritic cell-based systems, nucleic acid vaccines (DNA and mRNA), synthetic long peptides and viral or bacterial vectors. Clinical evidence shows that neoantigen vaccines induce potent tumour-specific T-cell responses with minimal autoimmunity and gain enhanced efficacy when combined with immune checkpoint inhibitors or adoptive T-cell transfer (ACT) using tumour-infiltrating lymphocytes (TILs). By reinvigorating anti-tumour T cells within the tumour microenvironment, these combination approaches support durable tumour regression and improved outcomes. Despite unresolved challenges, advances in AI-guided target discovery, nanotechnology-based delivery systems and scalable manufacturing offer promising solutions for achieving precise and durable cancer treatment.