Survivin expression is associated with a poor prognosis in many cancers. While survivin is being studied as a potentially important target for cancer therapy, its many biological functions in both normal and cancerous cells remain to be fully elucidated. There are at least six specific survivin splice variants that have been identified to date which appear to be self-regulating and may have distinct functions. Several survivin peptide vaccines are currently under development by different groups. Survivin vaccine strategies for the most part have focused upon particular regional epitopes of the molecule that are bound by MHC class I and can lead to a cytotoxic T cell response. Immunotherapy targeting survivin is still at an early stage of development; however, several agents are progressing through early phase clinical trials. Recent studies using SurVaxM, a multi-epitope cryptic peptide, survivin, mimic show specific CD8+ T cell responses, as well as specific CD4+ T cell stimulation. Currently SurVaxM is in Phase I clinical trials designed to study its safety, tolerability and immunological effects in patients with survivin-positive recurrent malignant gliomas and multiple myeloma.