1
|
Maitland K, Obonyo N, Hamaluba M, Ogoda E, Mogaka C, Williams TN, Newton C, Kariuki SM, Gibb DM, Walker AS, Connon R, George EC. A Phase I trial of Non-invasive Ventilation and seizure prophylaxis with levetiracetam In Children with Cerebral Malaria Trial (NOVICE-M Trial). Wellcome Open Res 2024; 9:281. [PMID: 39184127 PMCID: PMC11342035 DOI: 10.12688/wellcomeopenres.21403.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 08/27/2024] Open
Abstract
Background African children with cerebral malaria and seizures caused Plasmodium falciparum are at greater risk of poor outcomes including death and neurological sequelae. The agonal events are severe hypoventilation and respiratory arrest often triggered by seizures. We hypothesised that prophylactic anti-seizure medication (ASM) could avert 'spikes' of intracranial pressure during or following seizures and that adequate ventilation could be supported by biphasic Cuirass Ventilation (BCV) which requires no intubation. Methods A Phase I trial conducted in Kilifi, Kenya designed to provide data on safety, feasibility and preliminary data on seizure control using prophylactic ASM (levetiracetam) and BCV as non-invasive ventilatory support in children with cerebral malaria. Children aged 3 months to 12-years hospitalised with P falciparum malaria (positive rapid diagnostic test or a malaria slide), a Blantyre Coma Score ≤2 and a history of acute seizures in this illness are eligible for the trial. In a phased evaluation we will study i) BCV alone for respiratory support (n=10); ii) prophylactic LVT: 40mg/kg loading dose then 30mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10) and; iii) prophylactic LVT: 60mg/kg loading dose then 45mg/kg every 12 hours given via nasogastric tube for 72 hours (or until fully conscious) plus BCV support (n=10). Primary outcome measure: cumulative time with a clinically detected seizures or number of observed seizures over 36 hours. Secondary outcomes will be assessed by feasibility or ability to implement BCV, and recovery from coma within 36 hours. Safety endpoints include: aspiration during admission; death at 28 days and 180 days; and de-novo neurological impairments at 180 days. Conclusions This is a Phase I trial largely designed to test the feasibility, tolerability and safety of using non-invasive ventilatory support and LVT prophylaxis in cerebral malaria. Registration ISRCTN76942974 (5.02.2019); PACTR202112749708968 (20.12.2021).
Collapse
Affiliation(s)
- Kathryn Maitland
- Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College London, London, England, W2 1PG, UK
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Nchafasto Obonyo
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Mainga Hamaluba
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Emmanuel Ogoda
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Christabel Mogaka
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Thomas N. Williams
- Department of Infectious Disease and Institute of Global Health and Innovation, Division of Medicine, Imperial College London, London, England, W2 1PG, UK
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
| | - Charles Newton
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX, UK
| | - Symon M. Kariuki
- KEMRI Wellcome Trust Research Programme, Kilifi, Kilifi, PO BOX 230, Kenya
- Department of Public Health, Pwani University, Kilifi, Kilifi County, Kenya
| | - Diana M. Gibb
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| | - A. Sarah Walker
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| | - Roisin Connon
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| | - Elizabeth C. George
- Institute of Clinical Trials & Methodology, Medical Research Council Clinical Trials Unit at University College London, London, England, WC1V 6J, UK
| |
Collapse
|
2
|
Richert L, Lelièvre JD, Lacabaratz C, Hardel L, Hocini H, Wiedemann A, Lucht F, Poizot-Martin I, Bauduin C, Diallo A, Rieux V, Rouch E, Surenaud M, Lefebvre C, Foucat E, Tisserand P, Guillaumat L, Durand M, Hejblum B, Launay O, Thiébaut R, Lévy Y. T Cell Immunogenicity, Gene Expression Profile, and Safety of Four Heterologous Prime-Boost Combinations of HIV Vaccine Candidates in Healthy Volunteers: Results of the Randomized Multi-Arm Phase I/II ANRS VRI01 Trial. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:2663-2674. [PMID: 35613727 DOI: 10.4049/jimmunol.2101076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/03/2022] [Indexed: 06/15/2023]
Abstract
Heterologous prime-boost strategies are of interest for HIV vaccine development. The order of prime-boost components could be important for the induction of T cell responses. In this phase I/II multi-arm trial, three vaccine candidates were used as prime or boost: modified vaccinia Ankara (MVA) HIV-B (coding for Gag, Pol, Nef); HIV LIPO-5 (five lipopeptides from Gag, Pol, Nef); DNA GTU-MultiHIV B (coding for Rev, Nef, Tat, Gag, Env gp160 clade B). Healthy human volunteers (n = 92) were randomized to four groups: 1) MVA at weeks 0/8 + LIPO-5 at weeks 20/28 (M/L); 2) LIPO-5 at weeks 0/8 + MVA at weeks 20/28 (L/M); 3) DNA at weeks 0/4/12 + LIPO-5 at weeks 20/28 (G/L); 4) DNA at weeks 0/4/12 + MVA at weeks 20/28 (G/M). The frequency of IFN-γ-ELISPOT responders at week 30 was 33, 43, 0, and 74%, respectively. Only MVA-receiving groups were further analyzed (n = 62). Frequency of HIV-specific cytokine-positive (IFN-γ, IL-2, or TNF-α) CD4+ T cells increased significantly from week 0 to week 30 (median change of 0.06, 0.11, and 0.10% for M/L, L/M, and G/M, respectively), mainly after MVA vaccinations, and was sustained until week 52. HIV-specific CD8+ T cell responses increased significantly at week 30 in M/L and G/M (median change of 0.02 and 0.05%). Significant whole-blood gene expression changes were observed 2 wk after the first MVA injection, regardless of its use as prime or boost. An MVA gene signature was identified, including 86 genes mainly related to cell cycle pathways. Three prime-boost strategies led to CD4+ and CD8+ T cell responses and to a whole-blood gene expression signature primarily due to their MVA HIV-B component.
Collapse
Affiliation(s)
- Laura Richert
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Inria SISTM Team, Talence, France
- CHU de Bordeaux, Service d'Information Médicale, Bordeaux, France
- Vaccine Research Institute, Créteil, France
| | - Jean-Daniel Lelièvre
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
- Groupe Henri-Mondor Albert-Chenevier, AP-HP, Créteil, France
| | - Christine Lacabaratz
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Lucile Hardel
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Vaccine Research Institute, Créteil, France
| | - Hakim Hocini
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Aurélie Wiedemann
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Frédéric Lucht
- CHU de Saint Etienne, Saint-Priest-en-Jarez, France
- Université Jean Monnet and Université de Lyon, Saint-Etienne, France
| | - Isabelle Poizot-Martin
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, APHM Sainte-Marguerite, Service d'Immuno-Hématologie Clinique, Marseille, France
| | - Claire Bauduin
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Vaccine Research Institute, Créteil, France
| | | | - Véronique Rieux
- Vaccine Research Institute, Créteil, France
- INSERM-ANRS, Paris, France
| | - Elodie Rouch
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Vaccine Research Institute, Créteil, France
| | - Mathieu Surenaud
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Cécile Lefebvre
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Emile Foucat
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Pascaline Tisserand
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Lydia Guillaumat
- Vaccine Research Institute, Créteil, France
- INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Mélany Durand
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Inria SISTM Team, Talence, France
- Vaccine Research Institute, Créteil, France
| | - Boris Hejblum
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Inria SISTM Team, Talence, France
- Vaccine Research Institute, Créteil, France
| | - Odile Launay
- CIC 1417 F-CRIN I-REIVAC, INSERM, Hôpital Cochin, AP-HP, Paris, France; and
- Université Paris Descartes, Paris, France
| | - Rodolphe Thiébaut
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Inria SISTM Team, Talence, France
- CHU de Bordeaux, Service d'Information Médicale, Bordeaux, France
- Vaccine Research Institute, Créteil, France
| | | |
Collapse
|
3
|
Engelhardt J, Caire F, Damon-Perrière N, Guehl D, Branchard O, Auzou N, Tison F, Meissner WG, Krim E, Bannier S, Bénard A, Sitta R, Fontaine D, Hoarau X, Burbaud P, Cuny E. A Phase 2 Randomized Trial of Asleep versus Awake Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease. Stereotact Funct Neurosurg 2020; 99:230-240. [PMID: 33254172 DOI: 10.1159/000511424] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Asleep deep brain stimulation (DBS) for Parkinson's disease (PD) is being performed more frequently; however, motor outcomes and safety of asleep DBS have never been assessed in a prospective randomized trial. METHODS We conducted a prospective, randomized, noncomparative trial to assess the motor outcomes of asleep DBS. Leads were implanted in the subthalamic nucleus (STN) according to probabilistic stereotactic coordinates with a surgical robot under O-arm© imaging guidance under either general anesthesia without microelectrode recordings (MER) (20 patients, asleep group) or local anesthesia with MER and clinical testing (9 patients, awake group). RESULTS The mean motor improvement rates on the Unified Parkinson's Disease Rating Scale Part III (UPDRS-3) between OFF and ON stimulation without medication were 52.3% (95% CI: 45.4-59.2%) in the asleep group and 47.0% (95% CI: 23.8-70.2%) in the awake group, 6 months after surgery. Except for a subcutaneous hematoma, we did not observe any complications related to the surgery. Three patients (33%) in the awake group and 8 in the asleep group (40%) had at least one side effect potentially linked with neurostimulation. CONCLUSIONS Owing to its randomized design, our study supports the hypothesis that motor outcomes after asleep STN-DBS in PD may be noninferior to the standard awake procedure.
Collapse
Affiliation(s)
- Julien Engelhardt
- CHU de Bordeaux, Service de Neurochirurgie B, Bordeaux, France, .,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France, .,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France,
| | - François Caire
- Université de Limoges, CNRS, XLIM, UMR7252, Limoges, France.,CHU de Limoges, Service de Neurochirurgie, Limoges, France
| | - Nathalie Damon-Perrière
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations Fonctionnelles du Système Nerveux, Bordeaux, France
| | - Dominique Guehl
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations Fonctionnelles du Système Nerveux, Bordeaux, France
| | | | - Nicolas Auzou
- CHU de Bordeaux, Service de Neurologie, Bordeaux, France.,Laboratoire de Psychologie, Université de Bordeaux, Bordeaux, France
| | - François Tison
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service de Neurologie, Bordeaux, France
| | - Wassilios G Meissner
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service de Neurologie, Bordeaux, France
| | - Elsa Krim
- CH de Pau, Service de Neurologie, Pau, France
| | | | - Antoine Bénard
- CHU Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), Bordeaux, France
| | - Rémi Sitta
- CHU Bordeaux, Pôle de Santé Publique, Clinical Epidemiology Unit (USMR), Bordeaux, France
| | - Denys Fontaine
- CHU de Nice, Service de Neurochirurgie, Nice, France.,Université Côte d'Azur, Nice, France
| | - Xavier Hoarau
- Polyclinique de Navarre, Service de Neurochirurgie, Pau, France
| | - Pierre Burbaud
- Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.,CHU de Bordeaux, Service d'explorations Fonctionnelles du Système Nerveux, Bordeaux, France
| | - Emmanuel Cuny
- CHU de Bordeaux, Service de Neurochirurgie B, Bordeaux, France.,Institut des Maladies Neurodégénératives, Université de Bordeaux, UMR 5293, Bordeaux, France.,CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| |
Collapse
|
4
|
Mu R, Pan H, Xu G. A Bayesian adaptive phase I/II platform trial design for pediatric immunotherapy trials. Stat Med 2020; 40:382-402. [PMID: 33094528 DOI: 10.1002/sim.8780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/23/2020] [Accepted: 10/01/2020] [Indexed: 11/11/2022]
Abstract
Immunotherapy is the most promising new cancer treatment for various pediatric tumors and has resulted in an unprecedented surge in the number of novel immunotherapeutic treatments that need to be evaluated in clinical trials. Most phase I/II trial designs have been developed for evaluating only one candidate treatment at a time, and are thus not optimal for this task. To address these issues, we propose a Bayesian phase I/II platform trial design, which accounts for the unique features of immunotherapy, thereby allowing investigators to continuously screen a large number of immunotherapeutic treatments in an efficient and seamless manner. The elicited numerical utility is adopted to account for the risk-benefit trade-off and to quantify the desirability of the dose. During the trial, inefficacious or overly toxic treatments are adaptively dropped from the trial and the promising treatments are graduated from the trial to the next stage of development. Once an experimental treatment is dropped or graduated, the next available new treatment can be immediately added and tested. Extensive simulation studies have demonstrated the desirable operating characteristics of the proposed design.
Collapse
Affiliation(s)
- Rongji Mu
- KLATASDS-MOE, School of Statistics, East China Normal University, Shanghai, China
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Guoying Xu
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
5
|
Willingness to Participate in Hypothetical HIV Vaccine Trial and Associated Factors among People Who Inject Drugs in Dar es Salaam, Tanzania. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8507981. [PMID: 32714988 PMCID: PMC7354640 DOI: 10.1155/2020/8507981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022]
Abstract
This study is aimed at assessing the willingness to participate in the HIV vaccine trials and the associated factors among people who inject drugs (PWIDs) in Tanzania. Information about the willingness to participate and the associated factors was collected using interviewer-administered questionnaires at the medication treatment for opioid use disorder (MOUD) clinic in Dar es Salaam. Data analysis was performed using the IBM SPSS Statistic 20. The mean age of respondents was 36.7, and the standard deviation (SD) was ±7.2. The majority of respondents (68%) had primary education, and a high proportion of them were single (61.5%). More than one-third (37.9%) shared needles and syringes. Most (87.3%) had more than three sexual partners, and almost half (51.4%) did not use condoms during sexual intercourse with nonregular partners. About 63% had knowledge of HIV transmission while 27% had heard about HIV vaccine trials. Generally, 76% of the respondents expressed willingness to participate in future HIV vaccine trials regardless of prior knowledge of HIV vaccine trials. Willingness to participate in HIV vaccine trials was not associated with education level, people living with, knowledge about HIV transmission, awareness of HIV vaccine trials, sharing of syringe/needles, and number of sexual partners. Only older age (OR = 1.6, 95%CI = 1.01, 2.6) and condom use (OR = 0.49, 95%CI = 0.26, 0.97) showed an association with willingness. However, after performing logistic regression with factors at p value ≤ 0.2 to ascertain the other factors on the effects of age, condom use, education level, and sharing of needles/syringes, the results were not statistically significant. Although participants reported a high willingness to participate in hypothetical HIV vaccine trials, no definitive conclusion can be drawn about the associated factors. Further studies with intensive educational programs are needed to investigate the factors on willingness to participate in actual HIV vaccine trials among PWIDs.
Collapse
|
6
|
Moore CL, Stöhr W, Crook AM, Richert L, Leliévre JD, Pantaleo G, García F, Vella S, Lévy Y, Thiébaut R, McCormack S. Multi-arm, multi-stage randomised controlled trials for evaluating therapeutic HIV cure interventions. Lancet HIV 2020; 6:e334-e340. [PMID: 31047670 DOI: 10.1016/s2352-3018(19)30082-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 12/22/2022]
Abstract
The evaluation of immune-based approaches to achieve an antiretroviral therapy free remission of HIV infection requires proven efficacy through antiretroviral therapy interruption placebo-controlled trials. This approach is not without risk to participants and innovative trial designs need to be developed that minimise the number of participants treated with placebo and ineffective candidates. Multi-arm, multi-stage (MAMS) trial designs can be used in this context to accelerate the development of an immune-based therapeutic agent for HIV cure. Issues related to implementing a MAMS design within the planned EHVA T01 trial are considered here. EHVA T01 is a multicentre, MAMS, double-blind, phase 1 and 2 trial that aims to evaluate the effect of immune interventions on viral control in HIV-1 infected participants following analytic treatment interruption. The application of a MAMS design increases the likelihood that the EHVA T01 trial will identify a successful treatment and minimises the number of participants undergoing analytical treatment interruptions who have been treated with futile agents. The use of a MAMS design is a promising strategy to evaluate complex immune-based approaches aimed at curing HIV-infection, particularly relevant to the pipeline with multiple agents requiring examination.
Collapse
Affiliation(s)
- Cecilia L Moore
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Wolfgang Stöhr
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Angela M Crook
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Laura Richert
- Vaccine Research Institute, Créteil, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team SISTM, UMR 1219, and Inria, Bordeaux, France; European Clinical Trials Platform and Development, and French Clinical Research Infrastructure Network, CIC 1401, University of Bordeaux, Inserm, CHU Bordeaux, Bordeaux, France
| | - Jean-Daniel Leliévre
- Vaccine Research Institute, Créteil, France; INSERM U955, Paris Est Créteil University, Créteil, France
| | - Giuseppe Pantaleo
- Service of Immunology and Allergy, and Swiss Vaccine Research Institute, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Felipe García
- Infectious Diseases Department, Hospital Clinic of Barcelona-HIVACAT, University of Barcelona, Barcelona, Spain; Retrovirology and Viral Immunopathology Laboratory, AIDS Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)-HIVACAT, Barcelona, Spain
| | - Stefano Vella
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Yves Lévy
- Vaccine Research Institute, Créteil, France; INSERM U955, Paris Est Créteil University, Créteil, France; AP-HP, Hôpital Henri-Mondor Albert-Chenevier, Service d'Immunologie Clinique et Maladies Infectieuses, Créteil, France
| | - Rodolphe Thiébaut
- Vaccine Research Institute, Créteil, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team SISTM, UMR 1219, and Inria, Bordeaux, France; European Clinical Trials Platform and Development, and French Clinical Research Infrastructure Network, CIC 1401, University of Bordeaux, Inserm, CHU Bordeaux, Bordeaux, France
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| |
Collapse
|
7
|
Wang C, Rosner GL, Roden RB. A Bayesian design for phase I cancer therapeutic vaccine trials. Stat Med 2019; 38:1170-1189. [PMID: 30368868 PMCID: PMC6399043 DOI: 10.1002/sim.8021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 08/24/2018] [Accepted: 10/06/2018] [Indexed: 12/30/2022]
Abstract
Phase I clinical trials are the first step in drug development to test a new drug or drug combination on humans. Typical designs of Phase I trials use toxicity as the primary endpoint and aim to find the maximum tolerable dosage. However, these designs are poorly applicable for the development of cancer therapeutic vaccines because the expected safety concerns for these vaccines are not as much as cytotoxic agents. The primary objectives of a cancer therapeutic vaccine phase I trial thus often include determining whether the vaccine shows biologic activity and the minimum dose necessary to achieve a full immune or even clinical response. In this paper, we propose a new Bayesian phase I trial design that allows simultaneous evaluation of safety and immunogenicity outcomes. We demonstrate the proposed clinical trial design by both a numeric study and a therapeutic human papillomavirus vaccine trial.
Collapse
Affiliation(s)
- Chenguang Wang
- Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Gary L. Rosner
- Oncology Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | | |
Collapse
|
8
|
Surenaud M, Lacabaratz C, Zurawski G, Lévy Y, Lelièvre JD. Development of an epitope-based HIV-1 vaccine strategy from HIV-1 lipopeptide to dendritic-based vaccines. Expert Rev Vaccines 2018; 16:955-972. [PMID: 28879788 DOI: 10.1080/14760584.2017.1374182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Development of a safe, effective and globally affordable Human Immunodeficiency Virus strain 1 (HIV-1) vaccine offers the best hope for future control of the HIV-1 pandemic. However, with the exception of the recent RV144 trial, which elicited a modest level of protection against infection, no vaccine candidate has shown efficacy in preventing HIV-1 infection or in controlling virus replication in humans. There is also a great need for a successful immunotherapeutic vaccine since combination antiretroviral therapy (cART) does not eliminate the reservoir of HIV-infected cells. But to date, no vaccine candidate has proven to significantly alter the natural history of an individual with HIV-1 infection. Areas covered: For over 25 years, the ANRS (France Recherche Nord&Sud Sida-HIV hépatites) has been committed to an original program combining basic science and clinical research developing an epitope-based vaccine strategy to induce a multiepitopic cellular response against HIV-1. This review describes the evolution of concepts, based on strategies using HIV-1 lipopeptides towards the use of dendritic cell (DC) manipulation. Expert commentary: Understanding the crucial role of DCs in immune responses allowed moving from the non-specific administration of HIV-1 sequences with lipopeptides to DC-based vaccines. These DC-targeting strategies should improve HIV-1 vaccine efficacy.
Collapse
Affiliation(s)
- Mathieu Surenaud
- a INSERM, U955 , Créteil , France.,b Faculté de médecine , Université Paris Est , Créteil , France.,c Vaccine Research Institute (VRI) , Créteil , France
| | - Christine Lacabaratz
- a INSERM, U955 , Créteil , France.,b Faculté de médecine , Université Paris Est , Créteil , France.,c Vaccine Research Institute (VRI) , Créteil , France
| | - Gérard Zurawski
- a INSERM, U955 , Créteil , France.,c Vaccine Research Institute (VRI) , Créteil , France.,d Baylor Institute for Immunology Research , Dallas , TX , USA
| | - Yves Lévy
- a INSERM, U955 , Créteil , France.,b Faculté de médecine , Université Paris Est , Créteil , France.,c Vaccine Research Institute (VRI) , Créteil , France.,e AP-HP, Hôpital H. Mondor - A. Chenevier, Service d'Immunologie Clinique et Maladies Infectieuses , Créteil , France
| | - Jean-Daniel Lelièvre
- a INSERM, U955 , Créteil , France.,b Faculté de médecine , Université Paris Est , Créteil , France.,c Vaccine Research Institute (VRI) , Créteil , France.,e AP-HP, Hôpital H. Mondor - A. Chenevier, Service d'Immunologie Clinique et Maladies Infectieuses , Créteil , France
| |
Collapse
|
9
|
Richert L, Lhomme E, Fagard C, Lévy Y, Chêne G, Thiébaut R. Recent developments in clinical trial designs for HIV vaccine research. Hum Vaccin Immunother 2016; 11:1022-9. [PMID: 25751670 DOI: 10.1080/21645515.2015.1011974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
HIV vaccine strategies are expected to be a crucial component for controlling the HIV epidemic. Despite the large spectrum of potential candidate vaccines for both prophylactic and therapeutic use, the overall development process of an efficacious HIV vaccine strategy is lengthy. The design of clinical trials and the progression of a candidate strategy through the different clinical development stages remain methodologically challenging, mainly due to the lack of validated correlates of protection. In this review, we describe recent advances in clinical trial designs to increase the efficiency of the clinical development of candidate HIV vaccine strategies. The methodological aspects of the designs for early- (phase I and II) and later -stage (phase IIB and III) development are discussed, taking into account the specificities of both prophylactic and therapeutic HIV vaccine development.
Collapse
|
10
|
Lelièvre JD, Lévy Y. HIV-1 prophylactic vaccines: state of the art. J Virus Erad 2016; 2:5-11. [PMID: 27482428 PMCID: PMC4946697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The quest for an effective HIV-1 vaccine began early in the course of the HIV pandemic. Over time, the paradigm has evolved from B cell- towards T cell-based vaccines. Results from initial Phase II/III trials have been disappointing; however, while modest, the unexpected results of the Phase II/III RV144 trial in Thailand have re-energised the field. Indeed a clear correlation was demonstrated in this trial between protection and immunological biomarkers, namely non-neutralising antibodies against the V1V2 region. Recent data obtained from cohorts of recently HIV-1-infected individuals have enabled exploration of the role of neutralising antibodies and their potential use in HIV-1 prevention. Results from non-human primate models using a cytomegalovirus vector have also shown the potential for a prophylactic HIV vaccine to induce effective T cell responses. Finally, the development of new vaccine vectors and trial strategies has also allowed progress in the field. Therefore, HIV-1 vaccine research remains a dynamic field that has also been stimulated by the recent positive results of pre-exposure prophylaxis strategies with antiretrovirals.
Collapse
Affiliation(s)
- Jean-Daniel Lelièvre
- AP-HP, Hôpital Henri Mondor – Albert Chenevier, Service d’Immunologie Clinique et Maladies Infectieuses, Créteil, 94000, France,Corresponding author: Jean-Daniel Lelièvre, Service d’Immunologie Clinique et Maladies Infectieuses, CHU Henri Mondor, 51 avenue Mal de Lattre de Tassigny, 94010, Créteil, France
| | - Yves Lévy
- AP-HP, Hôpital Henri Mondor – Albert Chenevier, Service d’Immunologie Clinique et Maladies Infectieuses, Créteil, 94000, France
| |
Collapse
|
11
|
|