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Carpenter EL, Van Decar S, Adams AM, O'Shea AE, McCarthy P, Chick RC, Clifton GT, Vreeland T, Valdera FA, Tiwari A, Hale D, Kemp Bohan P, Hickerson A, Smolinsky T, Thomas K, Cindass J, Hyngstrom J, Berger AC, Jakub J, Sussman JJ, Shaheen MF, Yu X, Wagner TE, Faries M, Peoples GE. Prospective, randomized, double-blind phase 2B trial of the TLPO and TLPLDC vaccines to prevent recurrence of resected stage III/IV melanoma: a prespecified 36-month analysis. J Immunother Cancer 2023; 11:e006665. [PMID: 37536936 PMCID: PMC10401209 DOI: 10.1136/jitc-2023-006665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The tumor lysate, particle-loaded, dendritic cell (TLPLDC) vaccine is made by ex vivo priming matured autologous dendritic cells (DCs) with yeast cell wall particles (YCWPs) loaded with autologous tumor lysate (TL). The tumor lysate, particle only (TLPO) vaccine uses autologous TL-loaded YCWPs coated with silicate for in vivo DC loading. Here we report the 36-month prespecified analyses of this prospective, randomized, double-blind trial investigating the ability of the TLPO and TLPLDC (±granulocyte-colony stimulating factor (G-CSF)) vaccines to prevent melanoma recurrence in high-risk patients. METHODS Patients with clinically disease-free stage III/IV melanoma were randomized 2:1 initially to TLPLDC versus placebo (n=124) and subsequently TLPO versus TLPLDC (n=63). All patients were randomized and blinded; however, the placebo control arm was replaced in the second randomization scheme with another novel vaccine; some analyses in this paper therefore reflect a combination of the two randomization schemes. Patients receiving the TLPLDC vaccine were further divided by their method of DC harvest (with or without G-CSF pretreatment); this was not randomized. The use of standard of care checkpoint inhibitors was not stratified between groups. Safety was assessed and Kaplan-Meier and log-rank analyses compared disease-free (DFS) and overall survival (OS). RESULTS After combining the two randomization processes, a total of 187 patients were allocated between treatment arms: placebo (n=41), TLPLDC (n=103), or TLPO (n=43). The allocation among arms created by the addition of patients from the two separate randomization schemes does not reflect concurrent randomization among all treatment arms. TLPLDC was further divided by use of G-CSF in DC harvest: no G-CSF (TLPLDC) (n=47) and with G-CSF (TLPLDC+G) (n=56). Median follow-up was 35.8 months. Only two patients experienced a related adverse event ≥grade 3, one each in the TLPLDC+G and placebo arms. DFS was 27.2% (placebo), 55.4% (TLPLDC), 22.9% (TLPLDC+G), and 60.9% (TLPO) (p<0.001). OS was 62.5% (placebo), 93.6% (TLPLDC), 57.7% (TLPLDC+G), and 94.6% (TLPO) (p=0.002). CONCLUSIONS The TLPO and TLPLDC (without G-CSF) vaccines were associated with improved DFS and OS in this clinical trial. Given production and manufacturing advantages, the efficacy of the TLPO vaccine will be confirmed in a phase 3 trial. TRIAL REGISTRATION NUMBER NCT02301611.
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Affiliation(s)
| | - Spencer Van Decar
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Anne E O'Shea
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Patrick McCarthy
- General Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Robert Connor Chick
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Guy Travis Clifton
- Surgery, Uniformed Services University, Bethesda, Maryland, USA
- Surgical Oncology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Timothy Vreeland
- Surgery, Uniformed Services University, Bethesda, Maryland, USA
- Surgical Oncology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Franklin A Valdera
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Ankur Tiwari
- Department of Surgery, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Diane Hale
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Surgery, Uniformed Services University, Bethesda, Maryland, USA
| | - Phillip Kemp Bohan
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Annelies Hickerson
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Todd Smolinsky
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Katryna Thomas
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Jessica Cindass
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - John Hyngstrom
- Surgical Oncology, Huntsman Cancer Institute Cancer Hospital, Salt Lake City, Utah, USA
| | - Adam C Berger
- Department of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - James Jakub
- Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Jeffrey J Sussman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Montaser F Shaheen
- Medical Oncology, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Xianzhong Yu
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, USA
| | | | - Mark Faries
- Surgical Oncology, Cedars-Sinai Medical Center Angeles Clinic and Research Institute, Los Angeles, California, USA
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Carpenter EL, Haglund EA, Mace EM, Deng D, Martinez D, Wood AC, Chow AK, Weiser DA, Belcastro LT, Winter C, Bresler SC, Vigny M, Mazot P, Asgharzadeh S, Seeger RC, Zhao H, Guo R, Christensen JG, Orange JS, Pawel BR, Lemmon MA, Mossé YP. Erratum: Antibody targeting of anaplastic lymphoma kinase induces cytotoxicity of human neuroblastoma. Oncogene 2012. [DOI: 10.1038/onc.2012.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Carpenter EL, Haglund EA, Mace EM, Deng D, Martinez D, Wood AC, Chow AK, Weiser DA, Belcastro LT, Winter C, Bresler SC, Vigny M, Mazot P, Asgharzadeh S, Seeger RC, Zhao H, Guo R, Christensen JG, Orange JS, Pawel BR, Lemmon MA, Mossé YP. Antibody targeting of anaplastic lymphoma kinase induces cytotoxicity of human neuroblastoma. Oncogene 2012; 31:4859-67. [PMID: 22266870 DOI: 10.1038/onc.2011.647] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase aberrantly expressed in neuroblastoma, a devastating pediatric cancer of the sympathetic nervous system. Germline and somatically acquired ALK aberrations induce increased autophosphorylation, constitutive ALK activation and increased downstream signaling. Thus, ALK is a tractable therapeutic target in neuroblastoma, likely to be susceptible to both small-molecule tyrosine kinase inhibitors and therapeutic antibodies-as has been shown for other receptor tyrosine kinases in malignancies such as breast and lung cancer. Small-molecule inhibitors of ALK are currently being studied in the clinic, but common ALK mutations in neuroblastoma appear to show de novo insensitivity, arguing that complementary therapeutic approaches must be developed. We therefore hypothesized that antibody targeting of ALK may be a relevant strategy for the majority of neuroblastoma patients likely to have ALK-positive tumors. We show here that an antagonistic ALK antibody inhibits cell growth and induces in vitro antibody-dependent cellular cytotoxicity of human neuroblastoma-derived cell lines. Cytotoxicity was induced in cell lines harboring either wild type or mutated forms of ALK. Treatment of neuroblastoma cells with the dual Met/ALK inhibitor crizotinib sensitized cells to antibody-induced growth inhibition by promoting cell surface accumulation of ALK and thus increasing the accessibility of antigen for antibody binding. These data support the concept of ALK-targeted immunotherapy as a highly promising therapeutic strategy for neuroblastomas with mutated or wild-type ALK.
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Affiliation(s)
- E L Carpenter
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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