1
|
Holmes JP, Everest DJ, Shuttleworth CM. Repeated squirrelpox infection in Welsh red squirrels. Vet Rec 2023; 192:128-129. [PMID: 36734577 DOI: 10.1002/vetr.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J P Holmes
- APHA Shrewsbury, Veterinary Investigation Centre, Harlescott, Shrewsbury, Shropshire, SY14HD
| | - D J Everest
- APHA Weybridge, New Haw, Addlestone, Surrey, KT15 3NB
| | - C M Shuttleworth
- School of Natural Sciences, Bangor University, Bangor, Gwynedd, LL57 2UW
| |
Collapse
|
2
|
Williams W, Dakhil SR, Calfa C, Holmes JP, Bhattacharya S, Lukas J, Tan-Chui E, Peoples GE, Sunkari VG, Lacher MD, Wiseman CL. Abstract P2-14-02: Overall survival following treatment with a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p2-14-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: SV-BR-1-GM is a GM-CSF secreting breast cancer cell line derived from a Grade II (moderately differentiated) breast tumor that also expresses HLA class I & II antigens and is able to function as an antigen-presenting cell. Irradiated SV-BR-1-GM is used in a regimen including pre-dose low-dose cyclophosphamide and post-dose injection of IFNα2b into the inoculation sites. The SV-BR-1-GM regimen has been used alone (“monotherapy”, ClinicalTrials.gov NCT03066947 - study completed) and in combination with checkpoint inhibitors (“combination”, ClinicalTrials.gov NCT03328026 - study ongoing). Here we report survival data for patients with advanced metastatic breast cancer (aMBC) treated with the SV-BR-1-GM regimen. Methods: 27 patients with refractory aMBC were treated with the SV-BR-1-GM regimen as monotherapy (cycles every 2 weeks x3 and then monthly). The combination study uses the SV-BR-1-GM regimen with PD-1 inhibitors (PD-1i) pembrolizumab or retifanlimab with cycles every 3 weeks (12 patients dosed to date). Here we report progression free survival (PFS) and overall survival (OS) for patients where that data was collected. Results: A total of 35 patients received the SV-BR-1-GM regimen. The SV-BR-1-GM regimen alone (monotherapy) was given to 27 and 12 received the regimen with a PD-1i checkpoint inhibitor (combination therapy): 4 subjects crossed over from monotherapy. Patients had been heavily pre-treated, median prior regimens = 5. Most patients were estrogen receptor and/or progesterone receptor positive, 18% were Her2/neu positive and 33% were triple negative. The treatment was generally safe and well tolerated. The disease control rate was 30% for the SV-BR-1-GM regimen alone and 33% for the combination with a PD-1i. Several patients had objective complete regression of selected metastases. Median progression free survival was 2.8 months for the SV-BR-1-GM regimen alone and 4.2 months for the PD-1i combination. Median overall survival was 7.0 months for the SV-BR-1-GM regimen alone (data available on 9 patients), and 12.0 months for the PD-1i combination (data available on 7 patients). Conclusions: The median OS compares favorably with published data regarding survival in third line trials (Kazmi Breast Cancer Res Treat. 2020 Aug 17). The protracted OS seen in some subjects suggests some patient subpopulations are more likely to derive clinical benefit. The SV-BR-1-GM regimen alone or in combination with a PD-1i, when administered to heavily pre-treated patients with aMBC, may have elicited effective immune responses in some patients.
TablePatients by StudyCharacteristicSV-BR-1-GM Regimen Alone (n=27)SV-BR-1-GM Regimen + PD-1i (n=12)All Patients* (n=35)Age60 ± 1063 ± 1060 ± 10Mean Prior Systemic Regimens5 (range 0-12)6 (range 1-10)5 (range 0-12)% ER/PR +52%75%58%% Her2/neu +15%17%18%% Triple Negative36%25%33%Delayed-type Hypersensitivity81%91%82%Disease Control Rate30%33%29%Median (Range) Progression Free Survival (months)2.8 (0.4-7.4) (n=27)4.2 (0.8-9.4) (n=11)2.8 (0.4-9.4) (n=34)Median (Range) Overall Survival (months)7.0 (1-41) (n=9)12.0 (5.1-21.4) (n=7)10.2 (1-41) (n=14)• Note that 4 patients crossed over from the monotherapy study to the combination therapy study.
Citation Format: William Williams, Shaker R Dakhil, Carmen Calfa, Jarrod P Holmes, Saveri Bhattacharya, Jason Lukas, Elizabeth Tan-Chui, George E Peoples, Vivek G Sunkari, Markus D Lacher, Charles L Wiseman. Overall survival following treatment with a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-14-02.
Collapse
|
3
|
Fullick E, Bidewell CA, Duff JP, Holmes JP, Howie F, Robinson C, Goodman G, Beckmann KM, Philbey AW, Daunt F. Mass mortality of seabirds in GB. Vet Rec 2022. [PMID: 35119735 DOI: 10.1002/vetr.1462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- E Fullick
- APHA Thirsk, North Yorkshire, YO7 1PZ
| | | | | | | | - F Howie
- SRUC Veterinary Services, Pentlands Science Park, Bush Loan, Penicuik, Midlothian, EH26 0PZ
| | - C Robinson
- SRUC Veterinary Services, Pentlands Science Park, Bush Loan, Penicuik, Midlothian, EH26 0PZ
| | | | | | - A W Philbey
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Midlothian, EH26 9RG
| | - F Daunt
- UK Centre for Ecology & Hydrology, Bush Estate, Penicuik, Midlothian, EH26 0QB
| |
Collapse
|
4
|
Holmes JP, Peguero JA, Garland RC, North J, Young S, Brent LD, Joseph-Ridge N. Intravenous Cetirizine vs Intravenous Diphenhydramine for the Prevention of Hypersensitivity Infusion Reactions: Results of an Exploratory Phase 2 Study. J Infus Nurs 2021; 44:315-322. [PMID: 34555839 PMCID: PMC8565502 DOI: 10.1097/nan.0000000000000444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pretreatment with antihistamines for the prevention of hypersensitivity infusion reactions is recommended for certain biologics and chemotherapies. Cetirizine is the first injectable second-generation antihistamine recently approved for acute urticaria. A randomized, exploratory phase 2 study evaluated intravenous (IV) cetirizine 10 mg versus IV diphenhydramine 50 mg as pretreatment in patients receiving an anti-CD20 agent or paclitaxel. In the overall population (N = 34) and an elderly subgroup (n = 21), IV cetirizine was as effective as IV diphenhydramine in preventing infusion reactions (primary outcome) and associated with less sedation at all time points, a shorter infusion center stay, and fewer treatment-related adverse events.
Collapse
Affiliation(s)
- Jarrod P. Holmes
- St. Joseph Health Cancer Center, Santa Rosa, California (Dr Holmes); Oncology Consultants PA, Department of Research, Houston, Texas (Dr Peguero); Baylor Scott & White Medical Center, Temple, Texas (Dr Garland); and TerSera Therapeutics, Deerfield, Illinois (Ms North and Drs Young, Brent, and Joseph-Ridge)
- Jarrod P. Holmes, MD, FACP, is a hematologist/oncologist and associate medical director of oncology for Northern California, Providence Medical Group, in Santa Rosa, California
- Julio A. Peguero, MD, is board certified in internal medicine and medical oncology and the director of research at Oncology Consultants in Houston, Texas
- R. Campbell Garland, DO, is a hematologist/oncologist at Baylor Scott & White Medical Center based in Central Texas
- Janine North, BS, is executive director of clinical development at TerSera Therapeutics, in Deerfield, Illinois
- Stacia Young, PharmD, BCOP, MBA, is director of oncology medical science liaisons at TerSera Therapeutics
- Lonnie D. Brent, PharmD, is vice president of medical affairs at TerSera Therapeutics
- Nancy Joseph-Ridge, MD, is executive vice president of research and development and chief medical officer at TerSera Therapeutics
| | - Julio A. Peguero
- St. Joseph Health Cancer Center, Santa Rosa, California (Dr Holmes); Oncology Consultants PA, Department of Research, Houston, Texas (Dr Peguero); Baylor Scott & White Medical Center, Temple, Texas (Dr Garland); and TerSera Therapeutics, Deerfield, Illinois (Ms North and Drs Young, Brent, and Joseph-Ridge)
- Jarrod P. Holmes, MD, FACP, is a hematologist/oncologist and associate medical director of oncology for Northern California, Providence Medical Group, in Santa Rosa, California
- Julio A. Peguero, MD, is board certified in internal medicine and medical oncology and the director of research at Oncology Consultants in Houston, Texas
- R. Campbell Garland, DO, is a hematologist/oncologist at Baylor Scott & White Medical Center based in Central Texas
- Janine North, BS, is executive director of clinical development at TerSera Therapeutics, in Deerfield, Illinois
- Stacia Young, PharmD, BCOP, MBA, is director of oncology medical science liaisons at TerSera Therapeutics
- Lonnie D. Brent, PharmD, is vice president of medical affairs at TerSera Therapeutics
- Nancy Joseph-Ridge, MD, is executive vice president of research and development and chief medical officer at TerSera Therapeutics
| | - R. Campbell Garland
- St. Joseph Health Cancer Center, Santa Rosa, California (Dr Holmes); Oncology Consultants PA, Department of Research, Houston, Texas (Dr Peguero); Baylor Scott & White Medical Center, Temple, Texas (Dr Garland); and TerSera Therapeutics, Deerfield, Illinois (Ms North and Drs Young, Brent, and Joseph-Ridge)
- Jarrod P. Holmes, MD, FACP, is a hematologist/oncologist and associate medical director of oncology for Northern California, Providence Medical Group, in Santa Rosa, California
- Julio A. Peguero, MD, is board certified in internal medicine and medical oncology and the director of research at Oncology Consultants in Houston, Texas
- R. Campbell Garland, DO, is a hematologist/oncologist at Baylor Scott & White Medical Center based in Central Texas
- Janine North, BS, is executive director of clinical development at TerSera Therapeutics, in Deerfield, Illinois
- Stacia Young, PharmD, BCOP, MBA, is director of oncology medical science liaisons at TerSera Therapeutics
- Lonnie D. Brent, PharmD, is vice president of medical affairs at TerSera Therapeutics
- Nancy Joseph-Ridge, MD, is executive vice president of research and development and chief medical officer at TerSera Therapeutics
| | - Janine North
- St. Joseph Health Cancer Center, Santa Rosa, California (Dr Holmes); Oncology Consultants PA, Department of Research, Houston, Texas (Dr Peguero); Baylor Scott & White Medical Center, Temple, Texas (Dr Garland); and TerSera Therapeutics, Deerfield, Illinois (Ms North and Drs Young, Brent, and Joseph-Ridge)
- Jarrod P. Holmes, MD, FACP, is a hematologist/oncologist and associate medical director of oncology for Northern California, Providence Medical Group, in Santa Rosa, California
- Julio A. Peguero, MD, is board certified in internal medicine and medical oncology and the director of research at Oncology Consultants in Houston, Texas
- R. Campbell Garland, DO, is a hematologist/oncologist at Baylor Scott & White Medical Center based in Central Texas
- Janine North, BS, is executive director of clinical development at TerSera Therapeutics, in Deerfield, Illinois
- Stacia Young, PharmD, BCOP, MBA, is director of oncology medical science liaisons at TerSera Therapeutics
- Lonnie D. Brent, PharmD, is vice president of medical affairs at TerSera Therapeutics
- Nancy Joseph-Ridge, MD, is executive vice president of research and development and chief medical officer at TerSera Therapeutics
| | - Stacia Young
- St. Joseph Health Cancer Center, Santa Rosa, California (Dr Holmes); Oncology Consultants PA, Department of Research, Houston, Texas (Dr Peguero); Baylor Scott & White Medical Center, Temple, Texas (Dr Garland); and TerSera Therapeutics, Deerfield, Illinois (Ms North and Drs Young, Brent, and Joseph-Ridge)
- Jarrod P. Holmes, MD, FACP, is a hematologist/oncologist and associate medical director of oncology for Northern California, Providence Medical Group, in Santa Rosa, California
- Julio A. Peguero, MD, is board certified in internal medicine and medical oncology and the director of research at Oncology Consultants in Houston, Texas
- R. Campbell Garland, DO, is a hematologist/oncologist at Baylor Scott & White Medical Center based in Central Texas
- Janine North, BS, is executive director of clinical development at TerSera Therapeutics, in Deerfield, Illinois
- Stacia Young, PharmD, BCOP, MBA, is director of oncology medical science liaisons at TerSera Therapeutics
- Lonnie D. Brent, PharmD, is vice president of medical affairs at TerSera Therapeutics
- Nancy Joseph-Ridge, MD, is executive vice president of research and development and chief medical officer at TerSera Therapeutics
| | - Lonnie D. Brent
- St. Joseph Health Cancer Center, Santa Rosa, California (Dr Holmes); Oncology Consultants PA, Department of Research, Houston, Texas (Dr Peguero); Baylor Scott & White Medical Center, Temple, Texas (Dr Garland); and TerSera Therapeutics, Deerfield, Illinois (Ms North and Drs Young, Brent, and Joseph-Ridge)
- Jarrod P. Holmes, MD, FACP, is a hematologist/oncologist and associate medical director of oncology for Northern California, Providence Medical Group, in Santa Rosa, California
- Julio A. Peguero, MD, is board certified in internal medicine and medical oncology and the director of research at Oncology Consultants in Houston, Texas
- R. Campbell Garland, DO, is a hematologist/oncologist at Baylor Scott & White Medical Center based in Central Texas
- Janine North, BS, is executive director of clinical development at TerSera Therapeutics, in Deerfield, Illinois
- Stacia Young, PharmD, BCOP, MBA, is director of oncology medical science liaisons at TerSera Therapeutics
- Lonnie D. Brent, PharmD, is vice president of medical affairs at TerSera Therapeutics
- Nancy Joseph-Ridge, MD, is executive vice president of research and development and chief medical officer at TerSera Therapeutics
| | - Nancy Joseph-Ridge
- Corresponding Authors: Nancy Joseph-Ridge, MD, 520 Lake Cook Rd, Suite 500, Deerfield, IL 60015 () and Lonnie D. Brent, PharmD, 520 Lake Cook Rd, Suite 500, Deerfield, IL 60015 ()
| |
Collapse
|
5
|
Affiliation(s)
- J P Duff
- DoWS, APHA Penrith, Cumbria, CA11 9RR
| | | | - J P Holmes
- DoWS, APHA Shrewsbury, Shropshire, SY5 0YG
| | | | | | - Adrian M Whatmore
- Department of Bacteriology, APHA Weybridge, Woodham Lane, New Haw, Addlestone, Surrey, KT15 3NB
| |
Collapse
|
6
|
Shuttleworth C, Everest D, Wood C, Holmes JP. Sympatric cases of squirrelpox in red and grey squirrels. Vet Rec 2021; 188:358. [PMID: 33960446 DOI: 10.1002/vetr.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Craig Shuttleworth
- School of Natural Sciences, Bangor University, Bangor, Gwynedd, LL57 2UW
| | | | - C Wood
- APHA Weybridge, New Haw, Addlestone, Surrey, KT15 3NB
| | - J P Holmes
- APHA Shrewsbury, Veterinary Investigation Centre, Harlescott, Shrewsbury, Shropshire, SY1 4HD
| |
Collapse
|
7
|
Williams W, Dakhil SR, Calfa C, Holmes JP, Bhattacharya S, Lukas J, Tan-Chiu E, Peoples GE, Sunkari VG, Lacher MD, Wiseman CL. Abstract PS17-20: Response to a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer correlates with tumor grade. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps17-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: SV-BR-1-GM is a GM-CSF transfected breast cancer cell line, exceptional for having antigen-presenting capability and expressing both HLA I and II. The parent cell line, SV-BR-1, was derived from a patient with grade II (moderately differentiated) breast cancer. We report molecular characterization of SV-BR-1-GM, noting it retains features of a grade II tumor, and report enhanced disease control in patients with grade I or II breast cancer.Methods: SV-BR-1 and SV-BR-1-GM were characterized molecularly using RNAseq and proteomic analyses. We treated 23 evaluable patients with recurrent and/or metastatic breast cancer refractory to standard therapy. The SV-BR-1-GM regimen included cyclophosphamide 300 mg/m2 2-3d prior to intradermal injection of SV-BR-1-GM (20-40x106 cells divided into 4 sites) and IFNα into the inoculation sites (10,000 IU/site) about 48 and 96 hours subsequently. Cycles were q2 weeks x3 then qmo x 3 (clinical trial NCT03066947). Eleven patients were treated with the above regimen in combination with a PD-1 inhibitor (pembrolizumab or INCMGA00012) (clinical trial NCT03328026). Disease response was evaluated radiographically q3 mo and as clinically indicated. Results: To estimate the tumor grade represented by the SV-BR-1-GM cell line, we developed a score we refer to as Relative Molecular Grade (RMG). SV-BR-1-GM is most similar to the MDA-MB-468 cell line (RMG of 52.1), which was classified as Basal A phenotype. Basal A cancers are less aggressive than Basal B but more aggressive than Luminal, suggesting that SV-BR-1-GM may have retained features of a grade II breast cancer. We also noted that SV-BR-1-GM expresses both Class I (HLA-A, B & C) and Class II (HLA-DR and -DP) molecules, and that the HLA-DR expression is enhanced by treatment with IFNγ. SV-BR-1-GM expressed 31 genes which are overexpressed in breast cancer, 8 cancer-testis antigens and 3 genes expressed in breast tissue. In 30 patients treated with the SV-BR-1-GM regimen (19 with the SV-BR-1-GM regimen alone, 4 who began on the SV-BR-1-GM regimen and transitioned to combination with a PD-1i, and 7 with combination therapy alone) there were 7 with grade II breast cancer and 1 with grade I breast cancer (Table). These patients were heavily pre-treated with an average of 10 prior regimens. While only one patient with grade III cancer showed disease control, 75% of the patients with grade I or II tumors showed disease control. Patients remained on study for up to 259 days.Conclusions: SV-BR-1-GM appears to retain characteristics of a moderately differentiated breast cancer, expresses multiple potential tumor antigens, and can elicit disease control especially in patients with grade I and II breast cancer.
TablePatients with Grade I/II TumorsCharacteristicSV-BR-1-GM Regimen Alone(n=6)SV-BR-1-GM Regimen + PD-1i(n=3)All Patients(n=8)Age64 ± 767 ± 465 ± 7Mean Prior Systemic Regimens6 (range 1-20)15 (range 14-15)10 (range 1-20)% ER/PR +80%100%86%% Her2/neu +0%33%14%% Triple Negative20%0%14%Delayed-type Hypersensitivity83%100%88%Disease Control Rate*67%100%75%Days on Study (Range)94 (32-181)189 (133-259)141 (32-259)•Includes CR, PR, SD (including minor responses and mixed responses)
Citation Format: William Williams, Shaker R Dakhil, Carmen Calfa, Jarrod P Holmes, Saveri Bhattacharya, Jason Lukas, Elizabeth Tan-Chiu, George E Peoples, Vivek G Sunkari, Markus D Lacher, Charles L Wiseman. Response to a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer correlates with tumor grade [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS17-20.
Collapse
|
8
|
Affiliation(s)
- D J Everest
- APHA Weybridge, Woodham Lane, New Haw, Addlestone, Surrey KT15 3NB
| | - C M Shuttleworth
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2UW
| | - J P Holmes
- APHA Shrewsbury, Veterinary Investigation Centre, Harlescott, Shrewsbury, Shropshire SY1 4HD
| | - S Bell
- APHA Shrewsbury, Veterinary Investigation Centre, Harlescott, Shrewsbury, Shropshire SY1 4HD
| |
Collapse
|
9
|
Duff JP, Richey M, Holmes JP, Bianco C, Duff KP, Lawson B. Suspected collision trauma deaths in pied wagtails. Vet Rec 2020; 186:609-610. [PMID: 32527899 PMCID: PMC7365569 DOI: 10.1136/vr.m2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
| | - M Richey
- APHA Shrewsbury, Kendal Road, Shrewsbury SY1 4HD
| | - J P Holmes
- APHA Shrewsbury, Kendal Road, Shrewsbury SY1 4HD
| | - C Bianco
- APHA Lasswade, Bush Loan Road, Penicuik, Midlothian EH26 OPZ
| | - K P Duff
- Coventry University, Coventry CV1 2TU
| | - B Lawson
- Institute of Zoology, Zoological Society of London, London NW1 4RY
| |
Collapse
|
10
|
Williams W, Dakhil SR, Calfa CJ, Holmes JP, Bhattacharya S, Lukas JJ, Tan-Chiu E, Peoples GE, Sunkari V, Lacher M, Wiseman CL. Breast cancer grade and clinical benefit in patients with advanced breast cancer treated with an engineered whole tumor cell-targeted immunotherapy alone or in combination with checkpoint inhibition. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.3033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3033 Background: SV-BR-1 is a breast cancer cell line derived from a grade II (moderately differentiated) tumor. SV-BR-1 was transfected with the CSF2 gene (encoding GM-CSF) to form SV-BR-1-GM. SV-BR-1-GM expresses HLA class I & II antigens and has functional antigen-presenting cell activity, directly stimulating CD4+ T cells in an HLA-DR restricted fashion. The SV-BR-1-GM regimen consists of low-dose cyclophosphamide (300 mg/m2) to reduce immune suppression, intradermal inoculation with irradiated SV-BR-1-GM (20x106 cells divided into 4 sites) and interferon-α2b (10,000 IU into each inoculation site ~2 & 4 days later) to boost the response. Here, we evaluate the impact of tumor grade on clinical benefit following treatment with the SV-BR-1-GM regimen. Methods: Patients with advanced breast cancer were treated with either the SV-BR-1-GM regimen alone or with the SV-BR-1-GM regimen with pembrolizumab. For the SV-BR-1-GM regimen alone, cycles were administered every 2 weeks x 3 and then monthly, while combination with pembrolizumab (200 mg IV 1-5 days following SV-BR-1-GM inoculation) administered cycles every 3 weeks. Tumor restaging was every 6-12 weeks. Results: 33 patients were enrolled. The treatment was generally safe with inoculation site pruritis, erythema and induration the most common adverse events. 23 patients had grade III (poorly differentiated) tumors, 9 had grade II tumors and one had a grade I (well differentiated) tumor. None of the patients with grade III tumors exhibited clinical benefit. 7 patients with grade I/II tumors received the SV-BR-1-GM regimen alone, 2 received the SV-BR-1-GM regimen with pembrolizumab and 1 received both regimens. As noted in the Table, 7 patients experienced clinical benefit including all 3 patients treated in combination with pembrolizumab. This included 6 patients with stable disease and one with a partial response. Conclusions: The SV-BR-1-GM regimen with or without pembrolizumab appears safe and able to induce clinical benefit even in very heavily pre-treated patients with low or intermediate grade advanced breast cancer. Clinical trial information: NCT03328026 . [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | - Saveri Bhattacharya
- Department of Medical Oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | | | | | | | | | | | | |
Collapse
|
11
|
Clifton GT, Hale D, Vreeland TJ, Hickerson AT, Litton JK, Alatrash G, Murthy RK, Qiao N, Philips AV, Lukas JJ, Holmes JP, Peoples GE, Mittendorf EA. Results of a Randomized Phase IIb Trial of Nelipepimut-S + Trastuzumab versus Trastuzumab to Prevent Recurrences in Patients with High-Risk HER2 Low-Expressing Breast Cancer. Clin Cancer Res 2020; 26:2515-2523. [PMID: 32071118 DOI: 10.1158/1078-0432.ccr-19-2741] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/20/2019] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Preclinical data provide evidence for synergism between HER2-targeted peptide vaccines and trastuzumab. The efficacy of this combination was evaluated in patients with HER2 low-expressing breast cancer in the adjuvant setting. PATIENTS AND METHODS A phase IIb, multicenter, randomized, single-blinded, controlled trial enrolled disease-free patients after standard therapy completion (NCT01570036). Eligible patients were HLA-A2, A3, A24, and/or A26+, and had HER2 IHC 1+/2+, FISH nonamplified breast cancer, that was node positive and/or hormone receptor-negative [triple-negative breast cancer (TNBC)]. Patients received trastuzumab for 1 year and were randomized to placebo (GM-CSF, control) or nelipepimut-S (NPS) with GM-CSF. Primary outcome was 24-month disease-free survival (DFS). Secondary outcomes were 36-month DFS, safety, and immunologic response. RESULTS Overall, 275 patients were randomized; 136 received NPS with GM-CSF, and 139 received placebo with GM-CSF. There were no clinicopathologic differences between groups. Concurrent trastuzumab and NPS with GM-CSF was safe with no additional overall or cardiac toxicity compared with control. At median follow-up of 25.7 (interquartile range, 18.4-32.7) months, estimated DFS did not significantly differ between NPS and control [HR, 0.62; 95% confidence interval (CI), 0.31-1.25; P = 0.18]. In a planned exploratory analysis of patients with TNBC, DFS was improved for NPS versus control (HR, 0.26; 95% CI, 0.08-0.81, P = 0.01). CONCLUSIONS The combination of NPS with trastuzumab is safe. In HER2 low-expressing breast cancer, no significant difference in DFS was seen in the intention-to-treat analysis; however, significant clinical benefit was seen in patients with TNBC. These findings warrant further investigation in a phase III randomized trial.
Collapse
Affiliation(s)
- G Travis Clifton
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Diane Hale
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Timothy J Vreeland
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Annelies T Hickerson
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gheath Alatrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rashmi K Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Na Qiao
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anne V Philips
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason J Lukas
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Issaquah, Washington
| | - Jarrod P Holmes
- Department of Medical Oncology, St. Joseph Health Cancer Center, Santa Rosa, California
| | - George E Peoples
- Department of Surgery, Uniformed Services Health University, Bethesda, Maryland.
| | - Elizabeth A Mittendorf
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
12
|
Williams W, Dakhil SR, Holmes JP, Bhattacharya S, Calfa C, Kundra A, Adams DL, DaSilva D, Peoples GE, Sunkari V, Lacher M, Wiseman CL. Abstract P3-09-08: Efficacy and safety of a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer alone and in combination with immune checkpoint inhibitors. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-09-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: SV-BR-1-GM is a GM-CSF transfected breast cancer cell line, exceptional for having antigen-presenting capability expressing both HLA I and II. We report clinical efficacy, safety, and immunologic correlates of response from our initial Phase I/II trial and initial data from our trial of SV-BR1-GM in combination with immune checkpoint inhibitors. Methods: We enrolled patients with recurrent and/or metastatic breast cancer refractory to standard therapy. Patients received cyclophosphamide 300 mg/m2 2-3d prior to intradermal injection of SV-BR-1-GM (20-40 × 106 cells divided into 4 sites) and IFNα into the inoculation sites (10,000 IU/site) ~2 & 4 days subsequently. Cycles were q2 weeks x3 then qmo x 3. Adverse events (AE) were evaluated after each inoculation. Immunologic responses were measured by delayed type hypersensitivity (DTH) after each inoculation with humoral and cellular responses evaluated ~q3 mo. Disease response was evaluated radiographically q3 mo and as clinically indicated (clinical trial NCT03066947). A similar regimen was used with SV-BR-1-GM in combination with pembrolizumab (200 mg IV) with cycles every 3 weeks (Phase I/II study NCT03328026). Results: In Phase I/IIa (NCT03066947), 23 patients underwent 1 - 8 cycles of treatment. Tumor regression was seen in 3 patients, all of whom matched SV-BR-1-GM at least at one HLA allele. There were no related serious adverse events. The most common adverse event was minor local irritation at the inoculation site. Clinical data are shown in the table. A measurable DTH response was present in 21 patients. Of patients who developed a DTH response and had at least one HLA match, the tumor regression rate was 33% and for those with 2 HLA matches 67%. We saw evidence of antibody responses in 3 of 5 patients evaluated to date. Especially in responders after treatment, blood lymphocytes showed increased cytokine secretion (including ITAC, IFNγ, IL-6 & IL-8) following stimulation with antigens expressed in SV-BR-1-GM. 21/23 patients had expression of PD-L1 in identified circulating cancer-associated cells, and expression levels increased with treatment. Therefore, a combination study with pembrolizumab was initiated. Data on the first 6 patients shows that the regimen is clinically active and safe. One patient with a robust DTH response had evidence of tumor regression in liver metastases. This study is ongoing and is being modified to evaluate combination therapy with the PD-1 inhibitor INCMGA00012 and the IDO inhibitor epacadostat. Conclusions: SV-BR-1-GM appears to be safe and well-tolerated. Contrary to conventional wisdom, SV-BR-1-GM can produce regression of metastatic breast cancer correlating with an immunologic response and HLA matching. Combination therapy with checkpoint inhibitors is ongoing.
Citation Format: William Williams, Shaker R Dakhil, Jarrod P Holmes, Saveri Bhattacharya, Carmen Calfa, Ajay Kundra, Daniel L Adams, Diane DaSilva, George E Peoples, Vivek Sunkari, Markus Lacher, Charles L Wiseman. Efficacy and safety of a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer alone and in combination with immune checkpoint inhibitors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-09-08.
Collapse
|
13
|
Campf J, Clifton GT, Hale DF, Vreeland TJ, Hickerson A, Holmes JP, Litton JK, Murthy RK, Lukas JJ, Mittendorf EA, Peoples GE. Immunologic responses in triple-negative breast cancer patients in a randomized phase IIb trial of nelipepimut-S plus trastuzumab versus trastuzumab alone to prevent recurrence. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
556 Background: Breast cancer (BC) patients (pts) expressing low levels of HER2 by (immunohistochemistry (IHC) 1-2+) are not eligible for trastuzumab (Tz). However, in a randomized phase 2b trial, triple negative BC (TNBC) pts demonstrated a significantly better DFS with nelipepimut-S (NPS) + Tz vs Tz alone. Here, we assess the ex vivo and in vivo immune responses (IR) in both arms. Methods: Disease-free pts (n = 275) with HER2 IHC 1-2+, non-amplified BC who were node positive and/or had TNBC were randomized 1:1 to granulocyte-macrophage-colony stimulating factor (GM-CSF) or NPS+GM-CSF. ±NPS was given every 3 weeks x 6 followed by 4 boosters every 6 months (mo). All pts received Tz concurrently for 1 year per label regimen and were followed for recurrence. IR were evaluated ex vivo by clonal expansion of NPS-specific cytotoxic T lymphocytes (CTL) by dextramer-staining/flow cytometry at time points over 3 years. In vivo IR were assessed by delayed type hypersensitivity (DTH) reactions periodically. Results: The trial enrolled 97 TNBC pts; 60 had 4 timepoints available for analysis (37 NPS + Tz pts; 23 Tz pts). The NPS+Tz group exhibited increases in CTL frequencies vs baseline: 208%, 303%, 379% at 18, 24 and 30 mo, respectively. NPS+Tz pts’ mean CTL frequencies increased from 0.029 ±0.001% at baseline to 0.112±0.026% at 30 mo (p = 0.01) compared to Tz pts who were 0.027 ±0.001% at baseline and 0.057 ±0.016% at 30 mo (p = 0.71). Only 4 NPS+Tz pts recurred as compared to 13 in the Tz arm. While limited by low numbers, recurrent NPS + Tz pt did not mount an IR by ex vivo assessment (range: 0.0 - 0.026%) or by DTH (all measurements: 0 mm), while non-recurrent pts mounted both clonal CTL expansion (range: 0.000- 0.33%) and enhanced DTH (range: 0.0- 80.5mm). Conclusions: NPS+Tz combination is more efficacious in generating time-dependent antigen (NPS)-specific CTL by both ex vivo and in vivo measures vs Tz. Based on these preliminary data, it appears that both ex vivo and in vivo IR to NPS were attenuated in pts with TNBC recurrence. Further analysis of read-outs from these assays to validate the relationship of IRs to clinical effect seen with NPS+Tz in TNBC pts is underway. Clinical trial information: NCT02297698.
Collapse
Affiliation(s)
- Jessica Campf
- San Antonio Military Medical Center, Fort Sam Houston, TX
| | - Guy T. Clifton
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Williams W, Holmes JP, Bhattacharya S, Calfa C, Dakhil SR, Lukas JJ, Tan-Chiu E, Adams D, Peoples G, Lacher M, Wiseman CL. Safety and efficacy of a phase I/IIa trial (NCT03066947) of a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14026 Background: SV-BR-1-GM is a GM-CSF transfected breast cancer cell line which expresses HLA class I & II antigens and has functional antigen-presenting cell activity. Prior studies suggest that partial matching of the HLA type of the patient with SV-BR-1-GM may be predictive of tumor regression. Methods: Subjects received low-dose cyclophosphamide 2-3d prior to ID injection of irradiated SV-BR-1-GM (20 million cells divided into 4 sites) and interferon-α into the inoculation sites ~2 & 4 days subsequently. Cycles were q2 weeks x 3 then q mo. Results: A total of 30 patients were screened and 23 inoculated (Table). The patients were heavily pretreated with a median of 4 prior chemo/biological therapy regimens. There were no serious or unexpected adverse events. Local injection-site irritation was the most common toxicity. Objective tumor regression was seen in 3 patients, all of whom matched SV-BR-1-GM at least at one HLA locus: one patient with regression or clearing of 20 lung metastases; one with reduction in cutaneous involvement of the breast from 80% to 30% and one with regression of a breast lesion. Another 3 patients had decreases in circulating cancer-associated macrophage-like cells (CAMLs), which has been shown to correlate with tumor stage. They also all matched at least at one HLA allele. Circulating tumor cells and circulating epithelial cells were present in low numbers and tended to parallel trends in CAMLs which were present in larger numbers. CAMLs in 21/23 patients stained positive for PD-L1. Patients with tumor regression had robust DTH responses to SV-BR-1-GM. Conclusions: SV-BR-1-GM in this regimen appears to be safe and well-tolerated and is associated with objective regression of metastatic breast cancer and/or with decreases in circulating cancer-associated cells in 6/23 (26%) or patients. HLA matching may be a predictor of response. Clinical trial information: NCT03066947. [Table: see text]
Collapse
Affiliation(s)
| | | | - Saveri Bhattacharya
- Department of Medical Oncology at the Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Carmen Calfa
- University of Miami/Sylvester at Plantation, Plantation, FL
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Hickerson A, Clifton GT, Hale DF, Peace KM, Holmes JP, Vreeland TJ, Litton JK, Murthy RK, Lukas JJ, Mittendorf EA, Peoples GE. Final analysis of nelipepimut-S plus GM-CSF with trastuzumab versus trastuzumab alone to prevent recurrences in high-risk, HER2 low-expressing breast cancer: A prospective, randomized, blinded, multicenter phase IIb trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1 Background: Preclinical data shows synergism between trastuzumab (Tz) and HER2-targeted vaccines. We evaluated adjvuant nelipepimut-S (NPS) + GM-CSF with Tz compared to Tz with GM-CSF alone in HER2 low-expressing (LE) breast cancer (BC) patients (pts) to prevent recurrences. After a planned interim analysis showed benefit in triple negative BC (TNBC) pts, the decision was made to close the trial with guidance from the independent DSMB. Here, we report the final analysis of the trial with 7 months (mo) of added follow-up (f/u). Methods: The phase 2b trial enrolled clinically disease-free BC pts after standard therapy. Pts were HLA-A2, A3, A24, and/or A26+, had HER2-LE (IHC 1-2+, FISH non-amplified) BC and were node positive and/or TNBC. Pts were randomized to placebo with GM-CSF(control group, CG) or NPS with GM-CSF (vaccine group, VG), while all received Tz Q3wk for 1 year. GM-CSF or NPS + GM-CSF were given q3wks x 6 starting with the 3rd Tz dose, and boosters every 6 months x 4. Safety was assessed and pts were followed clinically for recurrences. The primary outcome was DFS at 24 mo. Results: 589 pts were screened at 26 sites. 275 pts were enrolled and randomized (VG:136, CG:139). There were no clinicopathologic differences between groups. Concurrent Tz and NPS was safe with no added overall or cardiac toxicity compared to CG and no grade 4/5 toxicities. In the ITT analysis (median f/u 25.7 mo), the estimated DFS was favorable but did not reach significance in the VG compared with the CG (HR 0.62, 95% CI: 0.31-1.25, p = 0.18). In the TNBC pts, the VG had statistically improved DFS compared to the CG (HR 0.26, 95% CI: 0.08-0.81, p = 0.013). Conclusions: The combination of NPS with Tz is safe with no added toxicity compared to Tz alone, even after prolonged exposure (25.7 mo). In this final analysis, there was a trend towards benefit in the ITT population that improved since the interim analysis with added f/u. The significant benefit seen at interim in the TNBC pts continued to strengthen in the VG group. These findings could position the NPS + Tz combination as an adjuvant therapy for early-stage TNBC and warrant further study. Clinical trial information: NCT01570036.
Collapse
|
16
|
Bhattacharya S, Holmes JP, Calfa C, Lukas J, Tan-Chiu E, Clifton GT, Peoples GE, Lacher M, Wiseman CL, Williams WV. Abstract P2-09-09: Initial safety and efficacy of a phase I/IIa trial of a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-09-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: SV-BR-1-GM is a GM-CSF transfected breast cancer cell line which expresses HLA class I & II antigens. In a previous clinical trial, a partial response of widely metastatic breast cancer was seen in a patient who matched SV-BR-1-GM at HLA-DRB3*02:02. Here we report the safety and efficacy analysis with immunologic correlates of response in the initial patients in a phase I/IIa trial of SV-BR-1-GM in patients with advanced breast cancer
Methods: This phase I/IIa trial enrolled patients with recurrent and/or metastatic breast cancer refractory to standard chemotherapy/targeted-therapy. Patients received low-dose cyclophosphamide 2-3d prior to intradermal injection of SV-BR-1-GM (20x106 cells divided into 4 sites) and interferon-α into the inoculation sites (10,000 IU/site) ˜2 & 4 days subsequently. Cycles were 2 weeks x3 then q mo x 3. Adverse events (AE) were evaluated after each inoculation and graded via CTCAE v4.03. Immunologic response was measured by delayed type hypersensitivity (DTH) after each inoculation. Disease response was evaluated radiographically q3 mo and as clinically indicated (clinical trial NCT03066947).
Results: To date, twenty-two patients have been enrolled and 17 have been inoculated for a total of 39 SV-BR-1-GM inoculations given. Per inoculation, the maximum related AE was grade 1 in 64%, grade 2 in 7.7%, and grade 3 in 7.7%. There were no related grade >3 or unexpected AE. Efficacy data is available on the first six (Table). Tumor regression was seen in 2 patients. 01-002 presented with liver, bone and 20 classic miliary lung metastases (up to 9mm). This subject previously received 7 chemotherapy regimens. She matched SV-BR-1-GM at Class I & II HLA loci. Imaging at 3 mo showed virtually complete regression of all 20 identifiable lesions in the lungs. This response was maintained at 6 mo but the subject was taken off protocol because of disease progression (liver and bone). 01-005, matching HLA-A*24:02, had notable regression of cutaneous lesions, but progressed in pleural and pericardial effusions, had irreversible cardiac arrest (unlikely related). DTH increased in 01-002 from 4mm (first dose) to 47mm (8th dose). Three of 3 patients evaluated developed antibodies responses (as measured by flow cytometry with SV-BR-1) including 01-002. Interleukin 8 also increased in 01-002.
Conclusions: SV-BR-1-GM in this regimen appears to be safe and well-tolerated. In this initial exploratory analysis, SV-BR-1-GM can produce regression of pre-treated metastatic breast cancer correlating with an immunologic response. HLA matching is being evaluated as a predictor of response.
PatientAgeMetastatic Sites# Prior RegimensHLA Matches# of CyclesTumor Regression?01-00146Pleura, Lymph Nodes7 chemo/bio, 5 hormonalDRB3*02:021No01-00273Lung, Liver, Bone6 chemo, 1 hormonalA*24:02, DRB3*02:028Lungs01-00554Lymph nodes, Pleura, Skin3 chemo/bioA*24:022Skin02-00170Lymph nodes1 chemo/bioNone1No02-00361Bone, Brain3 chemoNone6No02-00474Lymph nodes, Cutaneous3 chemo/bio, 1 hormonalDRB3*02:022Lost to Follow-up
Citation Format: Bhattacharya S, Holmes JP, Calfa C, Lukas J, Tan-Chiu E, Clifton GT, Peoples GE, Lacher M, Wiseman CL, Williams WV. Initial safety and efficacy of a phase I/IIa trial of a modified whole tumor cell targeted immunotherapy in patients with advanced breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-09-09.
Collapse
Affiliation(s)
- S Bhattacharya
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - JP Holmes
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - C Calfa
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - J Lukas
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - E Tan-Chiu
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - GT Clifton
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - GE Peoples
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - M Lacher
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - CL Wiseman
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| | - WV Williams
- Thomas Jefferson University, Philadelphia, PA; Redwood Reg Medcl Grp, Santa Rosa, CA; University of Miami, Miami, FL; The Everett Clinic, Everett, WA; Florida Cancer Specialists and Research Institute, Parkland, FL; Cancer Insight, San Antonio, TX; BriaCell Therapeutics Corporation, Berkeley, CA
| |
Collapse
|
17
|
Clifton GT, Kemp Bohan PM, Hale DF, Myers JW, Brown TA, Holmes JP, Vreeland TJ, Litton JK, Murthy RK, Mittendorf EA, Peoples GE. Abstract P2-09-01: Subgroups analysis of a multicenter, prospective, randomized, blinded phase 2b trial of trastuzumab + nelipeptimut-S (NeuVax) vs trastuzumab for prevention of recurrence in breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:HER2 low-expressing (LE) (IHC 1-2+, FISH non-amplified) breast cancer (BC) patients (pts) have not benefited from HER2-directed therapy despite HER2 antigen availability. Triple negative BC (TNBC), in particular, is immunogenic and in need of additional therapeutic options. We have previously shown the HER2-derived nelipeptimut-S (E75) + GM-CSF (NeuVax) to be synergistic with trastuzumab (Tz) in pre-clinical and pilot clinical studies. In a planned interim analysis of a multi-center, prospective, randomized, single-blinded, placebo-controlled phase 2b trial of Tz + NeuVax vs Tz to reduce recurrence in HER2 LE, node-positive (NP) and/or triple negative BC (TNBC) pts, we previously reported that the NeuVax + Tz was safe without added cardiac toxicity and demonstrated a significant reduction of recurrences in TNBC pts. This analysis examines additional subsets in this trial.
Methods:HER2 LE, NP and/or TNBC pts who were clinically disease-free after standard therapy were randomized to receive Tz+NeuVax (vaccine group; VG) or Tz+GM-CSF (control group; CG). All pts received 1 yr of Tz per label. NeuVax or GM-CSF was given every 3 weeks x 6 starting with the 3rdTz dose, and then boosted every 6 months x 4. This pre-specified interim analysis was triggered 6 months after last enrollment. The primary endpoint is intention-to-treat 24 month disease-free survival (DFS) evaluated by log rank.
Results: Of 275 pts randomized in the study (VG n=136, CG n=139), 98 had TNBC (VG=53, CG=45). In the interim analysis, estimated disease-free survival (DFS) was assessed with a median follow up of 18.8 months. No significant clinicopathologic differences were seen between treatment groups. In the TNBC group, estimated DFS was higher overall in VG vs CG (91.9% v 69.9%, p=0.023; hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.09-0.90). On TNBC subgroup analysis, estimated DFS was higher in VG vs CG among pts who received neoadjuvant chemotherapy (VG n=35, CG n=31; HR 0.26, CI 0.07-0.93; p=0.03), HER2 IHC 1+ BC (VG n=34, CG n=28; HR 0.20, CI 0.04-0.96; p=0.03), pts who were AJCC 7thedition stage I/II (VG n=37, CG n=27; HR incalculable, no recurrences in the VG, p=0.008), and pts 351yr of age (VG n=32 & CG n = 26; HR 0.26 CI 0.07,0.94; p=0.009). HRs did not appreciably vary based on the histologic grade or presence of lymphovascular invasion.
Conclusion:Examining the subgroups from the pre-specified interim analysis demonstrates a highly significant clinical benefit in TNBC pts overall. Within the TNBC cohort, specific benefit was seen in pts who received chemotherapy neoadjuvantly, expressed lower HER2, were earlier stage, and were older in age. These factors may help enrich the TNBC population targeted in a definitive Phase 3 study in TNBC patients with residual disease after neoadjuvant chemotherapy.
Citation Format: Clifton GT, Kemp Bohan PM, Hale DF, Myers JW, Brown TA, Holmes JP, Vreeland TJ, Litton JK, Murthy RK, Mittendorf EA, Peoples GE. Subgroups analysis of a multicenter, prospective, randomized, blinded phase 2b trial of trastuzumab + nelipeptimut-S (NeuVax) vs trastuzumab for prevention of recurrence in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-09-01.
Collapse
Affiliation(s)
- GT Clifton
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - PM Kemp Bohan
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - DF Hale
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - JW Myers
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - TA Brown
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - JP Holmes
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - TJ Vreeland
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - JK Litton
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - RK Murthy
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - EA Mittendorf
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| | - GE Peoples
- Brooke Army Medical Center, Fort Sam Houston, TX; St. Joseph Hospital, Santa Rosa, CA; MD Anderson Cancer Center, Houston, TX; Brigham and Women's Hospital, Boston, MA; Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
18
|
Holmes JP, Tan-Chiu E, Wiseman CL, Lacher MD, Peoples G, Williams WV. Abstract CT171: Safety and efficacy of a whole-cell targeted immunotherapy for breast cancer: Preliminary findings. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The purpose of this study is to evaluate the safety and preliminary efficacy of a targeted immunotherapy for breast cancer based on SV-BR-1-GM, a breast cancer cell line modified to secrete GM-CSF. The regimen used includes low dose cyclophosphamide (300 mg/m2) 2-3 days prior to inoculation to reduce immune suppression; irradiated SV-BR-1-GM (20,000 cGy) dosed intradermally (ID) in 4 sites (~20x106 cells total); and post-inoculation interferon-α (10,000 units ID into the SV-BR-1-GM inoculation sites) 2±1 and 4±1 days later. Dosing is every 2 weeks for the first month, then monthly for up to one year. This regimen was used in a prior study in 4 evaluable patients with advanced cancer (3 breast and 1 ovarian) and was safe and well tolerated. One patient, who had a partial response of widely metastatic breast cancer, was found to match SV-BR-1-GM at an MHC class II allele (HLA-DRB3*02:02).
This regimen is being used in a clinical trial (NCT03066947 in ClinicalTrials.gov) in patients with advanced breast cancer. To date 7 patients with metastatic breast cancer have been recruited and 6 dosed with evidence of tumor response in 2 patients. Ages ranged from 46-73. Time from initial diagnosis ranged from 2 - 12 years. The number of prior chemotherapy or biological therapy regimens ranged from 3-7. Treatment was generally safe and well tolerated. The majority of adverse events were limited to local irritation at the injection sites. No serious adverse events related to SV-BR-1-GM treatment have been reported and no new or unexpected safety issues related to SV-BR-1-GM have been observed. Two patients dropped out after a single cycle of treatment. One patient with inflammatory breast cancer dropped out after 2 treatments due to worsening breast inflammation. One patient appeared to be responding in the breast after the first treatment, with regression of soft tissue lesions in the breast, but developed a worsening pleural and pericardial effusions shortly after the second treatment with the development of pulseless electrical activity and was unable to be resuscitated. One patient has received 5 cycles of therapy and is ongoing. One patient had a notable response. For this 73-year-old woman with breast cancer diagnosed in 1995 with liver and lung metastases and 7 prior rounds of chemotherapy, after 3 months of treatment her scans noted “a clear response in the multiple bilateral pulmonary nodules” indicating that several lung tumors had disappeared or decreased in size. This response was maintained after 6 months. The liver tumors were stable to slightly increased at 3 months, and then progressed after 6 months. This patient matched with SV-BR-1-GM at 2 HLA loci (HLA-A*24:02 and HLA-DRB3*02:02).
The regimen used in this study has shown early evidence of activity in these patients with late stage, heavily pre-treated metastatic breast cancer. HLA matching may be useful in predicting those patients most likely to respond.
Citation Format: Jarrod P. Holmes, Elizabeth Tan-Chiu, Charles L. Wiseman, Markus D. Lacher, George Peoples, William V. Williams. Safety and efficacy of a whole-cell targeted immunotherapy for breast cancer: Preliminary findings [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT171.
Collapse
|
19
|
Holmes JP, Williams W, Peoples GE, Lacher M, Tan-Chiu E, Wiseman CL. SV-BR-1-GM a whole-cell targeted immunotherapy for breast cancer: Preliminary clinical data. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
20
|
Lasater EA, Massi ES, Stecula A, Politi J, Tan SK, Smith CC, Gunthorpe M, Holmes JP, Chehab F, Sali A, Shah NP. Novel TKI-resistant BCR-ABL1 gatekeeper residue mutations retain in vitro sensitivity to axitinib. Leukemia 2015; 30:1405-9. [PMID: 26511402 DOI: 10.1038/leu.2015.303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- E A Lasater
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | - E S Massi
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | - A Stecula
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA
| | - J Politi
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | - S K Tan
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | - C C Smith
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA
| | - M Gunthorpe
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - J P Holmes
- Annadel Medical Group, Santa Rosa, CA, USA
| | - F Chehab
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - A Sali
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, USA.,Department of Pharmaceutical Chemistry, University of California, San Francisco, CA, USA.,California Institute for Quantitative Biosciences, University of California, San Francisco, CA, USA
| | - N P Shah
- Division of Hematology/Oncology, University of California, San Francisco, CA, USA.,Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| |
Collapse
|
21
|
Mittendorf BA, Schneble EJ, Ibrahim NK, Greene JM, Berry JS, Trappey AF, Clifton GT, Holmes JP, Ponniah S, Peoples GE. Abstract OT3-1-09: Combination immunotherapy with trastuzumab and the HER2 vaccine E75 (nelipepimut-S) in high-risk HER2+ breast cancer patients to prevent recurrence. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-ot3-1-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In an adjuvant phase II trial, the HER2-derived nelipepimut-S (E75) + GM-CSF vaccine (Neuvax) has been shown to reduce breast cancer recurrence. Preclinical testing of the combination of trastuzumab (Tz) and nelipepimut-S has shown synergistic cytolysis against HER2 expressing cancer cells. In pilot phase II data in HER2+ patients (pts), 55 pts dosed with CD8-eliciting HER2 derived peptide vaccines sequentially after treatment with Tz resulted in no recurrences at 36 months median follow-up compared with a 16% recurrence rate in 34 randomized controls treated with Tz without vaccine (p=.012). Based on these data, we have designed a trial to evaluate the ability of the combination of Tz and the E75 vaccine concurrently to prevent recurrence in pts with high-risk, HER2+ breast cancer.
Trial Design: This study will be a multicenter, prospective, randomized, single-blinded, phase II trial evaluating adjuvant Tz + NeuVax (E75+GM-CSF) vs. Tz + GM-CSF alone in high-risk HER2+ (IHC 3+ and/or FISH >2.2) breast cancer pts. High-risk pts include: 1) those that did not achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy and HER2- targeted therapy or 2) those treated with upfront surgery that are node positive (> 4+ LN or 1-3+ LN if hormone receptor negative). Pts must be HLA-A2 /A3+ to be eligible (E75 is HLA-A2/A3-restricted) with ECOG performance status 0-1. Pts will be enrolled after completing standard of care multi-modal therapy but prior to the 3rd dose of Tz maintenance therapy (monotherapy). Pts will be randomized 1:1 to receive either NeuVax or GM-CSF alone which will be administered as six monthly intradermal inoculations concurrently with Tz therapy. Pts will then receive four booster inoculations of either NeuVax or GM-CSF every 6 months. The primary efficacy endpoint is to compare disease-free survival (DFS) between treatment arms. Secondary objectives will include evaluation of local and systemic toxicity, distant recurrence free survival, and in vivo/in vitro immunologic responses. From previously published experience with Tz, we expect a recurrence rate of 20% in Tz (plus GM-CSF) treated pts and anticipate that the combination of Tz with E75+GM-CSF will reduce this recurrence rate to 5%. In order to show statistical difference between these recurrence rates, we plan to enroll 50 pts per treatment arm (100 total) with a type I error rate of 5% and 80% power to detect the primary endpoint. Trial accrual is anticipated to begin in September of 2014, with a two year period for trial enrollment followed by a three year follow-up period.
Conclusion: We hypothesize that combination adjuvant immunotherapy with Tz and NeuVax will result in a greater reduction in breast cancer recurrence than Tz therapy alone. We have designed a prospective, randomized, single-blinded, phase II trial evaluating the efficacy of this immunotherapy combination in high-risk HER2+ breast cancer pts to test this hypothesis.
Contact Information: This trial is funded by a DoD grant to EAM with matching funds from Galena Biopharma and is being conducted with the assistance of the academic CRO, Cancer InCITe, LLC.
Citation Format: Beth A Mittendorf, Erika J Schneble, Nuhad K Ibrahim, Julia M Greene, John S Berry, Alfred F Trappey, Guy T Clifton, Jarrod P Holmes, Sathibalan Ponniah, George E Peoples. Combination immunotherapy with trastuzumab and the HER2 vaccine E75 (nelipepimut-S) in high-risk HER2+ breast cancer patients to prevent recurrence [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr OT3-1-09.
Collapse
|
22
|
Mittendorf EA, Clifton GT, Holmes JP, Schneble E, van Echo D, Ponniah S, Peoples GE. Final report of the phase I/II clinical trial of the E75 (nelipepimut-S) vaccine with booster inoculations to prevent disease recurrence in high-risk breast cancer patients. Ann Oncol 2014; 25:1735-1742. [PMID: 24907636 PMCID: PMC4143091 DOI: 10.1093/annonc/mdu211] [Citation(s) in RCA: 177] [Impact Index Per Article: 17.7] [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] [Received: 03/22/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND E75 (nelipepimut-S) is a human leukocyte antigen (HLA)-A2/A3-restricted immunogenic peptide derived from the HER2 protein. We have conducted phase I/II clinical trials vaccinating breast cancer patients with nelipepimut-S and granulocyte-macrophage colony-stimulating factor (GM-CSF) in the adjuvant setting to prevent disease recurrence. All patients have completed 60 months follow-up, and here, we report the final analyses. PATIENTS AND METHODS The studies were conducted as dose escalation/schedule optimization trials enrolling node-positive and high-risk node-negative patients with tumors expressing any degree of HER2 (immunohistochemistry 1-3+). HLA-A2/3+ patients were vaccinated; others were followed prospectively as controls. Local and systemic toxicity was monitored. Clinical recurrences were documented, and disease-free survival (DFS) was analyzed by Kaplan-Meier curves; groups were compared using log-rank tests. RESULTS Of 195 enrolled patients, 187 were assessable: 108 (57.8%) in the vaccinated group (VG) and 79 (42.2%) in the control group (CG). The groups were well matched for clinicopathologic characteristics. Toxicities were minimal. Five-year DFS was 89.7% in the VG versus 80.2% in the CG (P = 0.08). Due to trial design, 65% of patients received less than the optimal vaccine dose. Five-year DFS was 94.6% in optimally dosed patients (P = 0.05 versus the CG) and 87.1% in suboptimally dosed patients. A voluntary booster program was initiated, and among the 21 patients that were optimally boosted, there was only one recurrence (DFS = 95.2%). CONCLUSION The E75 vaccine is safe and appears to have clinical efficacy. A phase III trial evaluating the optimal dose and including booster inoculations has been initiated. CLINICAL TRIALS NCT00841399, NCT00584789.
Collapse
Affiliation(s)
- E A Mittendorf
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - G T Clifton
- Blanchfield Army Community Hospital, Fort Campbell
| | - J P Holmes
- Redwood Regional Medical Group, Santa Rosa
| | - E Schneble
- Department of Surgery, Brooke Army Medical Center, Ft Sam Houston
| | - D van Echo
- Department of Hematology Oncology, Walter Reed Army Medical Center, Washington
| | - S Ponniah
- Department of Surgery, Cancer Vaccine Development Program, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - G E Peoples
- Department of Surgery, Brooke Army Medical Center, Ft Sam Houston; Department of Surgery, Cancer Vaccine Development Program, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, USA.
| |
Collapse
|
23
|
Payne JH, Holmes JP, Hogg RA, van der Burgt GM, Jewell NJ, Welchman DDB. Lead intoxication incidents associated with shot from clay pigeon shooting. Vet Rec 2013; 173:552. [PMID: 24277920 DOI: 10.1136/vr.102120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J H Payne
- AHVLA Sutton Bonington, College Road, Sutton Bonington, Loughborough, Leicestershire LE12 5RB, UK
| | | | | | | | | | | |
Collapse
|
24
|
Berry JS, Trappey AF, Sears AK, Vreeland TJ, Clifton GT, Hale DF, Patil R, Holmes JP, Ponniah S, Mittendorf EA, Peoples GE, Van Echo DC. Biomarker correlation to clinical response in phase I/II trials of the adjuvant breast cancer vaccine neuvax (nelipepimut-S or E75). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps3126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3126 Background: We completed phase I/II clinical trials with NeuVax (nelipepimut-S), a HLA-A2/A3-restricted, HER2-derived peptide vaccine. The vaccine was administered in the adjuvant setting to prevent recurrence in breast cancer patients rendered disease-free with standard-of-care therapy. Here, we examine the relationship between in vitro immunologic response (IR) and clinical recurrence (CR) after 5-year follow-up. Methods: The phase I/II trials were performed as dose-escalation/schedule-optimization trials enrolling node positive and high-risk, node-negative patients (pts) with tumors expressing any level of HER2 (IHC 1+,2+,or 3+). HLA-A2/A3+ pts were enrolled in the vaccine group (VG) while HLA-A2/A3- pts were followed prospectively as an untreated control group (CG). The VG was given 4-6 monthly intradermal inoculations of nelipepimut-S+GMCSF (immunoadjuvant) during the primary vaccine series (PVS). In vitro IR was assessed for E75-specific, cytotoxic T lymphocyte clonal expansion by HLA-A2:IgG dimer assay and expressed as mean dimer index (mdi) at baseline, after PVS (R6), and six months after the PVS. HER2 under-expression was defined as an IHC 1/2, and a FISH < 2.2. VG and CG pts were followed for CR over 60 months. P-values were calculated using the Fisher’s exact test. Results: Of the 195 pts enrolled, 8 withdrew, leaving 187 evaluable pts; 108 in the VG and 79 in the CG. R6 dimer assays were available for 86 pts in the VG. The mean R6 dimer in the VG is 0.63 mdi+.08. Of the 30 pts with an R6 dimer above the mean, only one recurred, compared to eight of the 56 below the mean (p=.09). The difference between baseline and maximum mdi was available in 56 HER2 under-expressing VG pts. Of the 26 pts above the mean difference (1.08 mdi +.17), one recurred, compared to six CR in the 30 pts below the mean (p=.06). There were no CR in pts with HER2 under expression with a mean difference ranked in the top third. Conclusions: In prospective, completed phase I/II trials of NeuVax (nelipepimut-S), patients who exhibit robust in vitro IR have lower recurrence rates. This finding suggests that nelipepimut-specific CTL clonal expansion is a valid biomarker for CR in pts treated with NeuVax. Clinical trial information: NCT00841399.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ritesh Patil
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY
| | | | - Sathibalan Ponniah
- Cancer Vaccine Development Program, United States Military Cancer Institute, USUHS, Bethesda, MD
| | | | | | | |
Collapse
|
25
|
Berry JS, Trappey AF, Vreeland TJ, Hale DF, Clifton GT, Sears AK, Shumway NM, Ponniah S, Holmes JP, Ioannides C, Mittendorf EA, Peoples GE. Abstract 1251: Use of an attenuated version of a strongly immunogenic, peptide-based vaccine to enhance an anti-cancer immune response against folate receptor-alpha. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: FRα is over-expressed in ovarian and breast cancers. E39 (FBP 191-199) is an immunogenic, cytotoxic t lymphocyte (CTL) eliciting peptide derived from FRα used in a cancer vaccine strategy. Due to the in vitro observation of antigen-induced cell death with repeated T cell stimulation by E39, we developed an attenuated form of the E39, J65. We report the use of J65 alone or in combination with E39 to better induce E39-specific CTL and anti- FRα immunity. Methods: T2 stabilization assays were performed using flow cytometry to determine peptide HLA-A2 binding affinity. Interferon-γ (IFNγ) release was measured from peripheral blood mononuclear cell (PMBC) cultures after weekly stimulation with J65X3 followed by re-stimulation with either J65 or E39. Naïve PBMCS from healthy donors (HD) were primed with weekly J65X3 or E39X3, re-stimulated with E39 at concentrations of 5 and 25μG/M, and then tested for the ability to lyse FRα-expressing cancer cells. PBMCs from responding donors (RD) were stimulated with E39 or J65, then proliferation was measured by cell counts after 14d. IL-2 secretion was also measured. Results: The affinity of J65 for HLA-A2 was half that of the native E39 (65V130 MCF). After priming with J65X3, IFNγ levels were lower in the re-stimulated J65 culture compared to E39 re-stimulation (43V181 PG/ML). HD cultures demonstrated a higher tumor cell lysis (24.5 & 17.4% V 14.6 & 11.1%) after priming with J65X3 compared to E39X3. In RD cultures, PMBC cell counts were higher in the J65 culture compared with the same donor PMBCS stimulated with E39 (8.2X106V2.4X106 cells) and IL-2 concentrations were lower in the J65 cultures (820V580 PG/ML). Conclusions: In vitro analysis reveals the potential of J65 to induce CTL with the ability to proliferate while avoiding overstimulation. Importantly, these CTL demonstrate enhanced recognition and lysis of FRα-expressing cancer cells. The potential of this weaker, “survival inducing” version of E39 to induce a more robust anti-FRα immune response is currently being assessed in a first in human, Phase 1b clinical trial in ovarian and breast cancer patients.
Citation Format: John S. Berry, Alfred F. Trappey, Timothy J. Vreeland, Diane F. Hale, Guy T. Clifton, Alan K. Sears, Nathan M. Shumway, Sathibalan Ponniah, Jarrod P. Holmes, Constantin Ioannides, Elizabeth A. Mittendorf, George E. Peoples. Use of an attenuated version of a strongly immunogenic, peptide-based vaccine to enhance an anti-cancer immune response against folate receptor-alpha. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1251. doi:10.1158/1538-7445.AM2013-1251
Collapse
|
26
|
|
27
|
Clive KS, Tyler JA, Clifton GT, Holmes JP, Ponniah S, Peoples GE, Mittendorf EA. The GP2 peptide: a HER2/neu-based breast cancer vaccine. J Surg Oncol 2012; 105:452-8. [PMID: 22441896 DOI: 10.1002/jso.21723] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Preclinical studies suggest that GP2, a HER2/neu-derived peptide, is immunogenic. Subsequent phase I clinical trials demonstrated that GP2-based vaccines are safe and effective in stimulating peptide-specific immunity. A GP2 peptide vaccine is currently being evaluated in a phase II efficacy trial enrolling breast cancer patients. This article reviews initial studies characterizing GP2, clinical trials investigating GP2-based vaccines, and novel immunotherapy strategies incorporating GP2 in combination with other peptides or with the monoclonal antibody trastuzumab.
Collapse
Affiliation(s)
- Kevin S Clive
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, Ft. Sam Houston, Texas, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Mittendorf EA, Clifton GT, Holmes JP, Clive KS, Patil R, Benavides LC, Gates JD, Sears AK, Stojadinovic A, Ponniah S, Peoples GE. Clinical trial results of the HER-2/neu (E75) vaccine to prevent breast cancer recurrence in high-risk patients: from US Military Cancer Institute Clinical Trials Group Study I-01 and I-02. Cancer 2011; 118:2594-602. [PMID: 21989902 DOI: 10.1002/cncr.26574] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/16/2011] [Accepted: 08/24/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors conducted exploratory phase 1-2 clinical trials vaccinating breast cancer patients with E75, a human leukocyte antigen (HLA) A2/A3-restricted HER-2/neu (HER2) peptide, and granulocyte-macrophage colony-stimulating factor. The vaccine is given as adjuvant therapy to prevent disease recurrence. They previously reported that the vaccine is safe and effective in stimulating expansion of E75-specific cytotoxic T cells. Here, they report 24-month landmark analyses of disease-free survival (DFS). METHODS These dose escalation/schedule optimization trials enrolled lymph node-positive and high-risk lymph node-negative patients with HER2 (immunohistochemistry [IHC] 1-3(+) ) expressing tumors. HLA-A2/A3(+) patients were vaccinated; others were followed prospectively as controls for recurrence. DFS was analyzed by Kaplan-Meier curves; groups were compared using log-rank tests. RESULTS Of 195 enrolled patients, 182 were evaluable: 106 (58.2%) in the vaccinated group and 76 (41.8%) in the control group. The 24-month landmark analysis DFS was 94.3% in the vaccinated group and 86.8% in the control group (P = .08). Importantly, because of trial design, 65% of patients received a lower than optimal vaccine dose. In subset analyses, patients who benefited most from vaccination (vaccinated group vs control group) had lymph node-positive (DFS, 90.2% vs 79.1%; P = .13), HER2 IHC 1+-2+ (DFS, 94.0% vs 79.4%; P = .04), or grade 1 or 2 (DFS, 98.4% vs 86.0%; P = .01) tumors and were optimally dosed (DFS, 97.3% vs 86.8%; P = .08). A booster program has been initiated; no patients receiving booster inoculations have recurred. CONCLUSIONS The E75 vaccine has clinical efficacy that is more prominent in certain patients. A phase 3 trial enrolling lymph node-positive patients with HER2 low-expressing tumors is warranted.
Collapse
Affiliation(s)
- Elizabeth A Mittendorf
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Sears AK, Perez SA, Clifton GT, Benavides LC, Gates JD, Clive KS, Holmes JP, Shumway NM, Van Echo DC, Carmichael MG, Ponniah S, Baxevanis CN, Mittendorf EA, Papamichail M, Peoples GE. AE37: a novel T-cell-eliciting vaccine for breast cancer. Expert Opin Biol Ther 2011; 11:1543-50. [PMID: 21895539 DOI: 10.1517/14712598.2011.616889] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Immunotherapy, including vaccines targeting the human EGFR2 (HER-2/neu) protein, is an active area of investigation in combatting breast cancer. Several vaccines are currently undergoing clinical trials, most of which are CD8(+) T-cell-eliciting vaccines. AE37 is a promising primarily CD4(+) T-cell-eliciting HER-2/neu breast cancer vaccine currently in clinical trials. AREAS COVERED This article reviews preclinical investigations as well as findings from completed and ongoing Phase I and Phase II clinical trials of the AE37 vaccine. EXPERT OPINION Clinical trials have shown the AE37 vaccine to be safe and capable of generating peptide-specific, durable immune responses. This has been shown in patients with any level of HER-2/neu expression. Early clinical findings suggest there may be benefit to AE37 vaccination in preventing breast cancer recurrence.
Collapse
Affiliation(s)
- Alan K Sears
- Brooke Army Medical Center, Department of General Surgery, 3851 Roger Brooke Drive, Ft. Sam Houston, TX 78234, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Benavides LC, Sears AK, Gates JD, Clifton GT, Clive KS, Carmichael MG, Holmes JP, Mittendorf EA, Ponniah S, Peoples GE. Comparison of different HER2/neu vaccines in adjuvant breast cancer trials: implications for dosing of peptide vaccines. Expert Rev Vaccines 2011; 10:201-10. [PMID: 21332269 DOI: 10.1586/erv.10.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We have performed multiple adjuvant clinical trials using immunogenic peptides from the HER2/neu protein (AE37/E75/GP2) plus (GM-CSF) given intradermally to breast cancer patients. Four trials were performed with similar dose-escalation design with increasing doses of peptide (AE37/E75/GP2) and varying amounts of GM-CSF. Dose reductions (DRs) were made for significant local and/or systemic toxicity by decreasing GM-CSF for subsequent inoculations. Ex vivo and in vivo immunologic responses were used to compare groups. Of 132 patients, 39 required DR (30 for robust local reactions [DR-L]). DR patients, particularly DR-L, had greater immune responses both ex vivo and in vivo. Postvaccine delayed-type hypersensitivity in DR-L patients compared with all others was larger for E75 (p = 0.001), AE37 (p = 0.077) and GP2 (p = 0.076). All three peptide vaccines were safe and well-tolerated. These findings have led to a clinically relevant optimal vaccine dosing strategy, which may be applicable to other peptide-based cancer vaccines.
Collapse
Affiliation(s)
- Linda C Benavides
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Ft. Sam, Houston, TX 78234, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Sears AK, Clifton GT, Carmichael MG, Van Echo DC, Holmes JP, Zacharia A, Jama Y, Mursal M, Chiplis A, Mittendorf EA, Peoples GE, Ponniah S. Abstract LB-414: Comparison of in vitro and in vivo immunologic responses in a prospective, randomized, single-blinded phase II trial evaluating the HER-2/ neu peptide vaccines GP2 and AE37 in breast cancer patients. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-lb-414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: We are conducting a prospective, randomized, single-blinded phase II trial evaluating the HER-2/neu peptide vaccines AE37 and GP2 in the adjuvant setting to prevent breast cancer recurrence. AE37 is the Ii-Key hybrid of the HER-2/neu peptide AE36 (HER-2/neu aa:776–790) and is capable of stimulating CD4+ helper T-cells with anti-tumor activity. GP2 is an HLA-A2+ -restricted immunogenic peptide from the HER-2/neu protein (HER-2/neu aa: 654–662) which is capable of stimulating CD8+ cytotoxic T-lymphocytes with the ability to recognize and destroy HER-2/neu-expressing tumor cells. Here we present data comparing the immunological profiles between these CD4 and CD8 eliciting vaccines
METHODS: Node positive or high-risk node negative breast cancer patients with any level of HER-2/neu expression rendered disease-free by standard treatments were enrolled. Patients were HLA-typed at enrollment. HLA-A2+ patients were placed in the GP2 arm and randomized to either GP2 + GM-CSF (immunoadjuvant) or GM-CSF alone. HLA-A2− patients were placed in the AE37 arm and randomized to either AE37 + GM-CSF or GM-CSF alone. Vaccinations were given in six monthly intradermal inoculations. In vitro (3H-thymidine proliferation for AE37, HLA-A2:immunoglobulin dimer for GP2) and in vivo (delayed-type hypersensitivity (DTH)) immune responses were measured before (R0), mid-series (R3), upon completion (R6), and at six (RC6) and twelve (RC12) months after completion of the vaccine series.
RESULTS: We have enrolled 247 patients (AE37=171, 87 vaccine and 84 control) (GP2=76, 41 vaccine and 35 control). Proliferative responses to both AE37 and AE36 were increased from baseline in the vaccine group at all time points (AE37: R0=0.98, R3=3.29, R6=3.38, RC6=3.64, RC12=3.68, p<0.001; AE36: R0=0.95, R3=1.92, R6=2.12, RC6=2.18, RC12=1.80, p<0.001) while they did not change for the control group. The population of circulating GP2-specific CD8+ T-cells measured in the dimer assay increased from baseline in the vaccine group at all time points (R0=1.00, R3=1.61, R6=1.85, RC6=1.95, RC12=1.93, p<0.05) with no change in the control group. DTH responses increased in both AE37 and GP2 vaccinated patients from pre- to post-vaccination (AE37: 2.7 vs 30.2 mm, p<0.001; AE36: 2.2 vs 16.3 mm, p<0.001; GP2: 3.5 vs 29.4 mm, p<0.001) while there was no significant change in the control group.
CONCLUSIONS: In a novel prospective, randomized, single-blinded phase II vaccine trial of the AE37 and GP2 peptide vaccines with a GM-CSF only control group, breast cancer patients vaccinated with either a CD4 or CD8 eliciting peptide vaccine exhibit high levels of HER-2/neu-specific in vitro and in vivo immune responses.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr LB-414. doi:10.1158/1538-7445.AM2011-LB-414
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yusuf Jama
- 2Cancer Vaccine Development Program, Bethesda, MD
| | | | - Anna Chiplis
- 2Cancer Vaccine Development Program, Bethesda, MD
| | | | | | | |
Collapse
|
32
|
Clifton GT, Sears AK, Clive KS, Holmes JP, Mittendorf EA, Ioannides CG, Ponniah S, Peoples GE. Folate receptor α: a storied past and promising future in immunotherapy. Hum Vaccin 2011; 7:183-90. [PMID: 21321484 DOI: 10.4161/hv.7.2.13784] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Folate receptor alpha (FR α) is a membrane-bound transport protein with several features which make it an attractive target for cancer immunotherapy. FR α is largely shielded from the immune system in normal tissue but exposed while expressed on a variety of malignancies; it is functionally active in cancer pathogenesis; and it is immunogenic. A variety of different immunotherapeutic methods targeting FR α are being explored to treat cancer. Passive immunotherapy includes monoclonal antibodies, antibodies modified to deliver treatments, and modified T cell therapy. Active immunotherapy has focused on using FR α to increase the immunogenicity of cancer or to generate active FR α-directed immunity through a range of vaccination techniques. We will review the rationale behind targeting immunotherapy to FR α and cover the various techniques designed to do this. Folate receptor alpha (FRα) is a unique tumor-associated antigen (TAA) with many characteristics that make it an attractive target for immunotherapy in cancer. Many different immunotherapeutic modalities utilizing FRα are being explored to treat cancer. The research is in various stages: some are just beyond conception, others have been tried and abandoned, and others still are progressing through human clinical trials. This review will cover immunotherapeutic methods, both active and passive, that target FRα.
Collapse
Affiliation(s)
- Guy T Clifton
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, Ft. Sam Houston, TX, USA
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Holmes JP, Clifton GT, Patil R, Benavides LC, Gates JD, Stojadinovic A, Mittendorf EA, Ponniah S, Peoples GE. Use of booster inoculations to sustain the clinical effect of an adjuvant breast cancer vaccine: from US Military Cancer Institute Clinical Trials Group Study I-01 and I-02. Cancer 2010; 117:463-71. [PMID: 20845479 DOI: 10.1002/cncr.25586] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 07/12/2010] [Accepted: 07/19/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND The authors are conducting clinical trials of the HER-2/neu E75-peptide vaccine in clinically disease-free breast cancer (BC) patients. Their phase 1-2 trials revealed that the E75 + granulocyte-macrophage colony-stimulating factor (GM-CSF) vaccine is safe and effective in stimulating clonal expansion of E75-specific CD8(+) T cells. They assessed the need for and response to a booster after completion of primary vaccination series. METHODS BC patients enrolled in the E75 vaccine trials who were ≥6 months from completion of their primary vaccination series were offered boosters with E75 + GM-CSF. Patients were monitored for toxicity. E75-specific CD8(+) T cells were quantified using the human leukocyte antigen-A2:immunoglobulin G dimer before and after boosting. RESULTS Fifty-three patients received the vaccine booster. Median time from primary vaccination series was 9 months (range, 6-35 months), and median residual E75-specific immunity was 0.70% (range, 0-3.49%) CD8(+) lymphocytes. Elevated residual immunity (ERI) (CD8(+) E75-specific T cells >0.5%) was seen in 94.4% of patients at 6 months from primary vaccination series versus 48% of patients at >6 months (P = .002). The booster was well tolerated, with only grade 1 and 2 toxicity observed. Local reactions were more robust in patients receiving the booster at 6 months from primary vaccination series compared with those at >6 months (99.4 ± 6.1 mm vs 81.8 ± 4.1 mm, P = .01). In patients lacking ERI, 85% had increased ERI after vaccination (P = .0014). CONCLUSIONS The HER-2/neu E75 peptide vaccine E75 stimulates specific immunity in disease-free BC patients. However, immunity wanes with time. A vaccine booster is safe and effective in stimulating E75-specific immunity in those patients without ERI. These results suggest that the booster may be most effective at 6 months after completion of the primary vaccination series.
Collapse
Affiliation(s)
- Jarrod P Holmes
- Department of Hematology and Medical Oncology, Naval Medical Center San Diego, San Diego, California, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Clive KS, Tyler JA, Clifton GT, Holmes JP, Mittendorf EA, Ponniah S, Peoples GE. Use of GM-CSF as an adjuvant with cancer vaccines: beneficial or detrimental? Expert Rev Vaccines 2010; 9:519-25. [PMID: 20450326 DOI: 10.1586/erv.10.40] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been utilized in the clinical management of multiple disease processes. Most recently, GM-CSF has been incorporated into the treatment of malignancies as a sole therapy, as well as a vaccine adjuvant. While the benefits of GM-CSF in this arena have been promising, recent reports have suggested the potential for GM-CSF to induce immune suppression and, thus, negatively impact outcomes in the management of cancer patients. The purpose of this review is to critically evaluate these reports, while considering the most recent clinical data on immunotherapies. We aim to demonstrate the utility of this adjuvant, elucidate those instances in which GM-CSF may induce immune suppression and identify potential explanations for these recent findings.
Collapse
|
35
|
Clifton T, Pappas JA, Pavlik M, Papay D, Holmes JP, Ponniah S, Peoples GE. Cancer Vaccine Development Program collaborations. Mil Med 2010; 175:54-6. [PMID: 23634481 DOI: 10.7205/milmed-d-10-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Immunotherapy for cancer, which uses the body's immune system to fight the disease, is an increasingly active area of research. Successful therapies such as trastuzamab (Herceptin) for breast cancer and cytokine therapy for renal cell carcinoma and melanoma have validated the field as a viable area of investigation. However, the goal of developing an effective cancer vaccine has not yet been achieved. The military's Cancer Vaccine Development Program (CVDP) is collaborating with other military programs, along with civilian institutions, to advance scientific research surrounding cancer vaccines.
Collapse
Affiliation(s)
- Travis Clifton
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | | | | | | | | | | | | |
Collapse
|
36
|
Clifton GT, Patil R, Clive K, Tyler J, Zacharia A, Jama Y, Mursal M, Ciano K, Holmes JP, Mittendorf EA, Peoples GE, Ponniah S. Abstract LB-329: Defining rgulatory T-cells as CD4+CD25hiCD127- or as CD4+CD25hiFoxP3+ in immune monitoring of cancer vaccine clinical trials. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-lb-329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Regulatory T cells (Treg) are widely accepted to play a key role in the immune tolerance and escape of cancer cells. Originally Tregs were identified as being CD4+ T cells expressing high levels of CD25 (IL2 receptor). The identification of the transcription factor FoxP3 resulted in defining Tregs as CD4CD25hiFoxP3+ T cells by staining permeablized cells. Recently Tregs have been identified as CD4CD25hi T cells with low levels of CD127 (IL7 receptor) expressing a CD4+CD25hiCD127- cell surface phenotype. In an ongoing clinical trial with a MHC class II HER2/neu pep tide vaccine we have evaluated these various definitions of Treg phenotypes for immunological monitoring.
Methods: Tregs were quantified in disease-free, high risk BCa patients enrolled in adjuvant peptide-based breast cancer vaccine trials. Peripheral blood mononuclear cells (PBMCs) were both permeabilized and stained with CD4, CD25, and FoxP3 monoclonal antibodies and surface stained with CD4, CD25, and CD127. Samples were then analyzed by flow cytometry. The means are compared with t-test and correlation is determined with Pearson's correlation coefficient.
Results: 196 PBMC samples from 72 patients were available for Treg quantification. There was a greater mean percentage of cells identified as Treg in permeabilized than nonpermeabilized cells by staining with CD4+CD25hi (5.9±0.1% vs 4.8 ±0.1%, p<0.01) and excellent correlation between the tests (r=0.78, p<0.01). There was a greater mean percentage of cells identified as Tregs by CD4+CD25hi than CD4+CD25hiFoxP3+ (5.9±0.1% vs 3.6±0.1%, p<0.01) with good correlation (r=0.68, p<0.01). There was a greater mean percentage of Tregs by CD4+CD25+ than CD4+CD25+CD127- (4.8±0.1 vs 4.0±0.1, p<0.01) with excellent correlation (r=0.89, p<0.01). There was a greater mean percentage of Tregs by CD4+CD25hiCD127- than Tregs by CD4+ CD25hiFoxP3+ although levels were similar (4.0±0.1 vs 3.6±0.1, p<0.01) and the two tests had good correlation (r=0.58, p<0.01).
Conclusion: There was good correlation between various methods of defining Tregs with and without cell membrane permeabilization. Defining Treg cells as either CD4+CD25hiFoxP3+ or CD4+CD25+CD127- appear to be more specific than defining Tregs as CD4+CD25hi alone. Furthermore, defining Treg populations by surface staining as CD4+CD25hiCD127- yields similar levels with good correlation as CD4+CD25hiFoxP3+ and may be the preferred method for immune monitoring.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-329.
Collapse
Affiliation(s)
| | | | - Kevin Clive
- 1Brooke Army Medical Center, Fort Sam Houston, TX
| | - Josh Tyler
- 1Brooke Army Medical Center, Fort Sam Houston, TX
| | | | - Yusuf Jama
- 3Uniformed Services Health Science University, Bethesda, MD
| | - Mohamed Mursal
- 3Uniformed Services Health Science University, Bethesda, MD
| | - Kathy Ciano
- 3Uniformed Services Health Science University, Bethesda, MD
| | | | | | | | | |
Collapse
|
37
|
Carmichael MG, Benavides LC, Holmes JP, Gates JD, Mittendorf EA, Ponniah S, Peoples GE. Results of the first phase 1 clinical trial of the HER-2/neu peptide (GP2) vaccine in disease-free breast cancer patients: United States Military Cancer Institute Clinical Trials Group Study I-04. Cancer 2010; 116:292-301. [PMID: 19924797 DOI: 10.1002/cncr.24756] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND HER-2/neu, overexpressed in breast cancer, is a source of immunogenic peptides that include GP2 and E75. Phase 2 testing of E75 as an adjuvant vaccine has suggested a clinical benefit. GP2, derived from the transmembrane portion of HER-2/neu, has differing binding characteristics and may be more immunogenic than E75. Results of the first phase 1 trial of GP2 peptide vaccine are presented. METHODS Disease-free, lymph node-negative, human leukocyte antigen (HLA)-A2(+) breast cancer patients were enrolled. This dose escalation trial included 4 groups to determine safety and optimal GP2 peptide/granulocyte-macrophage colony-stimulating factor (GM-CSF) dose. Toxicities were monitored. Immunologic response was assessed ex vivo via the HLA-A2:immunoglobulin dimer assay to detect GP2-specific CD8(+) T cells (and E75-specific CD8(+) T cells to assess epitope spreading) and in vivo via delayed type hypersensitivity (DTH) reaction (medians/ranges). RESULTS Eighteen patients were enrolled. All toxicities were grade < or =2. Eight (88.9%) of 9 patients in the first 3 dose groups required GM-CSF dose reductions for local reactions > or =100 mm or grade > or =2 systemic toxicity. GM-CSF dose was reduced to 125 microg for the final dose group. All patients responded immunologically ex vivo (GP2-specific CD8(+) T cells from prevaccination to maximum, 0.4% [0.0%-2.0%] to 1.1% [0.4%-3.6%], P < .001) and in vivo (GP2 pre- to postvaccination DTH, 0 mm [0.0-19.5 mm] to 27.5 mm [0.0-114.5 mm, P < .001). E75-specific CD8(+) T cells also increased in response to GP2 from prevaccination to maximum (0.8% [0.0%-2.41%] to 1.6% [0.86%-3.72%], P < .001). CONCLUSIONS The GP2 peptide vaccine appears safe and well tolerated with minimal local/systemic toxicity. GP2 elicited HER-2/neu-specific immune responses, including epitope spreading, in high-risk, lymph node-negative breast cancer patients. These findings support further investigation of the GP2 vaccine for the prevention of breast cancer recurrence.
Collapse
Affiliation(s)
- Mark G Carmichael
- Cancer Vaccine Development Program, United States Military Cancer Institute, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
Patil R, Clifton GT, Holmes JP, Amin A, Carmichael MG, Gates JD, Benavides LH, Hueman MT, Ponniah S, Peoples GE. Clinical and immunologic responses of HLA-A3+ breast cancer patients vaccinated with the HER2/neu-derived peptide vaccine, E75, in a phase I/II clinical trial. J Am Coll Surg 2009; 210:140-7. [PMID: 20113933 DOI: 10.1016/j.jamcollsurg.2009.10.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 10/20/2009] [Accepted: 10/21/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND We have treated disease-free breast cancer patients with an HER2/neu-derived peptide, E75, as an adjuvant vaccine. E75 was originally described as HLA-A2-restricted and has been previously tested in this population. Based on computer modeling, E75 is predicted to bind to HLA-A3, and preclinical data support this. We conducted a clinical trial of E75 in HLA-A3(+), A2(-) (A3) patients. STUDY DESIGN Disease-free breast cancer patients were enrolled after standard therapy in phase I/II trials. A3 patients were enrolled in parallel with A2 patients and vaccinated with E75 and granulocyte-macrophage colony-stimulating factor immunoadjuvant. A2(-), A3(-) patients were followed as controls. Toxicities were graded. Immunologic responses were assessed by delayed-type hypersensitivity reactions and E75-specific interferon-gamma enzyme-linked immunosorbent spot assay. Clinical recurrences were documented. RESULTS Thirteen A3 patients completed the vaccine schedule. Clinicopathologic features were similar between A3, A2, and control patients, except for more HER2/neu-overexpressing tumors in the A2 group and more estrogen-receptor/progesterone-receptor-negative tumors in A2 and A3 groups. Toxicity profiles and postvaccination delayed-type hypersensitivity were similar in A3 and A2 patients. Enzyme-linked immunosorbent spot assay results varied, but A3 patients' median spots increased pre- to postvaccination (p = 0.2). Recurrences were lower in the A3 group (7.7%) at 30-month median follow-up compared with published recurrence in A2-vaccinated (8.3%) and control groups (14.8%) at 26-month median follow-up. CONCLUSIONS HLA restriction limits potential use of peptide-based cancer vaccines. This trial demonstrates that HLA-A3 patients respond similarly to E75 vaccination as HLA-A2 patients, suggesting the potential use of the E75 vaccine in up to 76% of the population.
Collapse
Affiliation(s)
- Ritesh Patil
- Joyce Murtha Breast Care Center, Windber Medical Center, Windber, PA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Hogg RA, Holmes JP, Ghebrehewet S, Elders K, Hart J, Whiteside C, Willshaw GA, Cheasty T, Kay A, Lynch K, Pritchard GC. Probable zoonotic transmission of verocytotoxigenic Escherichia coli O 157 by dogs. Vet Rec 2009; 164:304-5. [PMID: 19270322 DOI: 10.1136/vr.164.10.304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R A Hogg
- VLA - Preston, Barton Hall, Garstang Road, Preston PR3 5HE, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Benavides LC, Gates JD, Carmichael MG, Patil R, Patel R, Holmes JP, Hueman MT, Mittendorf EA, Craig D, Stojadinovic A, Ponniah S, Peoples GE. The impact of HER2/neu expression level on response to the E75 vaccine: from U.S. Military Cancer Institute Clinical Trials Group Study I-01 and I-02. Clin Cancer Res 2009; 15:2895-904. [PMID: 19351776 DOI: 10.1158/1078-0432.ccr-08-1126] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE HER2/neu, a source of immunogenic peptides, is expressed in >75% of breast cancer patients. We have conducted clinical trials with the HER2/neu E75 peptide vaccine in breast cancer patients with varying levels of HER2/neu expression. Vaccine response based on HER2/neu expression level was analyzed. EXPERIMENTAL DESIGN Patients were stratified by HER2/neu expression. Low expressors (n = 100) were defined as HER2/neu immunohistochemistry (IHC) 1(+) to 2(+) or fluorescence in situ hybridization < 2.0. Overexpressors (n = 51) were defined as IHC 3(+) or fluorescence in situ hybridization > or = 2.0. Additional analyses were done stratifying by IHC status (0-3(+)). Standard clinocopathlogic factors, immunologic response (in vivo delayed-type hypersensitivity reactions; ex vivo human leukocyte antigen A2:immunoglobulin G dimer assay), and clinical responses (recurrence; mortality) were assessed. RESULTS Low-expressor (control, 44; vaccinated, 56) versus overexpressor patients (control, 22; vaccinated, 29) were assessed. Low expressors, overexpressors, and most IHC-status vaccinated groups responded immunologically. Vaccinated low-expressor patients had larger maximum immunologic responses compared with overexpressor patients (P = 0.04), and vaccinated IHC 1(+) patients had increased long-term immune response (P = 0.08). More importantly, compared with controls, low-expressor patients had a mortality reduction (P = 0.08). The largest decrease in mortality was seen in IHC 1(+) patients (P = 0.05). In addition, a subset of overexpressor patients (n = 7) received trastuzumab before vaccination, and this combination seems safe and immunologically beneficial. CONCLUSIONS Most patients with various levels of HER2/neu expression responded immunologically and seemed to benefit from vaccination. The low expressors, specifically IHC 1(+) patients, had more robust immunologic responses and may derive the greatest clinical benefit from the E75 vaccine.
Collapse
Affiliation(s)
- Linda C Benavides
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, Houston, Texas 78234, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Gates JD, Carmichael MG, Benavides LC, Holmes JP, Hueman MT, Woll MM, Ioannides CG, Robson CH, McLeod DG, Ponniah S, Peoples GE. Longterm Followup Assessment of a HER2/neu Peptide (E75) Vaccine for Prevention of Recurrence in High-Risk Prostate Cancer Patients. J Am Coll Surg 2009; 208:193-201. [DOI: 10.1016/j.jamcollsurg.2008.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 09/24/2008] [Accepted: 10/23/2008] [Indexed: 11/25/2022]
|
42
|
Gates JD, Benavides LC, Carmichael MG, Hueman MT, Holmes JP, Khoo S, Stojadinovic A, von Hofe E, Ponniah S, Peoples GE. Circulating regulatory (CD4+CD25+FOXP3+) T cells decrease in breast cancer patients after vaccination with an Ii-Key-modified class II HER2/ neu peptide (AE37). Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3134
Background: CD4+CD25+FOXP3+ regulatory T cells (Tregs) have been implicated in the suppression of immune responses against various tumors. To monitor the potential induction of Tregs in breast cancer (BrCa) patients receiving a modified HLA Class II HER2/neu peptide (AE37) vaccine in a clinical trial, we have analyzed peripheral blood lymphocytes (PBL) from vaccinated patients for the presence of Tregs and correlated our findings with ex vivo immune assays and in vivo delayed type hypersensitivity (DTH) responses to the vaccine. Methods: Fifteen BrCa patients have completed 6 monthly injections of the AE37+GM-CSF vaccine in a dose escalation safety study. The AE37 peptide consists of a HER2/neu peptide (776-790) linked to the Ii-Key moiety of the HLA Class II-associated invariant chain, which enhances epitope interaction with the Class II molecule. PBL obtained pre- and post-vaccination were stained with anti-CD4/CD25 (n=15) and FOXP3 (n=9) antibodies (PCH101 and 236A/E7) and analyzed by flow cytometry. Cells were also stimulated ex vivo with AE37 peptide to measure IFN-γ ELISPOT, proliferation (3H-thymidine-cpm) and cytokine secretion (TGF-β). DTH responses to the AE37 peptide pre- and post-vaccination were also recorded. Results: The mean CD4+ and CD4+CD25+ T cell populations for all patients (n=15) did not change from pre- to post-vaccination (CD4+ = 52.3+3.3% vs. 50.5+3.9%, p=0.6; CD4+CD25+ = 1.9+0.2% vs. 2.4+0.5%, p=0.2). Tregs (CD4+CD25+FOXP3+) were reduced in all 9 patients tested pre- to post-vaccination for both FOXP3 antibodies (Ab) (FOXP3 Ab1 = 2.1+0.2% vs. 1.1+0.1%, p=0.002; FOXP3 Ab2 = 2.0+0.2% vs. 1.0+0.2%, p=0.0009). There was no difference in pre- to post-vaccination levels of TGF-β (2720+582 pg/ml vs. 3387+848 pg/ml; p=0.9). AE37-specific proliferative responses increased from pre- to post-vaccination (34+23cpm vs. 6427+1431 cpm; p<0.001). ELISPOT demonstrated an increased response from pre- to long term (6-12mo.) post-vaccination (Median – 2 vs. 34 spots/106 cells; p=0.003). DTH responses increased in all patients from pre- to post-vaccination (3.6+1.4 mm vs. 56.0+9.4 mm; p<0.0001), and there appeared to be an inverse relationship between the degree of Treg reduction and the size of DTH response to AE37 (R2=0.83).
 Discussion: The novel AE37 HER2/neu peptide vaccine does not result in increased levels of Tregs. Furthermore, the reduced levels of Tregs in vaccinated patients appear to be associated with more robust responses in ex vivo immune assays and in vivo DTH reactions suggesting that the AE37 vaccine may be clinically useful.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3134.
Collapse
Affiliation(s)
- JD Gates
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | - LC Benavides
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | - MG Carmichael
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - MT Hueman
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - JP Holmes
- 3 Dept. of Hematology/Oncology, Naval Medical Center San Diego, San Diego, CA
| | - S Khoo
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - A Stojadinovic
- 4 Dept. of Surgery, Walter Reed Army Medical Center, Washington, DC
| | | | - S Ponniah
- 2 Cancer Vaccine Development Program, USMCI, Dept. of Surgery, USUHS, Bethesda, MD
| | - GE Peoples
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| |
Collapse
|
43
|
Benavides LC, Gates JD, Holmes JP, Mittendorf EA, Ponniah S, Peoples GE. Optimal method of dosing HER2/ neu peptide vaccines: U.S. Military Cancer Institute Clinical Trials Group Study 1-01, 1-02, 1-03, and 1-04. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3139
Background: Our Cancer Vaccine Development Program has performed phase I and II clinical trials using immunogenic peptides from the HER2/neu protein. AE37 (aa:776-790+Ii-Key) is HLA promiscuous whereas E75 (aa:369-377) and GP2 (aa:654-662) are HLA-A2/A3+ restricted. The peptides are located on the intracellular, extracellular, and transmembrane portions of the HER2/neu protein. We evaluate patients who required dose reductions and compare them to those who did not in our three peptide vaccine trials to determine the immunologic and clinical relevance of different responses to the peptide vaccines. Methods: Three vaccine trials were performed separately with similar dose escalation design by varying the amount of AE37, GP2 or E75 peptide and GM-CSF adjuvant. Dose reductions (DR) were made in event of significant toxicity (>100mm local or ≥grade 2 systemic) by decreasing GM-CSF (or peptide if no GM-CSF) by 50% for subsequent inoculations. We compared patients necessitating DR and those who did not. Immune response was measured ex vivo via 3H-thymidine proliferative assays or HLA-A2:Ig dimer assays and in vivo via DTH reactions pre- and post-vaccine. Recurrence and mortality data were available for E75 treated patients at 30-month median follow-up. Results: 132 patients underwent peptide vaccination and 39 patients required DR (Table 1).
 
 No patient had grade 3-5 local or systemic toxicities. DR patients, particularly those reduced for robust local reactions (DR-L), had greater immune responses ex vivo and in vivo. The post-vaccine DTH in DR-L patients compared to all other vaccinated patients was significantly larger in E75 (24.5±4.1mm vs. 12.7±1.3mm; p=0.001) and trended towards significant in AE37 (69.4±10.3mm vs. 35.8±14.9mm; p=0.08) and GP2 (48.9±14.1mm vs. 24.1±3.3mm; p=0.08). No recurrences or deaths were noted in the E75 DR patients; but for patients not requiring dose reductions there were 10 (12.5%) recurrences and 1 (1.25%) death.Discussion: All three peptide vaccines are safe and well-tolerated with minimal toxicity. The safety was partly due to reducing GM-CSF (or peptide if no GM-CSF) by 50% for patients with >100mm local reactions or >grade 2 systemic toxicity. DR patients, particularly DR-L patients, immunological responses were larger. This increased immune response (noted by DTH) suggests improved clinical response as there have been no recurrences or deaths among DR patients. Our analysis indicates that the optimal method of dosing HER2/neu peptide vaccines consists of constant peptide dose with a large enough dose of adjuvant to generate robust local reactions and that when local reactions are >100mm performing DR of adjuvant by 50% for subsequent inoculations.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3139.
Collapse
Affiliation(s)
- LC Benavides
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | - JD Gates
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | - JP Holmes
- 2 Naval Medical Center, San Diego, CA
| | | | - S Ponniah
- 4 CVDL, Dept. of Surgery, USUHS, Bethesda, MD
| | - GE Peoples
- 1 Dept. of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| |
Collapse
|
44
|
Mittendorf EA, Holmes JP, Murray JL, von Hofe E, Peoples GE. CD4+T cells in antitumor immunity: utility of an Ii-Key HER2/neu hybrid peptide vaccine (AE37). Expert Opin Biol Ther 2008; 9:71-8. [DOI: 10.1517/14712590802614538] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
45
|
Amin A, Benavides LC, Holmes JP, Gates JD, Carmichael MG, Hueman MT, Mittendorf EA, Storrer CE, Jama YH, Craig D, Stojadinovic A, Ponniah S, Peoples GE. Assessment of immunologic response and recurrence patterns among patients with clinical recurrence after vaccination with a preventive HER2/neu peptide vaccine: from US Military Cancer Institute Clinical Trials Group Study I-01 and I-02. Cancer Immunol Immunother 2008; 57:1817-25. [PMID: 18392824 PMCID: PMC11031077 DOI: 10.1007/s00262-008-0509-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 03/24/2008] [Indexed: 12/24/2022]
Abstract
BACKGROUND E75, a HER2/neu immunogenic peptide, is expressed in breast cancer (BCa). We have performed clinical trials of E75 + GM-CSF vaccine in disease-free, node-positive and node-negative BCa patients at high recurrence risk and recurrences were noted in both control and vaccine groups. METHODS Among the 186 BCa patients enrolled, 177 completed the study. Patients were HLA typed; the HLA-A2(+)/A3(+) patients were vaccinated; HLA-A2(-)/A3(-) patients were followed as controls. Standard clinicopathological factors, immunologic response to the vaccine, and recurrences were collected and assessed. RESULTS The control group recurrence rate was 14.8 and 8.3% in the vaccinated group (P = 0.17). Comparing the 8 vaccinated recurrences (V-R) to the 88 vaccinated nonrecurrent patients (V-NR), the V-R group had higher nodal stage (> or = N2: 75 vs. 5%, P = 0.0001) and higher grade tumors (%grade 3: 88 vs. 31%, P = 0.003). The V-R group did not fail to respond immunologically as noted by equivalent dimer responses and post-DTH responses. Compared to control recurrent patients (C-R), V-R patients trended toward higher-grade tumors and hormone-receptor negativity. C-R patients had 50% bone-only recurrences, compared to V-R patients with no bone-only recurrences (P = 0.05). Lastly, V-R mortality rate was 12.5% compared with 41.7% for the C-R group (P = 0.3). CONCLUSIONS The vaccinated patients who recurred had more aggressive disease compared to V-NR patients. V-R patients had no difference in immune response to the vaccine either in vitro or in vivo. V-R patients, when compared to C-R patients, trended towards more aggressive disease, decreased recurrence rates, decreased mortality, and no bone-only recurrences.
Collapse
MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Breast Neoplasms/immunology
- Breast Neoplasms/pathology
- Breast Neoplasms/prevention & control
- Cancer Vaccines/administration & dosage
- Cancer Vaccines/adverse effects
- Cancer Vaccines/immunology
- Dose-Response Relationship, Drug
- Female
- Granulocyte-Macrophage Colony-Stimulating Factor/administration & dosage
- HLA-A2 Antigen/genetics
- HLA-A2 Antigen/immunology
- HLA-A3 Antigen/genetics
- HLA-A3 Antigen/immunology
- Humans
- Kaplan-Meier Estimate
- Neoplasm Recurrence, Local/immunology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Prognosis
- Receptor, ErbB-2/immunology
- Receptor, ErbB-2/therapeutic use
- Vaccines, Subunit/administration & dosage
- Vaccines, Subunit/adverse effects
- Vaccines, Subunit/immunology
Collapse
Affiliation(s)
- Asna Amin
- Department of Surgery, General Surgery Service, Walter Reed Army Medical Center, Washington, DC USA
| | - Linda C. Benavides
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Ft. Sam Houston, TX 78234 USA
| | - Jarrod P. Holmes
- Department of Medicine, Division of Hematology and Medical Oncology, Naval Medical Center San Diego, San Diego, CA USA
| | - Jeremy D. Gates
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Ft. Sam Houston, TX 78234 USA
| | - Mark G. Carmichael
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Matthew T. Hueman
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | | | - Catherine E. Storrer
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Yusuf H. Jama
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Dianna Craig
- Joyce Murtha Breast Care Center, Windber Medical Center, Windber, PA USA
| | - Alex Stojadinovic
- Department of Surgery, General Surgery Service, Walter Reed Army Medical Center, Washington, DC USA
| | - Sathibalan Ponniah
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - George E. Peoples
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Ft. Sam Houston, TX 78234 USA
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| |
Collapse
|
46
|
Holmes JP, Gates JD, Benavides LC, Hueman MT, Carmichael MG, Patil R, Craig D, Mittendorf EA, Stojadinovic A, Ponniah S, Peoples GE. Optimal dose and schedule of an HER-2/neu(E75) peptide vaccine to prevent breast cancer recurrence. Cancer 2008; 113:1666-75. [DOI: 10.1002/cncr.23772] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
47
|
Abstract
E75 (HER2/neu 369-377) is an immunogenic peptide from the HER2/neu protein which is overexpressed in many breast cancer patients. A large amount of preclinical work and a small number of Phase I trials have been completed evaluating the vaccine potential of the E75 peptide mixed with an immunoadjuvant. Our group has performed two concurrent E75 + GM-CSF Phase II trials in node-positive and node-negative disease-free breast cancer patients. These trials, totaling 186 patients, were designed to assess the ability of the E75 vaccine to prevent disease recurrence in these high risk patients. In this review article, we discuss the safety of the vaccine, the immunologic response to the peptide, and most importantly, the potential clinical benefit of the vaccine. The recurrence rate, mortality associated with recurrence, and the distribution of recurrences are presented and discussed. Additionally, the lessons learned from these trials to include optimal dosing and the need for booster inoculations are addressed. We also present data exploring possible explanations and mechanisms behind the potential clinical utility of this simple single epitope vaccine. Finally, we present some of the future directions for our Cancer Vaccine Development Program assessing multi-epitope peptide vaccines and combination immunotherapies.
Collapse
Affiliation(s)
- Elizabeth A. Mittendorf
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX USA
| | - Jarrod P. Holmes
- Division of Hematology and Medical Oncology, Department of Medicine, Naval Medical Center San Diego, San Diego, CA USA
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Sathibalan Ponniah
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - George E. Peoples
- Cancer Vaccine Development Program, Department of Surgery, United States Military Cancer Institute, Uniformed Services University of the Health Sciences, Bethesda, MD USA
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, Ft. Sam, Houston, TX 78234 USA
| |
Collapse
|
48
|
Gates JD, Benavides LC, Stojadinovic A, Mittendorf EA, Holmes JP, Carmichael MG, McCall S, Milford AL, Merrill GA, Ponniah S, Peoples GE. Monitoring circulating tumor cells in cancer vaccine trials. Hum Vaccin 2008; 4:389-92. [PMID: 18437056 DOI: 10.4161/hv.4.5.6115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The presence of circulating tumor cells (CTC) from various cancers has provided a wealth of information and possibilities. As the role of CTC detection in the treatment assessment of metastatic breast cancer becomes standard, there is interest in applying this tool in cancer vaccine development and clinical trial monitoring. Since we lack a proven immunologic assay that correlates with clinical response, CTC detection, quantification and phenotypic characterization may be a useful surrogate for clinical outcome. The Cancer Vaccine Development Program is involved in the development of HER2/neu peptide based vaccine development for the prevention of recurrence in HER2/neu expressing cancers like breast cancer. The CellSearch System (Veridex, LLC Warren, NJ) has been used by our lab in conjunction with in vivo and/or in vitro immunologic measurements to define a monitoring tool that could predict clinical response. Once validated, this assay could significantly shorten clinical trials and lead to more efficient assessment of potentially promising cancer vaccines.
Collapse
Affiliation(s)
- J D Gates
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, Ft. Sam Houston, Texas 78234, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Holmes JP, Benavides LC, Gates JD, Carmichael MG, Hueman MT, Mittendorf EA, Murray JL, Amin A, Craig D, von Hofe E, Ponniah S, Peoples GE. Results of the first phase I clinical trial of the novel II-key hybrid preventive HER-2/neu peptide (AE37) vaccine. J Clin Oncol 2008; 26:3426-33. [PMID: 18612158 DOI: 10.1200/jco.2007.15.7842] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE HER-2/neu is overexpressed in breast cancer and is the source of immunogenic peptides. CD4(+) T-helper peptides for HER-2/neu are being evaluated in vaccine trials. The addition of Ii-Key, a four-amino-acid LRMK modification, increases vaccine potency when compared with unmodified class II epitopes. We present the results of the first human phase I trial of the Ii-Key hybrid HER-2/neu peptide (AE37) vaccine in disease-free, node-negative breast cancer patients. PATIENTS AND METHODS The dose escalation trial included five dose groups, to determine safety and optimal dose of the hybrid peptide (100 microg, 500 microg, 1,000 microg) and granulocyte-macrophage colony-stimulating factor (GM-CSF; range, 0 to 250 microg). In the event of significant local toxicity, GM-CSF (or peptide in absence of GM-CSF) was reduced by 50%. Immunologic response was monitored by delayed-type hypersensitivity and [(3)H]thymidine proliferative assays for both the hybrid AE37 (LRMK-positive HER-2/neu:776-790) and AE36 (unmodified HER-2/neu:776-790). RESULTS All 15 patients completed the trial with no grade 3 to 5 toxicities. Dose reductions occurred in 47% of patients. In the second group (peptide, 500 microg; GM-CSF, 250 microg), all patients required dose reductions, prompting peptide-only inoculations in the third group. The vaccine induced dose-dependent immunologic responses in vitro and in vivo to AE37, as well as AE36. CONCLUSION The hybrid AE37 vaccine seems safe and well tolerated with minimal toxicity if properly dosed. AE37 is capable of eliciting HER-2/neu-specific immune responses, even without the use of an adjuvant. This trial represents the first human experience with the Ii-Key modification, and to our knowledge, AE37 is the first peptide vaccine to show potency in the absence of an immunoadjuvant.
Collapse
Affiliation(s)
- Jarrod P Holmes
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Peoples GE, Holmes JP, Hueman MT, Mittendorf EA, Amin A, Khoo S, Dehqanzada ZA, Gurney JM, Woll MM, Ryan GB, Storrer CE, Craig D, Ioannides CG, Ponniah S. Combined clinical trial results of a HER2/neu (E75) vaccine for the prevention of recurrence in high-risk breast cancer patients: U.S. Military Cancer Institute Clinical Trials Group Study I-01 and I-02. Clin Cancer Res 2008; 14:797-803. [PMID: 18245541 DOI: 10.1158/1078-0432.ccr-07-1448] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE E75 is an immunogenic peptide from the HER2/neu protein, which is overexpressed in many breast cancer patients. We have conducted two overlapping E75 vaccine trials to prevent recurrence in node-positive (NP) and node-negative (NN) breast cancer patients. EXPERIMENTAL DESIGN E75 (HER2/neu 369-377) + granulocyte macrophage colony-stimulating factor was given intradermally to previously treated, disease-free NP breast cancer patients in a dose escalation safety trial and to NN breast cancer patients in a dose optimization study. Local and systemic toxicity was monitored. Immunologic responses were assessed using in vitro assays and in vivo delayed-type hypersensitivity responses. Clinical recurrences were documented. RESULTS One hundred and eighty-six patients were enrolled in the two studies (NP, 95; NN, 91). Human leucocyte antigen A2 (HLA-A2) and HLA-A3 patients were vaccinated (n = 101), whereas all others (n = 85) were followed prospectively as controls. Toxicities were minimal, and a dose-dependent immunologic response to the vaccine was shown. Planned primary analysis revealed a recurrence rate of 5.6% in vaccinated patients compared with 14.2% in the controls (P = 0.04) at a median of 20 months follow-up. As vaccine-specific immunity waned over time, the difference in recurrence lost significance at 26 months median follow-up (8.3% versus 14.8%); however, a significant difference in the pattern of recurrence persisted. CONCLUSIONS E75 is safe and effective in raising a dose-dependent HER2/neu immunity in HLA-A2 and HLA-A3 NP and NN breast cancer patients. More importantly, E75 may reduce recurrences in disease-free, conventionally treated, high-risk breast cancer patients. These findings warrant a prospective, randomized phase III trial of the E75 vaccine with periodic booster to prevent breast cancer recurrences.
Collapse
Affiliation(s)
- George E Peoples
- Department of Surgery, General Surgery Service, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas 78234, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|