1
|
Algazi A, Bhatia S, Agarwala S, Molina M, Lewis K, Faries M, Fong L, Levine LP, Franco M, Oglesby A, Ballesteros-Merino C, Bifulco CB, Fox BA, Bannavong D, Talia R, Browning E, Le MH, Pierce RH, Gargosky S, Tsai KK, Twitty C, Daud AI. Intratumoral delivery of tavokinogene telseplasmid yields systemic immune responses in metastatic melanoma patients. Ann Oncol 2020; 31:532-540. [PMID: 32147213 DOI: 10.1016/j.annonc.2019.12.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [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: 09/05/2019] [Revised: 11/27/2019] [Accepted: 12/23/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Interleukin 12 (IL-12) is a pivotal regulator of innate and adaptive immunity. We conducted a prospective open-label, phase II clinical trial of electroporated plasmid IL-12 in advanced melanoma patients (NCT01502293). PATIENTS AND METHODS Patients with stage III/IV melanoma were treated intratumorally with plasmid encoding IL-12 (tavokinogene telseplasmid; tavo), 0.5 mg/ml followed by electroporation (six pulses, 1500 V/cm) on days 1, 5, and 8 every 90 days in the main study and additional patients were treated in two alternative schedule exploration cohorts. Correlative analyses for programmed death-ligand 1 (PD-L1), flow cytometry to assess changes in immune cell subsets, and analysis of immune-related gene expression were carried out on pre- and post-treatment samples from study patients, as well as from additional patients treated during exploration of additional dosing schedules beyond the pre-specified protocol dosing schedule. Response was measured by study-specific criteria to maximize detection of latent and potentially transient immune responses in patients with multiple skin lesions and toxicities were graded by the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0). RESULTS The objective overall response rate was 35.7% in the main study (29.8% in all cohorts), with a complete response rate of 17.9% (10.6% in all cohorts). The median progression-free survival in the main study was 3.7 months while the median overall survival was not reached at a median follow up of 29.7 months. A total of 46% of patients in all cohorts with uninjected lesions experienced regression of at least one of these lesions and 25% had a net regression of all untreated lesions. Transcriptomic and immunohistochemistry analysis showed that immune activation and co-stimulatory transcripts were up-regulated but there was also increased adaptive immune resistance. CONCLUSIONS Intratumoral Tavo was well tolerated and led to systemic immune responses in advanced melanoma patients. While tumor regression and increased immune infiltration were observed in treated as well as untreated/distal lesions, adaptive immune resistance limited the response.
Collapse
Affiliation(s)
- A Algazi
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - S Bhatia
- Department of Medicine, University of Washington, Seattle, USA
| | - S Agarwala
- St. Luke's Cancer Center, Bethlehem, USA
| | - M Molina
- Lakeland Health Medical Center, Lakeland, USA
| | - K Lewis
- University of Colorado Cancer Center - Anschutz, Denver, USA
| | - M Faries
- Providence John Wayne Cancer Institute, Santa Monica, USA
| | - L Fong
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - L P Levine
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - M Franco
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - A Oglesby
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - C Ballesteros-Merino
- Earle A. Chiles Research Institute at Providence Portland Medical Center, Portland, USA
| | - C B Bifulco
- Earle A. Chiles Research Institute at Providence Portland Medical Center, Portland, USA
| | - B A Fox
- Earle A. Chiles Research Institute at Providence Portland Medical Center, Portland, USA
| | - D Bannavong
- OncoSec Medical Incorporated, San Diego, USA
| | - R Talia
- OncoSec Medical Incorporated, San Diego, USA
| | - E Browning
- OncoSec Medical Incorporated, San Diego, USA
| | - M H Le
- OncoSec Medical Incorporated, San Diego, USA
| | - R H Pierce
- OncoSec Medical Incorporated, San Diego, USA
| | - S Gargosky
- OncoSec Medical Incorporated, San Diego, USA
| | - K K Tsai
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - C Twitty
- OncoSec Medical Incorporated, San Diego, USA
| | - A I Daud
- Department of Medicine, University of California, San Francisco, San Francisco, USA.
| |
Collapse
|
2
|
Menzies AM, Johnson DB, Ramanujam S, Atkinson VG, Wong ANM, Park JJ, McQuade JL, Shoushtari AN, Tsai KK, Eroglu Z, Klein O, Hassel JC, Sosman JA, Guminski A, Sullivan RJ, Ribas A, Carlino MS, Davies MA, Sandhu SK, Long GV. Anti-PD-1 therapy in patients with advanced melanoma and preexisting autoimmune disorders or major toxicity with ipilimumab. Ann Oncol 2017; 28:368-376. [PMID: 27687304 DOI: 10.1093/annonc/mdw443] [Citation(s) in RCA: 566] [Impact Index Per Article: 80.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Anti-PD-1 antibodies (anti-PD-1) have clinical activity in a number of malignancies. All clinical trials have excluded patients with significant preexisting autoimmune disorders (ADs) and only one has included patients with immune-related adverse events (irAEs) with ipilimumab. We sought to explore the safety and efficacy of anti-PD-1 in such patients. Patients and methods Patients with advanced melanoma and preexisting ADs and/or major immune-related adverse events (irAEs) with ipilimumab (requiring systemic immunosuppression) that were treated with anti-PD-1 between 1 July 2012 and 30 September 2015 were retrospectively identified. Results One hundred and nineteen patients from 13 academic tertiary referral centers were treated with anti-PD-1. In patients with preexisting AD (N = 52), the response rate was 33%. 20 (38%) patients had a flare of AD requiring immunosuppression, including 7/13 with rheumatoid arthritis, 3/3 with polymyalgia rheumatica, 2/2 with Sjogren's syndrome, 2/2 with immune thrombocytopaenic purpura and 3/8 with psoriasis. No patients with gastrointestinal (N = 6) or neurological disorders (N = 5) flared. Only 2 (4%) patients discontinued treatment due to flare, but 15 (29%) developed other irAEs and 4 (8%) discontinued treatment. In patients with prior ipilimumab irAEs requiring immunosuppression (N = 67) the response rate was 40%. Two (3%) patients had a recurrence of the same ipilimumab irAEs, but 23 (34%) developed new irAEs (14, 21% grade 3-4) and 8 (12%) discontinued treatment. There were no treatment-related deaths. Conclusions In melanoma patients with preexisting ADs or major irAEs with ipilimumab, anti-PD-1 induced relatively frequent immune toxicities, but these were often mild, easily managed and did not necessitate discontinuation of therapy, and a significant proportion of patients achieved clinical responses. The results support that anti-PD-1 can be administered safely and can achieve clinical benefit in patients with preexisting ADs or prior major irAEs with ipilimumab.
Collapse
Affiliation(s)
- A M Menzies
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - D B Johnson
- Vanderbilt University Medical Center, Nashville, USA
| | - S Ramanujam
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia
| | - V G Atkinson
- Princess Alexandra Hospital, Greenslopes Hospital and University of Queensland, Brisbane, Australia
| | - A N M Wong
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J J Park
- Crown Princess Mary Cancer Centre Westmead, Sydney, Australia
| | - J L McQuade
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - K K Tsai
- Department of Medical Oncology, University of California San Francisco, San Francisco, USA
| | - Z Eroglu
- Department of Medical Oncology, Moffitt Cancer Centre, Tampa, USA
| | - O Klein
- Department of Medical Oncology, Olivia Newton-John Cancer Centre & Cancer Research Institute, Austin Health, Melbourne, Australia
| | - J C Hassel
- Department of Dermatology, Heidelberg University, Heidelberg, Germany
| | - J A Sosman
- Vanderbilt University Medical Center, Nashville, USA
| | - A Guminski
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia
| | - R J Sullivan
- Massachusetts General Hospital Cancer Center, Boston, USA
| | - A Ribas
- Division of Hematology-Oncology, University of California Los Angeles, Los Angeles, USA
| | - M S Carlino
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Crown Princess Mary Cancer Centre Westmead, Sydney, Australia
| | - M A Davies
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - S K Sandhu
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - G V Long
- Melanoma Institute Australia and The University of Sydney, Sydney, Australia.,Royal North Shore and Mater Hospitals, Sydney, Australia
| |
Collapse
|