PL02.1.A EO2401, a novel microbiome-derived therapeutic vaccine for patients with recurrent glioblastoma: ROSALIE study

Background

EO2401 (EO) was designed to activate existing commensal memory T-cells cross-reacting with tumor associated antigens (TAAs). EO includes microbial-derived, synthetically produced peptides corresponding to HLA-A2 restricted epitopes with molecular mimicry to three TAAs upregulated in glioblastoma (GB), IL13Rα2, BIRC5 and FOXM1, with the CD4 helper peptide UCP2 and the adjuvant Montanide. Pre-clinically EO generated strong immune responses and cross-reactive CD8 cells recognizing the targeted TAAs.

Methods

This ongoing Ph 1/2 trial (NCT04116658) investigates the safety and tolerability (primary) of EO (300 µg/peptide, SC Q2W X 4, then Q4W), EO with nivolumab (3 mg/kg Q2W; EN), and EN with bevacizumab (10 mg/kg Q2W; ENB) among four Cohorts (Cs) of pts with GB at first progression/recurrence after radiotherapy/temozolomide. Treatment was delivered until progression, or 24 months. After the Ph 1 of EO followed by EN (C1), C2 investigated EN without (C2a) or with (C2b) surgery while C3 investigated ENB (population as C2a).

Results

Among 40 treated pts (C1 n=3, C2a n=23, C2b n=3, C3 n=11), median age was 60 years, 53% were male, 40% had KPS 90-100%, 35% had O6-methylguanine DNA-methyltransferase promotor hypermethylated tumors, and 5% isocitrate dehydrogenase 1 mutated tumors. All evaluable pts demonstrated strong CD8 T-cell ELISPOT responses against the 3 vaccine peptides; response was shown with tetramer staining of specific CD8 in 24/25 investigated pts after in vitro stimulation and in 19/20 pts directly ex vivo. Cross-reactivity against targeted TAAs was confirmed in 20/21 pts. Majority of response were detected by week 4 after 1st dose and as early as 2 weeks in some pts. EO, EN, and ENB were well tolerated (max exposure EN 86 wks, ENB 47 wks) with EO associated toxicity limited to local administration site reactions (48%; all grade 1-2). The frequency and severity of nivolumab- or bevacizumab-associated AEs was consistent with historical single-agent profiles. With a median follow-up of 13.6 months, median progression-free survival (mPFS), and median survival for EN (C1+C2a+C2b) were 1.8 months (2 ongoing at 7.3, and 18.5 months), and 11.0 months (survival at 12 months 42%), respectively. With a median follow-up of 7.3 months (range, 3.0-10.5), pts on ENB (C3) have mPFS and survival at 6 months of 5.5 months (3 ongoing at 5.6, 7.3 and 9.1 months), and 82% (9/11 alive), respectively. ORR/DCR (ORR+SD) for EN and ENB were 10%/34% and 55%/82%, respectively.

Conclusion

EO2401 generated strong systemic immune responses and was well tolerated in combination with nivolumab ± bevacizumab. Preliminary ORR/DCR and mPFS for ENB, and survival for EN seem encouraging. Updated results from the current 40 patients and results from additional 35 patients who already started treatment with EN with the option for low-dose bevacizumab edema treatment at neurological symptoms will be presented.

[Nerve fibre bundle defects in a pre-chiasmal lesion]

BACKGROUND

Prechiasmal lesions of the visual pathway are produced by visual field defects that either affect only one eye or, if both eyes are affected, they are clearly different. Typically, the defects respect the vertical meridian. This report of a case shows that the classical nerve fibre bundle defect must be taken into consideration for differential diagnosis.

CASE REPORT

In a 67-year-old patient, a meningeoma of the sphenoid was diagnosed that had spread into the optic canal. Examination of the visual field showed an inferior altitudinal nerve fibre bundle defect.

CONCLUSIONS

Apparently the retinal pattern of nerve fibres remains intact even when approaching the optic chiasm. Nerve fibre bundle defects are therefore sometimes found in prechiasmal lesions and should be considered for differential diagnosis (e. g., in the case of a suspected low tension glaucoma).

[Visual acuity testing in pre-school children: a comparison between the Sheridan-Gardiner test and the Räder (broken wheel) test]

PURPOSE

To evaluate the comparability between the well-established Sheridan-Gardiner test (SGT) and a new type of visual acuity test, called the Räder test (RT = broken wheel test) in pre-school children, and to compare test durations of these infant visual acuity tests.

SUBJECTS AND METHODS

The RT consists of 16 cards with visus values of 0.16, 0.2, 0.25, 0.3, 0.5, 0.6, 0.8 and 1.0. One pair of cards depicting a car is used for testing. On one of the cards the car has intact wheels, on the other the wheels are incomplete, symbolized by a Landolt ring. The child must indicate, at a viewing distance of 3 meters, which of the wheels is incomplete. The SGT consists of seven visus plates: 5/60, 5/36, 5/24, 5/18, 5/12, 5/9 and 5/6. Each level is tested with one letter and can be repeated by the presentation of a further letter (A, H, O, T, U, V, X). The examination distance is 5 meters. The child must indicate, with reference to a card depicting all seven symbols, which letter the examiner is showing. The SGT and RT were performed in a randomized cross-over sequence in 30 children (20male, 10 female) of pre-school age (from 2 years up to and including the age of 5 years, mean 3.4 years +/- 0.77 SD, median 3.0 years). In all cases, the right eye was examined first. Examination duration was assessed for each acuity test, and for each eye separately with a stopwatch. The instruction time was not considered. The possible visual acuity values of both bests were replaced by a unified scale of visual acuity levels (ranging from 1 to 10). A difference of at least two levels was considered as relevant. The results were compared by means of the sign test at a significance level of 0.05.

RESULTS

In particular, for higher visual acuity levels there were considerable differences, with SGT generally showing better results than RT: in 11 of 29 children, in both eyes RT values turned out to be at least 2 lines better than those obtained with SGT. The contrary situation, i. e., favoring SGT by more than 2 lines compared to RT, never occurred. According to the sign test, these differences were significant (p < 0.001). SGT revealed also clearly better visual acuity levels in those 22 children out of the 30, who exhibited differences by 2 lines or more in at least one eye (p < 0.001). The examination procedure with RT revealed problems in making the required directional decisions, especially between 2 and 4 years of age. This might interfere with the test interpretation and lead to distortion of the RT results. Total examination duration did not differ considerably between SGT (1.6 to 5.8 minutes, median 3.0 minutes) and RT (1.6 to 9.4 minutes, median 4.6 minutes), respectively.

CONCLUSIONS

The Sheridan-Gardiner test generally shows better results than the new Räder (RT = broken wheel) test in pre-school children. Problems in making the required directional decisions may interfere with RT in this age group.

[Hereditary motor and sensory neuropathy type I associated with a unilateral incomplete external oculomotor paralysis. A case report]

HMSN is a hereditary symmetric ascending neuropathy of the peripheral nerves. Several cases of HMSN with motility disorders of both eyes have been reported in the literature. We describe a patient with HMSN type 1 and an incomplete peripheral 3rd nerve palsy of the right eye. To the best of our knowledge, this is the first report of developed unilateral oculomotor disorder in a patient with HMSN.

Evidence for an intra- and extraplastidic pre-chorismate pathway

Pea plants grown under different conditions of cultivation, and eight different plant species with variegated leaves were used to study the intracellular localization of shikimate oxidoreductase (EC 1.1.1.25), the marker enzyme of the pre-chorismate pathway. The two series of experiments indicated an intra-and an extraplastidic compartimentalization of the enzyme, and both enzyme activities are regulated differentially. While the extraplastidic activity is permanently demonstrable, the intraplastidic activity is subject to the plants' developmental state and also depends on both illumination and fertilization.