This is a single institution, open-label, multi-arm, phase I study assessing the safety and immunogenicity of a personalized neoantigen-based personalized DNA vaccine combined with PD-1 blockade therapy in subjects with newly diagnosed, MGMT promoter unmethylated glioblastoma (GBM). Immune checkpoint blockade, specifically those targeting the PD-1/PD-L1 pathways, has shown efficacy in multiple solid and hematologic malignancies. Furthermore, as has been demonstrated in metastatic melanoma, combining PD-1/PD-L1 blockade with other immune checkpoint inhibitors has shown improved objective response rates, though there is a significant increase in serious immune-related adverse events. As such, current trials are exploring different doses, administration schedules, and immune checkpoint agents. One alternative approach, however, is to introduce a tumor-directed therapy such as a personalized neoantigen vaccine combined with these immune modulating agents (i.e. immune checkpoint blocking antibodies) to maximize the tumor-specific response but minimize the toxicity associated with increasing non-specific systemic immune activation by generating a potent and focused neoantigen specific immune response. This study will test the hypothesis that a personalized neoantigen DNA vaccine in combination with concurrent administration of immune checkpoint blockade therapy will enhance the magnitude and breadth of neoantigen-specific T cell responses while maintaining an acceptable safety profile. The overall goal of this study is to identify the optimal vaccine plus adjuvant platform that can be tested in a subsequent phase II study to determine the efficacy of a personalized neoantigen vaccine approach in patients with GBM.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
27
The sites of immunization may be rotated for each of the immunizations.
Retifanlimab will be supplied by Incyte.
Each DNA vaccination will be 1 mL vaccine administered intramuscularly using an integrated electroporation administration system
Washington University School of Medicine
St Louis, Missouri, United States
RECRUITINGSafety as measured by treatment-related dose-limiting toxicity (DLT) rate related to vaccination
* Safety will be defined as a \< 33% treatment-related DLT rate related to vaccination alone or in combination with retifanlimab, by the end of the DLT observation period for a given cohort. * A DLT will be defined as any grade 3 toxicity or greater according to CTCAE v5 considered at least possibly related to study treatment (exceptions are listed in the protocol). * The DLT observation period begins with date of first vaccine administration and continues for 30 days from administration of first dose of retifanlimab. For patients in Cohort A, this is Day 87 (first dose of retifanlimab is given with vaccine Dose 3 on Day 57), and for patients in Cohort B, this is Day 30 (first dose of retifanlimab is given with vaccine Dose 1 on Day 1).
Time frame: Through completion of DLT observation period for all enrolled subjects (estimated to be up to 12 months and 87 days)
Number of high-quality candidate neoantigens in patients enrolled in the study
Time frame: Through completion of vaccine manufacture for all enrolled subjects (estimated to be 15 months)
Progression-free survival (PFS)
* PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. * Progressive Disease (PD): At least a 25% increase in the sum of products of perpendicular diameters of at least 1 target lesion, taking as reference the smallest sum of products of perpendicular diameters on study (this includes the baseline sum if that is the smallest on study). The absolute increase in any dimension must be at least 5mm when calculating the products of perpendicular diameters. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions on stable or increasing doses of corticosteroids compared with baseline scan or best response after initiation of therapy\* not caused by comorbid events (e.g. radiation therapy, demyelination, ischemic injury, infection, seizures, postoperative changes, or other treatment effects).
Time frame: At 6 months
Overall survival (OS)
Time frame: At 12 months
Objective response rate (ORR)
Time frame: Through completion of treatment (estimated to be 12 months)
Immunogenicity as measured by the number of subjects in a cohort who develop at least one demonstrable neoantigen CD8 T cell response by day 71 after administration of the first dose of vaccine
Time frame: Day 71 after first vaccine dose
Immunogenicity as measured by the percentage of neoantigens that elicit a neoantigen-specific CD8 T cell response out of the total number of neoantigens vaccinated against within a cohort
-Total # neoantigens with measurable T cell response/total # of neoantigens vaccinated against
Time frame: Through progression (up to 36 months)
Immunogenicity as measured by T-cell phenotype, myeloid derived suppressor cell frequency (MDSC) assessed by flow cytometry
Time frame: Through progression (up to 36 months)
Immunogenicity as measured by T cell receptor (TCR) sequencing to assess diversity of clonality and putative antigen specificity
Time frame: Through progression (up to 36 months)
Immunogenicity as measured by pro- and anti-inflammatory chemokine analysis and cytokine analysis in plasma as assessed by multiplex ELISA
Time frame: Through progression (up to 36 months)
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