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12 februari 2024: Bron: Nature

Veelbelovende resultaten voor het specifiek samengestelde kankervaccin ELI-002 2P worden gezien in de fase I veiligheidsstudie bij 25 deelnemende patiënten, waarvan 20 met alvleesklierkanker en 5 met endeldarmkanker, allemaal met een KRAS positieve mutatie.

In deze fase I studie werden 20 patiënten met KRAS-gemuteerde alvleesklierkanker en 5 patiënten met endeldarmkanker behandelt met een locoregionale behandeling met het kankervaccin ELI-002 2P. Er werden geen dosisbeperkende bijwerkingen waargenomen.

De tumorbiomarkerrespons, het secundaire eindpunt, werd waargenomen bij 84% van de patiënten, terwijl de biomarkerklaring naar normale waarden werd waargenomen bij 24%, 3 patiënten met alvleesklierkanker en 3 patiënten met endeldarmkanker. De mediane recidiefvrije overleving was 16,33 maanden.

Uit het studieverslag hier het schema van toediening in 5 verschillende groepen en hoe de patiënten werden gekozen:

figure 1

a, Schematic for ELI-002 2P vaccine components, including Amph-mKRAS G12D and G12R long peptide antigens and Amph-CpG-7909 TLR9 agonist. PEG, polyethylene glycol. b, Stepwise schematic for Amph-directed lymph-node-targeted biodistribution mechanism using albumin ‘hitchhiking’: (1) subcutaneous Amph injection, followed by (2) lipid-mediated non-covalent molecular association of Amph vaccines with tissue-resident endogenous albumin, resulting in (3) preferential absorption into lymphatics and accumulation through afferent lymph flow into draining lymph nodes and, finally, (4) uptake of Amph vaccines by lymph-node-resident APCs to induce antigen presentation and coordinated co-stimulation of cognate T cells. c, CONSORT diagram. Patients were enrolled into five successive cohorts with progressively increasing doses of Amph-CpG-7909 with a fixed dose of Amph-Peptides 2P. Graphical elements from a and b were adapted from previous publications under a Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/) (refs. 57,58).

Alvleesklierkanker en vormen van darmkanker zijn vaak KRAS-gemuteerd en zijn meestal ongeneeslijk wanneer er een recidief optreedt met dezelfde tumor-DNA mutatie of tumoreiwit expressie na een (chemo) behandeling met als doel genezing.

Uit dierstudies is gebleken dat het kankervaccin ELI-002 2P de behandeling verbetert bij uitzaaiingen in de lymfeklieren en de immuunrespons met behulp van amfifiele (Amph) modificatie van G12D- en G12R-mutante KRAS (mKRAS) peptiden (Amph-Peptides-2P) indien gegeven samen met Amph-CpG-7909 (CpG-oligonucleotide-adjuvans).

De onderzoekers van de studie zagen deze onderstaande resultaten, zie grafieken onder Fig. 3a en uitgebreide data Fig. 3:

  • Directe ex vivo mKRAS-specifieke T-celreacties werden waargenomen bij 21 van de 25 patiënten (84%; 59% zowel CD4+ als CD8+);
  • tumorbiomarkerreacties werden waargenomen bij 21 van de 25 patiënten (84%);
  • klaring van biomarkers werd waargenomen bij zes van de 25 patiënten (24%; drie alvleesklierkankerpatiënten en drie darmkankerpatiënten);
  • en de mediane recidiefvrije tijd (RFS) was 16,33 maanden.
  • De werkzaamheid correleerde met T-celresponsen boven of onder de mediaan-voudige toename ten opzichte van de uitgangswaarde (12,75-voudig): de mediane reductie van de tumorbiomarker was -76,0% versus -10,2% (P < 0,0014), en de mediane recidiefvrije tijd (RFS) werd niet bereikt versus 4,01 maanden ( risicoratio = 0,14; P = 0,0167).

De conclusie van de onderzoekers: ELI-002 2P was veilig en stimuleerde aanzienlijke T-celreacties bij patiënten met voor immuuntherapie ongevoelige KRAS-gemuteerde tumoren.

(Fase II gerandomiseerde studie is reeds gestart met de volgende KRAS mutaties: G12D, G12R, G12V, G12A, G12C, G12S, G13D).  Zie dit studieprotocol

Het originele studierapport van de fase I studie is in Nature gepubliceerd en vrij in te zien of te downloaden:

Lymph-node-targeted, mKRAS-specific amphiphile vaccine in pancreatic and colorectal cancer: the phase 1 AMPLIFY-201 trial

Nature Medicine (2024)Cite this article



Abstract

Pancreatic and colorectal cancers are often KRAS mutated and are incurable when tumor DNA or protein persists or recurs after curative intent therapy. Cancer vaccine ELI-002 2P enhances lymph node delivery and immune response using amphiphile (Amph) modification of G12D and G12R mutant KRAS (mKRAS) peptides (Amph-Peptides-2P) together with CpG oligonucleotide adjuvant (Amph-CpG-7909). We treated 25 patients (20 pancreatic and five colorectal) who were positive for minimal residual mKRAS disease (ctDNA and/or serum tumor antigen) after locoregional treatment in a phase 1 study of fixed-dose Amph-Peptides-2P and ascending-dose Amph-CpG-7909; study enrollment is complete with patient follow-up ongoing. Primary endpoints included safety and recommended phase 2 dose (RP2D). The secondary endpoint was tumor biomarker response (longitudinal ctDNA or tumor antigen), with exploratory endpoints including immunogenicity and relapse-free survival (RFS). No dose-limiting toxicities were observed, and the RP2D was 10.0 mg of Amph-CpG-7909. Direct ex vivo mKRAS-specific T cell responses were observed in 21 of 25 patients (84%; 59% both CD4+ and CD8+); tumor biomarker responses were observed in 21 of 25 patients (84%); biomarker clearance was observed in six of 25 patients (24%; three pancreatic and three colorectal); and the median RFS was 16.33 months. Efficacy correlated with T cell responses above or below the median fold increase over baseline (12.75-fold): median tumor biomarker reduction was −76.0% versus −10.2% (P < 0.0014), and the median RFS was not reached versus 4.01 months (hazard ratio = 0.14; P = 0.0167). ELI-002 2P was safe and induced considerable T cell responses in patients with immunotherapy-recalcitrant KRAS-mutated tumors. ClinicalTrials.gov identifier: NCT04853017.

Development of ELI-002 is proceeding with a phase 1 and randomized phase 2 study () of a seven-peptide formulation (ELI-002 7P: KRAS/NRAS G12D, R, V, S, A, C and G13D). This will offer additional opportunities to evaluate the activity of Amph vaccines in malignancies driven by a broad spectrum of KRAS mutations.

Data availability

Requests must be made to datarequest@elicio.com, with responses provided within 30 d of request. To ensure that data sharing is consistent with the underlying study consent, de-identified patient data that can be shared will be done under data transfer agreements. Investigators and institutions who agree to the terms of the data transfer agreement, which will include, but will not be limited to, terms to address the use of these data for the purposes of a specific project and for research purposes only, to prohibit attempts to re-identify the data and to protect the confidentiality of the data, will be granted access to the data. Elicio Therapeutics will then facilitate the transfer of the requested de-identified data to the requestor using secure electronic data transmission. The data will then be available for up to 12 months.

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Acknowledgements

The study was sponsored and funded by Elicio Therapeutics. We thank the patients and their caregivers and families for their participation in this study; the physicians, nurses and site staff who cared for the patients and supported the study; and D. M. Lidgate for expert medical writing assistance. Employees of Elicio Therapeutics received salaries for their contributions to the study. Aside from grants to their institutions, no other authors received specific funding for this work.

Author information

Authors and Affiliations

  1. The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shubham Pant

  2. University of California, Los Angeles, Los Angeles, CA, USA

    Zev A. Wainberg

  3. Massachusetts General Hospital, Boston, MA, USA

    Colin D. Weekes

  4. University of Iowa, Iowa City, IA, USA

    Muhammad Furqan & Pashtoon M. Kasi

  5. Northwell Health, Lake Success, NY, USA

    Craig E. Devoe

  6. University of Colorado School of Medicine, Aurora, CO, USA

    Alexis D. Leal

  7. City of Hope, Duarte, CA, USA

    Vincent Chung

  8. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Olca Basturk & Eileen M. O’Reilly

  9. Elicio Therapeutics, Boston, MA, USA

    Haley VanWyk, Amy M. Tavares, Lochana M. Seenappa, James R. Perry, Thian Kheoh, Lisa K. McNeil, Esther Welkowsky, Peter C. DeMuth & Christopher M. Haqq

Contributions

C.M.H., E.W., P.C.D. and L.K.M. conceived the clinical trial concept. S.P., E.O.R., Z.W., C.W., M.F., P.K., C.D., A.L. and V.C. enrolled patients to the clinical trial, evaluated toxicity and participated in critical discussions and in manuscript writing and editing. O.B. performed the pathology assessments. H.V., A.T., L.M.S., J.R.P. and L.K.M. performed the immunological assays. L.K.M., T.K. and P.C.D. conducted formal analysis, data visualization, writing—original draft and writing—review and editing. E.W. obtained resources, managed data, performed project administration and performed writing—review and editing. P.C.D. and C.M.H contributed to writing—original draft, writing—review and editing, funding acquisition, formal analysis and data curation.

Corresponding authors

Correspondence to Shubham Pant, Christopher M. Haqq or Eileen M. O’Reilly.

Ethics declarations

Competing interests

S.P. reports clinical research funding to institution from Arqule, Bristol Myers Squibb, Eli Lilly, Elicio Therapeutics, Holy Stone Healthcare, Ipsen, Mirati Therapeutics, Novartis, Rgenix, Sanofi-Aventis, Xencor, Astellas, Framewave, 4D Pharma, Boehringer Ingelheim, NGM Biopharmaceuticals, Janssen, Arcus Biosciences, BioNTech, Zymeworks and Pfizer. S.P. also reports consultant/advisory fees from Zymeworks, Ipsen, Novartis, Janssen and Boehringer Ingelheim. Z.A.W. has received consultant/advisory fees from Lilly Oncology, AstraZeneca, Merck, Daiichi Sankyo, Macrogenics, Amgen, Bristol Myers Squibb, Astellas, Ipsen, Arcus, Novartis, Roche, Seagen and Pfizer and has received research funding (institutional) from Elicio Therapeutics, Arcus, Plexxikon, Novartis and Merck. C.D.W. reports research funding from Elicio Therapeutics, Novartis, Actuate Therapeutics, Merck, AstraZeneca and Mirati and advisory board relationships with Ipsen, Actuate Therapeutics and Genentech. M.F. has received research funding (institutional) from AstraZeneca, Bristol Myers Squibb, Eli Lilly, Merck, Novartis, Pfizer, Roche, Genmab, Elicio Therapeutics, Mirati, Amgen, Replimmune, Checkmate Pharmaceuticals, Gilead, GlaxoSmithKline, Immunocore, Seagen, Tesaro and Abbvie and has been on advisory boards for Abbvie, Beigene, Jazz Pharmaceuticals, Mirati and AstraZeneca. P.M.K. reports a consultancy/advisory board relationship with Elicio (scientific advisory board member/stock ownership); consultancy/advisory board relationships with Guardant Health, Illumina, Natera, Foundation Medicine, Daichi Sankyo, Tempus, Bayer, MSD Oncology/Merck, Delcath Systems, QED Therapeutics, Taiho Oncology (self/institution), Exact Sciences, Eisai, BostonGene, Neogenomics, Saga Diagnostics, Servier, Seagen, Eli Lilly and Ipsen (to institution); and research funding/trial support from Merck (to institution), Novartis (to institution), Agenus Bio (to institution), Boston Scientific (to institution), Tersera (to institution) and Advanced Accelerator Applications as well as a travel grant for IIT from AstraZeneca. C.E.D. reports research funding from Elicio Therapeutics. A.D.L. reports institutional contracts with Elicio Therapeutics, Bristol Myers Squibb, Exelixis, Arrys Therapeutics, Hutchison Medipharma, Corcept Therapeutics, Conjupro Biotherapeutics and AbbVie for trials where she is the local principal investigator. She serves as Pancreatic Cancer/Neuroendocrine Co-Chair on the Elsevier ClinicalPath Oncology Committee. V.C. has held a consulting or advisory role at Ispen, Gristone Oncology, Westwood Bioscience and Apeiron Biologics; he has been on the speakers’ bureau for Ipsen and Celgene; and he has received research funding from Elicio Therapeutics, Roche and Merck. O.B. reports no relevant disclosures. H.V., L.M.S., A.M.T., J.R.P., E.W., L.K.M., P.C.D., T.K. and C.M.H. are current or former employees of Elicio Therapeutics and, as such, receive salary and benefits, including ownership of stock and stock options, from the company. L.K.M., P.C.D. and C.M.H. have amphiphile vaccine patents pending to Elicio Therapeutics. E.M.O. reports relationships with Rafael Therapeutics (DSMB); Seagen, Boehringer Ingelheim, BioNTech, Ipsen, Merck, Silenseed, Novartis, AstraZeneca, BioSapien, Thetis and Autem, Tempus (consulting/advisory relationship); Agios, Genentech/Roche, Eisai, Zymeworks (spouse: consulting/advisory relationship); and Genentech/Roche, Celgene/Bristol Myers Squibb, BioNTech, AstraZeneca, Arcus, Elicio Therapeutics, Parker Institute, Pertzye and NCI/NIH (research funding).

KRAS gemuteerde solide tumoren, Kankervaccin ELI-002 2P, KRAS G12D KRAS G12R NRAS G12D NRAS G12R, G13D, immuuntherapie, AMPLIFY-201, alvleesklierkanker, darmkanker


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