Phase IIa Study of SurVaxM Plus Adjuvant Temozolomide for Newly Diagnosed Glioblastoma

Despite intensive treatment with surgery, radiation therapy, temozolomide (TMZ) chemotherapy, and tumor-treating fields, mortality of newly diagnosed glioblastoma (nGBM) remains very high. SurVaxM is a peptide vaccine conjugate that has been shown to activate the immune system against its target mol...

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Published in:	Journal of clinical oncology Vol. 41; no. 7; pp. 1453 - 1465
Main Authors:	Ahluwalia, Manmeet S, Reardon, David A, Abad, Ajay P, Curry, William T, Wong, Eric T, Figel, Sheila A, Mechtler, Laszlo L, Peereboom, David M, Hutson, Alan D, Withers, Henry G, Liu, Song, Belal, Ahmed N, Qiu, Jingxin, Mogensen, Kathleen M, Dharma, Sanam S, Dhawan, Andrew, Birkemeier, Meaghan T, Casucci, Danielle M, Ciesielski, Michael J, Fenstermaker, Robert A
Format:	Journal Article
Language:	English
Published:	United States Wolters Kluwer Health 01-03-2023
Subjects:	Adjuvants, Immunologic - therapeutic use Adult Aged Aged, 80 and over Antineoplastic Agents, Alkylating - therapeutic use Brain Neoplasms - drug therapy Female Glioblastoma - drug therapy Humans Male Middle Aged Original Reports Survivin - therapeutic use Temozolomide - therapeutic use Vaccines, Subunit - therapeutic use Young Adult
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Summary:	Despite intensive treatment with surgery, radiation therapy, temozolomide (TMZ) chemotherapy, and tumor-treating fields, mortality of newly diagnosed glioblastoma (nGBM) remains very high. SurVaxM is a peptide vaccine conjugate that has been shown to activate the immune system against its target molecule survivin, which is highly expressed by glioblastoma cells. We conducted a phase IIa, open-label, multicenter trial evaluating the safety, immunologic effects, and survival of patients with nGBM receiving SurVaxM plus adjuvant TMZ following surgery and chemoradiation (ClinicalTrials.gov identifier: NCT02455557). Sixty-four patients with resected nGBM were enrolled including 38 men and 26 women, in the age range of 20-82 years. Following craniotomy and fractionated radiation therapy with concurrent TMZ, patients received four doses of SurVaxM (500 μg once every 2 weeks) in Montanide ISA-51 plus sargramostim (granulocyte macrophage colony-stimulating factor) subcutaneously. Patients subsequently received adjuvant TMZ and maintenance SurVaxM concurrently until progression. Progression-free survival (PFS) and overall survival (OS) were reported. Immunologic responses to SurVaxM were assessed. SurVaxM plus TMZ was well tolerated with no serious adverse events attributable to SurVaxM. Of the 63 patients who were evaluable for outcome, 60 (95.2%) remained progression-free 6 months after diagnosis (prespecified primary end point). Median PFS was 11.4 months and median OS was 25.9 months measured from first dose of SurVaxM. SurVaxM produced survivin-specific CD8+ T cells and antibody/immunoglobulin G titers. Apparent clinical benefit of SurVaxM was observed in both methylated and unmethylated patients. SurVaxM appeared to be safe and well tolerated. The combination represents a promising therapy for nGBM. For patients with nGBM treated in this manner, PFS may be an acceptable surrogate for OS. A large randomized clinical trial of SurVaxM for nGBM is in progress.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.22.00996