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Ahluwalia MS, Reardon DA, Abad AP, Curry WT, Wong ET, Figel SA, Mechtler LL, Peereboom DM, Hutson AD, Withers HG, Liu S, Belal AN, Qiu J, Mogensen KM, Dharma SS, Dhawan A, Birkemeier MT, Casucci DM, Ciesielski MJ, Fenstermaker RA. Phase IIa Study of SurVaxM Plus Adjuvant Temozolomide for Newly Diagnosed Glioblastoma. J Clin Oncol 2023; 41:1453-1465. [PMID: 36521103 PMCID: PMC9995096 DOI: 10.1200/jco.22.00996] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/16/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE 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). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | - David A. Reardon
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Ajay P. Abad
- Department of Neuro-oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - William T. Curry
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Eric T. Wong
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sheila A. Figel
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- MimiVax LLC, Buffalo, NY
| | - Laszlo L. Mechtler
- Department of Neuro-oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Alan D. Hutson
- Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Henry G. Withers
- Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Song Liu
- Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Ahmed N. Belal
- Department of Radiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Jingxin Qiu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Kathleen M. Mogensen
- Department of Neuro-oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Sanam S. Dharma
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Andrew Dhawan
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | - Danielle M. Casucci
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- MimiVax LLC, Buffalo, NY
| | - Michael J. Ciesielski
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- MimiVax LLC, Buffalo, NY
| | - Robert A. Fenstermaker
- Department of Neurosurgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY
- MimiVax LLC, Buffalo, NY
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