Abstract
Lung cancer has long been regarded as a poor candidate for immunotherapy, because it has a relatively low content of tumor-infiltrating lymphocytes compared with, for example, melanoma. However, new developments in immunotherapy are about to change this situation. Therapeutic vaccines are different from the well-known prophylactic vaccines, in that they are designed to treat patients already suffering from a disease instead of preventing the disease in healthy individuals. Several therapeutic vaccines are in late-stage clinical development for non-small-cell lung cancer (NSCLC). These vaccines use different approaches, including peptides, cell lines or viral vectors, and are used in different settings within the pathology. Some are given as monotherapy, whereas others are combined with traditional therapy for this indication. More recently developed, and very promising, are the checkpoint-blocking antibodies. It is likely that in the future several approaches, including immunotherapy products, will be combined in the evolving standard of care for lung cancer. This review gives a summary of the candidate immunotherapy products currently in late-stage clinical development for NSCLC.
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References
Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346(2):92–8.
Sandler A, Gray R, Perry MC, Brahmer J, Schiller JH, Dowlati A, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355(24):2542–50.
Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353(2):123–32.
Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361(10):947–57.
Gerard C, Debruyne C. Immunotherapy in the landscape of new targeted treatments for non-small cell lung cancer. Mol Oncol. 2009;3(5–6):409–24. doi:10.1016/j.molonc.2009.09.001.
O’Mahony D, Kummar S, Gutierrez ME. Non-small-cell lung cancer vaccine therapy: a concise review. J Clin Oncol. 2005;23(35):9022–8.
Butts C, Murray N, Maksymiuk A, Goss G, Marshall E, Soulieres D, et al. Randomized phase IIB trial of BLP25 liposome vaccine in stage IIIB and IV non-small-cell lung cancer. J Clin Oncol. 2005;23(27):6674–81.
Butts C, Socinski M, Mitchell P, Thatcher N, Havel L, Krzakowski M., et al. START: A phase III study of L-BLP25 cancer immunotherapy for unresectable stage III non-small cell lung cancer. J Clin Oncol. 2013;31, 2013 (suppl; abstr 7500).
Merck Serono Announces Decision to Continue the Development of Tecemotide in Stage III Non-Small Cell Lung Cancer. 2013.
Vansteenkiste J, Zielinski M, Linder A, Dahabreh J, Gonzalez EE, Malinowski W, et al. Adjuvant MAGE-A3 immunotherapy in resected non-small-cell lung cancer: phase II randomized study results. J Clin Oncol. 2013;31(19):2396–403. doi:10.1200/JCO.2012.43.7103.
Tyagi P, Mirakhur B. MAGRIT: the largest-ever phase III lung cancer trial aims to establish a novel tumor-specific approach to therapy. Clin Lung Cancer. 2009;10(5):371–4. doi:10.3816/CLC.2009.n.052.
Barve M, Bender J, Senzer N, Cunningham C, Greco FA, McCune D, et al. Induction of immune responses and clinical efficacy in a phase II trial of IDM-2101, a 10-epitope cytotoxic T-lymphocyte vaccine, in metastatic non-small-cell lung cancer. J Clin Oncol. 2008;26(27):4418–25. doi:10.1200/JCO.2008.16.6462.
Brunsvig PF, Kyte JA, Kersten C, Sundstrom S, Moller M, Nyakas M, et al. Telomerase peptide vaccination in NSCLC: a phase II trial in stage III patients vaccinated after chemoradiotherapy and an 8-year update on a phase I/II trial. Clin Cancer Res. 2011;17(21):6847–57. doi:10.1158/078-0432.CCR-11-1385.
Nemunaitis J, Nemunaitis M, Senzer N, Snitz P, Bedell C, Kumar P, et al. Phase II trial of Belagenpumatucel-L, a TGF-beta2 antisense gene modified allogeneic tumor vaccine in advanced non small cell lung cancer (NSCLC) patients. Cancer Gene Ther. 2009;16(8):620–4. doi:10.1038/cgt.2009.15. Epub Mar 13.
Nemunaitis J, Dillman RO, Schwarzenberger PO, Senzer N, Cunningham C, Cutler J, et al. Phase II study of belagenpumatucel-L, a transforming growth factor beta-2 antisense gene-modified allogeneic tumor cell vaccine in non-small-cell lung cancer. J Clin Oncol. 2006;24(29):4721–30.
Giaccone G, Bazhenova L, Nemunaitis J. A phase III study of belagenpumatucel-L therapeutic tumor cell vaccine for non-small cell lung cancer (NSCLC). The European Cancer Congress. 2013;7(5):159–63.
D’Angelo S, Park B, Krug L. Immunogenicity of GI-4000 vaccine in adjuvant consolidation therapy following definitive treatment in patients with stage I-III adenocarcinoma of the lung with G12C, G12D, or G12V KRAS mutations. J Clin Oncol. 2011;29(20):2787–94.
Ramlau R, Quoix E, Rolski J, Pless M, Lena H, Levy E, et al. A phase II study of Tg4010 (Mva-Muc1-Il2) in association with chemotherapy in patients with stage III/IV Non-small cell lung cancer. J Thorac Oncol. 2008;3(7):735–44.
Quoix E, Ramlau R, Westeel V, Papai Z, Madroszyk A, Riviere A, et al. Therapeutic vaccination with TG4010 and first-line chemotherapy in advanced non-small-cell lung cancer: a controlled phase 2B trial. The Lancet Oncology. 2011;12(12):1125–33. doi:10.1016/S1470-2045(11)70259-5.
Parikh PM, Vaid A, Advani SH, Digumarti R, Madhavan J, Nag S, et al. Randomized, double-blind, placebo-controlled phase II study of single-agent oral talactoferrin in patients with locally advanced or metastatic non-small-cell lung cancer that progressed after chemotherapy. Talactoferrin alfa versus placebo in patients with refractory advanced non-small-cell lung cancer (FORTIS-M trial). J Clin Oncol. 2011;29(31):4129–36. doi:10.1200/JCO.2010.34.4127.
Ramalingam S, Crawford J, Chang A, Manegold C, Perez-Soler R, Douillard JY, et al. Talactoferrin alfa versus placebo in patients with refractory advanced non-small-cell lung cancer (FORTIS-M trial). Ann Oncol. 2013;24(11):2875–80. doi:10.1093/annonc/mdt371. Epub 2013 Sep 19.
Agennix Reports Results of FORTIS-M Phase III Trial with Talactoferrin Alfa in Non-small Cell Lung Cancer. 2012.
Zielinski C, Knapp S, Mascaux C, Hirsch F. Rationale for targeting the immune system through checkpoint molecule blockade in the treatment of non-small-cell lung cancer. Ann Oncol. 2013;24(5):1170–9. doi:10.093/annonc/mds647.
Lynch TJ, Bondarenko I, Luft A, Serwatowski P, Barlesi F, Chacko R, et al. Ipilimumab in combination with paclitaxel and carboplatin as first-line treatment in stage IIIB/IV non-small-cell lung cancer: results from a randomized, double-blind, multicenter phase II study. J Clin Oncol. 2012;30(17):2046–54. doi:10.1200/JCO.2011.38.4032.
Spigel DR, Socinski MA. Rationale for chemotherapy, immunotherapy, and checkpoint blockade in SCLC: beyond traditional treatment approaches. J Thorac Oncol. 2013;8(5):587–98. doi:10.1097/JTO.0b013e318286cf88.
Garon E, Balmanoukian A, Hamid O. Preliminary clinical safety and activity of MK-3475 monotherapy for the treatment of previously treated patients with non-small cell lung cancer (NSCLC). Journal of Thoracic Oncology. 2013;8, Supplement 2.
Topalian SL, Hodi FS, Brahmer JR, Gettinger SN, Smith DC, McDermott DF, et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med. 2012;366(26):2443–54. doi:10.1056/NEJMoa1200690.
Hodi F, Topalian S, Brahmer J. Survival and long-term safety in patients (pts) with advanced solid tumors receiving nivolumab (anti-PD-1; BMS-936558; ONO-4538) The European Cancer Congress. 2013.
Brahmer JR, Tykodi SS, Chow LQ, Hwu WJ, Topalian SL, Hwu P, et al. Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med. 2012;366(26):2455–65. doi:10.1056/NEJMoa1200694.
Soria J, Cruz C, Bahleda R. Clinical activity, safety and biomarkers of PD-L1 blockade in non-small cell lung cancer (NSCLC): Additional analyses from a clinical study of the engineered antibody MPDL3280A (anti-PDL1) The European Cancer Congress. 2013.
Soria JC, Mauguen A, Reck M, Sandler AB, Saijo N, Johnson DH, et al. Systematic review and meta-analysis of randomised, phase II/III trials adding bevacizumab to platinum-based chemotherapy as first-line treatment in patients with advanced non-small-cell lung cancer. Ann Oncol. 2013;24(1):20–30. doi:10.1093/annonc/mds590.
Shaw AT, Kim DW, Nakagawa K, Seto T, Crino L, Ahn MJ, et al. Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med. 2013;368(25):2385–94. doi:10.1056/NEJMoa1214886.
Azzoli CG, Temin S, Aliff T, Baker Jr S, Brahmer J, Johnson DH, et al. Focused Update of 2009 American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer. J Clin Oncol. 2011;29(28):3825–31. doi:10.1200/JCO.2010.34.774.
Scagliotti GV, Parikh P, von Pawel J, Biesma B, Vansteenkiste J, Manegold C, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(21):3543–51.
Quoix E, Zalcman G, Oster JP, Westeel V, Pichon E, Lavolé A, et al. Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial. Lancet. 2011;378(9796):1079–88. doi:10.1016/S0140-6736(11)60780-0.
Lilenbaum R, Villaflor VM, Langer C, O’Byrne K, O’Brien M, Ross HJ, et al. Single-agent versus combination chemotherapy in patients with advanced non-small cell lung cancer and a performance status of 2: prognostic factors and treatment selection based on two large randomized clinical trials. J Thorac Oncol. 2009;4(7):869–74. doi:10.1097/JTO.0b013e3181a9a020.
Ulloa-Montoya F, Louahed J, Dizier B, Gruselle O, Spiessens B, Lehmann FF, et al. Predictive gene signature in MAGE-A3 antigen-specific cancer immunotherapy. J Clin Oncol. 2013;31(19):2388–95. doi:10.1200/JCO.2012.44.3762.
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Conflicts of Interest
Jean-Marc Limacher is a permanent employee of Transgene. Elisabeth Quoix is the Principal Investigator of the trials of Transgene vaccine for lung cancer and have had some advisory activities related to Transgene. There is no monetary transaction regarding the article.
Human and Animal Rights and Informed Consent
The paper contains result of clinical studies (those with TG4010) for which Dr. Elisabeth Quoix, M.D. has been an investigator and Dr. Jean-Marc Limacher, M.D. as the medical lead from the industrial side. The studies were performed after approval by the appropriate Institutional Review Boards.
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Quoix, E., Limacher, J.M. Immunotherapy for non-small-cell lung cancer: current approaches. Curr Respir Care Rep 3, 19–25 (2014). https://doi.org/10.1007/s13665-014-0072-6
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DOI: https://doi.org/10.1007/s13665-014-0072-6