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A phase I study of recombinant (r) vaccinia-CEA(6D)-TRICOM and rFowlpox-CEA(6D)-TRICOM vaccines with GM-CSF and IFN-α-2b in patients with CEA-expressing carcinomas

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Abstract

Prime-boost vaccination with recombinant (r) vaccinia(V)-CEA(6D)-TRICOM (triad of co-stimulatory molecules B7.1, ICAM-1 and LFA-3) and rFowlpox(F)-CEA(6D)-TRICOM infect antigen-presenting cells and direct expression of co-stimulatory molecules. We hypothesized that co-administration of vaccine with GM-CSF and interferon alpha (IFN-α) would have efficacy in CEA-expressing cancers. Patients with CEA-expressing cancers received the rV-CEA(6D)-TRICOM vaccine subcutaneously (s.c.) on day 1 followed by GM-CSF s.c. to the injection site on days 1–4. In Cycle 1, patients received thrice weekly s.c. injections of IFN-α-2b the week after rV-CEA(6D)-TRICOM. In Cycles 2–4, patients received thrice weekly s.c. injections of IFN-α-2b the same week that rF-CEA(6D)-TRICOM was given. The first cohort received no IFN followed by dose escalation of IFN-α in subsequent cohorts. Thirty-three patients were accrued (mean 59.8 years). Grade 3 toxicities included fatigue and hyperglycemia. Grade 4–5 adverse events (unrelated to treatment) were confusion (1), elevated aspartate transaminase (AST)/alanine transaminase (ALT) (1), and sudden death (1). No patients had a partial response, and eight patients exhibited stable disease of ≥3 months. Median progression-free survival and overall survival (OS) were 1.8 and 6.3 months, respectively. Significantly higher serum CD27 levels were observed after vaccine therapy (p = 0.006 post 1–2 cycles, p = 0.003 post 3 cycles, p = 0.03 post 4–7 cycles) and 42 % of patients assayed developed CEA-specific T cell responses. Pre-treatment levels of myeloid-derived suppressor cells correlated with overall survival (p = 0.04). Administration of IFN-α led to significantly increased OS (p = 0.02) compared to vaccine alone. While the vaccine regimen produced no clinical responses, IFN-α administration was associated with improved survival.

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Abbreviations

AST/ALT:

Aspartate transaminase-to-alanine transaminase ratio

CEA:

Carcinoembryonic antigen

CEFT:

Mixture of cytomegalovirus, Epstein–Barr virus, influenza, and tetanus toxin

DIC:

Disseminated intravascular coagulation

DLT:

Dose-limiting toxicities

ECOG:

Eastern Cooperative Oncology Group

G-MDSC:

Granulocytic myeloid-derived suppressor cell

M-MDSC:

Monocytic myeloid-derived suppressor cell

MDSC:

Myeloid-derived suppressor cell

MTD:

Maximum tolerated dose

PFS:

Progression-free survival

PR:

Partial response

SD:

Stable disease

TAA:

Tumor-associated antigen

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Funding

This work was supported by NIH Grants: P01 CA095426 (W. Carson), P30 CA016058 (W. Carson), and T32 GM068412 (M. Duggan).

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Author notes

  1. Jacob Richards

    Present address: Food and Drug Administration, Center for Devices and Radiological Health, Silver Spring, MD, USA

Authors and Affiliations

  1. Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA

    Megan C. Duggan, Volodymyr Karpa, Elizabeth Foust, Bonnie Paul, Taylor Brooks, Susheela Tridandapani & Gregory B. Lesinski

  2. National Cancer Institute, Laboratory of Tumor Immunology and Biology, Bethesda, MD, USA

    Caroline Jochems, Renee N. Donahue, Jacob Richards & Jeffrey Schlom

  3. Division of Medical Oncology, The Ohio State University, Columbus, OH, USA

    Thomas Olencki

  4. Center for Biostatistics, The Ohio State University, Columbus, OH, USA

    Xueliang Pan

  5. Division of Surgical Oncology, The Ohio State University, N924 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA

    William E. Carson III

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  1. Megan C. Duggan
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Correspondence to William E. Carson III.

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Duggan, M.C., Jochems, C., Donahue, R.N. et al. A phase I study of recombinant (r) vaccinia-CEA(6D)-TRICOM and rFowlpox-CEA(6D)-TRICOM vaccines with GM-CSF and IFN-α-2b in patients with CEA-expressing carcinomas. Cancer Immunol Immunother 65, 1353–1364 (2016). https://doi.org/10.1007/s00262-016-1893-7

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