Phase I Trial of Recombinant Modified Vaccinia Ankara Encoding Epstein–Barr Viral Tumor Antigens in Nasopharyngeal Carcinoma Patients

American Association for Cancer Research (AACR) - Tập 73 Số 6 - Trang 1676-1688 - 2013
Edwin P. Hui1,2,3,4, Graham S. Taylor1,2,3,4, Hui Jia1,2,3,4, Brigette Ma1,2,3,4, Stephen L. Chan1,2,3,4, Rosalie Ho1,2,3,4, Wai-Lap Wong1,2,3,4, Steven Ray Wilson1,2,3,4, Benjamin F. Johnson1,2,3,4, Ceri Edwards1,2,3,4, Deborah Stocken1,2,3,4, Alan B. Rickinson1,2,3,4, Neil Steven1,2,3,4, Anthony T.�C. Chan1,2,3,4
1Authors' Affiliations: 1Department of Clinical Oncology, State Key Laboratory in Oncology in South China, Sir YK Pao Center for Cancer, Hong Kong Cancer Institute and Li Ka Shing Institute for Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong; 2Cancer Research UK Centre, School of Cancer Sciences, University of Birmingham; 3Health Protection Agency, West Midlands Public Health Laboratory, Heart of England Foundation Trust, Birmingham; 4Section of Virology, Imperial College, London; and 5Cancer Research UK Drug Development Office, London, United Kingdom
2Cancer Research UK Centre, School of Cancer Sciences, University of Birmingham
3Cancer Research UK Drug Development Office, London, United Kingdom
4Section of Virology, Imperial College, London

Tóm tắt

Abstract Epstein–Barr virus (EBV) is associated with several malignancies including nasopharyngeal carcinoma, a high incidence tumor in Chinese populations, in which tumor cells express the two EBV antigens EB nuclear antigen 1 (EBNA1) and latent membrane protein 2 (LMP2). Here, we report the phase I trial of a recombinant vaccinia virus, MVA-EL, which encodes an EBNA1/LMP2 fusion protein designed to boost T-cell immunity to these antigens. The vaccine was delivered to Hong Kong patients with nasopharyngeal carcinoma to determine a safe and immunogenic dose. The patients, all in remission more than 12 weeks after primary therapy, received three intradermal MVA-EL vaccinations at three weekly intervals, using five escalating dose levels between 5 × 107 and 5 × 108 plaque-forming unit (pfu). Blood samples were taken during prescreening, immediately before vaccination, one week afterward and at intervals up to one year later. Immunogenicity was tested by IFN-γ ELIspot assays using complete EBNA1 and LMP2 15-mer peptide mixes and known epitope peptides relevant to patient MHC type. Eighteen patients were treated, three per dose level one to four and six at the highest dose, without dose-limiting toxicity. T-cell responses to one or both vaccine antigens were increased in 15 of 18 patients and, in many cases, were mapped to known CD4 and CD8 epitopes in EBNA1 and/or LMP2. The range of these responses suggested a direct relationship with vaccine dose, with all six patients at the highest dose level giving strong EBNA1/LMP2 responses. We concluded that MVA-EL is both safe and immunogenic, allowing the highest dose to be forwarded to phase II studies examining clinical benefit. Cancer Res; 73(6); 1676–88. ©2012 AACR.

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Tài liệu tham khảo

Hislop, 2007, Cellular responses to viral infection in humans: lessons from Epstein–Barr virus, Annu Rev Immunol, 25, 587, 10.1146/annurev.immunol.25.022106.141553

Young, 2004, Epstein–Barr virus: 40 years on, Nat Rev Cancer, 4, 757, 10.1038/nrc1452

Parkin, 2006, The global health burden of infection-associated cancers in the year 2002, Int J Cancer, 118, 3030, 10.1002/ijc.21731

Baujat, 2006, Chemotherapy as an adjunct to radiotherapy in locally advanced nasopharyngeal carcinoma, Cochrane Database Syst Rev, 10.1002/14651858.CD004329.pub2

Lu, 2009, Concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: a treatment paradigm also applicable to patients in Southeast Asia, Cancer Treat Rev, 35, 345, 10.1016/j.ctrv.2009.01.002

Bensouda, 2011, Treatment for metastatic nasopharyngeal carcinoma, Eur Ann Otorhinolaryngol Head Neck Dis, 128, 79, 10.1016/j.anorl.2010.10.003

Razak, 2010, Nasopharyngeal carcinoma: the next challenges, Eur J Cancer, 46, 1967, 10.1016/j.ejca.2010.04.004

Brooks, 1992, Epstein–Barr virus latent gene transcription in nasopharyngeal carcinoma cells: coexpression of EBNA1, LMP1, and LMP2 transcripts, J Virol, 66, 2689, 10.1128/jvi.66.5.2689-2697.1992

Bell, 2006, Analysis of Epstein–Barr virus latent gene expression in endemic Burkitt's lymphoma and nasopharyngeal carcinoma tumour cells by using quantitative real-time PCR assays, J Gen Virol, 87, 2885, 10.1099/vir.0.81906-0

Lin, 2002, Immunization with Epstein–Barr Virus (EBV) peptide-pulsed dendritic cells induces functional CD8+ T-cell immunity and may lead to tumor regression in patients with EBV-positive nasopharyngeal carcinoma, Cancer Res, 62, 6952

Comoli, 2005, Cell therapy of stage IV nasopharyngeal carcinoma with autologous Epstein–Barr virus-targeted cytotoxic T lymphocytes, J Clin Oncol, 23, 8942, 10.1200/JCO.2005.02.6195

Louis, 2010, Adoptive transfer of EBV-specific T cells results in sustained clinical responses in patients with locoregional nasopharyngeal carcinoma, J Immunother, 33, 983, 10.1097/CJI.0b013e3181f3cbf4

Louis, 2009, Enhancing the in vivo expansion of adoptively transferred EBV-specific CTL with lymphodepleting CD45 monoclonal antibodies in NPC patients, Blood, 113, 2442, 10.1182/blood-2008-05-157222

Straathof, 2005, Treatment of nasopharyngeal carcinoma with Epstein–Barr virus–specific T lymphocytes, Blood, 105, 1898, 10.1182/blood-2004-07-2975

Smith, 2012, Effective treatment of metastatic forms of Epstein–Barr virus-associated nasopharyngeal carcinoma with a novel adenovirus-based adoptive immunotherapy, Cancer Res, 72, 1116, 10.1158/0008-5472.CAN-11-3399

Taylor, 2004, Dual stimulation of Epstein–Barr Virus (EBV)-specific CD4+- and CD8+-T-cell responses by a chimeric antigen construct: potential therapeutic vaccine for EBV-positive nasopharyngeal carcinoma, J Virol, 78, 768, 10.1128/JVI.78.2.768-778.2004

Voo, 2004, Evidence for the presentation of major histocompatibility complex class I-restricted Epstein–Barr virus nuclear antigen 1 peptides to CD8+ T lymphocytes, J Exp Med, 199, 459, 10.1084/jem.20031219

Tellam, 2004, Endogenous presentation of CD8+ T cell epitopes from Epstein–Barr virus-encoded nuclear antigen 1, J Exp Med, 199, 1421, 10.1084/jem.20040191

Lee, 2004, CD8 T cell recognition of endogenously expressed Epstein–Barr virus nuclear antigen 1, J Exp Med, 199, 1409, 10.1084/jem.20040121

Smith, 2005, Recombinant modified vaccinia Ankara primes functionally activated CTL specific for a melanoma tumor antigen epitope in melanoma patients with a high risk of disease recurrence, Int J Cancer, 113, 259, 10.1002/ijc.20569

Dangoor, 2010, Clinical and immunological responses in metastatic melanoma patients vaccinated with a high-dose poly-epitope vaccine, Cancer Immunol Immunother, 59, 863, 10.1007/s00262-009-0811-7

Fogg, 2009, Decreased EBNA-1-specific CD8+ T cells in patients with Epstein–Barr virus-associated nasopharyngeal carcinoma, Proc Natl Acad Sci U S A, 106, 3318, 10.1073/pnas.0813320106

Lin, 2008, CD4 and CD8 T cell responses to tumour-associated Epstein–Barr virus antigens in nasopharyngeal carcinoma patients, Cancer Immunol Immunother, 57, 963, 10.1007/s00262-007-0427-8

Sun, 2003, Defective CD8 T cell memory following acute infection without CD4 T cell help, Science, 300, 339, 10.1126/science.1083317

Shedlock, 2003, Requirement for CD4 T cell help in generating functional CD8 T cell memory, Science, 300, 337, 10.1126/science.1082305

Khanolkar, 2004, CD4 T cell-dependent CD8 T cell maturation, J Immunol, 172, 2834, 10.4049/jimmunol.172.5.2834

Straathof, 2005, Characterization of latent membrane protein 2 specificity in CTL lines from patients with EBV-positive nasopharyngeal carcinoma and lymphoma, J Immunol, 175, 4137, 10.4049/jimmunol.175.6.4137

Tsang, 2006, CD4+ T-cell responses to Epstein–Barr virus nuclear antigen EBNA1 in Chinese populations are highly focused on novel C-terminal domain-derived epitopes, J Virol, 80, 8263, 10.1128/JVI.00400-06

Lee, 2000, CTL control of EBV in nasopharyngeal carcinoma (NPC): EBV-specific CTL responses in the blood and tumors of NPC patients and the antigen-processing function of the tumor cells, J Immunol, 165, 573, 10.4049/jimmunol.165.1.573

Chan, 2002, Circulating EBV DNA as a tumor marker for nasopharyngeal carcinoma, Semin Cancer Biol, 12, 489, 10.1016/S1044579X02000913

Lo, 2000, Kinetics of plasma Epstein–Barr virus DNA during radiation therapy for nasopharyngeal carcinoma, Cancer Res, 60, 2351

Khanna, 1998, Molecular characterization of antigen-processing function in nasopharyngeal carcinoma (NPC): evidence for efficient presentation of Epstein–Barr virus cytotoxic T-cell epitopes by NPC cells, Cancer Res, 58, 310

Yao, 2000, Heterogeneity of HLA and EBER expression in Epstein–Barr virus-associated nasopharyngeal carcinoma, Int J Cancer, 88, 949, 10.1002/1097-0215(20001215)88:6<949::AID-IJC18>3.0.CO;2-6

Li, 2007, Functional inactivation of EBV-specific T-lymphocytes in nasopharyngeal carcinoma: implications for tumor immunotherapy, PLoS ONE, 2, e1122, 10.1371/journal.pone.0001122

Harrop, 2006, Vaccination of colorectal cancer patients with modified vaccinia Ankara delivering the tumor antigen 5T4 (TroVax) induces immune responses which correlate with disease control: a phase I/II trial, Clin Cancer Res, 12, 3416, 10.1158/1078-0432.CCR-05-2732

Bejon, 2006, Safety profile of the viral vectors of attenuated fowlpox strain FP9 and modified vaccinia virus Ankara recombinant for either of 2 preerythrocytic malaria antigens, ME-TRAP or the circumsporozoite protein, in children and adults in Kenya, Clin Infect Dis, 42, 1102, 10.1086/501459

Dunachie, 2006, A DNA prime-modified vaccinia virus ankara boost vaccine encoding thrombospondin-related adhesion protein but not circumsporozoite protein partially protects healthy malaria-naive adults against Plasmodium falciparum sporozoite challenge, Infect Immun, 74, 5933, 10.1128/IAI.00590-06

Harrop, 2008, Vaccination of colorectal cancer patients with TroVax given alongside chemotherapy (5-fluorouracil, leukovorin and irinotecan) is safe and induces potent immune responses, Cancer Immunol Immunother, 57, 977, 10.1007/s00262-007-0428-7

Ramlau, 2008, 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, 3, 735, 10.1097/JTO.0b013e31817c6b4f

McShane, 2004, Recombinant modified vaccinia virus Ankara expressing antigen 85A boosts BCG-primed and naturally acquired antimycobacterial immunity in humans, Nat Med, 10, 1240, 10.1038/nm1128

McConkey, 2003, Enhanced T-cell immunogenicity of plasmid DNA vaccines boosted by recombinant modified vaccinia virus Ankara in humans, Nat Med, 9, 729, 10.1038/nm881

Bollard, 2004, Cytotoxic T lymphocyte therapy for Epstein–Barr virus+ Hodgkin's disease, J Exp Med, 200, 1623, 10.1084/jem.20040890

Fox, 2010, A novel latent membrane 2 transcript expressed in Epstein–Barr virus-positive NK- and T-cell lymphoproliferative disease encodes a target for cellular immunotherapy, Blood, 116, 3695, 10.1182/blood-2010-06-292268

Lau, 2007, Increase in circulating Foxp3+CD4+CD25(high) regulatory T cells in nasopharyngeal carcinoma patients, Br J Cancer, 96, 617, 10.1038/sj.bjc.6603580