On November 10, 2017 Inovio Pharmaceuticals, Inc. (NASDAQ:INO) reported that two of its cancer immunotherapies demonstrated antigen-specific T-cell stimulation in phase 1 studies. INO-3112 (now called MEDI0457), an investigational T-cell activation immunotherapy that targets cancers caused by human papillomavirus (HPV) types 16 and 18 and licensed to MedImmune, the global Research and Development arm of AstraZeneca, also led to a head and neck cancer patient’s complete response when matched with a PD-1 checkpoint inhibitor (Press release, Inovio, NOV 10, 2017, View Source [SID1234521931]). In addition, INO-1400, Inovio’s investigational cancer immunotherapy targeting hTERT, which is over-expressed in a majority of cancers, generated hTERT-specific IFN-γ secreting T cells, suggesting an ability to break immune tolerance. These results were revealed at poster presentations at the Society for Immunotherapy of Cancer (SITC) (Free SITC Whitepaper) 32nd Annual Meeting starting today at National Harbor, Md.
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Dr. J. Joseph Kim, Inovio’s President and CEO, said, "This study of MEDI0457 shows efficacy signals that Inovio’s activation immunotherapy coupled with checkpoint inhibitor could have meaningful therapeutic impact, given an unusual complete response in one patient. Separately, we are evaluating our hTERT therapy, INO-1400, in nine different solid tumors including breast, lung and pancreatic cancers in a clinical study. Any success we see in our hTERT therapy gives us added confidence in our recently initiated efficacy studies combining PD-1/PD-L1 inhibitors and INO-5401, which includes three of Inovio’s top SynCon cancer antigens – hTERT, WT1, and PSMA, which are over-expressed in multiple tumor types. We look forward to sharing further data on our immunotherapies as studies progress."
In a phase 1 study of MEDI0457 in 22 HPV-positive patients with squamous cell carcinoma of the head and neck, Inovio has previously demonstrated that this cancer immunotherapy generated robust antigen-specific CD8+ killer T cell responses in both tumor tissue and peripheral blood. One patient which initially displayed a slight increase in T cell immune responses developed progressive disease at 11 months into the study and received nivolumab, a PD-1 checkpoint inhibitor. Subsequently, the patient had a sustained complete response after only four doses, and continues on therapy with no evidence of disease, 16 months after initiation of nivolumab.
Detailed immune analyses found that MEDI0457 had activated HPV16-specific CD8+ T cells in the patient and the subsequent treatment with nivolumab helped to unleash the expansion of these killer T cells, which is contributing to the sustained complete response observed in this patient. Medimmune is conducting a separate phase 1/2 trial combining its PD-L1 inhibitor (durvalumab) with MEDI0457 in HPV-associated head and neck cancer patients to evaluate the clinical efficacy of the combination treatment.
Dr. Charu Aggarwal, MD, MPH, medical oncologist and assistant professor of medicine at the hospital of the University of Pennsylvania and the principal investigator of this study, said "This observation suggests that treatment with MEDI0457 prior to PD-1 inhibition can be synergistic, and increase efficacy of checkpoint inhibitors."
In Inovio’s phase 1 dose-escalation study of its synthetic optimized DNA plasmids that target hTERT, the immunotherapies were administered via Inovio’s CELLECTRA delivery device to assess the safety, tolerability, and immune effects of INO-1400 or INO-1401 (two different versions of HTERT constructs), alone or co-administered with a plasmid encoding for IL-12 (INO-9012), in 90 patients with 9 different solid tumors. Interim results presented at the conference show positive safety and tolerability data as well as the generation of hTERT-specific IFN-γ secreting T cells, suggestive of an ability to break immune tolerance.
Dr. Robert Vonderheide, MD, DPhil, Director of the Abramson Cancer Center of the University of Pennsylvania and a principal investigator for the study, said: "If successful, this vaccine platform could represent not only a novel type of immune therapy for cancer patients, but also one day offer an opportunity for immune prevention of cancer."
High levels of human telomerase reverse transcriptase (hTERT) have been reported in many tumor types such as breast, lung, and pancreas. Inovio’s hTERT therapy may prove to be a promising immuno-oncology target for the treatment of these cancers. In 2017, over 530,000 new cases of breast, lung, or pancreatic cancers were reported in the United States and over 240,000 people died from these cancers. Despite available treatments, mortality rates remain unacceptably high in these tumor types. In addition, many existing treatment modalities are associated with significant adverse events.