In a phase IB trial, six treatment-naive patients with metastatic melanoma were treated with pembrolizumab and NOUS-PEV, a heterologous prime/boost vaccine based on Great Ape Adenoviral vector and Modified Vaccinia Ankara expressing up to about 60 personal 25-mer neoantigens. D’Alise and Leoni et al. observed robust neoantigen-specific CD4+ and CD8+ T cell responses targeting multiple neoantigens, and expansion of vaccine-induced neoantigen-specific TILs. Treatment was safe. One complete and 3 partial responses were reported. Low pretreatment expression of antigen processing genes was indicative of treatment failure.

Contributed by Ute Burkhardt

PURPOSE: Personalized vaccines targeting multiple neoantigens (nAgs) are a promising strategy for eliciting a diversified antitumor T cell response to overcome tumor heterogeneity. NOUS-PEV is a vector based personalized vaccine, expressing 60 nAgs and consists of priming with a non-human Great Ape Adenoviral vector (GAd20) followed by boosts with Modified Vaccinia Ankara (MVA). Here, we report data of a phase Ib trial of NOUS-PEV in combination with pembrolizumab in treatment naïve metastatic melanoma patients (NCT04990479). EXPERIMENTAL DESIGN: The feasibility of this approach was demonstrated by producing, releasing and administering to six patients 11 out of 12 vaccines within 8 weeks from biopsy collection to GAd20 administration. RESULTS: The regimen was safe, with no treatment-related serious adverse events observed and mild vaccine-related reactions. Vaccine immunogenicity was demonstrated in all evaluable patients receiving the prime/boost regimen, with detection of robust neoantigen specific immune responses to multiple neoantigens comprising both CD4 and CD8 T cells. Expansion and diversification of vaccine-induced TCR clonotypes was observed in the post-treatment biopsies of patients with clinical response providing evidence of tumor infiltration by vaccine-induced neoantigen-specific T cell. CONCLUSIONS: These findings indicate the ability of NOUS-PEV to amplify and broaden the repertoire of tumor reactive T cells to empower a diverse, potent and durable antitumor immune response. Finally, a gene signature indicative for reduced presence of activated T cells together with very poor expression of the antigen processing machinery (APM) genes has been identified in pre-treatment biopsies as a potential biomarker of resistance to the treatment.

Author Info: (1) Nouscom (Italy), Rome, Italy. (2) Nouscom, Rome, Italy. (3) Nouscom, Rome, Italy. (4) Nouscom (Italy), Rome, Italy. (5) Nouscom (Italy), Rome, Italy. (6) Nouscom (Italy), Rome,

Author Info: (1) Nouscom (Italy), Rome, Italy. (2) Nouscom, Rome, Italy. (3) Nouscom, Rome, Italy. (4) Nouscom (Italy), Rome, Italy. (5) Nouscom (Italy), Rome, Italy. (6) Nouscom (Italy), Rome, Italy. (7) Nouscom (Italy), Rome, Italy. (8) Nouscom (Italy), Rome, Italy. (9) Nouscom, Rome, Italy. (10) University of Rome Tor Vergata, Rome, Italy. (11) Nouscom AG, Switzerland. (12) Nouscom (Italy), Rome, Italy. (13) Nouscom AG, Basel, Switzerland. (14) Catalan Institute of Oncology, Barcelona, Spain. (15) START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain. (16) START-Madrid-FJD, Hospital Fundación Jimenez Diaz, Madrid, Spain. (17) University of Edinburgh, Edinburgh, United Kingdom. (18) Nouscom, Rome, Italy. (19) UZ Leuven, Leuven, Belgium.