In a phase 1 trial, 59 patients with metastatic or locally advanced solid tumors were treated subcutaneously with NHS-IL12, an immunocytokine composed of two IL-12 heterodimers fused to an antibody that targets histones in areas of tumor necrosis. Treatment was generally well tolerated up to the dose of 16.8 μg/kg. The best response was stable disease in 15 patients. In peripheral blood, IFNγ, IL-10, and mature and activated NK and NKT cells increased, and CD4+ EMRA T cells and plasmacytoid DCs decreased. In the tumor, there was an increase in TCR diversity and TIL density in patients with high IFNγ response.

PURPOSE: The NHS-IL12 immunocytokine is composed of two IL-12 heterodimers fused to the NHS76 antibody. Preclinical studies have shown that this antibody targets IL-12 to regions of tumor necrosis by binding histones on free DNA fragments in these areas, resulting in enhanced antitumor activity. The objectives of this phase I study were to determine the maximum tolerated dose (MTD) and pharmacokinetics of NHS-IL12 in subjects with advanced solid tumors. EXPERIMENTAL DESIGN: Subjects (n=59) were treated subcutaneously with NHS-IL12 in a single ascending dose cohort followed by a multiple ascending dose cohort (n=37 with every 4-week dosing). RESULTS: The most frequently observed treatment-related adverse events (TRAEs) included decreased circulating lymphocytes, increased liver transaminases and flu-like symptoms. Of the grade >/= 3 TRAEs, all were transient and only one was symptomatic (hyperhidrosis). The MTD is 16.8 microg/kg. A time-dependent rise in IFN-gamma and an associated rise in IL-10 were observed postNHS-IL12. Of peripheral immune cell subsets evaluated, most noticeable were increases in frequencies of activated and mature natural killer (NK) cells and NKT cells. Based on TCR sequencing analysis, increases in T-cell receptor diversity and tumor-infiltrating lymphocyte density were observed post-treatment where both biopsies and peripheral blood mononuclear cells were available. Although no objective tumor responses were observed, 5 subjects had durable stable disease (range 6-30+ months). CONCLUSIONS: NHS-IL12 was well tolerated up to a dose of 16.8 microg/kg, which is the recommended phase II dose. Early clinical immune-related activity warrants further studies, including combination with immune checkpoint inhibitors.

Author Info: (1) Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health. (2) Clinical Development, Bavarian Nordic (United States). (3) Yale Univer

Author Info: (1) Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health. (2) Clinical Development, Bavarian Nordic (United States). (3) Yale University. (4) Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health. (5) Laboratory of Tumor Immunology and Biology, National Cancer Institute. (6) Pediatrics, Tripler Army Medical Center. (7) Genitourinary Malignancies Branch, National Cancer Institute. (8) Myeloma Section, Lymphoid Malignancies Branch, Center for Cancer Research, National Cancer Institute, NIH. (9) Laboratory of Tumor Immunology and Biology, National Cancer Institute. (10) Genitourinary Malignancies Branch, National Cancer Institute. (11) Genitourinary Malignancies Branch, National Cancer Institute. (12) Global Clinical Biomarkers and Companion Diagnostics, EMD Serono. (13) Merck. (14) Laboratory of Tumor Immunology and Biology, National Cancer Institute. (15) Genitourinary Malignancies Branch, National Cancer Institute, National Institutes of Health gulleyj@mail.nih.gov.