In a phase I/Ib trial, 8 patients with newly diagnosed glioblastoma were treated with up to 20 long neoantigen peptides admixed with poly-ICLC in a prime-boost schedule following surgery and radiotherapy. Dexamethasone (dex) treatment for cerebral edema prevented T cell responses. Two patients who were not treated with dex during vaccine priming generated circulating, polyfunctional, neoantigen-specific CD4+ and CD8+ T cells that demonstrated an antigen-experienced memory phenotype. Neoantigen-specific T cells also infiltrated relapsed tumors, where they showed signs of cytotoxicity and/or exhaustion.
Neoantigens, which are derived from tumour-specific protein-coding mutations, are exempt from central tolerance, can generate robust immune responses(1,2) and can function as bona fide antigens that facilitate tumour rejection(3). Here we demonstrate that a strategy that uses multi-epitope, personalized neoantigen vaccination, which has previously been tested in patients with high-risk melanoma(4-6), is feasible for tumours such as glioblastoma, which typically have a relatively low mutation load(1,7) and an immunologically 'cold' tumour microenvironment(8). We used personalized neoantigen-targeting vaccines to immunize patients newly diagnosed with glioblastoma following surgical resection and conventional radiotherapy in a phase I/Ib study. Patients who did not receive dexamethasone-a highly potent corticosteroid that is frequently prescribed to treat cerebral oedema in patients with glioblastoma-generated circulating polyfunctional neoantigen-specific CD4(+) and CD8(+) T cell responses that were enriched in a memory phenotype and showed an increase in the number of tumour-infiltrating T cells. Using single-cell T cell receptor analysis, we provide evidence that neoantigen-specific T cells from the peripheral blood can migrate into an intracranial glioblastoma tumour. Neoantigen-targeting vaccines thus have the potential to favourably alter the immune milieu of glioblastoma.