Durability of response to VGX-3100 treatment of HPV16/18 positive cervical HSIL

Prakash K Bhuyan, Michael Dallas, Kim Kraynyak, Timothy Herring, Matthew Morrow, Jean Boyer, Susan Duff, Joseph Kim, David B Weiner, Prakash K Bhuyan, Michael Dallas, Kim Kraynyak, Timothy Herring, Matthew Morrow, Jean Boyer, Susan Duff, Joseph Kim, David B Weiner

Abstract

VGX-3100 is an investigational DNA-based immunotherapy being developed as an alternative to surgery and ablation for cervical High-Grade Squamous Intraepithelial Lesion (HSIL) with the aim of preserving reproductive health while treating precancerous disease. Response durability up to 1.5 y following dosing is now reported.Histologic regression and HPV16 and/or HPV 18 (HPV16/18) clearance were previously demonstrated in a randomized, placebo-controlled, double-blind trial and reported for 6 months after the last dose of VGX-3100 or placebo. The presence of HPV16/18, Pap smear diagnoses, and immunogenicity longer-term responses were assessed at 18 months after the last dose.91% (32/35) VGX-3100-treated women, whose cervical HSIL regressed and avoided excision at 6 months following study treatment completion, had no detectable HPV16/18 at 18 months following treatment completion. These results were comparable to those for women who received placebo and then later underwent surgery. For VGX-3100 recipients who regressed at 6 months following study treatment completion and avoided excision during the trial, Pap testing showed no HSIL recurrence at 18 months following VGX-3100 treatment. VGX-3100-induced cellular immune responses specific for HPV 16/18 E6/E7 remained higher than for placebo control recipients at 18 months.In women with cervical HSIL who responded to VGX-3100 and were able to avoid surgery, clinical outcomes were comparable to the placebo control group which underwent conventional surgical treatment. These findings extend the understanding of the durability of the treatment effect of VGX-3100 up to 1.5 y and support that VGX-3100 could be used as an alternative to surgery.

Trial registration: ClinicalTrials.gov NCT01304524.

Keywords: DNA; HPV; cancer; cervical; durability; immunotherapy.

Figures

Figure 1.
Figure 1.
Long-term follow-up populations
Figure 2.
Figure 2.
HPV16/18 E6/E7 IFN-gamma ELISpot results (SFU/106 PBMC) for follow-up groups by visit

References

    1. Bruni LAG, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. Human papillomavirus and related diseases in the world. Summary Report 17 June 2019. 2019.
    1. Group TFIS. Supplement to: The FUTURE II Study Group . Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007;356:SupplementalMaterial.
    1. Trimble CL, Morrow MP, Kraynyak KA, Shen X, Dallas M, Yan J, Edwards L, Parker RL, Denny L, Giffear M, et al. Safety, efficacy, and immunogenicity of VGX-3100, a therapeutic synthetic DNA vaccine targeting human papillomavirus 16 and 18 E6 and E7 proteins for cervical intraepithelial neoplasia 2/3: a randomised, double-blind, placebo-controlled phase 2b trial. Lancet (London, England). 2015;386(10008):2078–88. doi:10.1016/S0140-6736(15)00239-1.
    1. Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, Arbyn M, Bennett P, Paraskevaidis E.. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ (Clinical Research Ed). 2016;354:i3633.
    1. Hollenberg RK, Krieger DR, Samuels R, Kraynyak K, Sylvester A, Morrow M, Boyer J, Dallas M, Bhuyan PK.. Safety and immunogenicity of VGX-3100 formulations in a healthy young adult population. Hum Vaccin Immunother. 2020;16(6):1404–1412.
    1. Melnikow J, McGahan C, Sawaya GF, Ehlen T, Coldman A.. Cervical intraepithelial neoplasia outcomes after treatment: long-term follow-up from the British Columbia Cohort Study. J Natl Cancer Inst. 2009;101:721–28. doi:10.1093/jnci/djp089.
    1. Xiang L, Li J, Yang W, Xu X, Wu X, Wang H, Li Z, Yang H.. Conization using an electrosurgical knife for cervical intraepithelial neoplasia and microinvasive carcinoma. PloS One. 2015;10:e0131790. doi:10.1371/journal.pone.0131790.
    1. Koliopoulos G, Nyaga VN, Santesso N, Bryant A, Martin-Hirsch PP, Mustafa RA, Schünemann H, Paraskevaidis E, Arbyn M.. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev. 2017;8:Cd008587.
    1. Wright TC, Stoler MH, Behrens CM, Sharma A, Zhang G, Wright TL. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015;136(2):189–97. doi:10.1016/j.ygyno.2014.11.076.
    1. Renshaw AA, DiNisco SA, Minter LJ, Cibas ES. A more accurate measure of the false-negative rate of Papanicolaou smear screening is obtained by determining the false-negative rate of the rescreening process. Cancer. 1997;81:272–76. doi:10.1002/(SICI)1097-0142(19971025)81:5<272::AID-CNCR3>;2-P.
    1. Fahey MT, Irwig L, Macaskill P. Meta-analysis of Pap test accuracy. Am J Epidemiol. 1995;141:680–89. doi:10.1093/oxfordjournals.aje.a117485.
    1. Mast TC, Zhu X, Demuro-Mercon C, Cummings HW, Sings HL, Ferris DG. Development and psychometric properties of the HPV Impact Profile (HIP) to assess the psychosocial burden of HPV. Curr Med Res Opin. 2009;25:2609–19. doi:10.1185/03007990903238786.
    1. Long S, Leeman L. Treatment options for high-grade squamous intraepithelial lesions. Obstet Gynecol Clin North Am. 2013;40:291–316. doi:10.1016/j.ogc.2013.03.004.
    1. Armarnik S, Sheiner E, Piura B, Meirovitz M, Zlotnik A, Levy A. Obstetric outcome following cervical conization. Arch Gynecol Obstet. 2011;283:765–69. doi:10.1007/s00404-011-1848-3.
    1. Leimbacher B, Samartzis N, Imesch P, Dedes KJ, Fink D, Canonica C. Inpatient and outpatient loop electrosurgery excision procedure for cervical intraepithelial neoplasia: a retrospective analysis. Arch Gynecol Obstet. 2012;285:1441–45. doi:10.1007/s00404-011-2148-7.
    1. Martirosian TE, Smith SC, Baras AS, Darracott MM. Depot medroxyprogesterone acetate: a risk factor for cervical stenosis after loop electrosurgical excisional procedure management of cervical intraepithelial neoplasia? J Low Genit Tract Dis. 2010;14:37–42. doi:10.1097/LGT.0b013e3181b0f73f.
    1. ACOG. American College of Obstetricians and Gynecologists 2017 . Frequently asked questions, FAQ100. Loop Electrosurgical Excision Procedure (LEEP). 2017.

Source: PubMed

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