Heat shock fusion protein-based immunotherapy for treatment of cervical intraepithelial neoplasia III

Abstract

Objectives-SGN-00101 (HspE7, Nventa, San Diego, CA) is a novel therapeutic vaccine consisting of a fusion protein containing an M. bovis BCG heat shock protein (Hsp65) covalently linked to the entire sequence of HPV 16 E7. This trial was designed to evaluate the efficacy and toxicities of HspE7 in women with CIN III.Methods-HIV (−) women with biopsy-proven CIN III were eligible. Two cohorts were accrued; one cohort to establish efficacy and a second cohort with a longer follow-up period to improve the precision of the trial to estimate response rates. Each patient underwent 3 monthly subcutaneous vaccinations with 500 µg of HspE7 followed by monthly colposcopic follow-up for 1 month in cohort 1 and an extended observation period (2 months) in cohort 2. All patients then underwent a LEEP or cone biopsy of the cervix. A complete pathologic response (pCR) was defined as no evidence of CIN or CIN I (only HPV changes). A partial response (PR) was defined as colposcopic lesion regression of >50% in size. Cervicovaginal lavage samples were obtained at each visit for HPV typing using MY09/ MY11 HPV PCR.Results-Seventy-two patients were registered and screened, of whom 64 were eligible. Fifty-eight patients completed the trial and were evaluable (31 in cohort 1, 27 in cohort 2). There were no significant epidemiologic or HPV type differences between the 2 cohorts so responses were combined for analysis. Of the 58 evaluable patients, 13 (22.5%) had a pCR; 32 (55%) had a PR and 11 (19%) had stable disease. Two (3.5%) patients in cohort 2 had microinvasive disease and were defined as progressive disease. Thirty-three of 58 (57%) of the patients were infected with HPV 16 prior to vaccination or in subsequent visits. There was no significant difference in regression in women infected with HPV 16 compared to those without HPV 16 infection (88% vs. 70%; p=0.12). Women who had a previous LEEP or ablation for CIN were 2.7 times more likely to have a complete response compared to patients without previous treatment, although the difference was not statistically significant (95% CI for rate ratio: 0. 95-6.19, p=0.10). At a cellular level, there was a significant association between local inflammation and response; lower grade of lesional inflammation correlated with a response to HspE7 (p=0.04 using Wilcoxon rank sum test). Conclusions-HspE7 appeared to demonstrate activity in women with CIN III and met a priori assumptions for efficacy; however, it is unclear whether this response was due to natural regression rather than treatment effect. HspE7, which targets the HPV 16 E7 oncoprotein, had efficacy in patients infected with HPV types other than 16, suggesting cross-reactivity. A larger randomized, controlled trial is needed to better define efficacy and to identify subsets of women most likely to benefit from immunotherapy.

A Conserved E7-derived Cytotoxic T Lymphocyte Epitope Expressed on Human Papillomavirus 16-transformed HLA-A2+ Epithelial Cancers

“…Live viral vectors also have been tested in the clinic, with vaccinia virus constructs coding for either bovine Papillomavirus E2 (20,21) or HPV-16 and -18 E6 and E7 (22). As for protein vaccines, a fusion protein of heat shock protein 65 with HPV-16 E7 has been tested in three phase II trials (23)(24)(25). In addition, a fusion protein of HPV-16 E6, E7, and L2 was also in a phase II trial (26), and a HPV-16 E7 fusion protein with a Haemophilus influenza protein or HPV-16 E6 and E7 were applied in phase I trials in various adjuvants (13,27).…”

Prophylactic and Therapeutic Vaccines against Human Papillomavirus Infections

“…Regression to CIN 1was seen in some patients, but it was not clear whether this result was caused by the vaccine or it was just natural regression [101]. Later, the same preparation was administered in several doses during 3 weeks.…”

Immunotherapy: An Evolving Paradigm in the Treatment of Advanced Cervical Cancer

“…In the cervical cancer arena, protein-based vaccines have been tested in the treatment of preinvasive disease, revealing tolerability and antigen-specific T-cell responses. [52][53][54][55][56] Currently, additional studies are under way in an attempt to identify the most effective adjuvant to fuse with protein-based vaccines, including Bordetella pertussis adenylyl cyclase, Pseudomonas aeruginosa exotoxin A, a heat shock protein derived from Mycobacteria, Toll-like receptor agonists, and a penetrating peptide polyphemus protein.…”