Therapeutic HPV vaccination for stage IB1 cervical cancer

描述(申请人提供)：人乳头瘤病毒(HPV)相关的宫颈肿瘤提供了一个引人注目的机会来测试抗原特异性疫苗接种，因为两个非自身的病毒抗原E6和E7的表达在功能上共同需要启动和维持肿瘤损伤，包括高度不典型增生(CIN2/3)，浸润性癌症的前兆，以及癌症。这项I期临床试验将评估针对HPV16E7抗原pNGVL4a-CRT-E7(排毒)的DNA疫苗颗粒介导的表皮释放(PMEd)的安全性、耐受性和免疫原性，用于与HPV16相关的可手术期IB1宫颈癌患者，HPV基因最常与疾病相关。NCI RAIDA已经生产了临床级疫苗，并已研制出用于PMEd疫苗接种的配方。这项试验还将提供一个独特的机会，在标准治疗切除时获得的标本中，评估肿瘤间隔，以寻找免疫调节机制的分子证据。虽然设计免疫治疗策略的中心假设是激发针对肿瘤相关抗原的效应免疫反应将导致临床反应，但从对HPV疾病患者的HPV特异性免疫反应的测量中可以清楚地看出，外周血中免疫反应的存在并不总是与预后相关。因此，在这项试验中，我们不仅将评估该患者队列中接种疫苗的安全性和免疫原性，而且还将确定肿瘤间隔中的免疫调节措施是否与接种疫苗的能力相关。在这些患者群体中，我们在临床试验设计和执行方面有着良好的记录，这些患者群体中不成比例地由无法有效获得医疗保健系统的少数族裔妇女组成。该协议将转化由NCI孢子机制支持的早期开发，并利用与阿拉巴马大学GOG研究人员的长期合作。这项I期临床试验将测试在可手术的IB1期宫颈癌患者中，使用治疗性HPV疫苗pNGVL4a-CRT-E7(解毒)进行无针颗粒介导性疫苗接种的安全性、可行性和免疫原性。这项试验还将提供一个独特的机会，在标准治疗切除时获得的标本中，评估肿瘤间隔，以寻找免疫调节机制的证据。NCI Raid与PowderMed合作生产了临床级疫苗。这场试验是孢子和GOG的合作。

DESCRIPTION (provided by applicant): Human papillomavirus (HPV)-associated neoplasia of the cervix presents a compelling opportunity to test antigen-specific vaccination because expression of two nonself, viral antigens, E6 and E7, are together functionally required to initiate and maintain neoplastic lesions, both high grade dysplasia (CIN2/3), the precursor to invasive cancer, and cancer. This phase I clinical trial will assess the safety, tolerability, and immunogenicity of particle-mediated epidermal delivery (PMED) of a DNA vaccine which is targeted at the HPV16 E7 antigen, pNGVL4a-CRT-E7(detox), in patients with operable Stage IB1 cervical cancer associated with HPV16, the HPV genotype most commonly associated with disease. Clinical grade vaccine has been manufactured by NCI RAID, and has been formulated for PMED vaccination. This trial will also present a unique opportunity to assess the tumor compartment for molecular evidence of mechanisms of immune regulation, in specimens obtained at the time of standard therapeutic resection. Although the central assumption in designing immunotherapeutic strategies is that eliciting effector immune responses specific for tumor associated antigens will result in clinical response, it is clear from measures of HPV-specific immune responses in patients with HPV disease that the presence of immune responses in the peripheral blood does not always correlate with outcome. Therefore in this trial we will assess not only the safety and immunogenicity of vaccination in this patient cohort, but also determine whether measures of immune regulation in the tumor compartment correlate with ability to respond to vaccination. We have a demonstrated track record in clinical trial design and execution in this patient population, which is disproportionately comprised of minority women who do not access the medical care system effectively. This protocol will translate early development supported by the NCI SPORE mechanism, and take advantage of a longstanding collaboration with GOG investigators at the University of Alabama. This phase I clinical trial will test safety, feasibility, and immunogenicity of needle- free particle-mediated vaccination with a therapeutic HPV vaccine, pNGVL4a- CRT-E7(detox), in patients with operable Stage IB1 cervical cancer. This trial will also present a unique opportunity to assess the tumor compartment for evidence of mechanisms of immune regulation, in specimens obtained at the time of standard therapeutic resection. Clinical grade vaccine has been manufactured by NCI RAID, in collaboration with PowderMed. This trial is a SPORE-GOG collaboration.