Clinical Translation of a Mammaglobin A DNA Vaccine for Breast Cancer Therapy
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1 Clinical Translation of a Mammaglobin A DNA Vaccine for Breast Cancer Therapy William E. Gillanders, M.D. Recombinant DNA Advisory Committee December 14, 25
2 Overview This is a phase I dose ranging vaccine safety trial of a mammaglobin A DNA vaccine The broad objective of the study is to identify a safe and immunologically active dose of the mammaglobin A DNA vaccine that can be used in future studies
3 Mammaglobin A A Tissue Expression Ovary Uterus Placenta Lung B5 589 Breast Breast cancer Watson MA et al, Cancer Research 1996; 56:86
4 Mammaglobin A A Tissue Expression Breast Breast Cancer Ovary Placenta Uterus Testis Prostate PBL Lymph node Spleen Thymus Lung Colon Bladder Kidney Liver Brain No template GAPDH hmam Watson MA et al, Cancer Research 1996; 56:86
5 Mammaglobin A A Tissue Expression
6 Mammaglobin A A Tissue Expression Watson MA et al, Cancer Research 1999; 59:328
7 Mammaglobin A A Tissue Expression Ductal carcinoma in situ Well differentiated ductal carcinoma Poorly differentiated ductal carcinoma Watson MA et al, Cancer Research 1999; 59:328
8 Summary Mammaglobin A is expressed almost exclusively in normal breast epithelium and breast cancer Mammaglobin A is overexpressed in up to 8% of primary and metastatic breast cancers Mammaglobin A overexpression appears to be consistent in all stages of breast cancer
9 Presentation of Mammaglobin A HBL 1 AU 565 M DA M B 361 M DA M B 415 M CF 7 M DA M B Specific Lysis (%) Specific Lysis (%) Jaramillo A et al, International Journal of Cancer 22; 12:499
10 Mammaglobin A reactive T cells Frequency (reciprocal) Patients Controls CD8+ T cells CD4+ T cells Jaramillo A et al, International Journal of Cancer 22; 12:499
11 MHC Class I trimeric structure Peptide Heavy chain β 2 m
12 Predicting mammaglobin A A epitopes
13 Mammaglobin HLA A3 A3 peptides HLA A3 Binding Peptides Derived from Mammaglobin A Peptide Amino Acid Position Peptide Sequence HLA A3 binding score Mam A PLLENVISK 27. Mam A KTINPQVSK 6.75 Mam A KLLMVLMLA 4.5 Mam A TTNAIDELK 1.5 Mam A LMVLMLAAL 1.35 Mam A FLNQTDETL.6 Mam A LMLAALSQH.45 Mam A AIDELKECF.3 Jaramillo A et al, International Journal of Cancer 22; 12:499
14 Membrane Stabilization Assay Mam A3.1 Mam A3.2 Mam A3.3 Mam A3.4 Mam A3.5 Mam A3.6 Mam A3.7 Mam A3.8 Influenza Mean Fluorescence Shift Jaramillo A et al, International Journal of Cancer 22; 12:499
15 Mammaglobin A reactive T cells Frequency of CD8 T cells reactive to mammaglobin A derived peptides in the peripheral blood of HLA A3 breast cancer patients Patients Controls A A3.2 A HLA A3 peptides A A3.5 A A3.7 7 A Influenza
16 Summary CD8 and CD4 T cells specific for mammaglobin A can be generated in vitro from the peripheral blood of breast cancer patients confirming that the immune system can recognize this antigen Analyses of peripheral blood from breast cancer patients confirm that breast cancer patients have higher frequencies of mammaglobin A reactive T cells
17 Advantages of DNA Vaccination Safety Generic manufacture with high purity and stability relative to protein vaccines Cost advantage Vaccination with full length cdna avoids the requirement of MHC restriction
18 Humanized Mouse Model C57BL/6 mice transgenic for Human HLA A2 X C57BL/6 mice transgenic for Human CD8 Human HLA A2 + /CD8+ C57BL/6 mice Expression of HLA A2 on all tissues Tissue specific expression of human CD8 on CD8 + T cells Facilitates recognition of human MHC by mouse CD8 + T cells
19 Humanized Mouse Model Day : DNA vaccine Day 7: DNA vaccine Day 14: DNA vaccine Day 21: DNA vaccine Day 28: Immune Analysis
20 Humanized Mouse Model Control Vaccinated A 2 1 Narayanan et al, Journal of the National Cancer Institute 24; 96:1388
21 Breast Cancer Xenograft Model Day : Tumor Challenge HBL 1 or MDA 231 cells resuspended in basement membrane Day 14: Adoptive transfer of 4 x 1 7 spleen cells from vaccinated mice Tumor size measured by calipers weekly
22 Breast Cancer Xenograft Model Narayanan et al, Journal of the National Cancer Institute 24; 96:1388
23 Phase I Clinical Trial This is a phase I dose ranging vaccine safety trial of a mammaglobin A DNA vaccine The broad objective of the study is to identify a safe and immunologically active dose of the mammaglobin A DNA vaccine that can be used in future studies
24 Objectives Evaluate the safety of the mammaglobin A DNA vaccine Assess the in vivo immune response induced by the mammaglobin A DNA vaccine by evaluation of the CD8, CD4 and Treg immune responses
25 Objectives Assess the impact of mammaglobin A DNA vaccination on breast cancer tumor markers, including circulating breast cancer cells Evaluate enrolled patients for time to disease progression following vaccination with the mammaglobin A DNA vaccine
26 Patient Selection Patients with stage IV breast cancer are eligible for enrollment Eligible patients will have metastatic breast cancer that has been stable for at least 28 days after chemotherapy, or on hormonal therapy
27 Dose Escalation This trial is a dose ranging study of four doses of the mammaglobin A DNA vaccine Four groups of at least three patients will be vaccinated with mammaglobin A DNA delivered intramuscularly at four different dose levels (15 μg, 5 μg, 15 μg, 5 mg) every three weeks for four injections
28 Dose Escalation Dose escalation will only occur when the final patient at the prior dose level has safely completed all four injections and no dose limiting toxicity (DLT) has been noted in more than one patient at the final postvaccination visit
29 Immune Monitoring ELISPOT assays, intracellular cytokine expression analyses using multiparameter flow cytometry, and peptide MHC tetramer analyses will be used to assess the antigen specific T cell response to the mammaglobin A DNA vaccine
30 Anticipated Toxicity Based on experience with DNA vaccines in phase I clinical trials we expect toxicity to be limited to grade 1 vaccine site reactions Other reactions that have been described include hyperglycemia, hypoalbuminemia, myalgia, chills, allergic rhinitis, cough, headache and pruritis
31 Safety Safety defined as the absence of sever toxicity (grade 3 or greater) using the National Institutes of Health Common Toxicity Criteria
32 Optimal Dose The dose of mammaglobin A DNA vaccine that is associated with the maximum immune response will be considered optimal If there is no clear difference in the immune response to two or more doses of mammaglobin A DNA vaccine, the lowest dose of mammaglobin A DNA vaccine that is associated with the maximum immune response will be considered optimal
33 ping mammaglobin mammaglobin A A vector DraIII (4827) Bsp HI (4 771) NruI (4636) Bsp DI (46 ) Kanamycin Ori Sma I (4 419 ) X mai (4 417) Bsm I (4411) EcoNI (438) Cfr1I (4335) Bsr FI (4335) Bsm I (4334) K a na m yc in Pvu I (4295) HindIII (4171) Stu I (3669) AatI (3669 ) BanI (3465) BclI (3387) PmeI (3378) ping Mammaglobin 4851 bp Apa I (3373) Bsp 12I (3369 ) XbaI (336 3) BsrBI (3356 ) Not I (3351) Bst XI (334 6) EcoRV (3336) EcoRI (3324 ) Bsu 36 I (92) Bsp HI (178) O ri Alw 44I (584) Apa LI (584 ) Asp 7 (3143) Sno I (584 ) EcoRI (3324) Promoter M am m a globin Asp 7 (383) NheI (2919 ) Bsa I (29) Mlu I (2881) Bss HII (286) ping Mammaglobin 4851 bp DrdI (796) BglII (193) Bsp DI (1173) Bsr GI (1285) Ssp BI (1285) Sp e I (134 1) Mammaglobin Bss HII (284 ) Sca I (279) HpaI (276) P romo te r NdeI (1576) Sn abi (1682) PvuII (276) Bsa AI (1682) BfrI (2675) Ba ni (187) AflII (2675) BpmI (1955) NheI (2919) Exon BpmI (2488) Sa p I (2459 ) MroI (2441) Bsp EI (2441) E x on KspI (1997) Sa c II (19 97) Sph I (297) Bse AI (2441) Bp u112i (216 2) Acc III (244 1) CelII (2162) Bsa AI (24 36) Esp I (2162) XcmI (225) PpuMI (2333)
34
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