Luigi Buonaguro, M.D.

Transcription

1 National Cancer Institute IRCCS «Fondazione G. Pascale» Luigi Buonaguro, M.D. Molecular Biology and Viral Oncogenesis

2 Basics of immunity and immunotherapy for HCC 12th A.I.S.F. SPECIAL CONFERENCE HCC Italy 2016 Roma, 9 10 Giugno 2016

3 Global estimated age-standardisedincidence and mortality rates for HCC. MEN WOMEN

4 Staging and treatment strategies (BCLC)

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6 Immunotherapy approaches for HCC. Oncolytic viruses CIK Cytokine-induced Killer cells Mod. from Sowada Y et al., 2013

7 Anti-cancer immunotherapy strategies Galluzzi et al., Oncotarget, Vol. 5, No. 24

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9 Clinical outcome of HCC cancer vaccines evaluated in clinical trials Antigen Vaccine strategy Outcome OS mo Ref AFP peptides PD 6/6 9.3 Butterfield et al., 2003 AFP DC pulsed PD 9/ Butterfield et al., 2006 Autologous tumor lysate DC pulsed PR 4/31 SD 17/31 PD 10/31 Tumor cell line lysate DC pulsed PR 1/35 SD 6/35 PD 18/35 N/A 14/35 Telomerase Peptides SD 17/40 PD 20/40 N/A 3/40 Glypican-3 Peptides PR 1/33 SD 19/ Lee et al., 2005 Not available Palmer et al., Greten et al., Sawada et al., 2012

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11 Limiting factors in approaches for HCC. - Immusuppressive micro-environment; - TAAs used in the clinical trials are limited in number and not specific to HCC. Buonaguro L et al., J Hepatology 2013

12 The tumor microenvironment

13 The checkpoint molecules Tumor cell/antigen Presenting Cell T cell

14 Limiting factors in approaches for HCC HSCs = hepatic stellatic cells LSECs = liver sinusoidal endothelial cel Buonaguro L et al., J Hepatology 2013

15 Counteracting strategies: Chemoterapy (standard or metronomic)

16 Standard vs. metronomic chemotherapy Kareva et al.

17 Effects of Metronomic chemotherapy Vascularization Regulatory cells Effector cells Tumor size Pasquier et al., Nat. Rev. Clin. Oncol. 2010

18 Proposed mechanism for anti-immunosuppressive treatments

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21 Proposed strategies to improve HCC cancer vaccines. Peptides Proteins DNA Combinatorial Strategies Identification of novel specific tumor epitopes for HCC Live attenuated vectors Loco-regional treatments Improved efficacy of HCC cancer vaccine Ex vivo loaded DCs Adjuvants Genetically modified T cells Delivery systems Vaccine strategies Adjuvanting strategies Buonaguro L et al., J Hepatology 2013

22 Cancer vaccine development for hepatocellular carcinoma HEPAVAC

23 HepaVac Consortium: who we are. 7 Countries; 9 Partners: 7 Academia 2 Industrial Partners Univ Birmingham Birmingham UK INSERM Nantes F Univ Antwerp Antwerp B Univ Tuebingen IMMATICS CUREVAC Tuebigen DE Univ Navarra Pamplona ES Univ Insubria Varese IT INTNA Naples IT (Coordinator)

24 HepaVac Project: strategy The main goal of HepaVAC is to develop a novel therapeutic cancer vaccine strategy aiming at improving clinical outcome in HCC patients after standard therapy. It will be based on: An off-the-shelf vaccine comprising 18 newly identified MHC-I and II tumor-associated peptides (TUMAPs) naturally processed and presented on primary tumor tissues from HCC patients (HLA peptidome); An actively personalised vaccine (APVAC) approach, based on patient-specific mutated and naturally processed and presented peptides, in a sub-group of patients and used as boosting antigens. Both vaccines will be combined with a novel and potent RNA-based immunomodulator (RNAdjuvant ). Feasibility, safety and biological efficacy will be evaluated in an European multi-centre phase I/II clinical trial. This will be one of the very few vaccine trials for HCC and the first multiepitope, multi-target and multi-hla allele therapeutic cancer vaccine for this frequent and aggressive disease.

25 A A C U G C C A G U C C A A U G A A C U G C C A G U C C A A U G HepaVac Project: WPs WP1+2 Primary HCC tumors Preclinical HepaVAC Development HCC-HLA peptidome WP3 Formulation and GMP manufacture universal multi-target, multi-epitope vaccine HepaVAC Clinical HepaVAC Development HepaVAC and APVAC arm of controlled randomized Phase I/II clinical trial + novel potent immune stimulation Direct clinical proof of concept Selection of new HCC TUMAPs 8-10 AA peptides CTL activation (CD8) >15 AA peptides T helper cell activation (CD4) WP5+6 APVAC arm of controlled randomized Phase I/II clinical trial Patient individual HCC tumor selection WP4 Formulation and GMP manufacture individual mutated peptide vaccine APVAC + novel potent immune stimulation Direct clinical proof of concept

26 Idenditification, selection and validation of TUMAPs

27 GMP manufacturing and IMP/IND preparation IMA970 Multi-peptide Vaccine + CV8102 RNAdjuvant 12 HLA class I peptides - 7 HLA-A*02; - 5 HLA-A*24 4 HLA class II peptides

28 HepaVac phase I/II clinical trial: European multi-center. Single-arm trial: 40 patients treated with IMA970A plus 50µg RNAdjuvant Primary endpoints: Safety Immunogenicity Secondary endpoints: PFS OS Predicted beginning: Fall 2016

29 Addressing the immusuppressive micro-environment.

30 Proposed strategies to improve HCC cancer vaccines. Peptides Proteins DNA Combinatorial Strategies Identification of novel specific tumor epitopes for HCC Live attenuated vectors Loco-regional treatments Improved efficacy of HCC cancer vaccine Ex vivo loaded DCs Adjuvants Genetically modified T cells Delivery systems Vaccine strategies Adjuvanting strategies Buonaguro L et al., J Hepatology 2013

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33 Counts CTX 10mM Immunological Cell Death induced by multi-drug metronomic chemoterapy PTX 10mM DTX 10mM MIX 1mM Untreated CRT-Alexa488 Treated

34 Conclusions. The liver is intrinsically an immune-suppressive environment, further worsened by chronic hepatitis infection, which represents a favorable context for cancer development. Each of the current available treatments is palliative and immunotherapy has been only partially explored with limited clinical outcomes. Improving the knowledge on molecular and antigenic characteristics of HCC, to identify more specific and immunogenic tumor-associated antigens (wt and mutated), will very likely result in unprecedented clinical outcomes with great beneficial effects for HCC patients. Strategies to improve antigen delivery and efficiently counterbalance the immune-suppressive environment should increase vaccine immunogenicity and efficacy. HEPAVAC project will likely provide valuable data. Possible Italian Network for evaluating such strategies?

35 Acknowledgments. Ist. Naz.Tumori Fond. G. Pascale Napoli, ITALY M. Tagliamonte A. Petrizzo L. Circelli A. Mauriello M. Tornesello F.M. Buonaguro Molecular Biology and Viral Oncogenesis F. Izzo Hepatology Surgery M. Carriero Tumor Progression Unit M. Napolitano Clinical Immunology Unit F. Tatangelo G. Botti Clinical Pathology Unit C. Arra Animal Facility P. Maiolino Pharmacy G. Ciliberto Scientific Director

36 Acknowledgments. The HEPAVAC Consortium H-G. Rammensee R. Accolla H. Singh S. Kutscher D. Valmori M. Ayyoub R. Heidenreich D. Adams Funding Italian Ministry of Research Ricerca Corrente FP7 EU Program, HEPAVAC Grant Nr B. Sangro S. Francque