Phase 2A trial of Ad5.F35-GUCY2C-PADRE vaccine for recurrence prevention in gastrointestinal (GI) adenocarcinomas post definitive surgery and adjuvant therapies.
Authors: Bashir Babar , Mitchell Edith P. , Posey James , Basu Mallick Atrayee , Lin Daniel , Singla Rajan , Fernandez Eduardo , Ramirez Michael J. , Singh Jagmohan , Kraft Walter K. , Crutcher Madison , Lefler Daniel S. , Leiby Benjamin E. , Zhan Tingting , Waldman Scott A. , Snook Adam E. 
Published: January 2024

TPS235

Background: A significant proportion of patients with GI adenocarcinomas remain at high risk of recurrence despite adjuvant therapies. Guanylyl cyclase C (GUCY2C) is expressed by normal intestinal cells and immunologically compartmentalized. Its overexpression in GI adenocarcinomas makes it an appealing target for anti-cancer therapies. We previously completed a phase I study of the Ad5-GUCY2C-PADRE vaccine in patients (pts) where it was safe and well tolerated (NCT01972737). Pre-existing neutralizing antibodies (NAbs) to the Ad5 vector opposed vaccine-induced immune responses. To overcome this challenge, we generated a GUCY2C vaccine employing a chimeric viral vector composed of the Ad5 capsid and Ad35 fiber protein (Ad5.F35). The extracellular domain of GUCY2C, along with the PADRE CD4+ helper T-cell epitope, were cloned into the Ad5.F35 viral vector to generate a replication-incompetent vaccine. Preclinical studies showed that Ad5.F35-GUCY2C-PADRE was less sensitive to pre-existing Ad5-specific immunity. Methods: This is a Phase 2A, dose-finding, single-center, open-label, randomized trial (NCT04111172) to evaluate the safety and immunogenic activity of three dose levels of Ad5.F35-GUCY2C-PADRE vaccine in adult pts with select solid tumors (colorectal, pancreatic, gastric, esophageal, or small bowel) who are at risk of relapse post definitive surgery and adjuvant therapy. Pts must enroll at 4-24 weeks from completion of standard therapies. Other key eligibility requirements include ECOG status of 0-1 and adequate organ function. Pts are randomized to one of three dose levels (1011 vp or viral particles, 1012 vp, or 5x1012 vp) with stratification by disease type. After completing an initial safety run-in for 9 pts (3 pts in each arm), the study will recruit up to 81 pts in total (27 in each arm). Pts will receive three successive doses of vaccine (4 weeks apart) and will undergo end-of-treatment assessment 4 weeks after their last vaccine. Pts are followed for disease status by scheduled follow-up until 2 years or recurrence, whichever occurs first. An interim futility analysis will be performed after 15 patients have completed treatment in each arm based on the Simon minimax design. Study objectives include assessment of safety and tolerability (primary), as well as T-cell and antibody responses to GUCY2C (secondary). Additional exploratory objectives include evaluating the relationship between NAbs and immune responses to GUCY2C, GUCY2C protein expression in tumors, circulating tumor DNA kinetics in relation to vaccination, and disease-free and overall survival (where applicable). Prespecified safety run-in has been completed without dose limiting toxicities; second stage accrual began in November 2021, and 43 out of 81 pts have been enrolled. Study enrollment is ongoing. Clinical trial information: NCT04111172 .