Results of phase I-II bridging study for Nous-209, a neoantigen cancer immunotherapy, in combination with pembrolizumab as first line treatment in patients with advanced dMMR/MSI-h colorectal cancer.
Authors: Overman Michael J. , Maurel Joan , Oberstein Paul Eliezer , Roselló-Keränen Susana , Le Dung T. , Pedersen Katrina Sophia , Mukherjee Sarbajit , D'Alise Anna Morena , Leoni Guido , Siani Loredana , Scarselli Elisa , Faivre Théa , Delaite Patricia , Gogov Sven , Fakih Marwan 
Published: June 2023

e14665

Background: Microsatellite instability (MSI) is a molecular hallmark in which systemic deficiency of DNA mismatch-repair (dMMR) generates tumor-specific frameshift peptides (FSPs). Nous-209 is an off-the-shelf cancer vaccine targeting 209 FSPs selected from dMMR/MSI-H tumors (Leoni, G. et al., 2020). Treatment options for unresectable dMMR/MSI-H tumors have improved, but further efforts to increase long-term progression-free survival are needed. NOUS-209-01 Phase I demonstrated that Nous-209 and pembrolizumab is safe, well tolerated, and provides clinical benefit in advanced gastric and CRC dMMR/MSI-H tumors (Fakih et al., 2022). Moreover, Nous-209 induces durable specific anti-tumoral immune response, capable of successfully infiltrating the tumor (D’Alise et al., 2022). Here, we present data from NOUS-209-01 study Phase I-II expansion cohort at the recommended phase 2 dose (RP2D) of Nous-209 and pembrolizumab in adults with dMMR/MSI-H locally advanced unresectable or metastatic colorectal cancer (mCRC) eligible for 1st line immune checkpoint inhibition. Methods: NOUS-209-01 ( NCT04041310 ) Phase I-II bridge expansion cohort receives one GAd20-209-FSP prime intramuscularly at the 1st infusion of pembrolizumab, followed by 3 MVA-209-FSP boosts with the 2nd, 3rd and 4th pembrolizumab cycles. Patients can continue treatment with pembrolizumab for 18 months. Response assessment is evaluated every 9 (+/-1) weeks by CT imaging, according to RECIST v1.1 criteria. ctDNA assessments are at baseline, 11, 28, 49, 79 weeks and at objective progression on study. Results: Phase I-II bridge enrolled 8 patients with dMMR/MSI-H treatment-naïve mCRC. One patient had clinical progression before 1st scan and was excluded as non-evaluable and 7 were evaluable for tumor response. 5/7 (71%, CI: 95% 29.0, 96.3) patients achieved objective response: 1 (14%) complete response (CR) and 4 (57%) partial responses (PR). 2 patients (29%) had disease progression (PD) at the 1st scan. ctDNA assessments were available for 6 out of 7 patients (4 PR; 2 PD); ctDNA levels reduced >50% at week 11 in the 4 PR patients, in contrast to a 28% increase in 1 PD. Interestingly 1 PD patient had ctDNA > 50% reduction. The median follow-up at data cut-off was 7.5 months (range: 3.3-8.4), median progression free survival and median duration of response have not been reached. 6/7 (85.7%) patients had treatment emergent adverse events (TEAE), all mild or moderate grade; no TEAEs were serious or led to treatment discontinuation. Conclusions: The combination of Nous-209 and pembrolizumab is safe, well tolerated and shows encouraging clinical efficacy in patients with treatment-naive dMMR/MSI-H mCRC eligible for anti-PD-1 therapy. The study is ongoing and expanding to Phase II randomization with a new accelerated Nous-209 vaccination schedule. Clinical trial information: NCT04041310 .