Association of Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination With Extension of Survival Among Patients With Newly Diagnosed and Recurrent Glioblastoma
Authors: Liau Linda M. , Ashkan Keyoumars , Brem Steven , Campian Jian L. , Trusheim John E. , Iwamoto Fabio M. , Tran David D. , Ansstas George , Cobbs Charles S. , Heth Jason A. , Salacz Michael E. , D’Andre Stacy , Aiken Robert D. , Moshel Yaron A. , Nam Joo Y. , Pillainayagam Clement P. , Wagner Stephanie A. , Walter Kevin A. , Chaudhary Rekha , Goldlust Samuel A. , Lee Ian Y. , Bota Daniela A. , Elinzano Heinrich , Grewal Jai , Lillehei Kevin , Mikkelsen Tom , Walbert Tobias , Abram Steven , Brenner Andrew J. , Ewend Matthew G. , Khagi Simon , Lovick Darren S. , Portnow Jana , Kim Lyndon , Loudon William G. , Martinez Nina L. , Thompson Reid C. , Avigan David E. , Fink Karen L. , Geoffroy Francois J. , Giglio Pierre , Gligich Oleg , Krex Dietmar , Lindhorst Scott M. , Lutzky Jose , Meisel Hans-Jörg , Nadji-Ohl Minou , Sanchin Lhagva , Sloan Andrew , Taylor Lynne P. , Wu Julian K. , Dunbar Erin M. , Etame Arnold B. , Kesari Santosh , Mathieu David , Piccioni David E. , Baskin David S. , Lacroix Michel , May Sven-Axel , New Pamela Z. , Pluard Timothy J. , Toms Steven A. , Tse Victor , Peak Scott , Villano John L. , Battiste James D. , Mulholland Paul J. , Pearlman Michael L. , Petrecca Kevin , Schulder Michael , Prins Robert M. , Boynton Alton L. , Bosch Marnix L. 
Published: November 2022

Importance

Glioblastoma is the most lethal primary brain cancer. Clinical outcomes for glioblastoma remain poor, and new treatments are needed.

Objective

To investigate whether adding autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) to standard of care (SOC) extends survival among patients with glioblastoma.

Design, Setting, and Participants

This phase 3, prospective, externally controlled nonrandomized trial compared overall survival (OS) in patients with newly diagnosed glioblastoma (nGBM) and recurrent glioblastoma (rGBM) treated with DCVax-L plus SOC vs contemporaneous matched external control patients treated with SOC. This international, multicenter trial was conducted at 94 sites in 4 countries from August 2007 to November 2015. Data analysis was conducted from October 2020 to September 2021.

Interventions

The active treatment was DCVax-L plus SOC temozolomide. The nGBM external control patients received SOC temozolomide and placebo; the rGBM external controls received approved rGBM therapies.

Main Outcomes and Measures

The primary and secondary end points compared overall survival (OS) in nGBM and rGBM, respectively, with contemporaneous matched external control populations from the control groups of other formal randomized clinical trials.

Results

A total of 331 patients were enrolled in the trial, with 232 randomized to the DCVax-L group and 99 to the placebo group. Median OS (mOS) for the 232 patients with nGBM receiving DCVax-L was 19.3 (95% CI, 17.5-21.3) months from randomization (22.4 months from surgery) vs 16.5 (95% CI, 16.0-17.5) months from randomization in control patients (HR = 0.80; 98% CI, 0.00-0.94; P = .002). Survival at 48 months from randomization was 15.7% vs 9.9%, and at 60 months, it was 13.0% vs 5.7%. For 64 patients with rGBM receiving DCVax-L, mOS was 13.2 (95% CI, 9.7-16.8) months from relapse vs 7.8 (95% CI, 7.2-8.2) months among control patients (HR, 0.58; 98% CI, 0.00-0.76; P &amp;lt; .001). Survival at 24 and 30 months after recurrence was 20.7% vs 9.6% and 11.1% vs 5.1%, respectively. Survival was improved in patients with nGBM with methylated MGMT receiving DCVax-L compared with external control patients (HR, 0.74; 98% CI, 0.55-1.00; P = .03).

Conclusions and Relevance

In this study, adding DCVax-L to SOC resulted in clinically meaningful and statistically significant extension of survival for patients with both nGBM and rGBM compared with contemporaneous, matched external controls who received SOC alone.

Trial Registration

ClinicalTrials.gov Identifier: NCT00045968