Article
Author: Deery, Amy ; Wu, T C ; Palande, Vikrant ; Tsai, Hua-Ling ; Alvarez, Jade ; Singh, Dipika ; Roden, Richard B S ; Straughn, J Michael ; Smith, Kellie N ; Vang, Russell ; Leath, Charles A ; Zhang, Li ; Cope, Leslie ; Gaillard, Stéphanie ; Ostrander, Darin ; Lee, Chi-Fen ; Liang, Margaret I ; Arend, Rebecca C ; Horner, Karen ; Zhang, Tianbei ; Fader, Amanda N ; Wang, Hao ; Huh, Warner K
OBJECTIVE:Since anti-tumor immunity is enhanced by vaccination of mice adjacent to human papillomavirus type 16 (HPV16+) tumors, we examined whether HPV16 L2E7E6 fusion protein (TA-CIN) vaccination in the thigh of HPV16+ cervical cancer patients would be more immunogenic than their arm.
METHODS:HPV16+ cervical cancer (stage IB1-IVA) patients, who had completed standard-of-care treatment within the past year and absent evidence of disease (NED), were enrolled in a pilot study (NCT02405221). Participants were randomized 1:1 to receive three 100 μg TA-CIN monthly intramuscular immunizations either in the arm or thigh and followed for two years for safety (CTCAEv4.0), immune response, and recurrence.
RESULTS:Fifteen patients were enrolled (median age 44, range 35-83 years); one patient experienced a non-vaccine-related adverse event after one vaccination and withdrew. Treatment-related adverse events (n = 8) were grade 1, primarily at the injection site, and self-resolved. No recurrence was observed. TA-CIN-specific antibody titers tended to be higher in thigh-vaccinated patients. Bulk TCRseq revealed significant increases in expanded and de novo T cell clones following thigh-vaccination compared with the arm. No correlation with prior treatment modality was observed. E6-, E7-, and L2-specific TCR clones expanded, although L2-specific T cell responses were predominant. One month post-vaccination, scRNAseq revealed significant expansion of MAIT and cytotoxic CD8+ T cells, and both expanded and novel TCR clonotypes were identified in the latter.
CONCLUSIONS:Thigh or arm vaccination with TA-CIN was well tolerated, but the former elicited higher CD8 T cell and antibody responses in HPV16+ cervical cancer patients with NED after primary therapy.