ArticleOA
Author: Berger, Adam ; Lewis, Karl D ; Levine, Edward ; Keech, John ; Glaspy, John ; Hsueh, Eddy ; Milhem, Mohammed ; Curti, Brendan ; McCarron, Edward C ; Behl, Deepti ; Mihalcioiu, Catalin ; Beck, J Thaddeus ; Beitsch, Peter ; Shaheen, Montaser F ; Claveau, Joel ; Hyngstrom, John ; Pecora, Andrew ; Jang, Sekwon ; Slingluff, Craig L ; Kalmadi, Sujith ; Holtan, Shernan G ; Butler, Marcus O ; Paramo, Juan ; Weber, Robert ; Andtbacka, Robert ; Gastman, Brian ; Lutzky, Jose ; Milton, Daniel ; Markovic, Svetomir N ; Bar, Anna ; Badarinath, Suprith ; Hernandez-Aya, Leonel ; Bowles, Tawnya ; Padmanabhan, Arvinda ; Peterkin, Joanna J ; Gupta, Vinay ; Philips, Prejesh ; Hamid, Omid ; Blumenstein, Brent ; Travers, Jeffrey B ; Schmidt, William ; Thomas, Sajeve ; Kumar, Pallavi ; Sato, Takami ; Rapisuwon, Suthee
Background:Most patients with advanced melanomas relapse after checkpoint blockade therapy. Thus, immunotherapies are needed that can be applied safely early, in the adjuvant setting. Seviprotimut-L is a vaccine containing human melanoma antigens, plus alum. To assess the efficacy of seviprotimut-L, the Melanoma Antigen Vaccine Immunotherapy Study (MAVIS) was initiated as a three-part multicenter, double-blind, placebo-controlled phase III trial. Results from part B1 are reported here.
Methods:Patients with AJCC V.7 stage IIB-III cutaneous melanoma after resection were randomized 2:1, with stage stratification (IIB/C, IIIA, IIIB/C), to seviprotimut-L 40 mcg or placebo. Recurrence-free survival (RFS) was the primary endpoint. For an hypothesized HR of 0.625, one-sided alpha of 0.10, and power 80%, target enrollment was 325 patients.
Results:For randomized patients (n=347), arms were well-balanced, and treatment-emergent adverse events were similar for seviprotimut-L and placebo. For the primary intent-to-treat endpoint of RFS, the estimated HR was 0.881 (95% CI: 0.629 to 1.233), with stratified logrank p=0.46. However, estimated HRs were not uniform over the stage randomized strata, with HRs (95% CIs) for stages IIB/IIC, IIIA, IIIB/IIIC of 0.67 (95% CI: 0.37 to 1.19), 0.72 (95% CI: 0.35 to 1.50), and 1.19 (95% CI: 0.72 to 1.97), respectively. In the stage IIB/IIC stratum, the effect on RFS was greatest for patients <60 years old (HR=0.324 (95% CI: 0.121 to 0.864)) and those with ulcerated primary melanomas (HR=0.493 (95% CI: 0.255 to 0.952)).
Conclusions:Seviprotimut-L is very well tolerated. Exploratory efficacy model estimation supports further study in stage IIB/IIC patients, especially younger patients and those with ulcerated melanomas.
Trial registration number:NCT01546571.