Article
作者: Yu, Rebecca ; Rhee, Ina ; Olcese, Cristina ; Guasp, Pablo ; Amisaki, Masataka ; Balachandran, Vinod P ; Lihm, Jayon ; Wolchok, Jedd D ; Türeci, Özlem ; Patterson, Erin ; Won, Elizabeth ; Zebboudj, Abderezak ; Merghoub, Taha ; Epstein, Andrew S ; Müller, Felicitas ; Dobrin, Anton ; Yadav, Mahesh ; Payne, George ; Basturk, Olca ; Kingham, T Peter ; D'Angelica, Michael I ; Łuksza, Marta ; Sahin, Ugur ; Varghese, Anna M ; Chu, Alexander ; Waters, Theresa ; Sugarman, Ryan ; Derhovanessian, Evelyna ; Katz, Seth ; Soares, Kevin C ; O'Reilly, Eileen M ; Mellman, Ira ; Park, Wungki ; Ruan, Jennifer ; Do, Richard Kinh ; Gönen, Mithat ; Chandra, Adrienne Kaya ; Greenbaum, Benjamin D ; Pang, Nan ; Wei, Alice C ; Desai, Avni ; Odgerel, Zagaa ; Ceglia, Nicholas ; Jarnagin, William R ; Momtaz, Parisa ; Drebin, Jeffrey ; Tang, Laura ; Sadelain, Michel ; Sethna, Zachary ; Rojas, Luis A ; Cohen, Noah
Pancreatic ductal adenocarcinoma (PDAC) is lethal in 88% of patients1, yet harbours mutation-derived T cell neoantigens that are suitable for vaccines 2,3. Here in a phase I trial of adjuvant autogene cevumeran, an individualized neoantigen vaccine based on uridine mRNA-lipoplex nanoparticles, we synthesized mRNA neoantigen vaccines in real time from surgically resected PDAC tumours. After surgery, we sequentially administered atezolizumab (an anti-PD-L1 immunotherapy), autogene cevumeran (a maximum of 20 neoantigens per patient) and a modified version of a four-drug chemotherapy regimen (mFOLFIRINOX, comprising folinic acid, fluorouracil, irinotecan and oxaliplatin). The end points included vaccine-induced neoantigen-specific T cells by high-threshold assays, 18-month recurrence-free survival and oncologic feasibility. We treated 16 patients with atezolizumab and autogene cevumeran, then 15 patients with mFOLFIRINOX. Autogene cevumeran was administered within 3 days of benchmarked times, was tolerable and induced de novo high-magnitude neoantigen-specific T cells in 8 out of 16 patients, with half targeting more than one vaccine neoantigen. Using a new mathematical strategy to track T cell clones (CloneTrack) and functional assays, we found that vaccine-expanded T cells comprised up to 10% of all blood T cells, re-expanded with a vaccine booster and included long-lived polyfunctional neoantigen-specific effector CD8+ T cells. At 18-month median follow-up, patients with vaccine-expanded T cells (responders) had a longer median recurrence-free survival (not reached) compared with patients without vaccine-expanded T cells (non-responders; 13.4 months, P = 0.003). Differences in the immune fitness of the patients did not confound this correlation, as responders and non-responders mounted equivalent immunity to a concurrent unrelated mRNA vaccine against SARS-CoV-2. Thus, adjuvant atezolizumab, autogene cevumeran and mFOLFIRINOX induces substantial T cell activity that may correlate with delayed PDAC recurrence.