Association of Autologous Tumor Lysate-Loaded Dendritic Cell Vaccination with Extension of Survival among Patients with Newly Diagnosed and Recurrent Glioblastoma: A Phase 3 Prospective Externally Controlled Cohort Trial

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

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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 <.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.

Original languageEnglish
Pages (from-to)112-121
Number of pages10
JournalJAMA Oncology
Volume9
Issue number1
DOIs
StatePublished - Jan 19 2023

Bibliographical note

Funding Information:
Funding/Support: This study was supported by Northwest Biotherapeutics, Inc.

Publisher Copyright:
© 2023 American Medical Association. All rights reserved.

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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