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IMA901, a multipeptide cancer vaccine, plus sunitinib versus sunitinib alone, as first-line therapy for advanced or metastatic renal cell carcinoma (IMPRINT): a multicentre, open-label, randomised, controlled, phase 3 trial

IMA901, a multipeptide cancer vaccine, plus sunitinib versus sunitinib alone, as first-line therapy for advanced or metastatic renal cell carcinoma (IMPRINT): a multicentre, open-label, randomised, controlled, phase 3 trial
IMA901, a multipeptide cancer vaccine, plus sunitinib versus sunitinib alone, as first-line therapy for advanced or metastatic renal cell carcinoma (IMPRINT): a multicentre, open-label, randomised, controlled, phase 3 trial
BACKGROUND: In a phase 2 study in patients with metastatic renal cell carcinoma, overall survival was associated with T-cell responses against IMA901, a vaccine consisting of ten tumour-associated peptides. In this phase 3 trial, we aimed to determine the clinical effect of adding IMA901 to sunitinib, the standard first-line treatment in metastatic renal cell carcinoma with postulated favourable immunomodulatory effects.

METHODS: The IMPRINT study is an open-label, randomised, controlled, phase 3 trial done at 124 clinical sites in 11 countries. HLA-A*02-positive patients (aged ?18 years) with treatment-naive, histologically confirmed metastatic or locally advanced (or both) clear-cell renal cell carcinoma were randomly assigned (3:2) to receive sunitinib plus up to ten intradermal vaccinations of IMA901 (4·13 mg) and granulocyte macrophage colony-stimulating factor (75 ?g), with one dose of cyclophosphamide (300 mg/m2) 3 days before the first vaccination, or to receive sunitinib alone. Sunitinib (50 mg) was given orally once daily, with each cycle defined as 4 weeks on treatment followed by 2 weeks off treatment, until progression of disease as determined by the investigator, death, or withdrawal of consent. Block randomisation (block size five) was done centrally using an interactive web response system, stratified by prognostic risk, geographical region, and previous nephrectomy. Patients and investigators were not masked to treatment allocation. The primary endpoint was overall survival from randomisation until death of any cause as determined by the investigator, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01265901.

FINDINGS: Between Dec 22, 2010, and Dec 15, 2012, we screened 1171 patients, of whom 339 were randomly assigned to receive sunitinib plus IMA901 (n=204) or sunitinib monotherapy (n=135). Patients had a median follow-up of 33·27 months (IQR 29·92-35·64). Median overall survival did not differ significantly between the groups (33·17 months [95% CI 27·81-41·36] in the sunitinib plus IMA901 group vs not reached [33·67-not reached] in the sunitinib monotherapy group; hazard ratio 1·34 [0·96-1·86]; p=0·087). 116 (57%) of 202 patients in the sunitinib plus IMA901 group and 62 (47%) of 132 in the sunitinib group had grade 3 or worse adverse events, the most common of which were hypertension, neutropenia, and anaemia in both groups, and mild-to-moderate transient injection-site reactions (eg, erythema, pruritus) were the most frequent IMA901-related side-effect in the sunitinib plus IMA901 group. Serious adverse events leading to death occurred in four (2%) patients (one respiratory failure and circulatory collapse [possibly related to sunitinib], one oesophageal varices haemorrhage [possibly related to sunitinib], one cardiac arrest [possibly related to sunitinib], and one myocardial infarction) and eight (6%) patients in the sunitinib group (one case each of renal failure, oesophageal varices haemorrhage, circulatory collapse, wound infection, ileus, cerebrovascular accident [possibly treatment related], and sepsis).

INTERPRETATION: IMA901 did not improve overall survival when added to sunitinib as first-line treatment in patients with metastatic renal cell carcinoma. The magnitude of immune responses needs to be improved before further development of IMA901 in this disease is indicated.
1599-1611
Rini, Brian I.
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Stenzl, Arnulf
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Zdrojowy, Romauld
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Kogan, Mikhail
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Shkolnik, Mikhail
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Oudard, Stephane
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Weikert, Steffen
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Bracarda, Sergio
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Crabb, Simon J.
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Bedke, Jens
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Ludwig, Joerg
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Maurer, Dominik
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Mendrzyk, Regina
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Wagner, Claudia
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Mahr, Andrea
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Fritsche, Jens
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Weinschenk, Toni
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Walter, Steffen
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Kirner, Alexandra
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Singh-Jasuja, Harpreet
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Reinhardt, Carsten
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Eisen, Tim
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Rini, Brian I.
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Stenzl, Arnulf
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Zdrojowy, Romauld
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Kogan, Mikhail
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Shkolnik, Mikhail
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Oudard, Stephane
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Weikert, Steffen
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Bracarda, Sergio
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Crabb, Simon J.
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Maurer, Dominik
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Mendrzyk, Regina
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Wagner, Claudia
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Mahr, Andrea
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Fritsche, Jens
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Weinschenk, Toni
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Walter, Steffen
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Kirner, Alexandra
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Singh-Jasuja, Harpreet
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Reinhardt, Carsten
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Eisen, Tim
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Rini, Brian I., Stenzl, Arnulf, Zdrojowy, Romauld, Kogan, Mikhail, Shkolnik, Mikhail, Oudard, Stephane, Weikert, Steffen, Bracarda, Sergio, Crabb, Simon J., Bedke, Jens, Ludwig, Joerg, Maurer, Dominik, Mendrzyk, Regina, Wagner, Claudia, Mahr, Andrea, Fritsche, Jens, Weinschenk, Toni, Walter, Steffen, Kirner, Alexandra, Singh-Jasuja, Harpreet, Reinhardt, Carsten and Eisen, Tim (2016) IMA901, a multipeptide cancer vaccine, plus sunitinib versus sunitinib alone, as first-line therapy for advanced or metastatic renal cell carcinoma (IMPRINT): a multicentre, open-label, randomised, controlled, phase 3 trial. The Lancet Oncology, 17 (11), 1599-1611. (doi:10.1016/S1470-2045(16)30408-9). (PMID:27720136)

Record type: Article

Abstract

BACKGROUND: In a phase 2 study in patients with metastatic renal cell carcinoma, overall survival was associated with T-cell responses against IMA901, a vaccine consisting of ten tumour-associated peptides. In this phase 3 trial, we aimed to determine the clinical effect of adding IMA901 to sunitinib, the standard first-line treatment in metastatic renal cell carcinoma with postulated favourable immunomodulatory effects.

METHODS: The IMPRINT study is an open-label, randomised, controlled, phase 3 trial done at 124 clinical sites in 11 countries. HLA-A*02-positive patients (aged ?18 years) with treatment-naive, histologically confirmed metastatic or locally advanced (or both) clear-cell renal cell carcinoma were randomly assigned (3:2) to receive sunitinib plus up to ten intradermal vaccinations of IMA901 (4·13 mg) and granulocyte macrophage colony-stimulating factor (75 ?g), with one dose of cyclophosphamide (300 mg/m2) 3 days before the first vaccination, or to receive sunitinib alone. Sunitinib (50 mg) was given orally once daily, with each cycle defined as 4 weeks on treatment followed by 2 weeks off treatment, until progression of disease as determined by the investigator, death, or withdrawal of consent. Block randomisation (block size five) was done centrally using an interactive web response system, stratified by prognostic risk, geographical region, and previous nephrectomy. Patients and investigators were not masked to treatment allocation. The primary endpoint was overall survival from randomisation until death of any cause as determined by the investigator, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01265901.

FINDINGS: Between Dec 22, 2010, and Dec 15, 2012, we screened 1171 patients, of whom 339 were randomly assigned to receive sunitinib plus IMA901 (n=204) or sunitinib monotherapy (n=135). Patients had a median follow-up of 33·27 months (IQR 29·92-35·64). Median overall survival did not differ significantly between the groups (33·17 months [95% CI 27·81-41·36] in the sunitinib plus IMA901 group vs not reached [33·67-not reached] in the sunitinib monotherapy group; hazard ratio 1·34 [0·96-1·86]; p=0·087). 116 (57%) of 202 patients in the sunitinib plus IMA901 group and 62 (47%) of 132 in the sunitinib group had grade 3 or worse adverse events, the most common of which were hypertension, neutropenia, and anaemia in both groups, and mild-to-moderate transient injection-site reactions (eg, erythema, pruritus) were the most frequent IMA901-related side-effect in the sunitinib plus IMA901 group. Serious adverse events leading to death occurred in four (2%) patients (one respiratory failure and circulatory collapse [possibly related to sunitinib], one oesophageal varices haemorrhage [possibly related to sunitinib], one cardiac arrest [possibly related to sunitinib], and one myocardial infarction) and eight (6%) patients in the sunitinib group (one case each of renal failure, oesophageal varices haemorrhage, circulatory collapse, wound infection, ileus, cerebrovascular accident [possibly treatment related], and sepsis).

INTERPRETATION: IMA901 did not improve overall survival when added to sunitinib as first-line treatment in patients with metastatic renal cell carcinoma. The magnitude of immune responses needs to be improved before further development of IMA901 in this disease is indicated.

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Accepted/In Press date: 3 October 2016
e-pub ahead of print date: 3 October 2016
Published date: November 2016
Organisations: Cancer Sciences

Identifiers

Local EPrints ID: 401627
URI: http://eprints.soton.ac.uk/id/eprint/401627
PURE UUID: a51f35d7-f282-4ec3-acab-bd004c578fb8
ORCID for Simon J. Crabb: ORCID iD orcid.org/0000-0003-3521-9064

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Date deposited: 19 Oct 2016 08:29
Last modified: 15 Mar 2024 05:59

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Contributors

Author: Brian I. Rini
Author: Arnulf Stenzl
Author: Romauld Zdrojowy
Author: Mikhail Kogan
Author: Mikhail Shkolnik
Author: Stephane Oudard
Author: Steffen Weikert
Author: Sergio Bracarda
Author: Simon J. Crabb ORCID iD
Author: Jens Bedke
Author: Joerg Ludwig
Author: Dominik Maurer
Author: Regina Mendrzyk
Author: Claudia Wagner
Author: Andrea Mahr
Author: Jens Fritsche
Author: Toni Weinschenk
Author: Steffen Walter
Author: Alexandra Kirner
Author: Harpreet Singh-Jasuja
Author: Carsten Reinhardt
Author: Tim Eisen

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