Lisa K. McNeil, Win S, Natenshon A, Kenneth H. Mayer, Jessica Flechtner, Van Wagoner N, David I. Bernstein, Seth Hetherington, William Koltun, Thomas Oliphant, Anna Wald, Thomas C. Heineman, Gregg Lucksinger, Desai N, and Peter A. Leone
Background GEN-003 is an investigational genital herpes immunotherapy comprising gD2ΔTMR, an HSV-2 antigen that induces neutralizing antibody and T cell responses, ICP4.2, an HSV-2 T cell antigen selected through human T cell screens, and Matrix-M2™, a saponin-based adjuvant. This Phase 2b study was designed to evaluate efficacy and safety of GEN-003 vs. placebo. Methods Healthy persons, age 18–50 years, with 3–9 HSV-2 genital herpes outbreaks annually were randomized to 3 groups: placebo, or 60 µg of each antigen combined with 50 µg (60/50 group) or 75 µg (60/75 group) of adjuvant, administered 3 times 21 days apart. Study endpoints included safety, immunogenicity, HSV-2 shedding frequency, lesion rate and recurrence frequency. Viral shedding was measured from anogenital swabs by PCR. Swabs were collected for 28 days at baseline, and after the third dose, 6 months and 1 year. The presence of herpes lesions was recorded daily by electronic diary. Results One hundred and thirty-one participants enrolled and >90% received all 3 doses. In the 28-day post-treatment period, viral shedding was reduced by 40% and 27% in the 60/50 and 60/75 groups, respectively, compared with a 5% increase in the placebo group. At 6 months post-treatment, median lesion rates were significantly lower in the 60/50 and 60/75 groups (2.7% and 1.9%, respectively) vs. the placebo group (5.6%, p < 0.05), resulting in median reductions of 52% and 66%. In participants not receiving suppressive antivirals, the median recurrence frequency was 1.0/6 months in the 60/50 group vs. 2.0 in the placebo group (p = 0.08). The median recurrence duration in the 60/50 group was lower than in the placebo group (2.8 vs. 4.2 days; p < 0.05). The most commonly reported adverse events (AEs) following GEN-003 vaccination were injection site pain/tenderness (97%), fatigue (82%), headache (82%) and myalgia (80%). No vaccine-related serious AEs, autoimmune events or other AEs of special interest were reported. Conclusion In adults with recurrent genital herpes, GEN-003 reduced HSV-2 shedding frequency, genital herpes lesion rate, recurrence frequency and recurrence duration through 6 months after the last dose. Local and systemic symptoms were common in GEN-003 recipients, but treatment completion was high with few discontinuations due to AEs. Disclosures T. C. Heineman, GSK group of companies: Consultant and Shareholder, Consulting fee; D. Bernstein, Genocea Biosciences: Consultant and Investigator, Consulting fee and Research support; A. Wald, Genocea Biosciences: Investigator, Research grant and Support for travel to meetings for the study; N. Van Wagoner, Genocea Biosciences: Consultant, Research support and Travel support to present at scientific meetings; P. Leone, Genocea Biosciences: Grant Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium; T. Oliphant, Genocea Biosciences: Consultant, Consulting fee; A. Natenshon, Genocea Biosciences: Employee, Salary; L. K. McNeil, Genocea Biosciences: Employee, Salary; J. B. Flechtner, Genocea Biosciences: Employee, Salary; S. Hetherington, Genocea Biosciences: Employee, Salary