1. Neoadjuvant vidutolimod and nivolumab in high-risk resectable melanoma: A prospective phase II trial.
- Author
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Davar, Diwakar, Morrison, Robert M., Dzutsev, Amiran K., Karunamurthy, Arivarasan, Chauvin, Joe-Marc, Amatore, Florent, Deutsch, Julie S., Das Neves, Rodrigo X., Rodrigues, Richard R., McCulloch, John A., Wang, Hong, Hartman, Douglas J., Badger, Jonathan H., Fernandes, Miriam R., Bai, Yulong, Sun, Jie, Cole, Alicia M., Aggarwal, Poonam, Fang, Jennifer R., and Deitrick, Christopher
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MYELOID cells , *GUT microbiome , *TUMOR-infiltrating immune cells , *IMMUNE response , *MACROPHAGE activation - Abstract
Intratumoral TLR9 agonists and anti-PD-1 produce clinical responses and broad immune activation. We conducted a single-arm study of neoadjuvant TLR9 agonist vidutolimod combined with anti-PD-1 nivolumab in high-risk resectable melanoma. In 31 evaluable patients, 55% major pathologic response (MPR) was observed, meeting primary endpoint. MPR was associated with necrosis, and melanophagocytosis with increased CD8+ tumor-infiltrating lymphocytes and plasmacytoid dendritic cells (pDCs) in the tumor microenvironment, and increased frequencies of Ki67+CD8+ T cells peripherally. MPRs had an enriched pre-treatment gene signature of myeloid cells, and response to therapy was associated with gene signatures of immune cells, pDCs, phagocytosis, and macrophage activation. MPRs gut microbiota were enriched for Gram-negative bacteria belonging to the Bacteroidaceae and Enterobacteriaceae families and the small subgroup of Gram-negative Firmicutes. Our findings support that combined vidutolimod and nivolumab stimulates a broad anti-tumor immune response and is associated with distinct baseline myeloid gene signature and gut microbiota. ClinicalTrials.gov identifier: NCT03618641. [Display omitted] • Neoadjuvant intratumoral vidu/nivo produces pathologic responses in stage III melanoma • Response is linked to myeloid cells, pDCs, and CD8+ T cells within tumor • Responder gut microbiota signatures vidu/nivo are distinct from those in anti-PD-1 Neoadjuvant immunotherapy improves relapse-free survival in stage III melanoma. The novel combination of intratumoral vidu/nivo produces 55% major pathologic response (MPR) with an acceptable safety profile. MPR was associated with intratumoral myeloid cells, pDCs, and CD8+ TIL. Gut microbiota signatures in vidu/nivo MPR are distinct from those in anti-PD-1 responders. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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