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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • University of California at Los Angeles
  • King's College London (KCL)
  • University of Pennsylvania
  • Washington University St. Louis
  • Allina Health
  • Columbia University
  • New York Presbyterian Hospital
  • University of Florida
  • Swedish Medical Center
  • University of Michigan, Ann Arbor
  • Rutgers - The State University of New Jersey, New Brunswick
  • Sutter Health
  • Atlantic Healthcare
  • Rush University
  • Ohio State University
  • The Cancer Center
  • University of Rochester
  • University of Cincinnati
  • Rutgers - The State University of New Jersey, Newark
  • Henry Ford Health System
  • University of California at Irvine
  • Rhode Island Hospital
  • NSPC Brain and Spine Surgery
  • University of Colorado Boulder
  • Ascension St Thomas Brain and Spine Tumor Center
  • Mays Cancer Center
  • University of North Carolina at Chapel Hill
  • Dartmouth College
  • Advent Health
  • University of Antwerp
  • Icahn School of Medicine at Mount Sinai
  • Providence St. Joseph Hospital, Orange
  • Thomas Jefferson University
  • Vanderbilt University
  • Harvard University
  • Baylor Scott & White Health
  • Illinois Cancer Care
  • Medical University of South Carolina
  • Mount Sinai Medical Center Miami Beach
  • University of Miami
  • Hospital Bergmannstrost
  • Klinikum Stuttgart
  • Case Western Reserve University
  • Tufts University

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.

Details

Original languageEnglish
Pages (from-to)112-121
Number of pages10
JournalJAMA oncology
Volume9
Issue number1
Publication statusPublished - 19 Jan 2023
Peer-reviewedYes

External IDs

PubMed 36394838
WOS 000898732300009

Keywords

Sustainable Development Goals

Keywords

  • Humans, Glioblastoma/drug therapy, Temozolomide/therapeutic use, Prospective Studies, Brain Neoplasms/pathology, Recurrence, Dendritic Cells/pathology, Vaccination, Progression, Plus lomustine, Double-blind, Bevacizumab, Temozolomide