CimaVax-EGF

CimaVax-EGF is a vaccine used to treat cancer, specifically non-small-cell lung carcinoma (NSCLC). CIMAvax-EGF is composed of recombinant human epidermal growth factor (EGF) conjugated to a protein carrier.[1]

The vaccine was developed by the Center of Molecular Immunology, Havana, Cuba[2][3] There are agreements in place to test it in the United States, Japan, and some European countries.[4] It is currently available in Cuba, Colombia, Bosnia and Herzegovina, Peru and Paraguay.[5] In October 2015 Serbia's Institute of Virology, Vaccines and Sera (AKA Torlak Institute) signed a memorandum for use in 30 patients as part of a study.[6] CimaVax is relatively cheap to produce and store, and has low toxicity.[4] Side effects of the vaccine appear to be mild, and include chills, fever, and feeling sick.[7][8]

Mechanism

CimaVax is an active vaccine with which patients are immunized with epidermal growth factor (EGF), thus raising antibodies targeting EGF itself. The product is also formulated with the Neisseria meningitidis outer protein P64k and Montanide ISA 51 as adjuvants to potentiate the immune response.[9][8] The epidermal growth factor receptor (EGFR) is hijacked by many types of cancer, including cancers of the lung, colon, kidney, and head and neck. By raising antibodies against EGF, which is EGFR's major ligand, the concentrations of EGF in the blood are reduced. Thus CimaVax does not target the cancer cells directly, but is expected to work against these cancers by denying the cancers the growth stimulus they require.[8][10] For this reason, the Roswell Park Cancer Institute group thinks that it may prove most useful as a preventive vaccine rather than as a cancer therapy per se.[4]

Research

Cuba

Early trials showed a trend towards improved survival among vaccinated test subjects.[8][11] A direct correlation between the level of antibodies that a vaccinated patient raises against EGF and survival has been observed in several trials,[8] and in one of the largest trials[10] there was also an age-dependence, with only subjects under the age of 60 benefiting in terms of survival.[8] More antibodies are raised when the vaccine is formulated with Montanide ISA 51 rather than aluminum hydroxide as an adjuvant, and when patients receive a low dose of cyclophosphamide three days before vaccine administration.[8] Cyclophosphamide is thought to temporarily block the body's natural immune tolerance to EGF, thereby increasing antibody titers.[8]

Researchers caution that the early results to date have been in relatively small, early-stage trials with patients that were carefully selected based on predefined inclusion and exclusion criteria, and given specialized oncology care; they may therefore not be representative of most patients who might benefit from the vaccine.[8] It has been urged that CimaVax be tested in patients with earlier-stage NSCLC cancer and in patients who are not candidates for chemotherapy, and that research be conducted to determine which subgroups of NSCLC patients do and don't respond to the vaccine.[8] It has been suggested that CimaVax may also be effective in other types of cancer that are dependent on EGF/EGFR, including many cases of prostate cancer.[8]

International

Trials are being organized in the United States, the European Union, Japan,[4] and Serbia.[6] In late October 2016, the United States Food and Drug Administration authorized[12] the Roswell Park Cancer Institute to conduct a PhaseI/II clinical trial of CimaVAX in patients with non-small cell lung cancer.[13] By the middle of the following month, nearly 200 people had volunteered to be subjects in the trial.[14]

In September 2018, Principal Investigator Grace Dy shared the initial results of the first Roswell Park trial.[15] They found that the combination of CIMAvax with the PD-1 inhibitor checkpoint inhibitor nivolumab was safe and well tolerated in 13 people with advanced non-small cell lung cancer (NSCLC) when administered at the doses normally recommended for each agent individually.[15] Notably, they observed durable responses to the combination treatment in patients who were unlikely to benefit from nivolumab alone due to low tumor levels of PD-L1, suggesting that the combination may work better than either agent individually.[15]

The final results of this early trial were released in March 2019.[16] The results were in line with the September 2018 report, with the additional finding that patients receiving combination therapy in this trial were more likely to develop robust early antibody responses to CIMAvax as compared with what had been observed in earlier studies with CIMAvax alone.[16]

An ongoing Phase II clinical trial (clinicaltrials.gov identifier NCT02955290) has been expanded to include patients with advanced, recurrent head and neck squamous-cell carcinoma, as well as patients with advanced NSCLC but with high PD-L1 levels, who will be treated with pembrolizumab in combination with CIMAvax instead of nivolumab.[16]

References
  1. Crombet Ramos, T; Rodríguez, PC; Neninger Vinageras, E; Garcia Verdecia, B; Lage Davila, A (2015). "CIMAvax EGF (EGF-P64K) vaccine for the treatment of non-small-cell lung cancer". Expert Review of Vaccines. 14 (10): 1303–11. doi:10.1586/14760584.2015.1079488. PMID 26295963. S2CID 38130134.
  2. Dillow, C. (8 September 2011). "Cuba Announces Release of the World's First Lung Cancer Vaccine". Popular Science. Retrieved 2011-12-11.
  3. Grillo, I. (23 April 2015). "Cuba has had a lung cancer vaccine for years". GlobalPost. Retrieved 2014-05-24.
  4. Patel, N. (11 May 2015). "Cuba Has a Lung Cancer Vaccine—And America Wants It". Wired. Retrieved 2015-05-13.
  5. Tamayo, H. (8 September 2016). "Vacuna contra cáncer de pulmón llega al país". El Tiempo (Colombia). Retrieved 2016-09-09.
  6. "Cuban anti-cancer vaccines soon to be available in Serbia". October 21, 2015.
  7. "Can you tell me about the CimaVax lung cancer vaccine?". Cancer Research UK. 12 May 2015. Retrieved 2015-07-02.
  8. Rodríguez, P. C.; Rodríguez, G.; González, G.; Lage, A. (2010). "Clinical development and perspectives of CIMAvax EGF, Cuban vaccine for non-small-cell lung cancer therapy". MEDICC Review. 12 (1): 17–23. doi:10.37757/MR2010.V12.N1.4. PMID 20387330.
  9. Pérez A; et al. (Oct 2001). "Safety and preliminary immunogenicity of the recombinant outer membrane protein P64k of Neisseria meningitidis in human volunteers". Biotechnol Appl Biochem. 34 (2): 121–5. doi:10.1042/BA20010029. PMID 11592918. S2CID 27200881.
  10. Neninger Vinageras, E.; de la Torre, A.; Osorio Rodríguez, M.; Catalá Ferrer, M.; Bravo, I.; Mendoza del Pino, M.; Abreu Abreu, D.; Acosta Brooks, S.; Rives, R.; del Castillo Carrillo, C.; González Dueñas, M.; Viada, C.; García Verdecia, B.; Crombet Ramos, T.; González Marinello, G.; Lage Dávila, A. (2008). "Phase II randomized controlled trial of an epidermal growth factor vaccine in advanced non-small-cell lung cancer". Journal of Clinical Oncology. 26 (9): 1452–1458. doi:10.1200/JCO.2007.11.5980. PMID 18349395.
  11. Rodriguez, P. C.; Neninger, E.; García, B.; Popa, X.; Viada, C.; Luaces, P.; González, G.; Lage, A.; Montero, E.; Crombet, T. (2011). "Safety, immunogenicity and preliminary efficacy of multiple-site vaccination with an Epidermal Growth Factor (EGF) based cancer vaccine in advanced non small cell lung cancer (NSCLC) patients". Journal of Immune Based Therapies and Vaccines. 9 (7): 7. doi:10.1186/1476-8518-9-7. PMC 3215653. PMID 22024351.
  12. Davis, Henry (26 October 2016). "Roswell Park gets go-ahead to test Cuban lung cancer vaccine". The Buffalo News. Retrieved 3 December 2016.
  13. "CIMAvax Vaccine and Nivolumab in Treating Patients With Stage IIIB-IV Non-small Cell Lung Cancer - Full Text View - ClinicalTrials.gov". clinicaltrials.gov. Retrieved 2017-04-02.
  14. Hoshaw, Lindsey (2 December 2016). "Cuba Has a Lung Cancer Vaccine; Now U.S. Patients Will Test It". KQED News. Retrieved 3 December 2016.
  15. "Roswell Park Lung Cancer Expert Shares Initial Findings From First North American Study of CIMAvax". Roswell Park Comprehensive Cancer Center. September 26, 2018. Retrieved 10 April 2019.
  16. "With Safety Analysis Now Complete, Roswell Park Moves Forward With Expanded Study of CIMAvax". Roswell Park Comprehensive Cancer Center. March 30, 2019. Retrieved 10 April 2019.
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