A pilot trial of vaccination with Carcinoembryonic antigen and Her2/neu peptides in advanced colorectal cancer.

Checkpoint‐blockade therapy (CBT) is approved for select colorectal cancer (CRC) patents, but additional immunotherapeutic options are needed. We hypothesized that vaccination with carcinoembryonic antigen (CEA) and Her2/neu (Her2) peptides would be immunogenic and well tolerated by participants with advanced CRC. A pilot clinical trial (NCT00091286) was conducted in HLA‐A2+ or ‐A3+ Stage IIIC‐IV CRC patients. Participants were vaccinated weekly with CEA and Her2 peptides plus tetanus peptide and GM‐CSF emulsified in Montanide ISA‐51 adjuvant for 3 weeks. Adverse events (AEs) were recorded per NIH Common Terminology Criteria for Adverse Events version 3. Immunogenicity was evaluated by interferon‐gamma ELISpot assay of in vitro sensitized peripheral blood mononuclear cells and lymphocytes from the sentinel immunized node. Eleven participants were enrolled and treated; one was retrospectively found to be ineligible due to HLA type. All 11 participants were included in AEs and survival analyses, and the 10 eligible participants were evaluated for immunogenicity. All participants reported AEs: 82% were Grade 1‐2, most commonly fatigue or injection site reactions. Two participants (18%) experienced treatment‐related dose‐limiting Grade 3 AEs; both were self‐limiting. Immune responses to Her2 or CEA peptides were detected in 70% of participants. Median overall survival (OS) was 16 months; among those enrolled with no evidence of disease (n = 3), median OS was not reached after 10 years of follow‐up. These data demonstrate that vaccination with CEA or Her2 peptides is well tolerated and immunogenic. Further study is warranted to assess potential clinical benefits of vaccination in advanced CRC either alone or in combination with CBT. What's new? Carcinoembryonic antigen (CEA) and human epidermal growth factor receptor (Her2) are cancer‐associated antigens that are overexpressed in most colorectal cancer cases, making them promising targets for vaccine‐based immunotherapy. Here, the authors show that vaccination with HLA‐A2‐ and HLA‐A3‐restricted CEA and Her2 peptides is well‐tolerated by patients with advanced colorectal cancer. Immunogenicity was equivalent or superior to more costly vaccination strategies. These data encourage further evaluation of clinical benefits from CEA and Her2 vaccination and support the possibility that cancer‐associated peptide vaccination may enhance responses to checkpoint blockade therapy in patients with colorectal cancer. [ABSTRACT FROM AUTHOR]