IMP321

IMP321 is a large molecule cancer drug being developed by the clinical stage biotechnology company Prima BioMed (Nasdaq: PBMD). The drug is Prima's lead compound.

IMP321 is soluble version of the immune checkpoint molecule LAG3, used to increase an immune response to tumours. The drug is administered by subcutaneous injection. IMP321 has two intended clinical settings, 'low dose' (for example 250 µg) as adjuvant to cancer vaccines and 'high dose' (such as 12 injections of 6 mg each) as first-line 'chemo-immunotherapy', that is, combined with standard chemotherapy. IMP321 has been in Phase II clinical testing. The product has been shown to be non-immunogenic, that is, no anti-IMP321 antibodies have been detected in clinical trials.[1] Currently the main indication for the drug is metastatic breast cancer.

Background

IMP321 is a 200 kDA soluble dimeric recombinant fusion protein of the extracellular portion of LAG3 with immunoglobulin, designed to activate antigen presenting cells. LAG3 is expressed on various cells in the immune system including activated T cells, Natural Killer cells (NK cells), B cells and dendritic cells, being a ligand for MHC class II molecules. On T cells LAG-3 is an inhibitory receptor. However, on dendritic cells LAG-3 is an activator, causing increased antigen presentation to cytotoxic CD8+ T cells when it binds to MHC Class II. IMP321 is designed to harness this activation capacity as a 'chemo-immunotherapeutic', increasing antigen presentation in the wake of tumor debris created by chemotherapy.

History

Soluble LAG3 was first established as a dendritic cell activator in the late 1990s. Frédéric Triebel, who discovered LAG3 in 1990,[2] worked through the 1990s at his laboratory at the Institut Gustave Roussy, in collaboration with INSERM and Merck Serono, to elucidate LAG-3’s role in the immune system. Triebel et al. had successfully produced a soluble fusion protein of LAG3 and immunoglobulin around 1995[3] and had initially envisaged its use as an immunosuppressant after evidence that its interaction with MHC class II molecules leads to the down-regulation of CD4+ antigen-specific T cell clone proliferation and cytokine secretion,[4] and that it inhibited the alloresponses of naive peripheral blood lymphocytes.[5] However, in March 1999 a key paper in the Journal of Immunology from scientists at the University of Montreal, on which Triebel was listed as a co-author, demonstrated soluble LAG3's role as a dendritic cell activator.[6] Shortly after this, in 2001, Triebel formed a biotechnology company called Immutep SA in 2001 in order to develop the therapeutic potential of LAG3 including soluble LAG3. Immutep called its product 'ImmuFact IMP321', the 'act' part of ImmuFact referring to the products immune activating properties. By 2010 there was a large body of evidence of the efficacy of IMP321 in cancer.[7] Immutep was acquired by Prima BioMed in 2014 and as a result IMP321 became Prima BioMed's lead compound.

Pre-clinical work, 2000–2008

The years 2000 to 2008 saw a number of demonstrations of IMP321's effectiveness in vitro and in vivo.

Clinical trials

Early proof-of-concept studies, 2005-2007

Immutep conducted two Phase I studies with IMP321 designed to evaluate the safety as well as immune response profile of IMP321 in humans

Phase Ib study in renal cell carcinoma, 2005-2009

Immutep's first serious clinical study of IMP321 was an open label study in 21 metastatic renal cell carcinoma patients, with the drug being used as a monotherapy (ClinicalTrials.gov identifier NCT00351949, Immutep code name P003). These patients were known to be immunocompromised. The study, which initiated in late 2005[23] saw patients administered ascending doses of IMP321 up to 30 mg per injection fortnightly for six injections subcutaneously. The drug appeared to work at the two highest doses of 6 mg and 30 mg, with two notable outcomes for the eight patients who received these doses:

The results were published online in the journal Clinical Cancer Research in September 2009.[24]

Phase IIa study in metastatic breast cancer, 2006-2010

A 30-patient Phase IIa open label study in HER2-negative metastatic breast cancer (ClinicalTrials.gov identifier NCT00349934, Immutep code name P005) has suggested that IMP321 works as a chemo-immunotherapeutic in breast cancer, where chemotherapy creates tumor debris, and IMP321 increases activation of APCs as they take up that debris. This trial arose in part from the findings of a June 2005 online paper in the journal Cancer Letters by two researchers at the Centre René Huguenin in Saint-Cloud near Paris who had collaborated with Frédéric Triebel. That paper demonstrated that soluble LAG3 correlated with improved survival in breast cancer patients whose tumors were estrogen or progesterone receptor positive.[25] The Phase IIa study which partly confirmed this finding was initiated by Immutep around August 2006[26] and was conducted at the René Huguenin as well as two other Paris hospitals - the Hôpital Européen Georges-Pompidou (15th arrondissement) and the Hôpital Tenon (20th arrondissement). In the study, patients on paclitaxel were administered ascending subcutaneous doses of IMP321 on days 2 and 16 of a 28-day cycle of paclitaxel over six cycles. The maximum IMP321 dose was 6.25 mg. Paclitaxel was given on days 1, 8 and 15, meaning patients got IMP321 the day after paclitaxel had created tumor debris. There were two notable outcomes to this study:

The results of this study were reported in January 2010,[28] and following an oral presentation at the ASCO Annual Meeting in June 2010[29] the results were published in July 2010 in the Journal of Translational Medicine.[30] The study provided the basis of a new patent filing for IMP321 .[31]

Phase I study in pancreatic cancer, 2009-2012

In April 2009 Immutep announced its involvement in a Phase I study in pancreatic cancer conducted at Washington University School of Medicine in St. Louis.[32] This 18-patient study (ClinicalTrials.gov identifier NCT00732082, Immutep code name P008) evaluated for safety the combination of IMP321 with gemcitabine at doses up to 2 mg. The combination was found to be safe however no significant differences were observed when comparing pre- and post-treatment levels of monocytes, dendritic cells to T cells, probably due to sub-optimal dosing. The results of the study were reported online in the journal Investigational New Drugs in August 2012.[33]

Phase I studies in metastatic melanoma, 2006-2014

In September 2006 Immutep announced its involvement in a Phase I study being conducted at the Cancer Centre at the St Luc University Clinic in Brussels.[34] This 20-patient study (ClinicalTrials.gov identifier NCT00365937, Immutep code name P006) was a randomised open-label four-arm trial comparing a selected set of 8 HLA-A2 melanoma peptide antigens with or without IMP321 and/or Montanide ISA 51, a vaccine adjuvant composed of a light mineral oil and a surfactant system designed to make a water-in-oil emulsion. In this study all patients randomized in the peptides-alone arm relapsed during the first year whereas a majority of patients in the three other groups were still disease-free at follow-up, when the median disease-free survival follow-up was 33 months. The results of this study were presented to the 25th Annual Scientific Meeting of the International Society for Biological Therapy of Cancer in Washington, DC in October 2010.[35]

In August 2007 Immutep announced its involvement in a Phase I study being conducted at the University Hospital of Lausanne in Switzerland where a group was working on adoptive T cell transfer after transient lymphodepletion associated with peptide vaccination.[36] This study recruited 12 patients (ClinicalTrials.gov identifier NCT00324623, Immutep code name P007) where the patient's lymphocytes were depleted using chemotherapy, after which patients were given their own peripheral mononuclear cells, enriched with tumour-specific CD8 T cells. During the immune reconstitution period the patients were given a cancer vaccine containing a peptide melanoma antigen called MART1, adjuvanted with incomplete Freund’s adjuvant and, in half the patients, IMP321. While there was no confirmed responses as per the RECIST criteria for the 12 patients recruited, the investigators noted a significant expansion of MART-1-specific CD8 T cells in the IMP321 group, where there was also a higher proportions of effector cells and a significantly reduced expansion of regulatory T cells. These results were published in the Journal of Translational Medicine in April 2014.[37]

A third melanoma trial, also at the University Hospital of Lausanne (ClinicalTrials.gov identifier NCT01308294, Immutep code name P009) was designed to assess the effectiveness of IMP321 when combined with the melanoma peptides NA-17, MAGE-3.A2, NY-ESO-1, Melan-A and MAGE-A3-DP4.[38] This study has been terminated due to a low enrollment rate and has not reported any data.

Phase I/II prostate cancer study, 2010 -

In 2010 scientists at the Istituto Nazionale dei Tumori initiated a 20-patient open label study in prostate cancer patients that combined peptides from survivin with IMP321 (EudraCT Number 2009-017798-39, Immutep code name P010). The peptides, restricted for different HLA-I alleles, are emulsified in Montanide ISA 51. This study has yet to report any data.

Planned clinical studies

Prima plans to initiate a Phase IIb study of IMP321 in HER2-negative metastatic breast cancer, as well as a Phase I study in conjunction with an existing approved checkpoint inhibitor, in 2015. The Phase II will be a randomised, double-blind placebo-controlled Phase IIb study in first-line metastatic breast cancer. This trial, comparing IMP321+placlitaxel vs paclitaxel alone, will mainly take place in the European Union. The Phase I will mainly take place in US.[39]

Potential synergy with checkpoint inhibitors

Prima announced in late May 2015 that it had filed a provisional patent application over the use of IMP321 in combination with immune checkpoint inhibitors, following on from pre-clinical work showing higher response rates from the combinations.[40]

Potential use in a liver cancer vaccine

In May 2015 Prima announced a collaboration with NEC Corporation and Yamaguchi University in Japan in which Yamaguchi researchers will be combining IMP321 with a peptide vaccine they have developed as a potential therapeutic for hepatocellular carcinoma.[41]

Licensing in China

Immutep granted the rights to IMP321 in mainland China, Hong Kong, Macao and Taiwan in October 2013 to Eddingpharm, a privately held Chinese pharmaceutical company.[42]

Manufacture

IMP321 is manufactured in CHO cells. Immutep worked with Lonza in 2012 on cell line selection, master cell banking and process development for IMP321[43] after which the Shanghai-based WuXi PharmaTech was retained as contract manufacture.[44]

References

  1. Brignone C, Grygar C, Marcu M, Perrin G, Triebel F (March 29, 2007). "IMP321 (sLAG-3), an immunopotentiator for T cell responses against a HBsAg antigen in healthy adults: a single blind randomised controlled phase I study". J Immune Based Ther Vaccines 5 (1): 5. doi:10.1186/1476-8518-5-5. PMC 1852106. PMID 17394654.
  2. Triebel F, Jitsukawa S, Baixeras E, Roman-Roman S, Genevee C, Viegas-Pequignot E, Hercend T. (May 1, 1990). "LAG-3, a novel lymphocyte activation gene closely related to CD4.". J Exp Med. 171 (5): 1393–405. doi:10.1084/jem.171.5.1393. PMC 2187904. PMID 1692078.
  3. WO application 1995030750, Florence Faure, "LAG-3 protein soluble polypeptide fractions, method of production, therapeutic composition and anti-idiotype antibody", published 1995-12-2, assigned to Institut Gustave Roussy, INSERM, Merck Serono
  4. Huard B, Prigent P, Pagès F, Bruniquel D, Triebel F (May 1, 1996). "T cell major histocompatibility complex class II molecules down-regulate CD4+ T cell clone responses following LAG-3 binding". Eur J Immunol. 26 (5): 1180–6. doi:10.1002/eji.1830260533. PMID 8647185.
  5. Subramanyam M, Wands G, Nabioullin R, Tepper MA. (May 1, 1998). "Soluble human lymphocyte activation gene-3 modulates allospecific T cell responses". Int Immunol. 10 (5): 679–89. doi:10.1093/intimm/10.5.679. PMID 9645616.
  6. Avice M, Sarfati M, Triebel F, Delespesse G, Demeure CE. (March 1, 1999). "Lymphocyte activation gene-3, a MHC class II ligand expressed on activated T cells, stimulates TNF-alpha and IL-12 production by monocytes and dendritic cells.". J Immunol. 162 (5): :2748–53. PMID 10072520.
  7. "Key Publications". www.immutep.org. Immutep.
  8. El Mir S, Triebel F (June 1, 2000). "A soluble lymphocyte activation gene-3 molecule used as a vaccine adjuvant elicits greater humoral and cellular immune responses to both particulate and soluble antigens". J Immunol. 164 (11): 5583–9. doi:10.4049/jimmunol.164.11.5583. PMID 10820232.
  9. Andreae S, Piras F, Burdin N, Triebel F (April 15, 2002). "Maturation and activation of dendritic cells induced by lymphocyte activation gene-3 (CD223).". J Immunol. 168 (8): 3874–80. doi:10.4049/jimmunol.168.8.3874. PMID 11937541.
  10. Buisson S, Triebel F. (February 14, 2003). "MHC class II engagement by its ligand LAG-3 (CD223) leads to a distinct pattern of chemokine and chemokine receptor expression by human dendritic cells". Vaccine 21 (9): 862–8. doi:10.1016/s0264-410x(02)00533-9. PMID 12547595.
  11. Buisson S, Triebel F. (March 1, 2005). "LAG-3 (CD223) reduces macrophage and dendritic cell differentiation from monocyte precursors". Immunology 114 (3): :369–74. doi:10.1111/j.1365-2567.2004.02087.x. PMID 15720438.
  12. Cappello P, Triebel F, Iezzi M, Caorsi C, Quaglino E, Lollini PL, Amici A, Di Carlo E, Musiani P, Giovarelli M, Forni G (May 15, 2003). "LAG-3 enables DNA vaccination to persistently prevent mammary carcinogenesis in HER-2/neu transgenic BALB/c mice.". Cancer Res. 63 (10): 2518–25. PMID 12750275.
  13. Fougeray S, Brignone C, Triebel F (June 29, 2006). "A soluble LAG-3 protein as an immunopotentiator for therapeutic vaccines: Preclinical evaluation of IMP321.". Vaccine 24 (26): 5426–33. doi:10.1016/j.vaccine.2006.03.050. PMID 16621192.
  14. Casati C, Camisaschi C, Rini F, Arienti F, Rivoltini L, Triebel F, Parmiani G, Castelli C. (April 15, 2006). "Soluble Human LAG-3 Molecule Amplifies the In vitro Generation of Type 1 Tumor-Specific Immunity". Cancer Res. 66 (8): 4450–60. doi:10.1158/0008-5472.can-05-2728. PMID 16618772.
  15. Brignone C, Grygar C, Marcu M, Schäkel K, Triebel F (September 15, 2007). "A soluble form of lymphocyte activation gene-3 (IMP321) induces activation of a large range of human effector cytotoxic cells.". J Immunol. 179 (6): 4202–11. doi:10.4049/jimmunol.179.6.4202. PMID 17785860.
  16. Casati C, Camisaschi C, Novellino L, Mazzocchi A, Triebel F, Rivoltini L, Parmiani G, Castelli C (March 15, 2008). "Human Lymphocyte Activation Gene-3 Molecules Expressed by Activated T Cells Deliver Costimulation Signal for Dendritic Cell Activation". J Immunol. 180 (6): 3782–8. doi:10.4049/jimmunol.180.6.3782. PMID 18322184.
  17. Hege KM, Jooss K, Pardoll D (September 2006). "GM-CSF gene-modifed cancer cell immunotherapies: of mice and men". Int Rev Immunol. 25 (5-6): 321–352. doi:10.1080/08830180600992498. PMID 17169779.
  18. Li B, VanRoey M, Triebel F, Jooss K (June 1, 2008). "Lymphocyte activation gene-3 fusion protein increases the potency of a granulocyte macrophage colony-stimulating factor-secreting tumor cell immunotherapy". J Clin Cancer Res. 14 (11): 3545–54. doi:10.1158/1078-0432.CCR-07-5200. PMID 18519788.
  19. WO application 2009032256, Karin Jooss, "APC activators in combination with a cytokine-secreting cell and methods of use thereof", published 2009-05-07, assigned to Cell Genesys
  20. Brignone C, Grygar C, Marcu M, Perrin G, Triebel F (March 29, 2007). "IMP321 (sLAG-3), an immunopotentiator for T cell responses against a HBsAg antigen in healthy adults: a single blind randomised controlled phase I study". J Immune Based Ther Vaccines 5 (1): 5. doi:10.1186/1476-8518-5-5. PMC 1852106. PMID 17394654.
  21. "Immutep announces that Immufact IMP321 has successfully completed Phase I studies" (PDF). Immutep. 30 May 2006. Retrieved 1 July 2015.
  22. Brignone C, Grygar C, Marcu M, Perrin G, Triebel F (June 11, 2007). "IMP321 (sLAG-3) safety and T cell response potentiation using an influenza vaccine as a model antigen: a single-blind phase I study.". Vaccine 25 (24): 4641–50. doi:10.1016/j.vaccine.2007.04.019. PMID 17493710.
  23. "Immutep initiates Phase I clinical trial in renal cell cancer" (PDF) (Press release). November 22, 2005.
  24. Brignone C, Escudier B, Grygar C, Marcu M, Triebel F. (October 1, 2009). "A phase I pharmacokinetic and biological correlative study of IMP321, a novel MHC class II agonist, in patients with advanced renal cell carcinoma.". J Clin Cancer Res. 15 (19): 6225–31. doi:10.1158/1078-0432.CCR-09-0068. PMID 19755389.
  25. Triebel F, Hacene K, Pichon MF (April 8, 2006). "A soluble lymphocyte activation gene-3 (sLAG-3) protein as a prognostic factor in human breast cancer expressing estrogen or progesterone receptors.". Cancer Lett. 235 (1): 147–53. doi:10.1016/j.canlet.2005.04.015. PMID 15946792.
  26. "Immutep Announces That ImmuFact IMP321 Has Entered A Phase I Chemoimmunotherapy Trial In Breast Cancer" (PDF) (Press release). August 3, 2006.
  27. Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, Shenkier T, Cella D, Davidson NE. (December 27, 2007). "Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer.". N Engl J Med 357 (26): 2666–76. doi:10.1056/nejmoa072113. PMID 18160686.
  28. "Immutep Announces Final Results In Phase I/II Chemoimmunotherapy Trial In Breast Cancer" (PDF). Immutep. 4 January 2010. Retrieved 1 July 2015.
  29. "Immutep announces final results in phase I/II chemoimmunotherapy trial in metastatic breast cancer" (PDF) (7 September 2010). Immutep. Retrieved 1 July 2015.
  30. Brignone C, Gutierrez M, Mefti F, Brain E, Jarcau R, Cvitkovic F, Bousetta N, Medioni J, Gligorov J, Grygar C, Marcu M, Triebel F (July 23, 2010). "First-line chemoimmunotherapy in metastatic breast carcinoma: combination of paclitaxel and IMP321 (LAG-3Ig) enhances immune responses and antitumor activity". J Transl Med. 8 (71). doi:10.1186/1479-5876-8-71. PMC 2920252. PMID 20653948.
  31. WO application 2009044273, Frédéric Triebel, "Use of recombinant LAG-3 or the derivatives thereof for eliciting monocyte immune response", published 2009-04-09, assigned to Immutep
  32. "Immutep Announces Start of Clinical Trial in Pancreatic Cancer" (PDF). Immutep. 15 April 2009. Retrieved 1 July 2015.
  33. Wang-Gillam A, Plambeck-Suess S, Goedegebuure P, Simon PO, Mitchem JB, Hornick JR, Sorscher S, Picus J, Suresh R, Lockhart AC, Tan B, Hawkins WG (June 1, 2013). "A phase I study of IMP321 and gemcitabine as the front-line therapy in patients with advanced pancreatic adenocarcinoma". Invest New Drugs. 31 (3): 707–13. doi:10.1007/s10637-012-9866-y. PMID 22864469.
  34. "Immutep Announces That ImmuFact IMP321 Has Entered a Phase I Therapeutic Vaccine Trial in Melanoma" (PDF). Immutep. 25 September 2006. Retrieved 1 July 2015.
  35. "Abstracts for the 25th Annual Scientific Meeting of the International Society for Biological Therapy of Cancer" (PDF). J. Immunotheraoy. Retrieved 1 July 2015.
  36. "Immutep Announces That ImmuFact IMP321 Has Entered a Phase I Lymphodepletion Therapeutic Vaccine Trial in Metastatic Melanoma" (PDF). Immutep. August 28, 2007.
  37. Romano E, Michielin O, Voelter V, Laurent J, Bichat H, Stravodimou A, Romero P, Speiser DE, Triebel F, Leyvraz S1, Harari A (April 12, 2014). "MART-1 peptide vaccination plus IMP321 (LAG-3Ig fusion protein) in patients receiving autologous PBMCs after lymphodepletion: results of a Phase I trial.". J Transl Med. 12 (97). doi:10.1186/1479-5876-12-97. PMID 24726012.
  38. Immunotherapy of HLA-A2 Positive Stage II-IV Melanoma Patients (LAG-3/IMP321)
  39. "Prima BioMed Detailed Presentation" (PDF). Prima BioMed. Prima BioMed. 27 February 2015.
  40. "Prima BioMed announces new IP for its Lead IMP321 Development Program". Prima BioMed. 29 May 2015. Retrieved 30 June 2015.
  41. "Prima BioMed announces Japanese Collaboration". Prima BioMed. 11 May 2015. Retrieved 30 June 2015.
  42. "Immutep and Eddingpharm sign agreement for development of ImmuFact IMP321 in China" (PDF) (Press release). October 8, 2013.
  43. "Immutep and Lonza Sign Agreement for Cell Line Selection, Cell Banking and Process Development of ImmuFact IMP321" (PDF). Immutep. 10 April 2012. Retrieved 1 July 2015.
  44. "Immutep and Eddingpharm start production of ImmuFact IMP321 at WuXi AppTec in China" (PDF) (Press release). April 8, 2014.
This article is issued from Wikipedia - version of the Tuesday, May 03, 2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.