Article
作者: Hasbullah, H.H. ; Wirasorn, K ; Lulla, P. ; Brenner, M.K. ; Sirachainan, E ; Samol, J. ; Ding, C. ; Horak, I ; Ang, M K ; Ho, G F ; Algazi, A ; Wang, H.-M. ; Liu, Y C ; Toh, H C ; Ho, K F ; Toh, H.C. ; Myo, A. ; Wang, W.-W. ; Yang, M-H ; Wirasorn, K. ; Lertbutsayanukul, C. ; Ho, G.F. ; Ho, K.F. ; Wirth, L J ; Low, S.H.J. ; Tan, S H ; Tho, L M ; Nadler, E ; Wang, H-M ; Ding, C ; Low, S H J ; Colevas, A.D. ; Hong, R.-L. ; Ang, S F ; Chitapanarux, I. ; Nadler, E. ; Chitapanarux, I ; Brenner, M K ; Tho, L.M. ; Ang, S.F. ; Tan, S.H. ; Hsieh, C Y ; Liu, Y.C. ; Lulla, P ; Hsieh, C.Y. ; Myo, A ; Ang, M.K. ; Ong, W S ; Lertbutsayanukul, C ; Sirachainan, E. ; Yang, M.-H. ; Colevas, A D ; Hong, R-L ; Samol, J ; Wang, W-W ; Wirth, L.J. ; Ong, W.S. ; Horak, I. ; Algazi, A. ; Hasbullah, H H
BACKGROUND:Epstein-Barr virus-specific cytotoxic T lymphocyte (EBV-CTL) is an autologous adoptive T-cell immunotherapy generated from the blood of individuals and manufactured without genetic modification. In a previous phase II trial of locally recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) patients, first-line gemcitabine and carboplatin (GC) and EBV-CTL combination demonstrated objective antitumor EBV-CTL activity and a favorable safety profile. The present study explored whether this combined first-line chemo-immunotherapy strategy would produce superior clinical efficacy and better quality of life compared with conventional chemotherapy treatment.
PATIENTS AND METHODS:This multicenter, randomized, phase III trial evaluated the efficacy and safety of GC followed by EBV-CTL versus GC alone as first-line treatment of R/M NPC patients. Thirty clinical sites in Singapore, Malaysia, Taiwan, Thailand, and the USA were included. Subjects were randomized to first-line GC (four cycles) and EBV-CTL (six cycles) or GC (six cycles) in a 1 : 1 ratio. The primary outcome was overall survival (OS) and secondary outcomes included progression-free survival, objective response rate, clinical benefit rate, quality of life, and safety.
CLINICALTRIALS:gov identifier: NCT02578641.
RESULTS:A total of 330 subjects with NPC were enrolled. Most subjects in both treatment arms received four or more cycles of chemotherapy and most subjects in the GC + EBV-CTL group received two or more infusions of EBV-CTL. The central Good Manufacturing Practices (GMP) facility produced sufficient EBV-CTL for 94% of GC + EBV-CTL subjects. The median OS was 25.0 months in the GC + EBV-CTL group and 24.9 months in the GC group (hazard ratio = 1.19; 95% confidence interval 0.91-1.56; P = 0.194). Only one subject experienced a grade 2 serious adverse event related to EBV-CTL.
CONCLUSIONS:GC + EBV-CTL in subjects with R/M NPC demonstrated a favorable safety profile but no overall improvement in OS versus chemotherapy. This is the largest adoptive T-cell therapy trial reported in solid tumors to date.