• David A Reardon, James M Schuster, David Dinh Tran, Karen L Fink, Louis B Nabors, Gordon Li, Daniela Annenelie Bota, Rimas Vincas Lukas, Annick Desjardins, Lynn Stuart Ashby, J Paul Duic, Maciej M Mrugala, Andrea Werner, Thomas Hawthorne, Yi He, Jennifer Green, Michael Jay Yellin, Christopher D Turner, Thomas A Davis, and John H Sampson.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:198-9.

IntroductionEGFRvIII, a constitutively active EGFR deletion driver mutation, is associated with poor long-term survival in glioblastoma (GB). The investigational vaccine rindopepimut consists of a peptide sequence unique to EGFRvIII conjugated to keyhole limpet hemocyanin (KLH), delivered intradermally with granulocyte macrophage colony-stimulating factor. Three phase II studies in newly diagnosed, resected, EGFRvIII+ GB demonstrated encouraging progression-free survival (PFS), overall survival (OS), and safety profile. Compassionate-use experience suggests that rindopepimut may also provide benefit in relapsed GB, particularly with agents such as bevacizumab (BV).MethodsIn the Phase II "ReACT" study, BV-naïve patients in 1st or 2nd relapse with EGFRvIII+ GB were randomly assigned 1:1 to BV plus double-blinded injection of rindopepimut or control (KLH).End Points6-month PFS (PFS6; primary), objective response rate (ORR), PFS, OS, and safety.ResultsAccrual is complete (n = 72); study follow-up continues (n = 30). Primary rindopepimut toxicity is grade 1 to 2 injection site reaction. For rindopepimut + BV vs KLH + BV (per investigator; RANO criteria): PFS6 = 27% (9/33) vs 11% (4/35) (P = .048, 1-side χ test); ORR = 24% (7/29) vs 17% (5/30). Central PFS/ORR assessment is underway. Median (95% CI) OS = 12.0 (9.7, -) vs 8.8 (6.8, 11.4) months (HR = 0.47 [0.25, 0.91]; P = .0208), with 8 vs 4 patients progression-free. OS analyses favor rindopepimut including when adjusted for various prognostic factors. Rindopepimut induced robust anti-EGFRvIII titers (1:12800-1:6553600) in 80% of patients. Rapid titer generation was associated with prolonged OS (HR = 0.47 [0.18, 1.27]; P = .128) within the rindopepimut arm, and was most frequent in patients with KPS ≥ 90 (odds ratio = 9.75; P = .007). Evaluation of humoral response quality and HLA typing vs outcome are underway. In an additional cohort of BV-exposed patients (n = 53), four patients experienced objective tumor response.ConclusionThese near-final data show that rindopepimut induces potent EGFRvIII-specific immune response and tumor regression, and appears to significantly prolong survival when administered with BV in patients with relapsed GB.

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