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Overcoming PD-1 Blockade Resistance with CpG-A Toll-Like Receptor 9 Agonist Vidutolimod in Patients with Metastatic Melanoma
Journal article   Open access

Overcoming PD-1 Blockade Resistance with CpG-A Toll-Like Receptor 9 Agonist Vidutolimod in Patients with Metastatic Melanoma

Antoni Ribas, Theresa Medina, John M Kirkwood, Yousef Zakharia, Rene Gonzalez, Diwakar Davar, Bartosz Chmielowski, Katie M Campbell, Riyue Bao, Heather Kelley, …
Cancer discovery, Vol.11(12), pp.2998-3007
12/01/2021
DOI: 10.1158/2159-8290.CD-21-0425
PMCID: PMC8799774
PMID: 34326162
url
https://doi.org/10.1158/2159-8290.cd-21-0425View
Published (Version of record) Open Access

Abstract

Patients with advanced melanoma that is resistant to PD-1 blockade therapy have limited treatment options. Vidutolimod (formerly CMP-001), a virus-like particle containing a CpG-A Toll-like receptor 9 (TLR9) agonist, may reverse PD-1 blockade resistance by triggering a strong IFN response to induce and attract antitumor T cells. In the dose-escalation part of this phase Ib study, vidutolimod was administered intratumorally at escalating doses with intravenous pembrolizumab to 44 patients with advanced melanoma who had progressive disease or stable disease on prior anti-PD-1 therapy. The combination of vidutolimod and pembrolizumab had a manageable safety profile, and durable responses were observed in 25% of patients, with tumor regression in both injected and noninjected lesions, including visceral lesions. Patients who responded to vidutolimod and pembrolizumab had noninflamed tumors at baseline and induction of an IFNγ gene signature following treatment, as well as increased systemic expression of the IFN-inducible chemokine CXCL10. In this phase Ib study in patients with advanced melanoma, intratumoral TLR9 agonist vidutolimod in combination with pembrolizumab had a manageable safety profile and showed promising clinical activity, supporting the further clinical development of vidutolimod to overcome PD-1 blockade resistance through induction of an IFN response. See related commentary by Sullivan, p. 2960. This article is highlighted in the In This Issue feature, p. 2945.
Adjuvants, Immunologic Humans Melanoma - drug therapy Melanoma - genetics Programmed Cell Death 1 Receptor - therapeutic use T-Lymphocytes Toll-Like Receptor 9 - agonists

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