title: IMA901, a multipeptide cancer vaccine, plus sunitinib versus sunitinib alone, as first-line therapy for advanced or metastatic renal cell carcinoma (IMPRINT): a multicentre, open-label, randomised, controlled, phase 3 trial.
abstract: BACKGROUND
  In a phase 2 study in patients with metastatic renal cell carcinoma, overall survival was associated with T-cell responses against IMA901, a vaccine consisting of ten tumour-associated peptides. In this phase 3 trial, we aimed to determine the clinical effect of adding IMA901 to sunitinib, the standard first-line treatment in metastatic renal cell carcinoma with postulated favourable immunomodulatory effects.
  
  
  METHODS
  The IMPRINT study is an open-label, randomised, controlled, phase 3 trial done at 124 clinical sites in 11 countries. HLA-A*02-positive patients (aged ≥18 years) with treatment-naive, histologically confirmed metastatic or locally advanced (or both) clear-cell renal cell carcinoma were randomly assigned (3:2) to receive sunitinib plus up to ten intradermal vaccinations of IMA901 (4·13 mg) and granulocyte macrophage colony-stimulating factor (75 μg), with one dose of cyclophosphamide (300 mg/m2) 3 days before the first vaccination, or to receive sunitinib alone. Sunitinib (50 mg) was given orally once daily, with each cycle defined as 4 weeks on treatment followed by 2 weeks off treatment, until progression of disease as determined by the investigator, death, or withdrawal of consent. Block randomisation (block size five) was done centrally using an interactive web response system, stratified by prognostic risk, geographical region, and previous nephrectomy. Patients and investigators were not masked to treatment allocation. The primary endpoint was overall survival from randomisation until death of any cause as determined by the investigator, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01265901.
  
  
  RESULTS
  Between Dec 22, 2010, and Dec 15, 2012, we screened 1171 patients, of whom 339 were randomly assigned to receive sunitinib plus IMA901 (n=204) or sunitinib monotherapy (n=135). Patients had a median follow-up of 33·27 months (IQR 29·92-35·64). Median overall survival did not differ significantly between the groups (33·17 months [95% CI 27·81-41·36] in the sunitinib plus IMA901 group vs not reached [33·67-not reached] in the sunitinib monotherapy group; hazard ratio 1·34 [0·96-1·86]; p=0·087). 116 (57%) of 202 patients in the sunitinib plus IMA901 group and 62 (47%) of 132 in the sunitinib group had grade 3 or worse adverse events, the most common of which were hypertension, neutropenia, and anaemia in both groups, and mild-to-moderate transient injection-site reactions (eg, erythema, pruritus) were the most frequent IMA901-related side-effect in the sunitinib plus IMA901 group. Serious adverse events leading to death occurred in four (2%) patients (one respiratory failure and circulatory collapse [possibly related to sunitinib], one oesophageal varices haemorrhage [possibly related to sunitinib], one cardiac arrest [possibly related to sunitinib], and one myocardial infarction) and eight (6%) patients in the sunitinib group (one case each of renal failure, oesophageal varices haemorrhage, circulatory collapse, wound infection, ileus, cerebrovascular accident [possibly treatment related], and sepsis).
  
  
  CONCLUSIONS
  IMA901 did not improve overall survival when added to sunitinib as first-line treatment in patients with metastatic renal cell carcinoma. The magnitude of immune responses needs to be improved before further development of IMA901 in this disease is indicated.
  
  
  BACKGROUND
  Immatics Biotechnologies.
authors.affiliation: Cleveland Clinic Taussig Cancer Center, Cleveland, OH, USA. Electronic address: rinib2@ccf.org.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.affiliation: University of Tübingen, Tübingen, Germany.
authors.forename: Arnulf
authors.initials: A
authors.lastname: Stenzl
authors.affiliation: Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Romauld
authors.initials: R
authors.lastname: Zdrojowy
authors.affiliation: Rostov State Medical University of Roszdrav, Rostov-on-Don, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kogan
authors.affiliation: Russian Scientific Center of Radiology and Surgery Technologies, St Petersburg, Russia.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Shkolnik
authors.affiliation: Hopital Europeen Georges Pompidou, Paris, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Oudard
authors.affiliation: Vivantes Humboldt Clinic, Berlin, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Weikert
authors.affiliation: Ospedale San Donato, Arezzo, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bracarda
authors.affiliation: University of Southampton, Southampton, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Crabb
authors.affiliation: University of Tübingen, Tübingen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Bedke
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Joerg
authors.initials: J
authors.lastname: Ludwig
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Maurer
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Mendrzyk
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wagner
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mahr
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fritsche
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Toni
authors.initials: T
authors.lastname: Weinschenk
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Walter
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kirner
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Singh-Jasuja
authors.affiliation: Immatics Biotechnologies, Tübingen, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Reinhardt
authors.affiliation: University of Cambridge, Cambridge, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Eisen
mesh_terms: D000368:Aged; D019496:Cancer Vaccines / Q000008:administration & dosage* / Q000009:adverse effects; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077210:Sunitinib
chemical_list: D019496:Cancer Vaccines; C583867:IMA901 vaccine; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib