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Friday, May 20, 2016 11:03:51 PM
I would really be excited to see an intratumoral checkpoint inhibitor/Direct combination trial even though Direct may be good enough on its own. The Phase 2 trials could be with either product or both but I'm leaning mainly towards DCVax-L only because more is publicly known about it and I believe comments made by Dr. Prins point to DCVax-L.
DCVax-L vaccine quantity is limited by tumor mass size and potential for unresected tumor being the location of additional key antigen targets. Production improvements have been made to maximize the number of vaccines made from resected tumor but if best dosing interval is much shorter than previously thought then even this additional vaccine may not be sufficient to reach optimum results. Checkpoint inhibitors should effectively act to stretch out the effectiveness over time of each vaccine. This should essentially allow enough time for residual tumor to be cleared from tumor cavities after resection as well as help prevent escape and possibly lead to immune memory with heightened immune surveillance imparted. Eventually UCLA plans to isolate key post DC vaccine activated T-cell subsets to be cloned to produce a DCVax adjuvant therapy. In the mean time CI combinations with DCVax should work fairly well to exceptionally well in most patients. Best wishes.
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