Neoantigen Vaccines in Esophageal Squamous Cell Carcinoma

Official title

Neoantigen Vaccines in Combination with Immune Checkpoint Inhibitors for Maintenance Therapy Following Definitive Treatment of Locally Advanced Unresectable Esophageal Squamous Cell Carcinoma: an Open-Label, Randomized, Phase II Study

Overview

The aim of this clinical trial is to evaluate the efficacy and safety of consolidation therapy with a neoantigen-loaded dendritic cell vaccine (NeoDC-Vac) following radical chemoradiotherapy or chemoradiation-immunotherapy in patients with locally advanced, unresectable ESCC. The primary endpoint of the study is the OS rate. Secondary endpoints include OS, PFS, adverse events, CR rate, and quality of life (QoL) of patients. Exploratory endpoints involve the assessment of biomarkers such as TMB, PD-L1, and ctDNA. The key questions this study aims to answer are: -Can the combination of (ICIs and NeoDC-Vac as maintenance therapy improve OS and QoL in patients with locally advanced, unresectable ESCC following radical treatment? Can this novel approach provide an effective treatment option for these patients? Participant Procedures: 1. Endoscopic examination at West China Hospital. Baseline fresh tumor tissue collection for NGS in neoantigen vaccine group. 2. Screening assessments, informed consent, and random assignment to experimental or control group. Experimental Group\*\*: Neoantigen-loaded vaccine + standard ICIs as maintenance therapy. Control Group\*\*: Standard ICIs as maintenance. One cycle per month for one year. 3. Tumor tissue NGS, ctDNA analysis, TIME evaluation, T cell response profiling. All costs covered by research funding. 4. After completing the full treatment regimen, participants will be monitored with regular follow-up visits by healthcare professionals to assess ongoing health outcomes and safety.

Detailed description

The objective of this clinical trial is to evaluate the efficacy and safety of neoantigen-loaded dendritic cell (DC) vaccines as consolidation therapy following definitive chemoradiotherapy or radiotherapy with immunotherapy in patients with locally advanced unresectable esophageal squamous cell carcinoma (ESCC). The primary endpoint is the 2-year overall survival (OS) rate. Secondary endpoints include OS, progression-free survival (PFS), adverse events, complete response (CR) rate, and patient quality of life. Exploratory endpoints focus on biomarker analysis, including tumor mutational burden (TMB), PD-L1 expression, and circulating tumor DNA (ctDNA).

The key questions this study aims to answer are whether maintenance therapy with immune checkpoint inhibitors (ICIs) combined with neoantigen vaccines can improve overall survival and quality of life in patients with locally advanced, unresectable ESCC following definitive treatment, ultimately providing a new therapeutic strategy for these patients.

\*\*Participants in the study will:\*\*

1. \*\*Diagnostic Endoscopy at West China Hospital:\*\* Participants must undergo endoscopic examination at West China Hospital to confirm diagnosis. For patients in the neoantigen vaccine group, baseline fresh tissue samples will be obtained for next-generation sequencing (NGS) to screen for neoantigen peptides, which will be used to prepare individualized neoantigen vaccines. 2. \*\*Enrollment and Consent:\*\* Participants will complete relevant examinations to determine eligibility. Upon confirmation of eligibility, they will provide informed consent and undergo randomization.

\*\*Treatment Regimen:\*\* * \*\*Experimental Group:\*\* Neoantigen tumor vaccine in combination with standard immune checkpoint inhibitors (ICIs) as maintenance therapy following definitive treatment. * \*\*Control Group:\*\* Standard ICIs alone as maintenance therapy.

The treatment cycle will consist of monthly administrations for a total duration of one year. 3. \*\*Assessments During Treatment:\*\* Key assessments during treatment will include NGS sequencing of tumor tissue, ctDNA analysis from blood samples, evaluation of the tumor immune microenvironment (TIME), and T-cell response analysis. All of these assessments are essential for receiving the study treatment, and the associated costs will be covered by the research grant, ensuring that participants incur no additional financial burden.

Interventions

• Biological neoantigen-loaded dendritic cell vaccine (NeoDC-Vac)
  Experimental Group: Neoantigen Vaccine Combined with Immune Checkpoint Inhibitors (ICIs) Neoantigen Vaccine: Administered via subcutaneous injections at multiple sites, including bilateral axillary and bilateral inguinal regions. The initial phase consists of 5 injections during the first cycle, given at weeks 1, 2, 4, 6, and 8. Thereafter, the vaccine is administered once every 4 weeks, continuing for 1 year, or until disease progression, intolerable adverse events, or death from any cause. IC

Primary outcome measures

• 2-year OS rate [Time frame: 24months]

Secondary outcome measures (2)

• Progression-Free Survival (PFS) [Time frame: 12months]
• Treatment-related adverse effects (TRAEs) [Time frame: 12months]

Eligibility criteria

Inclusion criteria

A. Age 18-80 years

B. Locally advanced unresectable ESCC patients after radical treatment (radical chemoradiotherapy or chemoradiation); including:

• Cervical esophageal segment, T4, supraclavicular lymph node metastasis, or inability/refusal to undergo surgery due to personal reasons (refer to hospital below); ② Failure of neoadjuvant or conversion therapy; ③ Postoperative local recurrence, unresectable (target lesion present). C. No evidence of tumor recurrence or metastasis 2-3 weeks after radical treatment D. Ability to provide fresh tumor tissue samples (baseline) E. Normal major organ function F. Performance status (PS) score ≤ 1 G. Patients of childbearing potential must use contraception H. Voluntary participation with signed informed consent

Exclusion criteria

A. History of fistula caused by primary tumor invasion B. High risk of gastrointestinal bleeding, esophageal fistula, or esophageal perforation C. Poor nutritional status D. Immune-related adverse events during prior radical treatment, such as Grade ≥3 pneumonitis, myocarditis, etc.

E. Signs and symptoms of interstitial diseases F. Presence of any severe and/or uncontrolled medical conditions G. Presence of concurrent malignancies H. Presence of other autoimmune diseases, or prolonged use of immunosuppressants or steroids I. Difficulty in patient communication or inability to comply with long-term follow-up J. Other conditions deemed unsuitable by the investigator

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

China · 1 center

• West China Hospital of Sichuan University — Chengdu

Publications

• Chen Y, Zheng Y, Shi H, Yang W, Xu H, Li Y, Ding Z. Personalized neoantigen DC vaccine combined with camrelizumab following definitive therapy in locally advanced unresectable esophageal squamous cell carcinoma (CHANT-241): protocol for a randomized controlled trial. Front Immunol. 2026 Jan 12;16:1658670. doi: 10.3389/fimmu.2025.1658670. eCollection 2025. PMID 41601631

Identifiers

NCT: NCT06675201 · CHANT-241 Study

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗