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170 Bot and Obrocea<br />
Table 1 A Translational Approach in Support of a Novel, Plasmid-Based Active<br />
Immunotherapeutic Strategy (Cancer Vaccine)<br />
Steps (in chronological order) Rationale References<br />
Naked plasmid for immunization<br />
(intramuscular injection)<br />
Naked plasmid for intralymphatic<br />
immunization<br />
Plasmid priming, peptide boost, by<br />
intralymphatic administration<br />
Multitargeted, plasmid priming,<br />
peptide boost approach, using<br />
intralymphatic immunization<br />
Biomarker-guided clinical<br />
exploration of a prime boost,<br />
intranodal immunization approach<br />
Expanded array of assays in support<br />
of clinical exploration of a prime<br />
boost, intranodal immunization<br />
approach<br />
Plasmid induces broad immune<br />
responses in preclinical models<br />
Limited magnitude of immunity by<br />
intramuscular immunization<br />
Limited magnitude of immune<br />
response by plasmid<br />
immunization in man<br />
High-quality immune response<br />
afforded by plasmid priming<br />
High magnitude of immune<br />
response afforded by peptide<br />
boost<br />
Coexpression of several defined<br />
tumor-associated antigens within<br />
cancer tissue<br />
Coexpression of target antigens<br />
across several tumor types<br />
Evidence that preexisting immunity<br />
was associated with improved<br />
clinical outcome<br />
number of antigen-expressing cells pooled from many animals immunized with<br />
plasmid, resulted in greatly magnified immune responses as compared to those<br />
achieved in animals immunized with the same plasmid (9).<br />
On the basis of such observations and the hypothesis that directly transfected<br />
APCs are more potent in inducing immune responses, several preclinical<br />
studies showed that direct intrasplenic or lymphatic injection of plasmid has a<br />
potential to generate superior responses (10). There was significant excitement<br />
generated by the finding that minute amounts of plasmid delivered to the APCrich<br />
skin by gene gun immunization, or secondary lymphoid tissue, were able to<br />
elicit robust immunity in preclinical models (10,11). A closer look at the data<br />
showed that while less plasmid was required to elicit an immune response, the<br />
overall dose-effect plateau in terms of achievable immune response was not<br />
dramatically changed. Nevertheless, early-phase clinical trials encompassing<br />
plasmid infusion into the groin lymph nodes of patients with advanced melanoma<br />
were carried out to test the safety and immunogenicity of this approach<br />
(12,13). For example, a more recent trial encompassed a plasmid-expressing<br />
Melan-A/MART-1 epitopes including the previously characterized HLA-<br />
A2-restricted Melan-A26–35 epitope (13). The plasmid was slowly infused into<br />
22<br />
10<br />
12, 13<br />
23<br />
17<br />
18, 19, 24<br />
18, 19, 24<br />
13