HVTN P5 Vaccine Trials
Transcript of HVTN P5 Vaccine Trials
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HVTN P5 Vaccine Trials
Erica Andersen-Nissen, PhD Director, Cape Town HVTN Immunology Laboratory
“Considerations for a Pan-African HIV Vaccine Development Agenda” Kigali, Rwanda
16-17 March 2015
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HVTN Mission
• To fully characterize the safety, immunogenicity, and efficacy of HIV vaccine candidates with the goal of developing a safe, effective vaccine as rapidly as possible for prevention of HIV infections globally
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• Phase 3 program: RV144 regimen
• Correlates program: other promising vaccine regimens • DNA, Protein, NYVAC, ALVAC, adjuvants
Building and Expanding on the Results of RV144 in Southern Africa
RV144 HVTN 097 RV144 regimen
HVTN 100 Clade C products/
MF59 Adjuvant Month 12 boost
HVTN 702 Phase 3
South Africa Southern Africa Thailand
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The Strategy for the ALVAC/Protein Phase 3 program
Optimize regimen by increasing potency & durability
Construction of ALVAC-HIV-C (vCP2438)
Construction of Bivalent Subtype C gp120/MF59
Booster at 12 months
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Study Schema: HVTN 100
Immunogenicity evaluation to be applied to this study to inform advancement into phase 3
Products: • ALVAC-HIV (vCP2438) expressing HIV-1 env (clade C gp120), clade B (gp41), gag
(clade B) & protease (clade B) (Dose: >1 X 106 CCID50) • Bivalent subtype C gp120/MF59 containing 100mcg TV1.Cgp120 & 100mcg
1086.Cgp120
N (total 252)
Primary Vaccine Regimen Booster
Month 0 Month 1 Month 3 Month 6 Month 12
210 ALVAC-HIV (vCP2438)
ALVAC-HIV (vCP2438)
ALVAC-HIV+ Bivalent Subtype C gp120/
MF59®
ALVAC-HIV+ Bivalent Subtype C gp120/
MF59®
ALVAC-HIV+ Bivalent Subtype C
gp120/MF59® 42 Placebo Placebo Placebo + Placebo Placebo + Placebo Placebo + Placebo
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Scientific Objectives of Phase 1/2 testing in HVTN 100
• To demonstrate immune responses to the clade C vaccine are comparable to that in RV144 vaccine and sufficient to extend results of RV144
• To determine if levels of V1V2 antibody responses to clade C vaccine will enable testing of the V1V2 hypothesis as a vaccine Correlate of Protection (CoP)
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“Go” criteria • Adequate overall clade C vaccine response rate
• Env Ab binding response rate to vaccine insert
• Clade C vaccine immune effectors not inferior to those from RV144 in terms of: • Ab binding magnitude to env vaccine insert HIV strains • CD4 T cell ICS response rate to Env PTE peptides
• The V1V2 binding antibody response rate will be sufficient to test if the RV144 Correlate of Risk is a clade C vaccine-induced Correlate of Protection
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Study Schema: HVTN 702
Estimated Total Study duration 72 months: • Stage 1: 60 months-18 months for enrolment, 24 months of follow-up for HIV-1
uninfected individuals, 18 months follow up for HIV-1 infected individuals • Stage 2: an additional 12 months of follow up for uninfected individuals
N (total 5400)
Primary Vaccine Regimen Booster
Month 0 Month 1 Month 3 Month 6 Month 12
2700 ALVAC-HIV (vCP2438)
ALVAC-HIV (vCP2438)
ALVAC-HIV+ Bivalent Subtype C gp120/
MF59®
ALVAC-HIV+ Bivalent Subtype C gp120/
MF59®
ALVAC-HIV+ Bivalent Subtype C
gp120/MF59® 2700 Placebo Placebo Placebo + Placebo Placebo + Placebo Placebo + Placebo
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Timeline for Phase 3 Program
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Overall Strategy for Correlates Discovery
• Conduct a series of harmonized Phase 1 trials of priming and boosting regimens • Select regimens that are:
• most likely to reduce HIV acquisition • most diverse to move forward to Phase 2b
• Select up to three regimens to discover correlates of protection
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A Matrix of Prime/Boosts • Phase 1-2a trials (2015)
• Prime-boost vaccine regimen similar to that used in RV144 adjusted to target Clade C
• Multiple vaccine candidates
Prime-Boost Combinations Regimen Prime Boost
A DNA DNA + Env B DNA + Env DNA + Env C NYVAC NYVAC + Env D DNA NYVAC + Env E ALVAC ALVAC + Env F DNA ALVAC + Env
Env Dose and Adjuvant Types Option Env Dose Adjuvant
i 200 mg MF59 ii 200 mg AS01B
iii 40 mg AS01B ×
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Strategy for the Correlates Program
Increase potency, durability
& diversity
Construction of NYVAC
Construction of ALVAC-HIV-C
Construction of DNA
Formulation of bivalent Clade C gp 120/MF59
Formulation of bivalent Clade C
gp 120/alum
Formulation of bivalent Clade C gp 120/AS01B
Booster at 12 months
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Candidate Vaccine Products VACCINE PRODUCT DESCRIPTION DEVELOPER
ALVAC-C Expressing ZM96 gp120 (clade C strain) linked to gp41, and
gag and pro (clade B LAI strain). Sanofi Pasteur
NYVAC-C Bivalent highly attenuated vaccinia virus expressing clade C
ZM96 gp140 and ZM96 Gag-CN54 Pol-Nef fusion proteins Sanofi Pasteur
Gp120 protein
+ MF59
Clade C TV1 gp120 Env and clade C 1086 gp120 Env with
MF59 adjuvant Novartis Vaccines
Gp120 protein
+ ASO1B
Clade C TV1 gp120 Env and clade C 1086 gp120 Env with
ASO1B adjuvant GlaxoSmithKline
DNA-C
Trivalent DNA expressing clade C ZM96 Gag and gp140, and a
CN54 Pol-Nef fusion construct. This DNA product produces virus
like particles and trimeric configurations of gp140 IPPOX Foundation
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How are the trials going to identify a CoR/CoP for HIV vaccines?
• The Correlates Program focus • Next-generation clade C-adapted vaccines • Potent priming immunogens and adjuvants eliciting unique
immunological responses
• Phase 2b trial • Does not qualify vaccines for licensure • Advances the field by expanding knowledge of factors
contributing to HIV vaccine protective efficacy
• The Design • Efficiently evaluate vaccine safety and efficacy • Validate previously identified immune correlates of risk (CoR) • Identify additional CoR/CoP
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• NYVAC+protein • Potent Ab responses
• DNA/NYVAC+protein • Potent T-cell responses
• DNA-protein • Induction of novel priming for potent Ab and T-cell
boost responses • Coadministration of ALVAC and gp120 from
baseline • Modulation of IgA responses
Potent Priming Immunogens Elicit Distinct Immunological Profiles
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• MF59 = Squalene + Polysorbate 80 + Sorbitan Trioleate • An oil-in-water emulsion, squalene internal oil phase and a external aqueous phase.
The two non-ionic surfactants serve to stabilize the emulsion
• Increased vaccine potency and efficacy (Hep B, flu)
• Antigen sparing
• Expands Ab repetoire
• AS01B = liposome of MPL + QS21 • Monophosphoryl Lipid A (MPL) is a preparation derived from Salmonella minnesota,
R595.
• a TLR4 agonist already used in vaccines for Hep B and HPV (AS04)
• QS21 is a purified extract derived from the Soap bark tree; contains water-soluble triterpene glucoside compounds (saponins).
• Improved vaccine efficacy with malaria vaccine RTS,S
• Reported effects include expansion of the Ab repertoire
Potent Adjuvants with a Track Record
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2-Step Down Selection Process
For remaining regimens, determine the unique and ‘best’ regimens to select
STOP:
Vaccine removed Screening Failed
Screening Succeeded
For remaining regimens, determine the unique and ‘best’ regimens to select
STOP: Vaccine regimen removed
STOP: Vaccine regimen removed
Screening Succeeded
Step 1: Screening based on: • Safety • Adequate immune responses based on a core set of immune assays: Month 6.5 samples
Start with M HIV Vaccine Regimens
Compare each regimen to the ALVAC-‐gp120 C/C in MF59 regimen being tested in the Phase 3 program
Screening Failed
Screening Failed
Screening Succeeded
Step 2: SelecSon based on immune responses from a full set of immune assays: Month 6.5, 12 samples • Select regimens with unique and best-‐ranked immune responses
Peter Gilbert
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Step 1 of the Down Selection • Each vaccine regimen must have positive safety data and
sufficient immune response rates and levels, as summarized in the following table
Required Immune Response Benchmarks Required Most vaccine recipients have positive IgG binding antibody responses to the HIV
Envelope gp120 proteins in the vaccine
2/3 requ
ired
Most vaccine recipients have positive IgG binding antibody responses to the HIV Envelope V1V2 proteins in the vaccine [such responses are hypothesized to be responsible for the vaccine protection seen in the RV144 Thai trial]. Many of the responses need to be of similar magnitude as seen in the RV144 trial.
Most vaccine recipients have positive neutralization responses to the HIV Envelope gp120 proteins in the vaccine
Most vaccine recipients have CD4 or CD8 T cell responses to the HIV proteins in the vaccine
Peter Gilbert
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Step 2 of the Down Selection • Two sets of immune responses will form the basis for the
down selection: • A set based on published correlates of vaccine efficacy to prevent
HIV infection in the RV144 Thai trial • An inclusive set that the HIV vaccine field hypothesizes are relevant
for achieving prevention of HIV infection • The HVTN statistical group develops statistical methods for
guiding the down selection decision based on the multivariate immune response data
• Computer simulation studies are used to fine-tune the statistical methods to achieve an appropriate balance of: • high probability of selecting promising and distinctive vaccine regimens • low probability of selecting poor or redundant vaccine regimens
Peter Gilbert
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The Down-Selection Approach Will be Refined Up Until the Phase I Trial Data Analysis
• Statistical methods for analyzing immune response data are developed and validated on additional HVTN vaccine trial data sets over time
• Laboratory immune assays are developed and refined • e.g. panels of HIV Envelope reagents for measuring immune
responses are developed and refined
• New knowledge accrues about immune correlates of vaccine efficacy in the:
• RV144 Thai trial • non-human primate challenge trials
The down selection approach will be revised over time based on broad discussion with stakeholders in the HIV vaccine field Peter Gilbert
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Timeline for P5 Correlates Program
HVTN 108 Phase 1/2a DNA+bivalent gp120 AS01B/MF59
HVTN 109 Phase 1/2a DNA/NYVAC+bivalent gp120 AS01B/MF59
HVTN 701 Phase 2b Up to 3 active arms
6Mo 12Mo
8Mo 12Mo
7Mo 18Mo 7Mo 36Mo
HVTN 113 Phase 1/2a DNA/ALVAC+bivalent gp120 AS01B/MF59 6Mo 12Mo
2014 2017 2016 2015 2018 2019
REGIMEN SELECTION
REGULATORY REVIEW
ENROLLMENT
FOLLOW-UP
PROTOCOL DEVELOPMENT
PRIMARY IMMUNOGENICITY REPORT
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HVTN Site Expansion Necessary to Support Upcoming Studies
• Total of 12 sites being developed in Southern Africa • Malawi • Mozambique • Zambia • Zimbabwe • Tanzania • South Africa
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Acknowledgments
• BMGF • DAIDS/NIAID • EuroVacc • FHCRC (HVTN) • GSK
• IPPOX • Military HIV
Research Program • Novartis • RSA-MRC • Sanofi Pasteur
Study Participants and Site Staff
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THANK YOU!