Sponsor: Memorial Sloan Kettering Cancer Center (other)
Phase: 2
Start date: June 9, 2023
Planned enrollment: 43
IO102 (imsapepimut) is one of two long-peptide components in IO Biotech’s off‑the‑shelf therapeutic cancer vaccine regimen commonly referred to as IO102‑IO103 (US brand name under development: Cylembio; components imsapepimut [IO102, targets IDO1] and etimupepimut [IO103, targets PD‑L1]). The regimen has been studied in combination with anti‑PD‑1 therapy across melanoma, non‑small cell lung cancer (NSCLC), and head and neck squamous cell carcinoma (SCCHN), with a phase 3 trial in first‑line advanced melanoma reporting topline results in August 2025. (sec.gov, drugs.ncats.io, ncbi.nlm.nih.gov, reuters.com)
Melanoma (first‑line, advanced/metastatic) - Phase 1/2 single‑arm trial (NCT03047928; IO102‑IO103 + nivolumab; n=30 PD‑1‑naïve): ORR 80% (43% CR); median PFS 26 months (95% CI 15.4–69); median OS not reached at 22.9‑month median follow‑up. These data underpinned FDA Breakthrough Therapy Designation (BTD) for the combination. (ncbi.nlm.nih.gov) - Phase 3 randomized trial (KN‑D18/IOB‑013; Cylembio + pembrolizumab vs pembrolizumab; n=407): August 11, 2025 topline reported an improvement in median PFS (19.4 vs 11.0 months) but the primary endpoint narrowly missed statistical significance; no new safety signals and a positive OS trend were noted. The company planned FDA discussions in fall 2025. (reuters.com)
NSCLC (first‑line, PD‑L1 TPS ≥50%) - Phase 2 basket trial (KN‑D38/IOB‑022; IO102‑IO103 + pembrolizumab; n=37; 31 evaluable): confirmed ORR 48% (unconfirmed 55%), DCR 81%, median PFS 8.1 months; approximately 50% of patients had no progression at 12 months; median DOR not reached at reporting. (investors.iobiotech.com)
Head and neck squamous cell carcinoma (first‑line, PD‑L1 CPS ≥20) - Phase 2 basket trial cohort (KN‑D38/IOB‑022; n=18 evaluable): confirmed ORR 44.4%, DCR 66.7%, median PFS 6.6 months; results presented at ESMO 2024 (Abstract 1022P). (oncologypro.esmo.org, investors.iobiotech.com)
Neoadjuvant/adjuvant (resectable melanoma or SCCHN) - A randomized phase 2 study of IO102‑IO103 + pembrolizumab in the perioperative setting is fully enrolled; initial data readouts were expected in 2025. (ascopubs.org, investors.iobiotech.com)
Notes - IO102 is imsapepimut (IDO1 peptide); IO103 is etimupepimut (PD‑L1 peptide). Together they have been advanced clinically only in combination with anti‑PD‑1 therapy; monotherapy experience exists for IO103 in early studies (multiple myeloma) demonstrating immunogenicity with predominantly low‑grade injection‑site reactions. (drugs.ncats.io, pmc.ncbi.nlm.nih.gov)
Clinical status as of September 2, 2025: Phase 3 melanoma study reported topline data (primary endpoint not met for statistical significance); multiple phase 2 trials completed enrollment with additional readouts anticipated in 2025. (reuters.com, investors.iobiotech.com)
Last updated: Sep 2025
Goal: Evaluate safety and antitumor activity of the IO102/IO103 therapeutic cancer vaccine combined with fixed-dose nivolumab–relatlimab as first-line therapy for unresectable stage III/IV melanoma.
Patients: Adults ≥18 years with histologically confirmed unresectable stage III or metastatic stage IV cutaneous/subcutaneous melanoma, at least one measurable extracranial, extraskeletal lesion by RECIST v1.1, ECOG 0–1, and adequate organ function. Prior systemic therapy for unresectable disease is not allowed; prior neoadjuvant/adjuvant ICI or BRAF/MEK therapy permitted if recurrence occurred >6 months after last dose. Excludes uveal melanoma, untreated/active CNS or leptomeningeal disease (treated, asymptomatic brain metastases allowed), active significant autoimmune neuropathies, active HBV/HCV with viral load >100 IU/mL, significant immunosuppression, and pregnancy or breastfeeding.
Design: Single-arm, open-label phase II treatment study with planned enrollment of 43 participants; no randomization or comparator.
Treatments: Experimental regimen: IO102/IO103 plus nivolumab–relatlimab fixed-dose combination. Nivolumab–relatlimab is standard-of-care dual checkpoint blockade targeting PD-1 and LAG-3, administered Day 1 of each 28-day cycle for up to 2 years. IO102/IO103 is an off-the-shelf long-peptide vaccine pair consisting of imsapepimut (IO102, targets IDO1) and etimupepimut (IO103, targets PD-L1), given subcutaneously on Days 1 and 15 of cycles 1–2, then Day 1 of subsequent cycles for up to 2 years. The vaccine aims to prime and expand CD4+ and CD8+ T cells specific for IDO1- and PD-L1-expressing tumor and immunosuppressive cells, complementing checkpoint inhibition. In a prior single-arm phase 1/2 study in first-line advanced melanoma with IO102/IO103 plus nivolumab (n=30), ORR was 80% with 43% CR, median PFS 26 months, and safety comparable to PD-1 monotherapy aside from injection-site reactions; these data supported FDA Breakthrough Therapy Designation. A subsequent randomized phase 3 with IO102/IO103 plus pembrolizumab versus pembrolizumab improved median PFS but narrowly missed statistical significance, with no new safety signals and a favorable OS trend.
Outcomes: Primary: Overall response rate by RECIST v1.1. Secondary: Safety and tolerability by CTCAE v5.0; progression-free survival by RECIST v1.1. Assessment window up to 3 years for efficacy endpoints and up to 100 days post–last dose for safety.
Burden on patient: Moderate. Treatment requires clinic visits every 28 days for infusions and vaccine injections, with additional Day 15 visits during the first two cycles. Imaging at typical intervals for advanced melanoma and routine laboratory monitoring will be needed. There are no stated intensive pharmacokinetic schedules or mandatory research biopsies, which limits added burden, but the first two cycles include mid-cycle visits and ongoing injections that increase visit frequency compared with checkpoint therapy alone.
Inclusion Criteria:
1. Age ≥ 18 years at the time of informed consent
2. Patient must be able to provide informed consent.
3. Patient must have a histologically confirmed diagnosis of locally advanced unresectable stage III or metastatic stage IV melanoma not amenable to local therapy.
4. Patient must have not received any prior systemic therapy directed against unresectable stage III or IV melanoma. Prior neoadjuvant and adjuvant ICIs and BRAF/MEK inhibitors are permitted as long as the last dose was \> 6 months prior to recurrence.
5. Patients must have at least one extraskeletal, extracranial measurable melanoma lesion as defined by RECIST v1.1. Note: A formal RECIST read by a study radiologist is not needed at the time of enrollment. Measurable disease can be assessed by the treating investigator.
6. Patients must have Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1.
7. Adequate laboratory function at screening, defined as:
1. Hemoglobin ≥ 9.0 g/dL
2. WBC ≥ 2000/uL
3. Platelet count ≥ 100 × 10\^9 /L
4. Serum direct bilirubin ≤ 1.5 × upper limit of normal (ULN); AST and ALT ≤ 2.5 × ULN. (Total bilirubin \< 3 mg/dL for subjects with Gilbert's disease)
5. Calculated creatinine clearance (CrCl) ≥15 mL/min based on the Cockcroft-Gault equation
8. Patients of childbearing potential\* who are sexually activ partner must use two methods of effective contraception from screening, and must agree to continue using such precautions for 23 weeks after the final dose of investigational product: cessation of birth control after this point should be discussed with a responsible physician. Periodic abstinence, the rhythm method, and the withdrawal method are not acceptable methods of birth control.
\*Patients of childbearing potential are defined as those who are assigned female at birth and not surgically sterile (i.e., bilateral tubal ligation, bilateral oophorectomy, or complete hysterectomy) or postmenopausal (defined as 12 months with no menses without an alternative medical cause).
9. Male patients who are sexually active with partners of childbearing potential must use highly effective methods of contraception throughout the study and for at least four months following the last dose of study treatment. Male patients must agree not to donate sperm during the study treatment period.
Exclusion Criteria:
1. Uveal melanoma
2. Untreated central nervous system (CNS) metastases or any leptomeningeal involvement. Asymptomatic brain metastases that have been treated with external radiotherapy are permitted.
3. Any immunotherapy treatment for unresectable stage III/IV melanoma or any other prior unresectable malignancy. Prior neoadjuvant and adjuvant ICIs and BRAF/MEK inhibitors are permitted as long as the last dose was \> 6 months prior to recurrence.
4. Systemic steroid therapy higher than physiologic dose steroid replacement (\>10 mg/day of prednisone or equivalent), given within 14 days of starting treatment, or other immunosuppressive medications within 14 days of the start of treatment. Inhaled or topical steroids are permitted in the absence of active autoimmune disease. 5. Treatment with any live/attenuated vaccine within 30 days of first study treatment. Inactivated and mRNA vaccines are permitted.
6\. History of motor neuropathy considered to be of autoimmune origin to be of autoimmune origin (e.g., Guillain-Barre syndrome, myasthenia gravis) 7. Other active, concurrent malignancy that requires ongoing systemic treatment or interferes with radiographic assessment of melanoma response as determined by the investigator 8. History of severe allergic reactions to any unknown allergens or any components of the study drugs.
9\. Uncontrolled (i.e., unstable) concomitant medical condition or organ system dysfunction which, in the Investigator's opinion, could compromise the patient's safety or compliance with the study procedures. Participants with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll. 10. Active hepatitis B virus (HBV) with a viral load \>100 IU/mL 11. Active hepatitis C virus (HCV) with a viral load \>100 IU/mL 12. Patients who are breastfeeding or who are pregnant as evidenced by a positive serum pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) performed within 14 days of the first dose of study drug.
13\. Prisoners or participants who are involuntarily incarcerated. (Note: Under certain specific circumstances where local regulations permit, a person who has been imprisoned may be permitted to continue as a participant.) 14. Participants who are compulsorily detained for treatment of either a psychiatric or physical illness (e.g., transmissible infection)
Hartford, Connecticut, 06102, United States
No email / 860-676-7000
Status: Recruiting
Basking Ridge, New Jersey, 07920, United States
No email / 646-888-6782
Status: Recruiting
Middletown, New Jersey, 07748, United States
No email / 646-888-6782
Status: Recruiting
Montvale, New Jersey, 07645, United States
No email / 646-888-6782
Status: Recruiting
Commack, New York, 11725, United States
No email / 646-888-6782
Status: Recruiting
Harrison, New York, 10604, United States
No email / 646-888-6782
Status: Recruiting
New York, New York, 10065, United States
No email / 646-888-6782
Status: Recruiting
Uniondale, New York, 11553, United States
No email / 646-888-6782
Status: Recruiting
Allentown, Pennsylvania, 18103, United States
No email / 610-402-7880
Status: Recruiting