Microlyvaq™ is a first-line, non-randomized, two-arm clinical trial in advanced non-small cell lung cancer (NSCLC). In both arms, patients receive a personalized multi-epitope vaccine (Microlyvaq™) on top of standard-of-care chemo-immunotherapy, with treatment tailored by histology:

Arm 1 - Squamous NSCLC: Microlyvaq™ + carboplatin AUC 5 + paclitaxel 175 mg/m² + pembrolizumab Arm 2 - Non-squamous NSCLC: Microlyvaq™ + carboplatin AUC 5 + pemetrexed 500 mg/m² + pembrolizumab Because this is a non-randomized study, patients are assigned to arms based on tumor histology (squamous vs non-squamous), not by random allocation.

The core problem it addresses is that even with pembrolizumab plus histology-appropriate chemotherapy, many patients either never respond or respond briefly and then progress. Tumors evade by exhausting T cells, excluding them from the tumor bed, evolving antigen loss, and maintaining suppressive myeloid and stromal niches. Microlyvaq™ is designed to overcome these resistance modes by actively installing new, durable, polyfunctional anti-tumor immunity rather than relying only on pre-existing T cells.

Here's how it works. Each patient's tumor is sequenced (whole exome and RNA-seq) to identify both well-known lung cancer-associated antigens (e.g. NY-ESO-1, SOX2, p53, MAGE-A4, BRAF, BMI1, FXR1, HuD, HuC, CAGE) and private neoantigens created by that tumor's specific mutations, fusions, and splice variants. From this large antigen pool, machine learning models score each candidate epitope for that specific patient. The models consider predicted HLA class I and II presentation, how efficiently the antigen will actually be processed and displayed, whether it's expressed in tumor but not healthy tissue, how essential it is to most malignant cells (to avoid easy escape), and whether it is likely to drive functional, non-exhausted T-cell responses. This is not a generic ranking; it is individualized per patient.

The most promising epitopes then undergo a quantum molecular coupling evaluation. Instead of simply asking whether a peptide binds a given HLA, Microlyvaq™ modeling simulates the peptide-MHC complex as a physical system and approximates solutions to Ĥψ = Eψ to estimate whether the peptide will form a stable, low-energy, presentation-competent conformation that a realistic T-cell receptor can dock to without high energetic penalty. Epitopes that look good in simple binding screens but are predicted to be unstable, transient, or geometrically inaccessible to TCRs are excluded. The remaining epitope set is engineered to: (1) recruit potent CD8⁺ cytotoxic T cells that can kill tumor cells, and (2) recruit CD4⁺ Th1 helper T cells that produce IFN-γ, TNF-α, and IL-2 to sustain and support those killers. The vaccine is therefore intentionally multi-epitope, Th1-biased, and patient-specific.

Each personalized Microlyvaq™ lot is manufactured under GMP and given as a prime-boost series in sync with pembrolizumab and the appropriate chemotherapy backbone for the patient's histologic arm (carboplatin/paclitaxel for squamous; carboplatin/pemetrexed for non-squamous). Timing is deliberate: chemotherapy induces immunogenic tumor cell death and antigen release and transiently "opens up" the tumor microenvironment, while pembrolizumab lifts PD-1-mediated brakes on emerging T cells. Microlyvaq™ is dosed into that vulnerable window to expand vaccine-encoded clones just as new antigen is exposed and suppression is partially relieved. The goal is to generate rapid tumor shrinkage, then sustained immune pressure on residual disease, plus epitope spreading - where the immune system begins to recognize additional tumor targets beyond those in the vaccine, making escape more difficult.

The trial itself is structured as a seamless, adaptive, non-randomized Phase I/IIa study, with two predefined histology-based arms (squamous vs non-squamous) rather than randomized treatment allocations. The primary early endpoint is objective response rate (RECIST v1.1). Key secondary endpoints include progression-free survival, duration of response, and overall survival. In addition, the study incorporates real-time translational signals as decision points, including:

1. polyfunctional Th1 and CD8⁺ responses to vaccine epitopes by ELISpot/ICS,
2. durable expansion and persistence of vaccine-linked TCR clonotypes in blood and, when feasible, in tumor,
3. rapid decline in circulating tumor DNA as an early molecular marker of tumor clearance,
4. improved tumor infiltration by CD8⁺ and Th1 cells, and
5. remodeling of the tumor microenvironment away from suppressive myeloid states. If a given histology arm shows strong clinical responses plus these immune/molecular signals, that arm can seamlessly expand into survival-powered confirmation. If it does not, predefined futility rules allow that arm to stop, all within this non-randomized, adaptive framework.

This is an early Phase I, non-randomized, open-label, histology-stratified, two-arm interventional study evaluating Microlyvaq™, a personalized multi-epitope peptide vaccine, in combination with first-line pembrolizumab and platinum-based chemotherapy in adults with advanced or metastatic non-small cell lung cancer (NSCLC).

Patients are assigned to treatment arm according to tumor histology only (no randomization):

• Arm 1 (Squamous NSCLC): Microlyvaq™ + carboplatin AUC 5 + paclitaxel 175 mg/m² + pembrolizumab.
• Arm 2 (Non-squamous NSCLC): Microlyvaq™ + carboplatin AUC 5 + pemetrexed 500 mg/m² + pembrolizumab, with standard folate, vitamin B12, and corticosteroid premedication.

Rationale and Unmet Need Pembrolizumab plus platinum-based chemotherapy is a standard first-line option in metastatic NSCLC and improves survival compared with chemotherapy alone. However, many patients never respond, and responders often experience early progression. Current biomarkers (e.g., PD-L1 expression or tumor mutational burden) do not reliably predict durable benefit. Major causes of failure include incomplete or exhausted tumor-reactive T-cell repertoires, stromal and vascular barriers to T-cell infiltration, immunosuppressive myeloid and cytokine milieus, metabolic constraints in the tumor microenvironment, and antigenic escape under immune pressure. Releasing PD-1-mediated inhibition, even together with chemotherapy-induced antigen release, often does not generate a sustained, diversified, polyfunctional anti-tumor immune response.

Microlyvaq™ is designed to introduce into each patient a de novo, computationally defined set of tumor-directed T-cell specificities that are tailored to the individual tumor mutational and antigenic landscape, aligned with the patient's HLA genotype, and biased toward clonally important, difficult-to-lose lesions to reduce antigen-loss escape. The vaccine is administered in a prime-boost schedule intentionally synchronized with pembrolizumab and the histology-appropriate chemotherapy backbone.

The overarching early Phase I hypothesis is that a personalized multi-epitope vaccine can be safely integrated with standard chemo-immunotherapy, will induce measurable polyfunctional T-cell responses and favorable biomarker changes, and may provide preliminary signals of deeper and more durable clinical responses than would be expected with chemo-immunotherapy alone, thereby justifying later-phase studies.

Microlyvaq™ Platform (Tumor Profiling and Epitope Selection) For each participant, tumor material is analyzed using next-generation sequencing and HLA typing to generate a patient-specific pool of candidate antigens, including private neoantigens (from non-synonymous mutations, indels, fusions or splice variants) and selected tumor-associated antigens that are overexpressed in NSCLC. An AI/machine-learning-based immunogenetic scoring system evaluates each candidate epitope with respect to predicted HLA binding, processing and presentation, tumor specificity, clonality, and likelihood of immune escape. Quantum-inspired structural modeling is then used to further prioritize peptides predicted to form stable peptide-MHC complexes that are accessible to T-cell receptors. From this process, a finite panel of class I and class II peptides is selected to compose the personalized Microlyvaq™ lot for that patient.

The epitope selection algorithm is "context-aware" of the planned chemotherapy backbone (carboplatin/paclitaxel in Arm 1 vs carboplatin/pemetrexed in Arm 2), recognizing that these regimens differentially shape patterns of tumor cell death, vascular and stromal remodeling, and transient changes in lymphoid and myeloid compartments. Panels are therefore optimized with respect to both the patient's tumor biology and the expected treatment-induced immune milieu.

Manufacturing and Administration Microlyvaq™ is manufactured under Good Manufacturing Practice (GMP) conditions. Selected peptides are synthesized, purified, and blended into a multi-epitope peptide formulation, with standard identity, purity, sterility, and endotoxin testing and verification of chain-of-identity and chain-of-custody. Feasibility endpoints include the proportion of enrolled patients in whom a Microlyvaq™ lot can be successfully generated and released within a clinically relevant time window from biopsy to first vaccination, as well as logistical performance across manufacturing, storage, shipping, and on-site handling.

The vaccine is administered by subcutaneous or intradermal injection (final route defined in the protocol) in a prime-boost schedule coordinated with pembrolizumab and chemotherapy (e.g., a prime in Cycle 1 followed by boosts in subsequent cycles and, where appropriate, during pembrolizumab maintenance). Standard premedication and post-dose observation are used to monitor for local and systemic reactions.

Study Objectives and Assessments Because this is an early Phase I non-randomized trial, the primary focus is on safety, tolerability, and feasibility of integrating Microlyvaq™ into standard first-line regimens for squamous and non-squamous NSCLC. Treatment-emergent adverse events, serious adverse events, and immune-related adverse events will be collected and graded using standard criteria. Feasibility measures include adherence to the planned vaccination schedule and the ability to deliver individualized vaccine lots on time.

Key secondary and exploratory objectives include evaluation of vaccine-induced CD4⁺ and CD8⁺ T-cell responses against vaccine-encoded epitopes, T-cell receptor (TCR) repertoire dynamics (clonal expansion and persistence of vaccine-linked clonotypes), circulating tumor DNA (ctDNA) kinetics, and changes in the tumor microenvironment in patients who consent to on-treatment biopsies. Preliminary anti-tumor activity (e.g., overall response rate, duration of response, progression-free survival and overall survival per RECIST v1.1) will be described separately in each arm; the study is not powered for formal inter-arm comparisons.

Patient Population and Treatment Eligible patients are adults with advanced (stage IIIB/IIIC) or metastatic (stage IV) NSCLC who are candidates for first-line pembrolizumab plus platinum-based chemotherapy according to local standards, have ECOG performance status 0-1, adequate organ function, and sufficient tumor tissue for sequencing and HLA typing. Patients with squamous histology are assigned to Arm 1; those with non-squamous histology (e.g., adenocarcinoma or large-cell) are assigned to Arm 2. Key exclusions include prior PD-1/PD-L1/CTLA-4 blockade in the metastatic setting, uncontrolled CNS metastases, and clinically significant active autoimmune disease. Full eligibility criteria are specified elsewhere in the protocol.

Safety Monitoring and Oversight Patients will undergo regular clinical evaluations, laboratory testing, and radiologic assessments. Dosing of Microlyvaq™, pembrolizumab, and chemotherapy may be withheld, modified, or discontinued according to protocol-defined criteria in the event of toxicity. Immune-related toxicities will be managed in accordance with contemporary guidelines for checkpoint inhibitors, with additional guidance for suspected vaccine-related events. An independent Data Safety Monitoring Board (DSMB) will periodically review accumulating safety, feasibility, and emerging efficacy/biomarker data and may recommend modification, temporary suspension, or early termination of one or both histology-defined arms if warranted.

Sample Size and Design Summary The initial safety cohort will enroll 12 patients who will be evaluable for toxicity. If no Microlyvaq™-related adverse event of > Grade 2 is observed in more than 3 patients and no Grade 4 Microlyvaq™-related toxicity is observed in any patient, enrollment may expand to a total of 30 patients across both non-randomized arms. Data from this early Phase I study are intended to support the feasibility, safety, and biological activity of Microlyvaq™ and to guide the design of subsequent Phase Ib/II trials in squamous and non-squamous NSCLC.

Inclusion Criteria:

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Subjects are eligible if all of the following are met:

Age

≥18 years at the time of informed consent. Diagnosis / Histology

Histologically or cytologically confirmed non-small cell lung cancer (NSCLC) that is:

Non-squamous (e.g. adenocarcinoma, large-cell, NSCLC-NOS adjudicated non-squamous), or Squamous (if/when that stratum is open). Diagnosis must be locally documented and source-verifiable. Stage / Disease Status Stage IIIB / IIIC / IV or recurrent/metastatic NSCLC not amenable to curative surgery or radiotherapy, per AJCC 8th edition staging.

Disease is considered first-line metastatic/systemic setting:

No prior systemic therapy for advanced/metastatic disease in this line. Prior adjuvant/neoadjuvant therapy or consolidation chemo-RT is allowed if completed and the subject relapsed outside the protocol-defined disease-free interval (e.g. relapse ≥6-12 months after completion, per final protocol text).

Measurable Disease At least one measurable lesion per RECIST v1.1 at baseline imaging. Baseline imaging must be within 28 days prior to Day 1 (CT chest/abdomen/pelvis ± contrast, plus brain MRI if clinically indicated).

ECOG Performance Status ECOG 0 or 1 at screening. Subject must be ambulatory and clinically stable enough to receive combination therapy (pembrolizumab + chemo ± Microlyvaq™).

Adequate Organ and Marrow Function (Representative thresholds - to be finalized numerically in the protocol SOP, but typically:) Absolute neutrophil count (ANC) ≥1.5 × 10⁹/L. Platelets ≥100 × 10⁹/L. Hemoglobin ≥9.0 g/dL (transfusion allowed per institutional standard prior to enrollment).

AST and ALT ≤2.5 × upper limit of normal (ULN), or ≤5 × ULN if liver metastases are present.

Total bilirubin ≤1.5 × ULN (≤3 × ULN if known Gilbert's syndrome). Creatinine clearance / eGFR ≥45 mL/min/1.73 m² (sufficient for pemetrexed/platinum; final numeric cutoff may align to pemetrexed label).

Coagulation: INR and aPTT compatible with safe biopsy (if biopsy expected) per site policy.

Oxygenation: No resting hypoxemia prohibitive for safe treatment in investigator judgment.

Tumor Tissue Availability

Adequate tumor material must be available for:

PD-L1 assessment, DNA/RNA extraction (whole exome sequencing / RNA-seq or targeted panel sufficient for epitope discovery), High-resolution HLA typing support, Optional spatial profiling.

Acceptable sources:

Recent core needle biopsy or surgical specimen (preferred), OR Archival FFPE block or ≥15 unstained slides with documented tumor cellularity. Tumor cellularity must meet the minimum input requirement for sequencing and PD-L1 scoring (macrodissection allowed).

Biospecimen / Translational Willingness

Willing and able to provide required blood samples at protocol-defined timepoints:

PBMC (for ELISpot, ICS, TCR sequencing), Plasma/serum (for ctDNA, exosomal miRNA, cytokines), HLA typing. Willing to allow shipment of these biospecimens under chain-of-custody to central labs.

Willing to undergo optional on-treatment biopsy (e.g. around Cycle 3 / ~Week 6-9) if, in the investigator's judgment, it is clinically safe and technically feasible. If unsafe, liquid biopsy alone is acceptable.

Contraception / Reproductive Status Females of childbearing potential: negative pregnancy test at screening and prior to first dose.

Females of childbearing potential and males with partners of childbearing potential must agree to use highly effective contraception during study treatment and for the protocol-defined post-treatment window:

Typically ≥120 days after last pembrolizumab dose and ≥90 days after last Microlyvaq™ dose, whichever is longer (final timing per protocol).

No intention to conceive or donate gametes during this protection window. Informed Consent

Capable of understanding and signing informed consent(s), including:

Main study consent (chemo + pembrolizumab + Microlyvaq™), Genomic profiling / HLA typing consent, Optional on-treatment biopsy / leukapheresis consent (if applicable at site), Data/privacy language (GDPR-compliant). Willing to comply with study visits, dosing schedule, safety monitoring, PRO questionnaires (if enrolled in PRO subset), and survival follow-up.

Exclusion Criteria:

Subjects must not meet any of the following:

Prior Systemic Therapy in Metastatic Setting Any prior systemic therapy for metastatic / unresectable NSCLC in the current line.

Exception: prior adjuvant/neoadjuvant chemo, IO, or chemoradiation allowed if relapse occurred outside the protocol's defined exclusion interval (e.g. relapse ≥6-12 months after completion); exact interval to be specified.

Known Oncogene-Addicted Disease Requiring Targeted SOC Subjects whose tumors harbor actionable drivers for which an approved targeted therapy is standard first-line care (e.g. EGFR activating mutation, ALK rearrangement, ROS1 rearrangement, certain ERBB2/HER2 drivers, MET exon 14 skipping, RET fusion, NTRK fusion, KRAS G12C where local standard is targeted frontline) may be excluded or enrolled only in specific sub-cohorts if allowed by the statistical design.

Rationale: It may be unethical to withhold proven first-line targeted agents. The final protocol will define whether these genotypes are (a) excluded, (b) stratified, or (c) routed to a molecularly restricted exploratory cohort.

Uncontrolled CNS Disease Active, symptomatic brain metastases or leptomeningeal disease requiring immediate local intervention.

Allowed:

Previously treated/stable brain metastases are permitted if:

Clinically stable, Off high-dose steroids (e.g. >10 mg prednisone equivalent daily) for ≥14 days before Day 1, No new/worsening neurologic symptoms for ≥2 weeks.

Excluded:

Ongoing steroid dependency above immunosuppressive thresholds, uncontrolled seizures, mass effect with high intracranial pressure, or unstable neuro deficits judged unsafe.

Autoimmune / Immune-Mediated Conditions of Concern Active, uncontrolled autoimmune disease that has required systemic immunosuppression >10 mg/day prednisone-equivalent (or biologic immunosuppressive agent) within 14 days prior to Day 1.

History of severe (life-threatening) immune-related adverse event (irAE) to prior PD-1/PD-L1/CTLA-4 (e.g. Grade 4 pneumonitis, myocarditis, neurologic irAE that did not fully resolve), unless cleared by Medical Monitor.

Autoimmune disorders that are mild, stable, and not expected to flare under PD-1 blockade (e.g. controlled hypothyroidism on replacement; vitiligo; stable type 1 diabetes on insulin) may be allowed.

Significant Active Infection Any uncontrolled active infection requiring IV antibiotics or hospitalization at screening.

Uncontrolled HBV, HCV, or HIV viremia above protocol thresholds:

HBV: high viral load without appropriate antiviral management. HCV: untreated, high-level viremia with ongoing hepatic decompensation. HIV: uncontrolled (e.g. not on stable antiretroviral therapy, CD4 below a prespecified safe cutoff); final numeric cutoffs defined in protocol.

Active tuberculosis or other serious opportunistic infection. Clinically Significant Pulmonary Compromise Baseline pneumonitis requiring steroids. Prior ≥Grade 3 immune-mediated pneumonitis from checkpoint inhibitor therapy that did not resolve to ≤Grade 1.

Severe, uncontrolled interstitial lung disease that would make pembrolizumab plus investigational immunostimulation unsafe.

Other Serious Uncontrolled Comorbidities Uncontrolled congestive heart failure, unstable angina, recent myocardial infarction or stroke (typically <6 months).

Clinically significant uncontrolled arrhythmia. Severe uncontrolled hypertension. Any condition that, in the investigator's judgment, would make study therapy unacceptably high risk (e.g. ECOG drift, frailty, severe malnutrition).

Bleeding Risk / Biopsy Unsuitability (When Biopsy is Expected) Active, clinically significant bleeding or coagulopathy that cannot be corrected.

Platelet count or anticoagulation status that, in investigator judgment, makes mandatory biopsy unsafe.

NOTE: If a site/arm requires an on-treatment biopsy for core analysis and it is deemed unsafe, subject may still be eligible if protocol allows liquid-biopsy-only participation in that stratum. (This must be explicitly permitted to avoid excluding medically fragile patients.) Known Hypersensitivity Known severe hypersensitivity (e.g. anaphylaxis) to pembrolizumab, to the planned chemotherapy backbone (e.g. pemetrexed, carboplatin) despite standard premedication strategies, or to critical Microlyvaq™ excipients / adjuvant components.

In pemetrexed-containing regimens: inability/unwillingness to receive mandatory folate and vitamin B12 supplementation and steroid premedication.

In carboplatin regimens: uncontrolled prior carboplatin hypersensitivity not manageable by desensitization.

Pregnancy / Breastfeeding Pregnant or breastfeeding at screening. Intention to become pregnant (or impregnate a partner) during study therapy or within the required contraception window after last dose.

Concurrent Participation in Confounding Interventional Trials Enrollment in another interventional clinical study that could confound efficacy/safety readouts or interfere with immune profiling.

Exceptions:

Non-interventional / observational registries, Certain supportive care trials with Medical Monitor approval, Protocol-approved combination substudies (if integrated under the Microlyvaq™ umbrella and statistically planned).

Any Condition That Interferes With Protocol Compliance

Inability or unwillingness to comply with:

Scheduled visits, Biospecimen collections (for HLA typing, PBMC isolation, ctDNA, etc.), Imaging schedule (q6 weeks through Week 24, then q9-12 weeks), Safety follow-up and PRO questionnaires (if PRO subset), Survival follow-up calls ~q12 weeks post-treatment. Cognitive, psychiatric, or social situations that in the investigator's judgment would preclude safe, reliable participation and follow-up.

Notes / Operational Clarifiers

HLA typing and sequencing feasibility:

The subject must have enough viable tumor + PBMC DNA/RNA to allow:

WES / RNA-seq or equivalent targeted sequencing for neoantigen discovery, High-resolution HLA-A/B/C typing. If a subject cannot generate a viable personalized epitope set (e.g. insufficient material for immunogen design), that subject may be ineligible for Microlyvaq™ dosing but could be eligible for safety follow-up / SOC reference cohorts, depending on how the arm is structured.

Brain metastases:

Stable, treated, asymptomatic brain mets are allowed. This matters in first-line metastatic NSCLC, because excluding all brain mets would make the trial clinically irrelevant. The key exclusion is uncontrolled CNS disease requiring urgent steroids/radiation/surgery.

Actionable oncogene drivers:

Final protocol must say explicitly whether EGFR/ALK/ROS1/etc. are:

excluded entirely, allowed but stratified, or diverted to exploratory "post-standard-targeted-therapy" cohorts. This is both ethical and regulatory: you don't want to randomize someone away from globally recognized, mutation-directed SOC.

Autoimmune disease:

The bar is not "no autoimmune history ever." It's "no uncontrolled, high-risk autoimmune activity that would likely flare catastrophically when we give a personalized Th1-skewing vaccine + PD-1 blockade."

Contraception window:

Needs to line up with pembrolizumab label and with any reproductive toxicity data from Microlyvaq™ (e.g. ≥120 days / ≥90 days windows). Keep that harmonized across patient materials, pharmacy manual, and consent.

This criteria block is inspection-facing: it protects safety, preserves interpretability of immune endpoints, ensures we can actually manufacture/deliver a personalized Microlyvaq™ lot, and keeps the population consistent with first-line pembrolizumab+chemo standards in advanced NSCLC.

The following de-identified, participant-level data will be included:

Core clinical efficacy data Demographics and baseline disease characteristics (e.g. age, sex, ECOG performance status, histology, PD-L1 tumor proportion score strata, presence/absence of actionable oncogenic drivers).

Treatment assignment (study arm) and treatment exposure (dates and number of cycles of Microlyvaq™, pembrolizumab, platinum/taxane or pemetrexed-based chemotherapy).

Tumor response assessments per RECIST v1.1 (target lesion measurements, best overall response, confirmation status).

Time-to-event endpoints: progression-free survival (PFS), duration of response (DoR), overall survival (OS), and censoring information (dates and reasons).

Disease control status at protocol-defined timepoints. Concomitant anti-cancer therapies received after on-study treatment discontinuation.

The IPD package described above will be prepared after:

Database lock for the primary clinical analysis of the relevant cohort/arm, Resolution of all serious safety queries for that analysis set, Acceptance or public presentation/publication of primary efficacy and key safety results.

A structured dictionary / codebook (variable definitions, derivations, censoring rules) will accompany the shared IPD so that outside investigators can interpret the fields without needing access to internal SOPs.

We will share de-identified, subject-level clinical efficacy, safety, imaging-derived response calls, ctDNA kinetics summaries, T-cell pharmacodynamic summaries (polyfunctionality and clonal expansion/persistence scores), and predefined tumor microenvironment scores. We will not broadly release raw genomic sequences, raw TCR sequences, full unmasked pathology images, or any directly identifying information. Access to more granular molecular data can be requested, but will require enhanced review, additional agreements, and documented safeguards.