Companion atlas · one modality, in depth

Neoantigen & personalized peptide
vaccine atlas — RTK II glioblastoma

Data pulled 9 Sep 2026
Re-verify every entry before acting

A focused companion to the RTK II Glioblastoma Trial Finder, covering a single approach: a therapeutic vaccine built from the patient’s own tumour mutations (neoantigens), or from a per-patient selection of tumour-antigen peptides. See also the Treatment-Optimization Atlas, a toggleable decision timeline covering CeGaT/cecava (the private-provider entry below) alongside standard care, the Duke immunotherapy trial, and every other adjunct under consideration. Same patient as the main dashboard — a treatment-naïve 48-year-old whose 1.2 cm IDH-wildtype, methylation-class RTK II glioblastoma was gross-totally resected. Section 1 is trials run by hospitals and institutions the patient could plausibly qualify for, worldwide. Section 2 is private providers around the world that sell this as a paid service outside a registered trial.

Diagnosis GBM, IDH-wildtype, methylation class RTK II Age 48 Surgery 1.2 cm lesion, gross-total resection Status Newly diagnosed, treatment-naïve MGMT methylated (confirmed 11 Sep 2026) NGS panel (11 Sep 2026) TERT promoter mut. · TP53 mut. · PTEN loss · TMB 9.4 · MSS

New NGS panel result (11 Sep 2026) — TERT promoter c.-124C>T (C228T), VAF 42.05% · TP53 p.G266R, VAF 87.78% · PTEN loss, 77% · TMB 9.4 mut/Mb · MSI 3.39 (microsatellite-stable, MSS). What this changes here: MGMT promoter status confirmed 11 Sep 2026: methylated. This closes the last major biomarker gap and confirms — rather than assumes — that the four entries removed earlier for requiring MGMT-unmethylated status genuinely do not apply here. It is also the reason the NeoVax landmark card below was substantially rewritten: NeoVax has outcome data broken out specifically for MGMT-methylated patients, and this tumour is now confirmed to be exactly that population.

Tamavaq’s “>10 TMB” requirement is now known, not just presumed, to be unmet (9.4 < 10) — its Low fit stands, now with a real number instead of “unlikely to meet.” (Assay-dependent: confirm this NGS panel is comparably calibrated to the panel the trial specifies before treating 9.4 as final.)
The Paris PTPRZ1/TERT trial’s biological rationale is strengthened: this tumour is confirmed TERT-promoter-mutant, the exact reactivation mechanism the hTERT-targeting vaccine arm relies on. HLA-A2 positivity and tumour PTPRZ1 expression — the trial’s actual Phase 1 gates — are still unknown and unaffected by this panel.
BreakVax (added below) excludes dMMR/MSI-H/POLE-mutant tumours — cleared: this tumour is MSS.
TMB 9.4 is well above the ~1–2 mut/Mb usual for GBM — a genuinely favourable signal for personalized-neoantigen-vaccine manufacturability (more candidate neoepitopes for CeGaT, the Jaime Leandro Foundation, iNeo and similar programmes in Section 2) — but it is below the 10 mut/Mb threshold used for tissue-agnostic pembrolizumab (FoundationOne CDx) and for Tamavaq, so it does not newly unlock either.
PTEN loss is linked to a more immune-“cold,” T-cell-excluded tumour microenvironment in GBM and can blunt checkpoint-inhibitor combinations — a headwind for any vaccine-plus-checkpoint entry below (NeoVax+pembrolizumab, ZSky+TMZ, etc.), not a disqualifier.
TP53 p.G266R is not targeted by anything in this atlas (it is a peptide/neoantigen-vaccine atlas; TP53-directed approaches in GBM are gene-therapy platforms such as SGT-53, a different modality — out of scope here but worth raising with the tumour board).
DNA-methylation classifier confirmed (11 Sep 2026): family IDH wildtype (0.990), class IDH wildtype (0.989), subclass GBM, RTK II (0.953) — a high-confidence call at all three levels (the Heidelberg/DKFZ classifier treats ≥0.9 as confident). This confirms, with an actual score, the case description this whole atlas has been built around. It changes nothing about trial or provider matching — methylation subclass is almost never an eligibility criterion itself, as the bullets above already reflect.

Does this delay standard care? Usually no. Designing and GMP-synthesising a personalized vaccine takes roughly 6–12 weeks. Standard chemoradiation (the Stupp protocol) starts ~4–6 weeks post-op and runs ~6 weeks, then a break, then adjuvant temozolomide. Almost every programme here vaccinates during the adjuvant window, after chemoradiation (NeoVax: first dose within 12 weeks of surgery, after radiotherapy; ZSNeo-DC: after concurrent chemoradiation is complete). So the vaccine is generally additive, not a substitute or a delay — but the tumour tissue needed to build it had to be preserved at surgery. For an already-resected patient the first question is what was banked (see “How it is made” below).

This is an information aid, not medical advice. It is assembled from public registry records, published literature, and clinic marketing, and may contain errors or be out of date. It does not replace the treating neuro-oncology team or a molecular tumour board, and it cannot tell you whether a specific person is eligible — only a trial’s investigators can. Nothing here is an endorsement, and nothing here predicts an outcome for any individual. Verify every trial on ClinicalTrials.gov and with the study team. Nothing here should delay standard care that the treating team recommends.

Static reference page: no account, no login, no forms or input fields; it collects and transmits nothing, sells nothing, and is not affiliated with, nor endorsed by, any clinic, company, hospital or trial named. Clinic and company names are shown as plain text, not links.

How a personalized neoantigen peptide vaccine is made

The core idea: a glioblastoma carries somatic mutations found in no normal cell. Some mutated protein fragments bind the patient’s HLA molecules and can be seen by T cells — these are neoantigens. Sequence the tumour, predict which mutated fragments will be presented, synthesise those peptides, and inject them with an immune adjuvant to raise a tumour-specific T-cell response.

1 — Tissue

Tumour + blood

Fresh-frozen tumour (or FFPE with high tumour content) from the resection, plus a blood sample for the patient’s normal genome and HLA type.

2 — Sequence

Exome / RNA

Whole-exome (± RNA) sequencing of tumour vs normal to call the tumour’s somatic mutations and check they are expressed.

3 — Predict

Neoepitopes

Algorithms rank mutated peptides by predicted HLA class I/II binding. A shortlist (often 10–20, up to ~40 for DNA constructs) is chosen.

4 — Manufacture

GMP peptides

Synthetic long peptides made and released under GMP — the “printing” step — then formulated with an adjuvant (poly-ICLC, Montanide, or similar). ~6–12 weeks total.

5 — Vaccinate

Prime + boost

A priming series then periodic boosts, usually in the post-chemoradiation adjuvant window, frequently paired with a checkpoint inhibitor.

Delivery format varies. The same neoantigen shortlist can be given as free synthetic peptides, as an mRNA or DNA construct encoding them, or pulsed onto the patient’s dendritic cells. This atlas covers all four, tagged by format; classic “peptide vaccines” are the free-peptide version.
Personalized peptide vaccination (PPV) is a related but different Japanese method: a fixed pool of ~30 mostly shared tumour-antigen peptides, from which 2–4 are chosen per patient by HLA-A type and pre-existing antibody reactivity. It is not built from the patient’s own mutations.
Shared-antigen peptide vaccines (survivin/SurVaxM, EGFRvIII/rindopepimut, telomerase) target one fixed antigen for everyone. Listed in an appendix for comparison, not as personalized entries.

How RTK II / IDH-wildtype changes the picture

Glioblastoma is usually a low-mutation tumour — this one is better than average. Typically ~1–2 mutations/Mb; this patient’s 11 Sep 2026 NGS panel reports TMB 9.4 mut/Mb and MSS (MSI 3.39 — not a mismatch-repair-deficiency hypermutator; the elevated count is presumably intrinsic to this tumour or panel calibration, not MMR loss). That is a meaningfully larger neoepitope pool than the GBM baseline — a favourable sign for personalized-vaccine manufacturability — but still below the ≥10 mut/Mb bar some programmes use (e.g. Tamavaq in Section 1, and the tissue-agnostic pembrolizumab TMB-H threshold). Some patients with true hypermutation (constitutional mismatch-repair deficiency, a POLE mutation, or later temozolomide-induced hypermutation at recurrence) get far more targets than this; this patient is not in that group. Being treatment-naïve now means no TMZ-driven hypermutation boost yet — a cleaner baseline, not a ceiling.
RTK II is the EGFR family. EGFR amplification and often EGFRvIII — and EGFRvIII is a genuine shared tumour-specific antigen. But the EGFRvIII peptide vaccine rindopepimut failed a phase 3 (ACT IV): the tumour recurred EGFRvIII-negative. Worth testing EGFRvIII status; EGFRvIII CAR-T / bispecifics are in the main dashboard, not here.
Steroids blunt the response. Across neoantigen-vaccine trials in GBM (NeoVax and others), the patients on dexamethasone were consistently the poor immune responders. Minimising steroids around vaccination matters.
Chemoradiation causes lymphopenia. Radiation + temozolomide drop CD4 counts; timing vaccination to lymphocyte recovery is part of most designs.
Checkpoint monotherapy has failed in newly-diagnosed GBM (CheckMate-498/-548). Vaccines are usually combined with a checkpoint inhibitor anyway, to counter the immunosuppressive microenvironment — the combination is unproven for survival but mechanistically motivated. This tumour’s confirmed PTEN loss (77%) is the expected chromosome-10 partner to RTK II’s chromosome-7 gain, and PTEN loss is separately linked to a more T-cell-excluded, PD-L1-high microenvironment in glioma — a specific reason a vaccine-plus-checkpoint combination may face extra headwind in this tumour, not just GBM in general.
Methylation subclass “RTK II” is almost never an eligibility criterion. Matching keys on IDH-wildtype status, MGMT promoter methylation, EGFR/EGFRvIII, HLA type, mutational burden, and whether usable tumour tissue was banked.

At a glance

Six institutional programmes are open or about to open somewhere in the world and are at least plausibly relevant to a newly-diagnosed, fully-resected, IDH-wildtype patient — US entries first, then the rest. Entries that require an MGMT-unmethylated promoter (and so exclude a methylated tumour) have been removed per case direction — that took out the UF RNA-LP trial, the Washington University / Geneos GNOS-PV01 landmark, and the PEP-CMV and UCPVax appendix entries. BreakVax (Miami) was added 11 Sep 2026 — it is exactly this atlas's modality (a per-patient peptide vaccine of the tumour's own neoantigens) and had been missing; its MSI-H/dMMR/POLE exclusion is now confirmed cleared by the new NGS panel. Section 2 (private providers) sits right below, US-first; the completed / landmark platforms this field is built on are at the end of the page. Buyable private providers are concentrated in Germany, Japan and China. In the United States: no walk-in clinic sells this, but there is one self-pay route outside a standard trial — the Jaime Leandro Foundation’s FDA expanded-access programme (~USD 83k) — while Dana-Farber / Mass General and Albert Einstein / Mount Sinai run genuine personalized-neoantigen programmes but only as clinical trials (NeoVax, currently not enrolling).

Institutional trials open / about to open

Landmark platforms, between trials

Trial that explicitly requires IDH-wildtype (matches)

Entries removed (MGMT-unmethylated-only)

Open trials needing international travel (all but BreakVax)

Private providers with any published GBM data

Section 1 entries by vaccine format

Section 1 entries by region

Section 1 — Institutional trials the patient could qualify for

Hospital-, university- and cooperative-group trials of a personalized neoantigen vaccine (peptide, mRNA, DNA or dendritic-cell format), a personalized peptide selection, or — flagged as such — a closely related shared-antigen peptide vaccine. Worldwide, but United States entries are listed first. Each entry carries a fit label (the compiler’s triage guess, not an eligibility ruling) and an evidence score using the main dashboard’s rubric: 5 = positive randomised phase 3 · 4 = positive randomised phase 2 · 3 = single-arm survival signal vs historical control · 2 = early biological/radiographic signal · 1 = first-in-human · ⚠ = a prior pivotal trial of this approach was negative. Completed / not-currently-enrolling trials — NeoVax, the Washington University DNA vaccine, GAPVAC-101 and others — are collected at the end of the page.

Vaccine format

Region

Fit

Sort

Section 2 — Private providers using this technique, worldwide

Clinics and companies that sell a neoantigen or personalized peptide vaccine as a paid service, outside a registered clinical trial. This is a different category from Section 1: not FDA- or EMA-approved as effective, not randomised, evidence is a case series or none, and it is paid out of pocket. Grouped by region with United States first. Every card carries the same fields as the main dashboard’s private-provider list — contact / website, what is manufactured, starting material, regulatory framework, est. cost, insurance, evidence, patient story, and a plain statement of what is unverified. Included because they were asked for — not as a recommendation.

Legal-to-sell and proven-to-work are different questions. Germany’s named-patient / “individual healing attempt” rules and Japan’s regenerative-medicine safety framework permit these treatments; they do not establish efficacy. None of the providers below has published randomised outcome data for glioblastoma. Independent reviewers have specifically criticised delivering personalized vaccines to GBM patients outside trials (selection bias, no controls, cost, conflicts of interest — see the Neuro-Oncology 2025 commentary in Sources). Discuss any of this with the treating team before travel that could conflict with standard-of-care timing.

Before contacting or paying any provider

Ask for the actual deliverables: the tumour/normal sequencing report, the ranked neoepitope list, the number of peptides, and a Certificate of Analysis (identity, purity, sterility, endotoxin) for each synthesised peptide. Ask for GBM-specific outcome data — not all-comers, not testimonials — ideally with an independent (non-provider) analysis, and ask how many patients were sequenced but never vaccinated. Get a complete, itemised, all-inclusive written quote before travelling: diagnostics, manufacturing, each vaccination, immune monitoring, adjuvant/checkpoint drugs, and any mandatory add-ons. Confirm which country’s framework applies, what it actually reviews (safety vs efficacy), how adverse events are handled, and what recourse exists. Call your own insurer’s international / out-of-network line first — do not rely on the provider’s claim that reimbursement is possible; get it in writing and pre-verified. Bring it to the treating neuro-oncology team and molecular tumour board before paying, and confirm it will not delay or conflict with standard care or a trial you could otherwise join.

Appendix — shared / off-the-shelf tumour-antigen peptide vaccines

Not personalized — one fixed antigen for every patient — but the nearest neighbours to this modality. Mostly completed or closed. Included for comparison only. (The PEP-CMV and UCPVax entries were removed per case direction — both enrol MGMT-unmethylated GBM only.)

Vaccine	Antigen	Registry	Status & setting	Where	Reported so far	Relevance here

For later reference — recurrent-disease trials

Personalized-vaccine trials that enrol only at progression/recurrence. Not options now; useful if the disease returns.

Trial	Registry	What it is	Where

Questions to bring to the tumour board

Was fresh-frozen tumour banked at my resection? Is the FFPE block’s tumour content high enough (>~20–30%) for reliable exome sequencing and neoantigen calling? What is my tumour mutational burden and predicted neoantigen count? Any mismatch-repair deficiency or hypermutator signature? What is my HLA class I and II type? (Needed for PPV and for good epitope prediction.) Have EGFRvIII and MGMT promoter methylation been tested? (They gate several of the trials in this atlas.) Can a neoantigen vaccine be given in the post-chemoradiation adjuvant window without delaying the Stupp protocol? What steroid dose am I likely to need, and can it be minimised around vaccination? Is a domestic successor trial (a NeoVax or Washington University follow-on) about to open that would be preferable to travelling? How would enrolling in a vaccine trial now affect my eligibility for other options at recurrence?

Glossary

Neoantigen: A protein fragment from a tumour’s own somatic mutation, absent from normal cells — the target of a personalized vaccine.
Neoepitope: The specific short piece of a neoantigen predicted to bind the patient’s HLA and be seen by a T cell.
TMB (tumour mutational burden): Mutations per megabase. GBM is usually low (~1–2/Mb), which limits how many neoantigens are available.
HLA type: The individual set of molecules that present peptides to T cells. Determines which neoepitopes can work and is required for PPV.
Synthetic long peptide (SLP): A ~20–30-amino-acid synthetic peptide spanning a neoepitope; the usual building block of a peptide vaccine.
Poly-ICLC / Montanide: Immune adjuvants mixed with the peptides to provoke a stronger, more durable T-cell response.
Personalized peptide vaccination (PPV): Japanese method: 2–4 peptides chosen per patient from a fixed pool of ~30 shared tumour antigens, by HLA-A type and pre-existing IgG. Not neoantigen-based.
NeoVax: The Dana-Farber personalized neoantigen synthetic-long-peptide vaccine (up to ~20 peptides + poly-ICLC); the reference platform.
APVAC (GAPVAC-101): A two-part personalized vaccine (APVAC1 = pre-manufactured warehouse peptides; APVAC2 = truly patient-specific) tested by the German glioma group.
Named-patient / individueller Heilversuch: German legal route to give an unlicensed, individually-made treatment to one patient at their own cost — a safety/consent framework, not an efficacy approval.
Regenerative Medicine Act (Japan): Requires clinics offering cell/immunotherapy to notify and meet safety standards; reviews safety, not whether the treatment works.
EGFRvIII: A tumour-specific EGFR rearrangement common in RTK II GBM. A shared neoantigen — but the rindopepimut vaccine against it failed a phase 3 by antigen escape.
IDH-wildtype: No IDH1/IDH2 mutation; defines the most aggressive adult GBM group. Given here — and it makes the IDH1-R132H peptide vaccine (NOA-16) inapplicable.

Completed & landmark trials — not currently enrolling

The trials that established this approach in glioblastoma. All are completed or between studies — nothing here is an option to enrol in today. Listed last, on purpose, so the field’s actual published evidence is visible and as a watch-list for successor trials at Dana-Farber, Albert Einstein / Mount Sinai and the German groups. United States entries first. (The Washington University / Geneos GNOS-PV01 DNA vaccine was removed from this list per case direction — it enrols MGMT-unmethylated GBM only.)