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Effects of Vaccinations With HLA-A2-Restricted Glioma Antigen-Peptides in Combination With Poly-ICLC for Adults With High-Risk WHO Grade II Astrocytomas and Oligo-Astrocytomas
This study is currently recruiting participants.
Verified by University of Pittsburgh, January 2009
First Received: November 19, 2008   Last Updated: January 7, 2009   History of Changes
Sponsor: University of Pittsburgh
Collaborator: Oncovir, Inc.
Information provided by: University of Pittsburgh
ClinicalTrials.gov Identifier: NCT00795457
  Purpose

In this research study, doctors will use an experimental tumor vaccine made from small molecules called peptides and Montanide ISA-51 (an oil-in-water emulsion). Most vaccines are preventative, meaning that they are given to healthy people to prevent infection with a particular microbe (germ), such as a virus or bacterium. They work by getting your immune system ready to act quickly against that microbe if it enters the body in the future. In contrast, the vaccine used in this study is therapeutic, meaning that it is made to treat a disease that you already have. In addition to protecting the body from outside invaders such as viruses and bacteria, the immune system has the ability to attack abnormal cells in the body, such as cancer cells. The goal of a cancer vaccine is to get your body to do that.

Although cancer cells seem to be the same as normal ones in most ways, scientists have found that they may make molecules not commonly found in the body, called tumor-associated antigens. The vaccine used in this study contains antigen peptides (pieces of protein) that are known to be expressed by glioma tumors. It is designed to help your immune system fight against your tumor and help to prevent or slow the growth of new brain tumor cells.

This vaccine will be given in combination with a study drug called Poly-ICLC (Polyinosinic-Polycytidylic acid with Polylysine and Carboxymethylcellulose). Poly-ICLC is a drug manufactured by Oncovir, Inc. It is also considered experimental and works in a similar way that the tumor vaccine does with your immune system. Poly-ICLC has already been received and generally well tolerated by subjects in earlier studies and has been shown to decrease the size of brain tumors in some cases.

The purpose of this research study is to test the safety of this combination and to see how it affects your immune system.

This research study is considered experimental because neither the tumor vaccine nor the study drug, Poly-ICLC, has received approval from the Food and Drug Administration (FDA) for this use.


Condition Intervention Phase
Astrocytoma
Oligo-Astrocytoma
Glioma
Biological: GAA/TT-peptide vaccine and poly-ICLC
Phase 0

Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Parallel Assignment, Safety/Efficacy Study
Official Title: A Bi-Institutional Pilot Study to Evaluate the Effects of Vaccinations With HLA-A2-Restricted Glioma Antigen-Peptides in Combination With Poly-ICLC for Adults With High-Risk WHO Grade II Astrocytomas and Oligo-Astrocytomas

Resource links provided by NLM:


Further study details as provided by University of Pittsburgh:

Primary Outcome Measures:
  • Induction of GAA-specific T-cell response [ Time Frame: 2 year ] [ Designated as safety issue: No ]
  • The incidence and severity of adverse events associated with the vaccine regime will be assessed, with an early stopping rule based on the frequency of Regimen Limiting Toxicity (RLT). [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Clinical Response: Radiological response will be determined using the standard WHO response criteria. Based on serial magnetic resonance imaging (MRI) scans 2-year progression-free survival (PFS) will be evaluated in an exploratory manner. [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Biopsy/resection will be encouraged for patients who develop progression. Whenever post-vaccine tumor tissues are available, they will be analyzed for GAA expression status and infiltration of GAA-specific T-cells. [ Time Frame: 3 years ] [ Designated as safety issue: No ]
  • Influence of RT on induction of GAA-specific immune response: we will compare the rate and magnitude of GAA-specific immune responses in Cohorts 1 and Cohort 2 using IFN-gamma-enzyme-linked immuno-spot (ELISPOT), and tetramer assays. [ Time Frame: 3 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 6
Study Start Date: January 2009
Estimated Study Completion Date: November 2014
Estimated Primary Completion Date: November 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1: Experimental
Patients must have undergone surgery or biopsy alone ≤16 weeks prior to study entry (no postoperative radiation or chemotherapy).
Biological: GAA/TT-peptide vaccine and poly-ICLC
Participants will be treated with subcutaneous injections of GAA/TT-vaccines on Weeks 0, 3, 6, 9, 12, 15, 18 and 21. I.m. poly-ICLC will be administered (20 mg/kg i.m.) on the day of, and on day 4 after each vaccine (e.g. if the vaccine is administered on Thursday, poly-ICLC will be administered on the day of vaccine and the following Monday). Each vaccine will be administered within 2 hours before or after the i.m. poly-ICLC administration.
2: Experimental
Patients received surgery or biopsy and radiation therapy (RT) (including fractionated external beam radiation therapy and/or stereotactic radiosurgery), which was completed ≥6 months prior to enrollment, and have a baseline MRI scan (within 4 weeks of the first vaccine) that shows stable disease or regression.
Biological: GAA/TT-peptide vaccine and poly-ICLC
Participants will be treated with subcutaneous injections of GAA/TT-vaccines on Weeks 0, 3, 6, 9, 12, 15, 18 and 21. I.m. poly-ICLC will be administered (20 mg/kg i.m.) on the day of, and on day 4 after each vaccine (e.g. if the vaccine is administered on Thursday, poly-ICLC will be administered on the day of vaccine and the following Monday). Each vaccine will be administered within 2 hours before or after the i.m. poly-ICLC administration.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Pathological criteria - Participants must have documented pathological diagnosis of a supratentorial WHO grade II astrocytoma or oligoastrocytoma.
  • HLA-A2 positive based on flow cytometry.
  • There will be two cohorts of patients based on whether patients have received prior RT. Cohort 1: patients must have undergone surgery or biopsy alone ≤16 weeks prior to study entry (no postoperative radiation or chemotherapy). Cohort 2: Patients received surgery or biopsy and radiation therapy (RT) (including fractionated external beam radiation therapy and/or stereotactic radiosurgery), which was completed ≥6 months prior to enrollment, and have a baseline MRI scan (within 4 weeks of the first vaccine) that shows stable disease or regression.
  • 1) age ≥ 40 with any extent resection; 2) age 18-39 with incomplete resection (post-op MRI showing > 1cm residual disease, based on the maximum dimension of residual T2 or FLAIR abnormality from the edge of the surgical cavity either laterally, antero-posteriorally, or supero-inferiorally) or 3) age 18-39 with neurosurgeon-defined GTR but the tumor size is ≥ 4 cm (the maximum preoperative tumor diameter, based on the axial and/or coronal T2 or FLAIR MR images). Participants must be ≥ 18 years old because the safety of each therapeutic component has not been established in children.
  • All participants must sign an informed consent document indicating that they are aware of the investigational nature of this study, which includes an authorization for the release of their protected health information.
  • Participants must have a Karnofsky performance status of > 60 (Appendix I).
  • Documented negative serum beta HCG for female participants of child-bearing age. Because the effect of the peptide-based vaccine and poly-ICLC on the fetus has not sufficiently been investigated, pregnant females will not be included in the study. However, no female of childbearing potential will be excluded from the study as long as there serum beta HCG is negative. An effective form of contraception of the woman's choice (hormonal or barrier method of birth control; abstinence) will be required at all times during study (from the first vaccine to two weeks after the last vaccine). Males and females must agree, in the consent form, to use effective birth control methods during the course of vaccination. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with the peptide based vaccine and poly-ICLC, breastfeeding should be discontinued if the mother is treated in this study.
  • Participants must be free of systemic infection. Subjects with active infections (whether or not they require antibiotic therapy) may be eligible after complete resolution of the infection. Subjects on antibiotic therapy must be off antibiotics for at least 7 days before beginning treatment.
  • Participants with adequate organ function as measured by white blood count ≥ 2500/mm3; lymphocytes ≥ 800/mm3; platelets ≥ 100,000/mm3, hemoglobin ≥ 10.0 g/dL, AST, ALT, GGT, LDH, alkaline phosphatase within 2.5 x upper normal limit, and total bilirubin greater than or equal to 2.0 mg/dL, and serum creatinine within 1.5 X upper limit of normal limit. Coagulation tests PT and PTT have to be within normal limits.

Exclusion Criteria:

  • Presence of cranial or spinal leptomeningeal metastatic disease.
  • Prior chemotherapy or anti-glioma therapy of any type other than radiation therapy (see 3.1.3)
  • Concurrent treatment or medications including:

    • Radiation therapy
    • Chemotherapy
    • Interferon (e.g. Intron-A®)
    • Allergy desensitization injections
    • Growth factors (e.g. Procrit®, Aranesp®, Neulasta®)
    • Interleukins (e.g. Proleukin®)
    • Any investigational therapeutic medication
  • Participants must not have had prior autoimmune disorders requiring cytotoxic or immunosuppressive therapy, or autoimmune disorders with visceral involvement. Participants with an active autoimmune disorder requiring these therapies are also excluded. The following will not be exclusionary:

    • Mild arthritis requiring NSAID medications

  • Use of immunosuppressives within four weeks prior to study entry or anticipated use of immunosuppressive agents. Dexamethasone, or other corticosteroid medications, if used peri-operative period and/or during radiotherapy, must be tapered and discontinued at least four weeks before administration of the first vaccine. Topical corticosteroids and Inhaled steroids (e.g.:Advair®, Flovent®, Azmacort®) are acceptable. .
  • Participants who have another cancer diagnosis, except that the following diagnoses will be allowed:

    • squamous cell cancer of the skin without known metastasis
    • basal cell cancer of the skin without known metastasis
    • carcinoma in situ of the breast (DCIS or LCIS)
    • carcinoma in situ of the cervix
    • any cancer without distant metastasis that has been treated successfully, without evidence of recurrence or metastasis for over 5 years
  • Participants with known addiction to alcohol or illicit drugs.
  • Because patients with immune deficiency are not expected to respond to this therapy, HIV positive patients are excluded from the study.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00795457

Contacts
Contact: Hideho Okada, MD (412) 623-1111 okadah@upmc.edu
Contact: Teresa Donegan, PhD (412) 647-8580 donegante@upmc.edu

Locations
United States, Pennsylvania
University of Pittsburgh Cancer Institute Not yet recruiting
Pittsburgh, Pennsylvania, United States, 15232
University of Pittsburgh Cancer Institute Recruiting
Pittsburgh, Pennsylvania, United States, 15232
Contact: Hideho Okada, MD     412-623-1111     okadah@upmc.edu    
Contact: Teresa Donegan, PhD     (412) 647-8580     donegante@upmc.edu    
Sponsors and Collaborators
University of Pittsburgh
Oncovir, Inc.
  More Information

No publications provided

Responsible Party: University of Pittsburgh Cancer Institute ( Hideho Okada, MD, PhD )
Study ID Numbers: 07-057, R21CA133859-01A1
Study First Received: November 19, 2008
Last Updated: January 7, 2009
ClinicalTrials.gov Identifier: NCT00795457     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by University of Pittsburgh:
vaccine
WHO Grade II Astrocytoma
WHO Grade II Oligo-Astrocytoma

Additional relevant MeSH terms:
Interferon Inducers
Neoplasms by Histologic Type
Astrocytoma
Immunologic Factors
Physiological Effects of Drugs
Neoplasms, Nerve Tissue
Poly ICLC
Pharmacologic Actions
Neuroectodermal Tumors
Neoplasms
Neoplasms, Germ Cell and Embryonal
Oligodendroglioma
Glioma
Neoplasms, Neuroepithelial
Neoplasms, Glandular and Epithelial

ClinicalTrials.gov processed this record on November 20, 2009