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Vaccine Therapy, MDX-010, and GM-CSF in Treating Patients With Metastatic Prostate Cancer
This study is ongoing, but not recruiting participants.
First Received: July 26, 2005   Last Updated: July 11, 2009   History of Changes
Sponsor: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00124670
  Purpose

RATIONALE: Vaccines made from a gene-modified virus may help the body build an effective immune response to kill tumor cells. Biological therapies, such as MDX-010 and GM-CSF, may stimulate the immune system in different ways and stop tumor cells from growing. Giving vaccine therapy together with MDX-010 and GM-CSF may be an effective treatment for prostate cancer.

PURPOSE: This phase I trial is studying the side effects and best dose of MDX-010 when given together with vaccine therapy and GM-CSF in treating patients with metastatic prostate cancer.


Condition Intervention Phase
Prostate Cancer
Biological: fowlpox-PSA-TRICOM vaccine
Biological: ipilimumab
Biological: sargramostim
Biological: vaccinia-PSA-TRICOM vaccine
Phase I

Study Type: Interventional
Study Design: Treatment, Open Label
Official Title: Phase I Trial of a PSA Based Vaccine and an Anti-CTLA-4 Antibody in Adults With Metastatic Androgen Independent Prostate Cancer

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Safety by CTCAE v 3.0 [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Objective responses by RECIST every 2 months [ Designated as safety issue: No ]
  • Prostate-specific antigen (PSA) response by monthly serum PSA [ Designated as safety issue: No ]
  • Compare immunologic responses by ELISPOT at baseline and day 99 [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: June 2005
Estimated Primary Completion Date: February 2007 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose of anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) when given with sargramostim (GM-CSF) and vaccine therapy comprising vaccinia-PSA-TRICOM vaccine and fowlpox-PSA-TRICOM vaccine in patients with androgen-independent metastatic prostate cancer.
  • Determine the safety and tolerability of this regimen in these patients.

Secondary

  • Determine immunologic response, as measured by an increase in prostate-specific antigen (PSA) specific T-cells by ELISPOT assay, in HLA-A2-positive patients treated with this regimen.
  • Determine the clinical response, as measured by RECIST and PSA consensus criteria, in patients treated with this regimen.

OUTLINE: This is an open-label, dose-escalation study of anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010).

Patients receive a priming vaccination with vaccinia-PSA-TRICOM vaccine subcutaneously (SC) on day 1 and sargramostim (GM-CSF) SC on days 1-4. Patients then receive booster vaccinations with fowlpox-PSA-TRICOM vaccine SC and MDX-010 IV over 90 minutes on days 15, 43, 71, 99, 127, and 155. Patients also receive GM-CSF SC on days 15-18, 43-46, 71-74, 99-102, 127-130, and 155-158. Patients without disease progression after day 155 may continue to receive fowlpox-PSA-TRICOM vaccine and GM-CSF every 28 days in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of MDX-010 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose-limiting toxicity.

After completion of study treatment, patients are followed at 4 weeks and then annually for 15 years.

PROJECTED ACCRUAL: A maximum of 30 patients will be accrued for this study within 2-3 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed prostate cancer

    • Metastatic disease
    • Androgen-independent disease
  • No bone pain requiring narcotics
  • No brain metastases

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-1

Life expectancy

  • At least 6 months

Hematopoietic

  • Granulocyte count ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Lymphocyte count ≥ 500/mm^3
  • Hemoglobin ≥ 9 g/dL

Hepatic

  • AST and ALT ≤ 2.5 times upper limit of normal
  • Bilirubin ≤ 1.5 mg/dL (total bilirubin ≤ 3.0 mg/dL for patients with Gilbert's syndrome)
  • Hepatitis B negative
  • Hepatitis C negative

Renal

  • Creatinine clearance ≥ 60 mL/min
  • No proteinuria ≥ grade 2 (unless the cause is determined to be nonrenal)

Cardiovascular

  • No history of congestive heart failure OR objective evidence of congestive heart failure by physical exam or imaging
  • No New York Heart Association class II-IV cardiac disease

Pulmonary

  • No pulmonary disease with fatigue or dyspnea during ordinary physical activity

Gastrointestinal

  • No inflammatory bowel disease
  • No Crohn's disease
  • No ulcerative colitis
  • No active diverticulitis

Immunologic

  • HIV negative
  • No history of allergy or untoward reaction to prior vaccination with vaccinia virus or to any component of the vaccinia regimen
  • No serious hypersensitivity reaction to egg products
  • No autoimmune disease that requires treatment, including any of the following:

    • Addison's disease
    • Hashimoto's thyroiditis
    • Systemic lupus erythematosus
    • Sjögren's syndrome
    • Scleroderma
    • Goodpasture's syndrome
    • Active Graves disease
    • Autoimmune hemolytic anemia
    • Ulcerative and hemorrhagic colitis
    • Endocrine disorders (e.g., thyroiditis, hyperthyroidism, hypothyroidism, autoimmune hypophysitis/hypopituitarism, or adrenal insufficiency)
    • Sarcoid granuloma
    • Myasthenia gravis
    • Polymyositis
    • Guillain-Barre syndrome
  • History of autoimmunity allowed provided it has not required systemic immunosuppressive therapy OR does not threaten vital organ function, including the CNS, heart, lungs, kidneys, skin, and gastrointestinal tract
  • No history of multiple sclerosis
  • No immunodeficiency or immunosuppression (by disease or therapy)
  • No history of or active eczema or other eczematoid skin disorder
  • No other acute, chronic, or exfoliative skin condition, including any of the following:

    • Atopic dermatitis
    • Burns
    • Impetigo
    • Varicella zoster
    • Severe acne
    • Other open rashes or wounds

Other

  • Fertile patients must use effective contraception during and for ≥ 4 months after completion of study treatment
  • No history of seizures
  • No history of encephalitis
  • No other active malignancy within the past 12 months except nonmelanoma skin cancer or carcinoma in situ of the bladder
  • No life-threatening illness
  • Able to avoid close household contact with the following individuals for ≥ 3 weeks after vaccination:

    • Individuals with prior or active eczema or other eczematoid skin disorder
    • Individuals with other acute, chronic, or exfoliative skin condition, including any of the following:

      • Atopic dermatitis
      • Burns
      • Impetigo
      • Varicella zoster
      • Severe acne
      • Other open rashes or wounds
    • Children 3 years of age or younger
    • Pregnant or nursing women
    • Immunodeficient or immunosuppressed individuals (by disease or therapy), including HIV-infected individuals
  • No other serious medical illness that requires treatment and would preclude study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • Prior vaccinia immunization allowed
  • No prior anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010)
  • No other concurrent anticancer immunotherapy

Chemotherapy

  • See Disease Characteristics
  • No prior chemotherapy
  • No concurrent chemotherapy

Endocrine therapy

  • More than 2 weeks since prior and no concurrent systemic or topical steroids, including steroid eye drops

    • Nasal or inhaled steroids allowed
  • Concurrent gonadotropin-releasing hormone agonist or antagonist therapy required for patients who have not undergone prior bilateral surgical orchiectomy
  • No concurrent anticancer systemic glucocorticoids

    • Concurrent replacement glucosteroids for patients with pituitary insufficiency allowed
  • Concurrent steroids for therapy-induced autoimmunity allowed

Radiotherapy

  • No concurrent anticancer radiotherapy

Surgery

  • See Endocrine therapy
  • Recovered from prior surgery
  • No prior splenectomy
  • No concurrent major surgery for treatment of cancer

Other

  • Recovered from prior therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00124670

Locations
United States, Maryland
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
Bethesda, Maryland, United States, 20892-1182
Sponsors and Collaborators
Investigators
Principal Investigator: James L. Gulley, MD, PhD, FACP National Cancer Institute (NCI)
  More Information

Additional Information:
Publications:
Gulley JL, Arlen PM, Madan R, et al.: Phase I trial of a PSA based vaccine and ipilimumab in patients (pts) with metastatic castrate resistant prostate cancer (CRPC). [Abstract] American Association for Cancer Research: Molecular Targets and Cancer Therapeutics, October 22-26, 2007, San Francisco, CA A-142, 2007.

Study ID Numbers: CDR0000437785, NCI-05-C-0167, NCI-7207
Study First Received: July 26, 2005
Last Updated: July 11, 2009
ClinicalTrials.gov Identifier: NCT00124670     History of Changes
Health Authority: United States: Food and Drug Administration

Keywords provided by National Cancer Institute (NCI):
recurrent prostate cancer
stage IV prostate cancer

Additional relevant MeSH terms:
Neoplasms
Neoplasms by Site
Prostatic Diseases
Genital Neoplasms, Male
Urogenital Neoplasms
Genital Diseases, Male
Prostatic Neoplasms

ClinicalTrials.gov processed this record on November 27, 2009