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Vaccine Therapy in Treating Patients With Newly Diagnosed Glioblastoma Multiforme (ACTIVATe)

This study has been completed.
Sponsor:
ClinicalTrials.gov Identifier:
NCT00643097
First Posted: March 26, 2008
Last Update Posted: February 1, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Collaborator:
National Institute of Neurological Disorders and Stroke (NINDS)
Information provided by (Responsible Party):
John Sampson, Duke University Medical Center
  Purpose

RATIONALE: Vaccines made from a peptide may help the body build an effective immune response to kill tumor cells. Colony-stimulating factors, such as GM-CSF, increase the number of white blood cells and platelets found in bone marrow or peripheral blood. Giving vaccine therapy after surgery may kill any tumor cells that remain after surgery.

PURPOSE: This phase II trial is studying how well vaccine therapy works in treating patients with newly diagnosed glioblastoma multiforme.


Condition Intervention Phase
Malignant Neoplasms of Brain Biological: PEP-3 vaccine Biological: sargramostim Drug: Temozolomide Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Complementary Trial of an Immunotherapy Vaccine Against Tumor-Specific EGFRvIII

Resource links provided by NLM:


Further study details as provided by John Sampson, Duke University Medical Center:

Primary Outcome Measures:
  • Humoral and Cellular Immune Response [ Time Frame: 26 months ]
    Number of patients that developed a delayed-type hypersensitivity (DTH) response at following vaccination. Any skin reaction in response to the intradermal injection of the antigen was measured and recorded. A positive skin test was defined as > 5 mm induration (swelling).

  • Clinical Efficacy of Vaccination, in Terms of Progression-free Survival (PFS) [ Time Frame: 58 months ]

    Time in months from the start of study treatment to the date of first progression according to Macdonald criteria, or to death due to any cause. Patients alive who had not progressed as of the last follow-up had PFS censored at the last follow-up date. Median PFS was estimated using a Kaplan-Meier curve.

    Macdonald criteria are standard criteria in neuro-oncology. Tumor assessment was made according to the adapted MacDonald criteria based on the combined evaluation of: 1) assessment of the MRI scan for measurable, evaluable, and new lesions (made by the independent external expert too), 2) overall assessment of neurological performance (made by the investigator), 3) concomitant steroid use (as reported by the investigator).



Secondary Outcome Measures:
  • Response to Vaccination [ Time Frame: 26 months ]
    The objective is to assess the duration of immunosuppressive cytokine secretion and to identify a receptive interval for active immunotherapy. Immunosuppression will determined by monitoring a panel of immunosuppressive serum/plasma cytokines longitudinally and by determining the response of each patient to Recombivax Hepatitis B (HB) vaccination. Response is defined as seropositive or seronegative to the Hepatitis B surface antigen.

  • Toxicity to PEP-3 Vaccine Immunization [ Time Frame: 26 months ]
    To assess for any potential toxicity to the PEP-3 vaccine immunization in patients with newly diagnosed glioblastoma, Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 was used to tabulate any toxicities attributable to PEP-3. The number of patients with toxicity attributable to vaccine while on study are tabulated.


Enrollment: 40
Study Start Date: September 2007
Study Completion Date: November 2016
Primary Completion Date: January 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I (ACTIVATE)
Patients first receive 3 initial vaccinations of an epidermal growth factor receptor variant III (EGRRvIII)-specific peptide (PEP-3) keyhole limpet hemocyanin (KLH) conjugate vaccine and sargramostim (GM-CSF), referred to as PEP-3 vaccine, every 2 weeks starting 4 weeks after the completion of radiation. Subsequent vaccinations were given once a month until clinical or radiographic evidence of progression or death.
Biological: PEP-3 vaccine
Given intradermally
Biological: sargramostim
Given intradermally
Drug: Temozolomide
Standard of care chemotherapy
Other Names:
  • TMZ
  • Temodar
Experimental: Arm II (ACT II STD)
Patients first receive 3 initial vaccinations of an epidermal growth factor receptor variant III (EGRRvIII)- specific peptide (PEP-3) keyhole limpet hemocyanin (KLH) conjugate vaccine and sargramostim (GM-CSF), referred to as PEP-3 vaccine, biweekly starting within 6 weeks of completing radiation. Additional vaccinations were given until clinical or radiographic evidence of progression or death. Patients subsequently receive temozolomide at a targeted dose of 200 mg/m2 for the first 5 days of a 28 day cycle.
Biological: PEP-3 vaccine
Given intradermally
Biological: sargramostim
Given intradermally
Drug: Temozolomide
Standard of care chemotherapy
Other Names:
  • TMZ
  • Temodar
Experimental: Arm III (ACT II DI)
Patients first receive 3 initial vaccinations of an epidermal growth factor receptor variant III (EGRRvIII)- specific peptide (PEP-3) keyhole limpet hemocyanin (KLH) conjugate vaccine and sargramostim (GM-CSF), referred to as PEP-3 vaccine, biweekly starting within 6 weeks of completing radiation. Additional vaccinations were given until clinical or radiographic evidence of progression or death. Patients subsequently receive temozolomide at a targeted dose of 100 mg/m2 for the first 21 days of a 28 day cycle.
Biological: PEP-3 vaccine
Given intradermally
Biological: sargramostim
Given intradermally
Drug: Temozolomide
Standard of care chemotherapy
Other Names:
  • TMZ
  • Temodar

Detailed Description:

OBJECTIVES:

Primary

  • To assess humoral and cellular immune responses to adjuvant PEP-3-KLH conjugate vaccine in patients with newly diagnosed glioblastoma multiforme (GBM).
  • To assess the clinical efficacy of the PEP-3-KLH conjugate vaccine, in terms of progression-free survival, in patients with newly diagnosed GBM.

Secondary

  • To determine whether patients with GBM, who are known to be at least mildly immunosuppressed, can respond to standard and proven vaccine strategies.
  • To assess for any potential toxicity to the PEP-3-KLH conjugate vaccine in patients with newly diagnosed GBM.

OUTLINE: This is a multicenter study. Patients are stratified according to participating center.

At the time the study was initiated, standard of care temozolomide was not established, therefore, Arm I (ACTIVATE)was given without monthly cycles of temozolomide. At the point of interim analysis, monthly cycles of temozolomide had become standard of care. Arm II was then given the standard of care 5-day cycles of monthly temozolomide and during this time, dose-intensified temozolomide was in trials to compare with the 5-day temozolomide. Therefore, Arm III was initiated to determine the immunologic effects of 21-day monthly cycles of temozolomide with vaccine.

  • Arm I (ACTIVATE): Patients receive PEP-3-KLH conjugate vaccine and sargramostim (GM-CSF) intradermally on days 1, 15, and 29 and then monthly in the absence of disease progression or unacceptable toxicity.
  • Arm II (ACT II Standard (STD)): Patients first receive 3 initial vaccinations of an epidermal growth factor receptor variant III (EGRRvIII)- specific peptide (PEP-3) keyhole limpet hemocyanin (KLH) conjugate vaccine and sargramostim (GM-CSF) biweekly starting within 6 weeks of completing radiation. Additional vaccinations are given until clinical or radiographic evidence of progression or death. Patients subsequently receive temozolomide at a targeted dose of 200 mg/m2 for the first 5 days of a 28 day cycle.
  • Arm III (ACT II Dose-intensified (DI)): Patients first receive 3 initial vaccinations of an epidermal growth factor receptor variant III (EGRRvIII)- specific peptide (PEP-3) keyhole limpet hemocyanin (KLH) conjugate vaccine and sargramostim (GM-CSF) biweekly starting within 6 weeks of completing radiation. Additional vaccinations are given until clinical or radiographic evidence of progression or death. Patients subsequently receive temozolomide at a targeted dose of 100 mg/m2 for the first 21 days of a 28 day cycle.

    • Patients undergo delayed-type hypersensitivity (DTH) skin testing* at baseline, after the third vaccination, and then monthly thereafter. Patients also undergo leukapheresis to obtain sufficient peripheral blood lymphocytes for immunologic monitoring at baseline, after the third vaccination, and then, if applicable, at the time of positive DTH response, disease progression, or after the sixth course of post-radiotherapy temozolomide. Methods used for immunologic monitoring include Enzyme-linked Immunospot(ELISPOT) assays, cytotoxicity assays, fluorescence activated cell sorting (FACS), and ELISA.

NOTE: *Patients with positive DTH skin testing, also undergo skin punch biopsies.

After completion of study therapy, patients are followed periodically.

  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histologically confirmed newly diagnosed glioblastoma multiforme
  • Has undergone prior gross total resection (GTR) followed by conformal radiotherapy* with or without concurrent chemotherapy

    • GTR is defined as ≥ 95% volumetric resection of the contrast-enhancing component on the preoperative MRI
    • Residual radiographic contrast enhancement on post-resection CT scan or MRI must be ≤ 1 cm in maximal diameter in any two perpendicular axial planes
    • No evidence of disease progression after completion of radiotherapy* NOTE: *Patients may enroll in part 2 of the study within 2 weeks after surgery; these patients will receive radiotherapy with concurrent chemotherapy during the study
  • EGFRvIII-positive tumor by immunohistochemistry, polymerase chain reaction, or related molecular techniques
  • Karnofsky performance status 80-100%
  • Curran group status I-IV
  • Signed informed consent form

Exclusion Criteria:

  • Absolute Neutrophil Count (ANC) < 1,000/mm³
  • Platelet count < 50,000/mm³
  • Prothrombin Time/Partial Thromboplastin Time (PT/PTT) > 1.5 times normal
  • Positive hepatitis B (HB) surface antigen (HbsAg), antibody to hepatitis B surface antigen (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc)
  • Pregnant or nursing
  • Positive pregnancy test
  • Active infection requiring treatment
  • Unexplained febrile illness (T max > 101.5 F)
  • Inflammatory bowel disease, lupus erythematosus, rheumatoid arthritis, or other autoimmune disease
  • Known immunosuppressive disease
  • Known HIV infection
  • Diffuse leptomeningeal disease
  • Unstable or severe concurrent medical condition, such as severe heart and lung disease or active hepatitis
  • Demonstrated allergy to temozolomide or inability to tolerate temozolomide for reasons other than lymphopenia
  • Concurrent corticosteroids (except for nasal or inhaled steroids) at a dose above physiologic levels (> 2 mg of dexamethasone/day).
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00643097


Locations
United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710
United States, Texas
M. D. Anderson Cancer Center at University of Texas
Houston, Texas, United States, 77030-4009
Sponsors and Collaborators
John Sampson
National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
Principal Investigator: Gordana Vlahovic, MD Duke University
  More Information

Publications:
Responsible Party: John Sampson, Professor of Neurology, Duke University Medical Center
ClinicalTrials.gov Identifier: NCT00643097     History of Changes
Obsolete Identifiers: NCT00090597
Other Study ID Numbers: Pro00004040
P50NS020023 ( U.S. NIH Grant/Contract )
CDR0000589632 ( Other Identifier: National Cancer Institute )
DUMC-5421 ( Registry Identifier: DUMC IRB )
First Submitted: March 25, 2008
First Posted: March 26, 2008
Results First Submitted: January 6, 2014
Results First Posted: February 17, 2014
Last Update Posted: February 1, 2017
Last Verified: December 2016

Keywords provided by John Sampson, Duke University Medical Center:
adult giant cell glioblastoma
adult gliosarcoma
adult glioblastoma

Additional relevant MeSH terms:
Glioblastoma
Neoplasms
Brain Neoplasms
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Central Nervous System Neoplasms
Nervous System Neoplasms
Neoplasms by Site
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vaccines
Keyhole-limpet hemocyanin
Temozolomide
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Adjuvants, Immunologic