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Ph I Personalized NeoAntigen Cancer Vaccine With Radiotherapy for Patients With MGMT Unmethylated, Newly Diagnosed Glioblastoma

This study is currently recruiting participants. (see Contacts and Locations)
Verified November 2016 by Dana-Farber Cancer Institute
Sponsor:
Collaborators:
The Ben & Catherine Ivy Foundation
Accelerate Brain Cancer Cure
Information provided by (Responsible Party):
Patrick Ott, MD, Dana-Farber Cancer Institute
ClinicalTrials.gov Identifier:
NCT02287428
First received: October 29, 2014
Last updated: November 15, 2016
Last verified: November 2016
  Purpose

This research study is studying a new type of vaccine as a possible treatment for patients with MGMT-unmethylated glioblastoma. This research study is a Phase I clinical trial, which tests the safety of an investigational intervention and also tries to define the appropriate dose of the intervention to use for further studies. "Investigational" means that the intervention is being studied and that research doctors are trying to find more about it. It also means that the FDA (U.S. Food and Drug Administration) has not approved the Personalized NeoAntigen Cancer Vaccine for any use in patients, including people with glioblastoma.

The purpose of this study is to determine if it is possible to make and administer safely a vaccine against glioblastoma by using information gained from specific characteristics of the participants tumor. It is known that glioblastomas have mutations (changes in genetic material) that are specific to an individual patient's tumor. These mutations can cause the tumor cells to produce proteins that appear very different from the body's own cells. It is possible that these proteins used in a vaccine may induce strong immune responses, which may help the body fight any tumor cells that could cause the glioblastoma to come back in the future.


Condition Intervention Phase
Glioblastoma
MGMT-unmethylated Glioblastoma
Gliosarcoma
Glioblastoma With Oligodendroglial Features
Giant Cell Glioblastoma
Glioblastoma Multiforme
Radiation: Radiation Therapy
Biological: Personalized NeoAntigen Vaccine
Phase 1

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I Study of a Personalized NeoAntigen Cancer Vaccine With Radiotherapy Among MGMT Unmethylated, Newly Diagnosed Glioblastoma Patients

Resource links provided by NLM:


Further study details as provided by Dana-Farber Cancer Institute:

Primary Outcome Measures:
  • Number of participants with Adverse Events as a measure of safety and tolerability [ Time Frame: 2 Years ]
    We will be looking at adverse events (including DLTs) to evaluate safety and tolerability of administering NeoVax in participants with newly diagnosed glioblastoma.

  • Number of participants with at least 10 actionable peptides as a measure of study feasibility [ Time Frame: 2 Years ]
    This information will be used to determine the feasibility of generating and administering NeoVax in participants with newly diagnosed glioblastoma.

  • Number of participants who are clinically able to initiate post-RT vaccine therapy within 12 weeks or less from date of surgery as a measure of study feasibility [ Time Frame: 2 Years ]
    This information will be used to determine the feasibility of generating and administering NeoVax in participants with newly diagnosed glioblastoma.


Secondary Outcome Measures:
  • Number of participants who achieve IFN-γ T-cell response (more than 55 SFU/106 PBMC or 3 times their baseline level) at week 16 via ELISPOT assessments [ Time Frame: 2 Years ]
    This information will be used to assess the induction of neoantigen-specific cellular immune responses following administration of NeoVax.

  • Number of participants who are alive without progression at eight months after surgery resection [ Time Frame: 2 Years ]
    Estimate of the proportion of participants alive without disease progression at eight months after resection. The endpoint will be calculated as the time between pathological confirmation of resection and the first of disease recurrence or death.


Estimated Enrollment: 20
Study Start Date: November 2014
Estimated Study Completion Date: June 2018
Estimated Primary Completion Date: September 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Personalized NeoAntigen Vaccine

After the screening procedures confirm participant eligible to participate in the research study (must be registered to within 6 weeks of resection):

  • ~ 6 weeks of standard radiation therapy (RT) followed by an RT-recovery period.
  • During that time, participant NeoAntigen Vaccine-Preparation is created (process takes ~ 12 weeks)

After participant recovers from RT and vaccine is created, s/he will re-screen to confirm s/he is eligible to receive study vaccinations. Once registered, participant will proceed to receive study vaccinations:

- NeoAntigen Vaccine: NeoVax will be administered on an individual basis using a dosing schedule that incorporates both priming and boost phases (~ 7 months total: 5 priming followed by 2 boost vaccine administrations)

Radiation: Radiation Therapy
Standard radiotherapy (approximately 60 Gy over 6 weeks)
Biological: Personalized NeoAntigen Vaccine
NeoVax will be administered on an individual basis using a dosing schedule that incorporates both priming and boost phases.
Other Name: NeoVax

Detailed Description:

It is known that glioblastomas have mutations that are specific to an individual patient's tumor. These mutations can cause the tumor cells to produce proteins that appear very different from the body's own cells. It is possible that these proteins used in a vaccine may induce strong immune responses, which may help the body fight any tumor cells that could cause glioblastoma to recur.

Methylguanine methyltransferase (MGMT) is a DNA repair protein which can be increased in some cancers, including glioblastoma. MGMT works to repair the DNA of cancer cells that are damaged by treatment. If a tumor is found to be "unmethylated", it means there is more MGMT present in the tumor than one that is "methylated".

Methylation of MGMT is believed to make tumor cells more responsive to drugs like temozolomide. Studies have shown that temozolomide provides a very small improvement in outcome for many patients whose glioblastoma is MGMT-unmethylated. This study is for patients with MGMT-unmethylated glioblastoma.

Patients with glioblastoma usually receive six weeks of radiation with a daily chemotherapy called temozolomide after their surgery, followed by six to twelve months of additional temozolomide. In this study, participants will not take temozolomide, as their tumors are MGMT-unmethylated, and studies have shown that temozolomide provides a very small improvement in outcome for many patients whose glioblastoma is MGMT-unmethylated.

Instead, on this trial, participants will receive the Personalized NeoAntigen Vaccine after completing six weeks of radiation:

- Therapy On This Study:

  • Surgery
  • Followed by six weeks of radiation therapy
  • Followed by a series of vaccine administrations (~ 7 months)

The study will examine the safety of the vaccine when given at several different time points and will examine the participant blood cells for signs that the vaccine induced an immune response.

  Eligibility

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

NOTE: Eligibility will be confirmed and participants registered on 2 separate, serial occasions on this trial: 1.) Initial Study Screening: Shortly after initial resection, newly diagnosed patient is identified and screened. Once overall trial eligibility is confirmed and participant is registered to study, the creation of the participant's vaccine is initiated. 2.) Secondary Screening: As participant's 1st study vaccine dose may not be administered until 10-17 weeks from initial study registration, there will be a secondary "screen" conducted after participant has completed RT and his/her vaccines have been prepared, to ensure s/he meets criteria to receive study treatment. If confirmed eligible for this next phase of the study (eligible to treat), participant will proceed to receive vaccines on study.

I. Inclusion Criteria:

A. Study Eligibility Criteria for Overall Study Participation (for Initial Registration) Participants must meet the following criteria on screening examination to be eligible to participate in the study (labs/tests/assessments within 14 days prior to initial study registration unless otherwise specified)

  • Participant is willing and able to give written informed consent
  • Pathologically confirmed WHO grade IV glioblastoma or variants (gliosarcoma, glioblastoma with oligodendroglial features, giant cell glioblastoma) with adequate tumor material for genomic sequencing as confirmed by study pathologist Keith Ligon, MD, PhD or his designate. Participants will be eligible if the original diagnosis was a lower grade glioma and a subsequent histologic diagnosis of glioblastoma or its variants was made, and they received no prior therapy other than surgery
  • The tumor must be primarily supratentorial in location as determined by diagnostic imaging performed preoperatively
  • Radiographic contrast enhancement attributable to residual tumor on post-operative imaging performed within 72 hours of resection must not exceed 4 cm in maximal diameter in any plane
  • Age ≥18 years
  • Karnofsky performance status ≥ 70
  • Participant is a candidate for, and agrees to receive conventional external beam radiotherapy
  • Normal organ and bone marrow function as defined below

    • Leukocytes ≥ 3,000/μL
    • Absolute lymphocyte count ≥800/μL
    • Absolute neutrophil count ≥ 1,000/μL
    • Platelets ≥ 100,000/μL
    • Hemoglobin ≥ 10.0 g/dL
    • Total serum bilirubin ≤ 1.5 x institutional upper limit of normal
    • Aspartate aminotransferase (AST/SGOT) / Alanine transaminase (ALT/SGPT) ≤ 2.0 x institutional upper limit of normal
    • Serum creatinine ≤ 1.5 x institutional upper limit of normal
  • Tumor MGMT promoter unmethylated as per clinical Clinical Laboratory Improvement Amendments (CLIA) report which will be reviewed and confirmed by study pathologist Keith Ligon, MD, PhD, or his designate

    • MGMT Promoter Methylation testing will be performed by BWH's CLIA-approved Molecular Diagnostics and Cytogenetics Laboratory in the Center for Advanced Molecular Diagnostics (CAMD); there they will utilize their standard clinical two-step methylation specific polymerase chain reaction (PCR) assay to detect DNA methylation within the promoter region of the MGMT gene. Fully methylated and unmethylated control DNAs are run concurrently with each assay to ensure quality control
    • Only those results that read "Unmethylated" will be eligible for this trial; Results of "Partially Methylated" or "Methylated" will be ineligible for this trial
  • Adequate tumor content as determined by study pathologist Keith Ligon, MD, PhD, or his designate for nucleic acid extraction and DNA sequence analysis;
  • Patients unable to undergo magnetic resonance (MR) imaging because of non-compatible devices can be enrolled, provided CT scans are obtained and are of sufficient quality. Patients without non-compatible devices may not have CT scans performed to meet this requirement
  • Women of childbearing potential (WOCBP) must have a negative pregnancy test (minimum sensitivity 25 IU/L or equivalent of HCG) before entry onto the trial, because the effects NeoVax on the developing human fetus are unknown
  • Female participants enrolled in the study, who are not free from menses for >2 years, post hysterectomy / oophorectomy, or surgically sterilized, must be willing to use either 2 adequate barrier methods or a barrier method plus a hormonal method of contraception to prevent pregnancy or to abstain from sexual activity throughout the study, starting with visit 1 through 4 weeks after the last dose of study therapy. Approved contraceptive methods include, for example: intra uterine device, diaphragm with spermicide, cervical cap with spermicide, male condoms, or female condom with spermicide. Spermicides alone are not an acceptable method of contraception
  • Male participants must agree to use an adequate method of contraception starting with the first dose of radiation therapy through 4 weeks after the last dose of study therapy

B. Study Eligibility Criteria to Initiate Treatment (for Secondary Registration) Participants must meet the following criteria to be eligible to proceed to receive vaccine treatment on the study (labs/tests/assessments within 7 days prior to secondary study registration and within 14 days of first vaccine administration unless otherwise specified)

  • Scan within 14 days prior to initiation of study vaccinations shows no evidence of progressive disease prior to study vaccination initiation based on the Response Assessment in Neuro-Oncology (RANO) criteria; Participant with progressive disease after radiation therapy will not be a candidate for the vaccine despite being previously enrolled and will be removed from the study and replaced
  • Normal organ and bone marrow function as defined below

    • Leukocytes ≥ 3,000/μL
    • Absolute lymphocyte count ≥ 800/μL
    • Absolute neutrophil count ≥ 1,000/μL
    • Platelets ≥ 100,000/μL
    • Total serum bilirubin ≤ 1.5 x institutional upper limit of normal
    • AST (SGOT)/ALT (SGPT) ≤ 2.0 x institutional upper limit of normal
    • Serum creatinine ≤ 1.5 x institutional upper limit of normal
  • Karnofsky performance status ≥70
  • No new or worsened existing acute medical condition that would require a dose hold or delay as noted in protocol
  • No uncontrolled intercurrent illness including, but not limited to ongoing or active infection requiring treatment, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia
  • No planned major surgery
  • Requirement of ≤ 4 mg/day of dexamethasone (or other corticosteroid bioequivalent) within one week of vaccination initiation
  • Participant is neither pregnant nor nursing --- Women of childbearing potential (WOCBP) must have a negative pregnancy test (minimum sensitivity 25 IU/L or equivalent of HCG) within 7 days prior to start of study medication, because the effects NeoVax on the developing human fetus are unknown. It is the investigators' responsibility to repeat the pregnancy test should start of treatment be delayed

II. Exclusion Criteria:

Participants who exhibit any of the following conditions at either screening timepoint will not be eligible for admission into or continuation on the study

  • Stereotactic biopsy (without further resection)
  • Tumors primarily localized in the infratentorial compartment or spinal cord - tumors with limited infratentorial compartment or spinal cord involvement are eligible
  • Radiographic or cytologic evidence of diffuse leptomeningeal extension - tumors with limited subependymal involvement are eligible
  • Participants who have received or plan to receive any additional treatment for glioblastoma aside from surgical resection and conventional radiotherapy including but not limited to temozolomide, stereotactic radiosurgery, placement of Gliadel® (carmustine; BCNU) wafers, any other intratumoral or intracavitary treatment, brachytherapy, bevacizumab, or investigational therapeutic agents
  • Tumor MGMT promoter methylated, partially methylated or methylation status not determined
  • Concomitant therapy with any anti-cancer agents, other investigational anti-cancer therapies, or immunosuppressive agents including but not limited to methotrexate, chloroquine, azathioprine, etc. within six months of study participation
  • History of severe allergic reactions attributed to any vaccine therapy for the prevention of infectious diseases
  • Active, known, or suspected autoimmune disease or immunosuppressive conditions with the exception of vitiligo, type 1 diabetes, residual autoimmune-related hypothyroidism requiring hormone replacement, or psoriasis not requiring systemic treatment
  • Known chronic infections with HIV, hepatitis B or C
  • Uncontrolled intercurrent illness including, but not limited to ongoing or active infection requiring treatment, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia
  • Any underlying medical condition, psychiatric condition or social situation that in the opinion of the investigator would compromise study administration as per protocol or compromise the assessment of Adverse Events (AEs)
  • Planned major surgery
  • Pregnant women are excluded from this study because personalized neoantigen peptides and poly-ICLC are agents with unknown risks to the developing fetus Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with personalized neoantigen peptides and poly-ICLC, nursing women are excluded from this study
  • Individuals with a history of an invasive malignancy are ineligible except for the following circumstances: a) individuals with a history of invasive malignancy are eligible if they have been disease-free for at least 3 years and are deemed by the investigator to be at low risk for recurrence of that malignancy; b) individuals with the following cancers are eligible if diagnosed and treated - carcinoma in situ of the breast, oral cavity or cervix and basal cell or squamous cell carcinoma of the skin
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT02287428

Contacts
Contact: David A Reardon, MD 617-632-2166 david_reardon@dfci.harvard.edu
Contact: Jennifer Stefanik, NP 617-632-2166 jastefanik@partners.org

Locations
United States, Massachusetts
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02115
Contact: David Reardon, MD    617-632-2166    david_reardon@dfci.harvard.edu   
Contact: Jennifer Stefanik, NP    (617) 632-2166    jastefanik@partners.org   
Sponsors and Collaborators
Patrick Ott, MD
The Ben & Catherine Ivy Foundation
Accelerate Brain Cancer Cure
Investigators
Principal Investigator: David A. Reardon, MD Dana-Farber Cancer Institute
  More Information

Responsible Party: Patrick Ott, MD, Sponsor-Investigator, Dana-Farber Cancer Institute
ClinicalTrials.gov Identifier: NCT02287428     History of Changes
Other Study ID Numbers: 14-362
Study First Received: October 29, 2014
Last Updated: November 15, 2016

Additional relevant MeSH terms:
Glioblastoma
Gliosarcoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Vaccines
Immunologic Factors
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on April 28, 2017