A Trial of Atezolizumab and Vigil in Patients With Advanced Gynecological Cancers
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ClinicalTrials.gov Identifier: NCT03073525 |
Recruitment Status :
Completed
First Posted : March 8, 2017
Results First Posted : April 5, 2023
Last Update Posted : April 5, 2023
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Condition or disease | Intervention/treatment | Phase |
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Advanced Gynecological Cancers Ovarian Cancer Cervical Cancer Uterine Cancer | Biological: Vigil Drug: Atezolizumab | Phase 2 |
Expanded Access : An investigational treatment associated with this study is temporarily not available outside the clinical trial. More info ...

Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 25 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Intervention Model Description: | This was a 3 part study. Parts 1 and 3 did not involve randomization. In part 2, eligible participants were randomized to receive two cycles of either Vigil alone or Atezolizumab alone, then followed by combination treatment with the two agents. |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Randomized, Intra-patient Crossover, Safety, Biomarker and Anti-Tumor Activity Assessment of the Combination of Atezolizumab and Vigil in Patients With Advanced Gynecological Cancers (A Companion Study to CL-PTL-119) |
Actual Study Start Date : | May 31, 2017 |
Actual Primary Completion Date : | May 22, 2019 |
Actual Study Completion Date : | May 18, 2022 |

Arm | Intervention/treatment |
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Experimental: Part 1: Vigil + Atezo
This was a safety run in and intervention was combined. The first three participants received Vigil immunotherapy at a concentration of 1x10e7 cells/dose given via intradermal injection every 3 weeks for a minimum of 4 doses and a maximum of 12 doses. Atezolizumab was administered at a dose of 1200 mg as an intravenous infusion every 3 weeks. 1 cycle = 21 days.
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Biological: Vigil
The Vigil vaccine is made up of irradiated autologous tumor cells which have been electroporated ex vivo with the Vigil plasmid designed to suppress expression of both the TGFβ1 and TGFβ2 proteins while simultaneously expressing rhGMCSF protein.
Other Names:
Drug: Atezolizumab Atezolizumab was prepared and administered at the FDA approved dose and schedule as described in the U.S. Package Insert (USPI). The initial dose was administered over one hour and if well tolerated, subsequent infusions may have been administered over 30 minutes. Atezolizumab in formulation F03 (1200 mg per vial) was administered in 250 mL 0.9% NaCl IV infusion bags and infusion lines equipped with 0.2 μm in-line filters. Other Names:
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Experimental: Part 2: Vigil first then combination Vigil + Atezo
After Part 1 participants completed completed combination therapy without dose-limiting toxicity, then Part 2 participants randomized to Vigil first received two cycles of Vigil alone, then Vigil and atezolizumab given in sequence (Vigil administered first, followed 30 minutes later by atezolizumab) Vigil immunotherapy was administered at a concentration of 1 x 10e6 or 1 x 107 cells/dose given via intradermal injection every 3 weeks for a minimum of 4 doses and a maximum of 12 doses. Atezolizumab was administered at a dose of 1200 mg as an intravenous infusion every 3 weeks, with a maximum of 12 doses. When Vigil and atezolizumab was given together, Vigil 1 cycle = 21 days |
Biological: Vigil
The Vigil vaccine is made up of irradiated autologous tumor cells which have been electroporated ex vivo with the Vigil plasmid designed to suppress expression of both the TGFβ1 and TGFβ2 proteins while simultaneously expressing rhGMCSF protein.
Other Names:
Drug: Atezolizumab Atezolizumab was prepared and administered at the FDA approved dose and schedule as described in the U.S. Package Insert (USPI). The initial dose was administered over one hour and if well tolerated, subsequent infusions may have been administered over 30 minutes. Atezolizumab in formulation F03 (1200 mg per vial) was administered in 250 mL 0.9% NaCl IV infusion bags and infusion lines equipped with 0.2 μm in-line filters. Other Names:
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Experimental: Part 2: Atezo first then combination of Vigil + Atezo
After Part 1 participants completed completed combination therapy without dose-limiting toxicity, then Part 2 participants randomized to atezolizumab first received two cycles of atezolizumab alone, then Vigil and atezolizumab given in sequence (Vigil administered first, followed 30 minutes later by atezolizumab). Vigil immunotherapy was administered at a concentration of 1 x 10e6 or 1 x 107 cells/dose given via intradermal injection every 3 weeks for a minimum of 4 doses and a maximum of 12 doses. Atezolizumab was administered at a dose of 1200 mg as an intravenous infusion every 3 weeks, with a maximum of 12 doses. 1 cycle = 21 days |
Biological: Vigil
The Vigil vaccine is made up of irradiated autologous tumor cells which have been electroporated ex vivo with the Vigil plasmid designed to suppress expression of both the TGFβ1 and TGFβ2 proteins while simultaneously expressing rhGMCSF protein.
Other Names:
Drug: Atezolizumab Atezolizumab was prepared and administered at the FDA approved dose and schedule as described in the U.S. Package Insert (USPI). The initial dose was administered over one hour and if well tolerated, subsequent infusions may have been administered over 30 minutes. Atezolizumab in formulation F03 (1200 mg per vial) was administered in 250 mL 0.9% NaCl IV infusion bags and infusion lines equipped with 0.2 μm in-line filters. Other Names:
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Part 3: Atezo Only
Participants who completed all cycles of Part 2 were pre-approved by the sponsor for inclusion into Part 3. Atezolizumab alone was administered at a dose of 1200 mg as an intravenous infusion every 3 weeks. 1 cycle = 21 days
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Drug: Atezolizumab
Atezolizumab was prepared and administered at the FDA approved dose and schedule as described in the U.S. Package Insert (USPI). The initial dose was administered over one hour and if well tolerated, subsequent infusions may have been administered over 30 minutes. Atezolizumab in formulation F03 (1200 mg per vial) was administered in 250 mL 0.9% NaCl IV infusion bags and infusion lines equipped with 0.2 μm in-line filters. Other Names:
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- Number of Treatment-emergent AEs of Vigil + Atezolizumab [ Time Frame: AEs reported from first treatment dose and up to 30 days after last treatment, about 12 months. ]The safety evaluation included Adverse Events (AEs), Adverse Events of Special Interest (AESIs), Serious Adverse Events (SAEs) and changes from baseline in laboratory evaluations, vital signs, electrocardiograms and physical examinations. AEs were graded according to the National Cancer Institute (NCI) CTCAE v4.03 and coded using the Medical Dictionary for Regulatory Activities. Laboratory abnormalities were graded according to the NCI CTCAE v4.03, if applicable.
- Immune Response Rate [ Time Frame: Up to 30 days after last treatment ]Whole blood for correlative studies will be obtained at baseline, at the start of cycle 3 (the first cycle of combination therapy), every 3 cycles thereafter and end of treatment.
- Time to Progression [ Time Frame: From baseline (prior to treatment) up to 3 years ]
Overall assessment of time to progression and survival will be measured by Radiological Tumor Assessment by local investigators using the Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1.
In Part 1, disease progression was assessed at baseline and every third cycle thereafter. In Part 2, the disease was assessed at baseline, at the end of Cycle 2 of single-agent therapy, and every third cycle thereafter.
- Radiographic Overall Response Rate (ORR) [ Time Frame: From first dose to end of study treatment (up to 9 months) ]
Radiographic ORR is defined as the percentage of participants achieving a Complete Response (CR) or Partial Response (PR), as assessed by investigators using RECIST 1.1.
In Part 1, ORR was assessed at baseline and every third cycle thereafter. In Part 2, the disease was assessed at baseline, at the end of Cycle 2 of single-agent therapy, and every third cycle thereafter.
95% confidence interval from exact binomial distribution (Blopper-Pearson method).
- Overall Survival (OS) [ Time Frame: OS will be evaluated from time of randomization up to 37 months following documented disease progression. ]OS is defined as time of randomization to date of death due to any cause.

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, Older Adult) |
Sexes Eligible for Study: | Female |
Accepts Healthy Volunteers: | No |
Tissue Procurement Inclusion Criteria:
Subjects will be eligible for tissue procurement for the Vigil manufacturing process, if they meet all of the following criteria:
- Histologically confirmed Stage IIIb, IIIc or IV high-grade papillary serous, clear cell, or endometrioid ovarian, fallopian tube or primary peritoneal carcinoma
- Age ≥ 18 years.
- Estimated survival ≥ 6 months.
- ECOG Performance Status ≤ 1
- Metastatic disease
- Planned standard of care surgical procedure (e.g., tumor biopsy or palliative resection or thoracentesis) and expected availability of a cumulative soft-tissue mass of ~10-30 grams tissue ("grape" to "golf-ball" size) or ascites fluid estimated volume ≥ 500mL (from a primary or secondary paracentesis, yielding in a high volume of tumor cells) for immunotherapy manufacture.
- Tumor intended for immunotherapy manufacture is not embedded in bone and does not contain luminal tissue (e.g. bowel, ureter, bile duct).
- Ability to understand and the willingness to sign a written informed protocol specific consent for tissue harvest or a parental/guardian informed consent and pediatric assent when appropriate.
Tissue Procurement Exclusion Criteria:
Subjects meeting any of the following criteria are not eligible for tissue procurement for the Vigil manufacturing:
- Medical condition requiring any form of chronic systemic immunosuppressive therapy (steroid or other) except physiologic replacement doses of hydrocortisone or equivalent (no more than 30 mg hydrocortisone or 10 mg prednisone equivalent daily) for < 30 days duration.
- Known history of other malignancy unless having undergone curative intent therapy without evidence of that disease for ≥ 3 years except cutaneous squamous cell and basal cell skin cancer, superficial bladder cancer, in situ cervical cancer or other in situ cancers are allowed if definitively resected.
- Brain metastases unless treated with curative intent (gamma knife or surgical resection) and without evidence of progression for ≥ 2 months.
- Any documented history of autoimmune disease with exception of Type 1 diabetes on stable insulin regimen, hypothyroidism on stable dose of replacement thyroid medication, vitiligo, or asthma not requiring systemic steroids.
- Known HIV or chronic Hepatitis B or C infection.
- Known history of allergies or sensitivities to gentamicin.
- History of or current evidence of any condition (including medical, psychiatric or substance abuse disorder), therapy, or laboratory abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate, in the opinion of the treating Investigator.
- Receipt of the last dose of anti-cancer therapy (chemotherapy, immunotherapy, endocrine therapy, targeted therapy, biologic therapy, tumor embolization, monoclonal antibodies, other investigational agent) less than 21 days prior to tissue procurement.
Study Enrollment Inclusion Criteria:
Subjects will be eligible for registration into the trial if they meet all of the following inclusion criteria:
- Successful manufacturing of at least 4 vials of Vigil.
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One of the following:
- Failure to meet the eligibililty criteria for Protocol CL-PTL-119 due to i) histology of ovarian cancer and failure to achieve a complete clinical response following primary debulking surgery and standard paclitaxel/carboplatin therapy OR, ii) a histologic diagnosis of another gynecologic malignancy which is not ovarian cancer.
- Recurrent ovarian cancer.
- Randomized on Protocol CL-PTL-119 and were subsequently unblinded at recurrence and were assigned to the placebo arm.
- ECOG performance status (PS) ≤ 1 (or ≤ 2 due to carcinoid syndrome).
- Estimated survival ≥ 6 months.
- Measureable per RECIST 1.1 or evaluable disease.
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Adequate organ and bone marrow function as defined below:
- Absolute neutrophil count (ANC) ≥ 1.5 × 10e9/L (1500 per mm^3)
- Platelets >100 × 10e9/L (100,000 per mm^3)
- Hemoglobin ≥9.0 g/dL (5.59 mmol/L)
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Creatinine clearance (CrCL) >50 mL/min by the Cockcroft-Gault formula or by 24-hour urine collection for determination of creatinine clearance:
Females:
CrCL (mL/min) = Weight (kg) × (140 - Age) × 0.85/72 × serum creatinine (mg/dL)
- Serum bilirubin ≤1.5 × upper limit of normal (ULN). This will not apply to patients with confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinemia that is predominantly unconjugated in the absence of evidence of hemolysis or hepatic pathology) who will be allowed in consultation with their physician.
- AST and ALT ≤2.5 × ULN in patients with no liver metastasis
- AST or ALT ≤5 × ULN in patients with liver metastasis
- TSH within institutional limits. If TSH is greater or less than institutional limits patients may participate if their T4 is within normal limits (WNL); patients may be on a stable dose of replacement thyroid medication; dose adjustments are allowed if needed
- Subject has recovered to CTCAE Grade 1 or better from all adverse events associated with prior therapy or surgery (or ≤ 2 due to carcinoid syndrome).
- Pre-existing motor or sensory neurologic pathology or symptoms must be recovered to CTCAE Grade 2 or better
- Patients with irreversible toxicity that is not reasonably expected to be exacerbated by the IPs (Vigil and/or atezolizumab) may be included (e.g., hearing loss) after consultation with the Principal Investigator
- Subjects who are not rendered surgically sterile as a result of surgery for ovarian cancer, must have, negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a negative serum test will be required for study entry.
- Ability to understand and the willingness to sign a written informed protocol specific consent.
- Willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up. Patients must have fully recovered from chemotherapy associated toxicities prior to starting treatment on this protocol.
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Palliative radiotherapy is permitted provided:
- More than 3 weeks have elapsed between the end of radiotherapy and the first dose of study therapy, AND
- The irradiated lesion(s) (unless measurable progression after irradiation) cannot be used as target lesions.
Study Enrollment Exclusion Criteria:
In addition to the procurement exclusion, subjects (both with Vigil manufactured and undergoing procurement) will NOT be eligible for study registration and enrollment if meeting any of the following criteria:
- Participation in another clinical study with an investigational product within the last 3 weeks prior to study start.
- Receipt of steroid therapy within the 2 weeks of the first dose of study therapy.
- Live vaccine used for the prevention of infectious disease administered < 30 days prior to the start of study therapy. NOTE: Subjects, if enrolled, should not receive live vaccine during the study and for 5 months after the last dose of atezolizumab.
- Post-surgery complication that in the opinion of the treating investigator would interfere with the subject's study participation or make it not in the best interest of the subject to participate.
- Mean QT interval corrected for heart rate (QTc) ≥470 ms calculated from 3 electrocardiograms (ECGs) using Fridericia's Correction.
- Female subjects who are pregnant, breast-feeding or of reproductive potential who are not employing an effective method of birth control defined in the protocol. Effective contraception is required for women receiving atezolizumab for 5 months after the last dose.
- Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results.
- Receipt of the last dose of anti-cancer therapy (chemotherapy, immunotherapy, endocrine therapy, targeted therapy, biologic therapy, tumor embolization, monoclonal antibodies, other investigational agent) less than 21 days prior to the first dose of study drug or less than 6 weeks for nitrosourea or mitomycin C.
- Receipt of any anti-cancer therapy between tissue procurement on CL-PTL-126 and first dose of study drug.

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): NCT03073525
United States, Alabama | |
University of South Alabama Mitchell Cancer Institute | |
Mobile, Alabama, United States, 36604 | |
United States, Georgia | |
Georgia Cancer Center at Augusta University | |
Augusta, Georgia, United States, 30912 | |
United States, Michigan | |
Henry Ford Hospital | |
Detroit, Michigan, United States, 48202 | |
United States, Montana | |
Billings Clinic | |
Billings, Montana, United States, 59101 | |
United States, New Hampshire | |
Dartmouth-Hitchcock Medical Center/ Norris Cotton Cancer Center | |
Lebanon, New Hampshire, United States, 03756 | |
United States, South Carolina | |
Prisma Health Cancer Institute | |
Greenville, South Carolina, United States, 29605 |
Study Director: | John Nemunaitis, MD | Gradalis, Inc. |
Documents provided by Gradalis, Inc.:
Other Publications:
Responsible Party: | Gradalis, Inc. |
ClinicalTrials.gov Identifier: | NCT03073525 |
Other Study ID Numbers: |
CL-PTL-126 |
First Posted: | March 8, 2017 Key Record Dates |
Results First Posted: | April 5, 2023 |
Last Update Posted: | April 5, 2023 |
Last Verified: | April 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Stage IIIb Stage IV Ovarian Cancer |
Cervical Cancer Uterine Cancer Immunotherapy |
Ovarian Neoplasms Uterine Cervical Neoplasms Uterine Neoplasms Endocrine Gland Neoplasms Neoplasms by Site Neoplasms Ovarian Diseases Adnexal Diseases Genital Diseases, Female Female Urogenital Diseases Female Urogenital Diseases and Pregnancy Complications Urogenital Diseases |
Genital Neoplasms, Female Urogenital Neoplasms Genital Diseases Endocrine System Diseases Gonadal Disorders Uterine Cervical Diseases Uterine Diseases Atezolizumab Immune Checkpoint Inhibitors Molecular Mechanisms of Pharmacological Action Antineoplastic Agents, Immunological Antineoplastic Agents |