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A Trial of Atezolizumab and Vigil in Patients With Advanced Gynecological Cancers

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.
 
ClinicalTrials.gov Identifier: NCT03073525
Recruitment Status : Completed
First Posted : March 8, 2017
Results First Posted : April 5, 2023
Last Update Posted : April 5, 2023
Sponsor:
Collaborator:
Roche-Genentech
Information provided by (Responsible Party):
Gradalis, Inc.

Brief Summary:
The clinical trial was a companion study to protocol CL-PTL-119 (A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial of Vigil Engineered Autologous Tumor Cell Immunotherapy in Subjects with Stage IIIb-IV Ovarian Cancer in Clinical Complete Response following Surgery and Primary Chemotherapy (VITAL) NCT02346747). Participants who had investigational product (Vigil) successfully made but were not eligible to enroll onto the VITAL study or previously randomized to placebo were given the opportunity to participate in this protocol. The main goal of this clinical trial was to determine the safety of combining Vigil therapy with atezolizumab.

Condition or disease Intervention/treatment Phase
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 ...

Show Show detailed description

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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
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.
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:
  • Bi-shRNAfurin and GMCSF Augmented Autologous Tumor Cell Immunotherapy
  • FANG vaccine

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:
  • TECENTRIQ™
  • MPDL3280A

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:
  • Bi-shRNAfurin and GMCSF Augmented Autologous Tumor Cell Immunotherapy
  • FANG vaccine

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:
  • TECENTRIQ™
  • MPDL3280A

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:
  • Bi-shRNAfurin and GMCSF Augmented Autologous Tumor Cell Immunotherapy
  • FANG vaccine

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:
  • TECENTRIQ™
  • MPDL3280A

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
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:
  • TECENTRIQ™
  • MPDL3280A




Primary Outcome Measures :
  1. 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.


Secondary Outcome Measures :
  1. 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.

  2. 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.


  3. 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).


  4. 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.



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.


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

Tissue Procurement Inclusion Criteria:

Subjects will be eligible for tissue procurement for the Vigil manufacturing process, if they meet all of the following criteria:

  1. Histologically confirmed Stage IIIb, IIIc or IV high-grade papillary serous, clear cell, or endometrioid ovarian, fallopian tube or primary peritoneal carcinoma
  2. Age ≥ 18 years.
  3. Estimated survival ≥ 6 months.
  4. ECOG Performance Status ≤ 1
  5. Metastatic disease
  6. 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.
  7. Tumor intended for immunotherapy manufacture is not embedded in bone and does not contain luminal tissue (e.g. bowel, ureter, bile duct).
  8. 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:

  1. 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.
  2. 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.
  3. Brain metastases unless treated with curative intent (gamma knife or surgical resection) and without evidence of progression for ≥ 2 months.
  4. 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.
  5. Known HIV or chronic Hepatitis B or C infection.
  6. Known history of allergies or sensitivities to gentamicin.
  7. 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.
  8. 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:

  1. Successful manufacturing of at least 4 vials of Vigil.
  2. One of the following:

    1. 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.
    2. Recurrent ovarian cancer.
    3. Randomized on Protocol CL-PTL-119 and were subsequently unblinded at recurrence and were assigned to the placebo arm.
  3. ECOG performance status (PS) ≤ 1 (or ≤ 2 due to carcinoid syndrome).
  4. Estimated survival ≥ 6 months.
  5. Measureable per RECIST 1.1 or evaluable disease.
  6. Adequate organ and bone marrow function as defined below:

    1. Absolute neutrophil count (ANC) ≥ 1.5 × 10e9/L (1500 per mm^3)
    2. Platelets >100 × 10e9/L (100,000 per mm^3)
    3. Hemoglobin ≥9.0 g/dL (5.59 mmol/L)
    4. 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)

    5. 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.
    6. AST and ALT ≤2.5 × ULN in patients with no liver metastasis
    7. AST or ALT ≤5 × ULN in patients with liver metastasis
    8. 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
  7. 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).
  8. Pre-existing motor or sensory neurologic pathology or symptoms must be recovered to CTCAE Grade 2 or better
  9. 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
  10. 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.
  11. Ability to understand and the willingness to sign a written informed protocol specific consent.
  12. 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.
  13. Palliative radiotherapy is permitted provided:

    1. More than 3 weeks have elapsed between the end of radiotherapy and the first dose of study therapy, AND
    2. 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:

  1. Participation in another clinical study with an investigational product within the last 3 weeks prior to study start.
  2. Receipt of steroid therapy within the 2 weeks of the first dose of study therapy.
  3. 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.
  4. 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.
  5. Mean QT interval corrected for heart rate (QTc) ≥470 ms calculated from 3 electrocardiograms (ECGs) using Fridericia's Correction.
  6. 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.
  7. Any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of patient safety or study results.
  8. 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.
  9. Receipt of any anti-cancer therapy between tissue procurement on CL-PTL-126 and first dose of study drug.

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): NCT03073525


Locations
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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
Sponsors and Collaborators
Gradalis, Inc.
Roche-Genentech
Investigators
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Study Director: John Nemunaitis, MD Gradalis, Inc.
  Study Documents (Full-Text)

Documents provided by Gradalis, Inc.:
Publications of Results:
Rodney Paul Rocconi, Erin E. Stevens, Justin N. Bottsford-Miller, Sharad A. Ghamande, Phylicia Aaron, Gladice Wallraven, Ernest Bognar, Meghan Manley, Staci Horvath, Luisa Manning, John J. Nemunaitis, Thomas J Herzog, Bradley J. Monk, Robert L. Coleman, and Vigil Team (2020), A phase I combination study of vigil and atezolizumab in recurrent/refractory advanced-stage ovarian cancer: Efficacy assessment in BRCA1/2-wt patients. DOI: 10.1200/JCO.2020.38.15_suppl.3002 Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020) 3002-3002.

Other Publications:
Senzer N, Barve M, Nemunaitis J, Kuhn J, Melnyk A, et al. (2013) Long Term Follow Up: Phase I Trial of "Bi-Shrnafurin/GMCSF DNA/Autologous Tumor Cell" Immunotherapy (FANG™) in Advanced Cancer. J Vaccines Vaccin 4:209. doi:10.4172/2157-7560.1000209

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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

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Gradalis, Inc.:
Stage IIIb
Stage IV
Ovarian Cancer
Cervical Cancer
Uterine Cancer
Immunotherapy
Additional relevant MeSH terms:
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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