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Poly-ICLC (Hiltonol) and Anti-PD1 or Anti-PD-L1

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT03721679
Recruitment Status : Recruiting
First Posted : October 26, 2018
Last Update Posted : November 1, 2019
Sponsor:
Collaborators:
Chevy Chase Healthcare, Chevy Chase MD
Mt. Sinai School of Medicine, New York, New York
Bay Hematology Oncology PA, Easton MD
Information provided by (Responsible Party):
Oncovir, Inc.

Brief Summary:

This is an open labeled, non-randomized adaptive pilot study. The study interventions involved in this study are:

Poly-ICLC (Polyinosinic-Polycytidylic acid stabilized with polylysine and carboxymethylcellulose, also known as Hiltonol®) treatment in combination with anti-PD-1 (Nivolumab, Cemiplimab or Pembrolizumab) or anti-PD-L1 (Atezolizumab or Durvalumab)


Condition or disease Intervention/treatment Phase
Solid Cancer Biological: Poly-ICLC combination treatment with aPD-1 (Nivolumab or Pembrolizumab) or aPD-L1 (Atezolizumab or Durvalumab) over 6 months Phase 1 Phase 2

Detailed Description:

This research study is a PhaseI/II clinical trial investing a combination of targeted therapies as possible treatment for advanced solid cancers

FDA has not yet approved Poly-ICLC as treatment for diseases in this study

Pembrolizumab, Nivolumab, Atezolizumab, Cemiplimab and Durvalumab are now FDA approved for certain patients with multiple cancer types.

The study is designed to evaluate the safety of intramuscular (IM) Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose (Poly-ICLC, Hiltonol®) in combination with Anti-PD-1 or Anti-PD-L1 for treatment of study subjects with advanced solid cancers.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Intervention Model: Sequential Assignment
Intervention Model Description: The study is largely a signal-finding exercise to determine if there is an immune and/or clinical response to the addition of poly-ICLC to aPD-1 or aPDL-1 therapy, as predicted by preclinical models.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Poly-ICLC (Hiltonol®) Plus Anti-PD1 or Anti-PD-L1 in Unresectable Solid Cancers An Adaptive Phase I/II Clinical Pilot Study
Actual Study Start Date : September 25, 2018
Estimated Primary Completion Date : August 31, 2021
Estimated Study Completion Date : August 31, 2023

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Poly-ICLC treatment combination aPD-1or aPD-1L1

Weeks 1 and 2: Poly-ICLC (Hiltonol®) 1 mg (0.5 ml) IM ONLY twice a week with a 48-72 hour interval between the two injections

Weeks 3-25:

  1. Poly-ICLC (Hiltonol®) 1 mg (0.5 ml) IM twice a week with a 48-72 hour interval between the two injections, AND
  2. ONLY 1 of the following regimens will be administered, per manufacturer's dosing and clinical oncologist's discretion as follows:

    • Nivolumab (Opdivo), OR
    • Pembrolizumab (Keytruda), OR
    • Cemiplimab (Libtayo) OR
    • Atezolizumab (Tecentriq) OR
    • Durvalumab (Imfinzi) Follow up: After completion of treatment subjects may be contacted by telephone at least twice over 12 months, or longer with patient consent, in order to inquire on their health status (e.g., in remission, progressive disease, on new cancer treatment).
Biological: Poly-ICLC combination treatment with aPD-1 (Nivolumab or Pembrolizumab) or aPD-L1 (Atezolizumab or Durvalumab) over 6 months
Same as above
Other Name: Same as above




Primary Outcome Measures :
  1. Tumor assessment [ Time Frame: 6 month timepoint compared to baseline ]
    Response and progression will be evaluated in this study. Tumor Response will be assessed by the RECIST 1.1 Criteria. Response is defined as CR, PR or SD over a period of at least 4 weeks. Changes in the sum of the two largest perpendicular diameters (SPD) of the tumor lesions, or the shortest diameter in the case of malignant lymph nodes are used in the RECIST 1.1 criteria. Study subjects with progressive disease will be evaluated to determine whether the progression causes symptoms and/or functional decline and study subjects with non-clinically relevant progression of disease may remain on study at the investigator's discretion.



Information from the National Library of Medicine

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

Inclusion Criteria

  1. Histologically confirmed diagnosis of Solid Cancer, independent of PD-L1 tumor status.
  2. Patients must be 18 years of age or older.
  3. Unresectable disease. Patients with resectable disease but who refuse surgery may be enrolled after a documented consultation with a surgeon.
  4. Radiologically or visually measurable disease that is at least 10mm in longest dimension, AND/OR with elevated disease specific serum markers that can be followed for progression (eg CA-125, AFP, PSA, CA19-9 or CEA)
  5. ECOG performance status of ≤ 2.
  6. Acceptable hematologic, renal and liver function as follows:

    A) Absolute neutrophil count > 1000/mm3 B) Platelets > 50,000/mm3, C) Creatinine ≤ 2.5 mg/dl, D) Total bilirubin ≤ 1.5 mg/dl, unless due to tumor or Gilbert's syndrome E) Transaminases ≤ 2 times above the upper limits of the institutional normal. F) INR<2 if off of anticoagulation. Patients on anticoagulation therapy with an INR>2 may be enrolled at the discretion of the investigator if they have not had any episodes of severe hemorrhage.

  7. Patients must be able to provide informed consent.
  8. Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. Contraception must be continued for at least 2 months following the last dose of Poly-ICLC. Women of childbearing potential must have a negative pregnancy test. While animal reproductive studies have been negative, the simulated viral infection and anti-proliferative activity of this experimental drug may theoretically affect the developing fetus or nursing infant.

    Cohort Specific Inclusion Criteria (see § 9.5 Evaluation of Best Overall Response (BOR)

    Cohort A

  9. Patients who have received at least 8 weeks of immunotherapy.
  10. Patients have progressive disease based on RECIST 1.1 criteria

    Cohort B)

  11. Patients who have received at least 8 weeks of aPD1 or aPDL1 immunotherapy.
  12. Patients have stable disease or a partial response based on RECIST 1.1 criteria.

    Cohort C)

  13. Patients who have not received an anti-PD-1 or anti-PD-L1 agent, but who carry a diagnosis for which one of these agents is the SOC.
  14. Patients willing to delay receipt of first dose of anti-PD-1 or anti-PD-L1 until after the receipt of their first two doses of intramuscular Poly-ICLC

Exclusion Criteria

  1. Patients may not be receiving any other investigational agents.
  2. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring antibiotics (exception is a brief (≤10days) course of antibiotics to be completed before initiation of treatment), symptomatic congestive heart failure, unstable angina pectoris, or psychiatric illness/social situations that would limit compliance with study requirements.
  3. Patients must not be pregnant or nursing due to the potential for congenital abnormalities and the potential of this regimen to harm nursing infants.
  4. Has a diagnosis of primary immunodeficiency or is receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment. Patients on chronic steroids (more than 4 weeks at stable dose) equivalent to ≤ 10mg prednisone will not be excluded.
  5. Has active autoimmune disease that has required systemic treatment in the past 1 year (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is acceptable.
  6. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating Investigator.
  7. HIV positive with detectable viral load, or anyone not on stable anti-viral (HAART) regimen, or with <200 CD4+ T cells/microliter in the peripheral blood.
  8. Has known active Hepatitis B (e.g., HBV detected by elevated PCR or active Hepatitis C (e.g., HCV RNA [qualitative] is detected).
  9. History of allogeneic hematopoietic cell transplantation or solid organ transplantation.
  10. Documented allergic or hypersensitivity response to any protein therapeutics (e.g., recombinant proteins, vaccines, intravenous immune globulins, monoclonal antibodies, receptor traps)
  11. Principal investigator believes that for one or multiple reasons the patient will be unable to comply with all study visits, or if they believe the trial is not clinically in the best interest of the patient.

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): NCT03721679


Contacts
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Contact: Andres M Salazar, MD 202-342-1726 asalazar@oncovir.com
Contact: Rose Marie Holman, MA 917-885-9680 rmholman@oncovir.com

Locations
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United States, Maryland
Chevy Chase RCCA Recruiting
Chevy Chase, Maryland, United States, 20815
Contact: Frederick P Smith, MD    301-657-8587    fpsonc@aol.com   
Contact: Susan Bendel, RN    301- 657- 8587    sbendel@regionalcancercare.org   
Bay Hematology Oncology Recruiting
Easton, Maryland, United States, 21601
Contact: David Smith, MD    410-820-5945    md@bayonc.com   
Contact: Amy Wright, RN    410 820 5945 ext 4    amy@bayonc.com   
United States, New York
Icahn School of Medicine at Mount Sinai Not yet recruiting
New York, New York, United States, 10029
Contact: Nina Bhardwaj, MD, PhD    212-824-8427    nina.bhardwaj@mssm.edu   
Contact: Melissa Diamond    212 824 8449    melissa.diamond@mssm.edu   
Principal Investigator: Nina Bhardwaj, MD, PhD         
Sponsors and Collaborators
Oncovir, Inc.
Chevy Chase Healthcare, Chevy Chase MD
Mt. Sinai School of Medicine, New York, New York
Bay Hematology Oncology PA, Easton MD
Investigators
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Principal Investigator: Frederick P Smith, MD Chevy Chase Healthcare
Principal Investigator: David H Smith, MD Bay Hematology Oncology PA
Principal Investigator: Nina Bhardwaj, MD, PhD Icahn School of Medicine at Mount Sinai

Publications of Results:
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Responsible Party: Oncovir, Inc.
ClinicalTrials.gov Identifier: NCT03721679    
Other Study ID Numbers: ONC2018-001
First Posted: October 26, 2018    Key Record Dates
Last Update Posted: November 1, 2019
Last Verified: October 2019
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 Oncovir, Inc.:
Immunotherapy
Vaccine Therapy
Additional relevant MeSH terms:
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Poly I-C
Pembrolizumab
Nivolumab
Durvalumab
Atezolizumab
Carboxymethylcellulose Sodium
Poly ICLC
Antineoplastic Agents, Immunological
Antineoplastic Agents
Interferon Inducers
Immunologic Factors
Physiological Effects of Drugs
Laxatives
Gastrointestinal Agents
Antiviral Agents
Anti-Infective Agents