Viral Therapy in Treating Patients With Recurrent Glioblastoma Multiforme

• MTD, defined as the dose level below the lowest dose that induces dose-limiting toxicity in at least 1/3 of patients (at least 2/6 new patients) or the highest dose level for Arm B, if =< 1/6 patients experience dose-limiting toxicity [ Time Frame: 2 weeks ]
• Number and severity of all adverse events, per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 [ Time Frame: Up to 15 years ]
  The number and severity of all adverse events (overall, by dose-level, and by tumor group) will be tabulated and summarized in this patient population.
• Number and severity of grade 3+ adverse events, per NCI CTCAE version 3.0 [ Time Frame: Up to 15 years ]
  The number and severity of grade 3+ adverse events (overall, by dose-level, and by tumor group) will be tabulated and summarized in this patient population.
• Overall toxicity incidence, per NCI CTCAE version 3.0 [ Time Frame: Up to 15 years ]
  Overall toxicity incidence will be explored and summarized. Frequency distributions, graphical techniques and other descriptive measures will form the basis of these analyses.
• Time until any treatment related toxicity [ Time Frame: Up to 15 years ]
• Time until hematologic nadir (white blood cells [WBC], ANC, platelets) [ Time Frame: Up to 15 years ]
• Time until treatment related grade 3+ toxicity [ Time Frame: Up to 15 years ]
• Toxicity profile by dose level, patient, and tumor site, per NCI CTCAE version 3.0 [ Time Frame: Up to 15 years ]
  Toxicity profiles by dose level, patient, and tumor site will be explored and summarized. Frequency distributions, graphical techniques and other descriptive measures will form the basis of these analyses.

• Best response, defined as the best objective status recorded from the start of the treatment until disease progression/recurrence [ Time Frame: Up to 15 years ]
  The number of responses will be summarized by simple descriptive summary statistics delineating response type (complete response vs partial response vs regression), as well as stable and progressive disease in this patient population.
• Progression-free survival (PFS) [ Time Frame: Length of time from date of registration to a) date of progression or death due to any cause or b) last follow-up, assessed up to 6 months ]
  Percentage of patients who are progression free at 3 and 6 months (PFS3 and PFS6) will be summarized descriptively.
• Survival [ Time Frame: Up to 15 years ]
  Reported using standard Kaplan-Meier estimation method.
• Time to disease progression [ Time Frame: Up to 15 years ]
  Reported using standard Kaplan-Meier estimation method.
• Time to treatment failure [ Time Frame: Time from registration to documentation of progression, unacceptable toxicity, or refusal to continue participation by the patient, assessed up to 15 years ]

• CEA titers [ Time Frame: Up to 15 years ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Change in CD4 counts [ Time Frame: Baseline to day 28 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Change in CD46 status [ Time Frame: Baseline to up to day 5 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Change in CD8 counts [ Time Frame: Baseline to day 28 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Change in viral shedding [ Time Frame: Baseline to day 28 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Change in viremia [ Time Frame: Baseline to up to 15 years ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Measles virus specific immunity, in terms of change in interferon gamma [ Time Frame: Baseline to day 28 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Measles virus specific immunity, in terms of change in lymphoproliferative assay results [ Time Frame: Baseline to day 28 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.
• Viral propagation in tumor [ Time Frame: Up to day 5 ]
  Descriptive statistics and simple scatterplots will form the basis of presentation of these data. Correlates between these laboratory values and other outcome measures like response and dose levels will be carried out in an exploratory manner.

PRIMARY OBJECTIVES:

I. To assess the safety and toxicity of intratumoral and resection cavity administration of an Edmonston's strain measles virus genetically engineered to produce CEA (MV-CEA) in patients with recurrent glioblastoma multiforme.

II. To determine the maximum tolerated dose (MTD) of MV-CEA. III. To characterize viral gene expression at each dose level as manifested by CEA titers.

IV. To assess viremia, viral replication, and measles virus shedding/persistence following intratumoral administration.

V. To assess humoral and cellular immune response to the injected virus. VI. To assess in a preliminary fashion antitumor efficacy of this approach.

OUTLINE: This is a dose-escalation study. Patients are assigned to 1 of 2 sequential treatment arms.

ARM A (RESECTION CAVITY ADMINISTRATION): Patients undergo en block resection of their tumor (after confirming diagnosis) on day 1, followed by MV-CEA administered into the resection cavity.

ARM B (INTRATUMORAL AND RESECTION CAVITY ADMINISTRATION): Patients undergo stereotactic biopsy (to confirm the diagnosis) and placement of a catheter within the tumor, followed by carcinoembryonic antigen-expressing measles virus intratumorally (IT) through the catheter over 10 minutes on day 1. Patients then undergo en block resection of their tumor with computer-assisted stereotactic techniques on day 5, followed by MV-CEA administered around the tumor bed.

After completion of study treatment, patients are followed up at 28 days (non-cohort I patients), 7 weeks (patients in cohort I only), every 2 months until progression, every 3 and 12 months after progression, and then yearly thereafter for up to 15 years.

• Anaplastic Astrocytoma
• Anaplastic Oligodendroglioma
• Mixed Glioma
• Recurrent Glioblastoma

• Biological: Carcinoembryonic Antigen-Expressing Measles Virus
  Given via injection into resection cavity or around tumor bed and/or IT
  Other Name: MV-CEA
• Other: Laboratory Biomarker Analysis
  Correlative studies
• Procedure: Therapeutic Conventional Surgery
  Undergo en bloc resection

• Experimental: Arm A (resection cavity administration)
  Patients undergo en block resection of their tumor (after confirming diagnosis) on day 1, followed by MV-CEA administered into the resection cavity.
  Interventions:

  • Biological: Carcinoembryonic Antigen-Expressing Measles Virus
  • Other: Laboratory Biomarker Analysis
  • Procedure: Therapeutic Conventional Surgery
• Experimental: Arm B (intratumoral and resection cavity administration)
  Patients undergo stereotactic biopsy (to confirm the diagnosis) and placement of a catheter within the tumor, followed by MV-CEA IT through the catheter over 10 minutes on day 1. Patients then undergo en block resection of their tumor with computer-assisted stereotactic techniques on day 5, followed by MV-CEA administered around the tumor bed.
  Interventions:

  • Biological: Carcinoembryonic Antigen-Expressing Measles Virus
  • Other: Laboratory Biomarker Analysis
  • Procedure: Therapeutic Conventional Surgery

Inclusion Criteria:

• Recurrent grade 3 or 4 glioma, including astrocytoma, oligodendroglioma or mixed glioma with histologic confirmation at initial diagnosis or recurrence
• Candidate for gross total or subtotal resection
• Absolute neutrophil count (ANC) >= 1500/uL
• Platelets (PLT) >= 100,000/uL
• Total bilirubin =< 1.5 x upper normal limit (ULN)
• Aspartate aminotransferase (AST) =< 2 x ULN
• Creatinine =< 2.0 x ULN
• Hemoglobin (Hgb) >= 9.0 gm/dL
• Prothrombin time (PT) and activated partial thromboplastin time (aPTT) =< 1.3 x ULN
• Ability to provide informed consent
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2
• Anti-measles virus immunity as demonstrated by immunoglobulin G (IgG) anti-measles antibody levels of >= 1.1 EU/ml as determined by enzyme immunoassay
• Normal serum CEA levels (< 3 ng/ml) at the time of registration
• Willing to provide biologic specimens as required by the protocol
• Negative serum pregnancy test done =< 7 days prior to registration (for women of childbearing potential only)

Exclusion Criteria:

• Any of the following:

  • Pregnant women
  • Nursing women
  • Men or women of childbearing potential who are unwilling to employ adequate contraception
• Active infection =< 5 days prior to registration
• History of tuberculosis or history of purified protein derivative (PPD) positivity

• Any of the following therapies:

  • Chemotherapy =< 4 weeks prior to registration (6 wks for nitrosourea-based chemotherapy)
  • Immunotherapy =< 4 weeks prior to registration
  • Biologic therapy =< 4 weeks prior to registration
  • Bevacizumab =< 12 weeks prior to registration
  • Non-cytotoxic antitumor drugs, i.e., small molecule cell cycle inhibitors =< 2 weeks prior to registration
  • Radiation therapy =< 6 weeks prior to registration
  • Any viral or gene therapy prior to registration
• Failure to fully recover from acute, reversible effects of prior chemotherapy regardless of interval since last treatment
• New York Heart Association classification III or IV
• Requiring blood product support
• Inadequate seizure control
• Expected communication between ventricles and resection cavity as a result of surgery
• Human immunodeficiency virus (HIV)-positive test result, or history of other immunodeficiency
• History of organ transplantation
• History of chronic hepatitis B or C
• Other concurrent chemotherapy, immunotherapy, radiotherapy or any ancillary therapy considered investigational (utilized for a non-Food and Drug Administration [FDA]-approved indication and in the context of a research investigation)
• Exposure to household contacts =< 15 months old or household contact with known immunodeficiency
• Allergy to measles vaccine or history of severe reaction to prior measles vaccination