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Trial record 9 of 24 for:    WAGR

Adjuvant Dendritic Cell-immunotherapy Plus Temozolomide in Glioblastoma Patients (ADDIT-GLIO)

This study is currently recruiting participants.
Verified June 2017 by Zwi Berneman, University Hospital, Antwerp
Sponsor:
ClinicalTrials.gov Identifier:
NCT02649582
First Posted: January 7, 2016
Last Update Posted: June 16, 2017
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.
Information provided by (Responsible Party):
Zwi Berneman, University Hospital, Antwerp
  Purpose
In this phase I/II trial, the primary objective is to determine overall and progression-free survival of patients with newly diagnosed glioblastoma when autologous Wilms' tumor 1 (WT1) messenger (m)RNA-loaded dendritic cell (DC) vaccination is added to adjuvant temozolomide maintenance treatment following (sub)total resection and temozolomide-based chemoradiation.

Condition Intervention Phase
Glioblastoma Multiforme of Brain Biological: Dendritic cell vaccine plus temozolomide chemotherapy Phase 1 Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Adjuvant Dendritic-Cell Immunotherapy Plus Temozolomide Following Surgery and Chemoradiation in Patients With Newly Diagnosed Glioblastoma

Resource links provided by NLM:


Further study details as provided by Zwi Berneman, University Hospital, Antwerp:

Primary Outcome Measures:
  • Overall survival [ Time Frame: Through study completion (anticipated 2 years) with 2-year follow-up ]
    Patients will be followed for survival, from diagnosis and from start of treatment, for which the accurate date and reason of death (cancer-related or non-related) will be recorded for every patient.


Secondary Outcome Measures:
  • Number of glioblastoma patients post surgical resection with feasible and safe DC vaccine production [ Time Frame: Vaccine production and quality testing (i.e. 4 weeks after leukapheresis) ]

    Production of autologous DC vaccines from newly diagnosed glioblastoma patients that underwent maximal, safe surgical resection will be evaluated for:

    1. feasibility, assessed by success of leukapheresis and production of sufficient and qualified (phenotypic and functional requirements) vaccines.
    2. Safety, assessed by microbiological testing (bacteria, yeast, fungi, mycoplasma, endotoxin) of the DC vaccines.

  • Feasibility of DC vaccine administration to glioblastoma patients combined with chemotherapy [ Time Frame: Upon maintenance chemotherapy treatment (i.e. +/- 12 weeks post leukapheresis) ]
    Administration of 3 weekly DC vaccines following adjuvant chemoradiation (induction phase) and additional DC vaccination at day 21 of each maintenance chemotherapy cycle (booster phase) will be evaluated for feasibility, assessed by successful DC vaccine administration of the proposed treatment scheme.

  • Number of participants with adverse events as a measure of safety and tolerability [ Time Frame: Through study completion (anticipated 2 years) with 2-year follow-up ]
    Monitoring the incidence of adverse events to evaluate the safety profile and tolerability of the treatment. The severity of adverse events will be assessed according to the NCI CTCAE scale (v4.03, published June 14, 2010).

  • Immunological responses to the DC vaccine [ Time Frame: At first DC vaccination + day 1 of first and fourth temozolomide treatment cycles ]
    Immunological responses to the vaccine will be evaluated ex vivo. Blood samples will be collected from patients on the day of the first DC vaccine, and on day 1 of the first and fourth maintenance temozolomide treatment cycles and will be examined for cell subset distribution and activation status and antigen-specific immunity.

  • Objective clinical responses by tumor evaluation (clinical efficacy) [ Time Frame: Through study completion (anticipated 2 years) with 2-year follow-up ]

    Disease evolution and progression-free survival will be assessed according to the Response Assessment in Neuro-Oncology (RANO) criteria, based on imaging findings (MRI, CT), clinical status and corticosteroid use.

    Disease will be assessed following chemoradiation (≤ 2 weeks after completing chemoradiation), after every two cycles of temozolomide maintenance treatment and at least every 12 weeks during the booster phase, and every 9-12 weeks during follow-up after treatment discontinuation.



Estimated Enrollment: 20
Study Start Date: December 2015
Estimated Study Completion Date: December 2019
Estimated Primary Completion Date: December 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Single Arm
Dendritic cell vaccine plus temozolomide chemotherapy
Biological: Dendritic cell vaccine plus temozolomide chemotherapy

When eligible after total or subtotal resection (as assessed by neurosurgeon and post-operative brain MRI):

  1. Leukocyte apheresis ± 1 week before chemoradiation (for DC vaccine production)
  2. Chemoradiation (standard treatment): 2 Gy once daily 5 days/week for 6 weeks with 75 mg/m² temozolomide daily from the first until the last day of radiotherapy (no longer than 49 days in total)
  3. Induction immunotherapy: intradermal vaccination with autologous WT1 mRNA-loaded DCs weekly for 3 weeks, starting 1 week after radiotherapy
  4. Chemo-immunotherapy: 150-200 mg/m²/d temozolomide days 1-5 every 28 days (max. 12 months) starting 1 week after induction immunotherapy + DC on day 21 of every 28-day cycle

Detailed Description:

Glioblastoma multiforme (GBM), a microscopically infiltrative disease, is the most common malignant brain tumor worldwide. Despite optimized standard of care treatment median survival and prognosis remain poor with a median survival of only 15% and five year survival after diagnosis of 5%.

In this single arm single centre phase I/II trial the investigators will determine the overall and progression free survival of patients with newly diagnosed GBM when autologous WT1 mRNA loaded dendritic cell vaccination is added to standard of care treatment. During two years of recruitment the investigators will include 20 patients with newly diagnosed, histologically verified glioblastoma (WHO grade IV) who have received a total or subtotal resection of the tumor. Patients who underwent prior radiation or chemotherapy or with a history of other malignancy will be excluded. In addition to standard of care consisting of adjuvant chemoradiation with temozolomide and temozolomide maintenance patients will receive an intradermal vaccination with autologous WT1 mRNA-loaded dendritic cells commencing 1 week after radiotherapy. The dendritic cell therapy product will be generated and administered in the Antwerp University Hospital, more specifically the Center for Cell Therapy and Regenerative Medicine (CCRG) and the Division of Hematology, both headed by Prof. Zwi Berneman.

Recruitment will begin in December 2015. After 2 years of follow up overall and progression free survival analysis will be performed and this will be compared with the published data of standard of care treatment without vaccination. In addition the investigators will look for feasibility, incidence of adverse events and immunogenicity.

  Eligibility

Information from the National Library of Medicine

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

Inclusion Criteria:

  • Newly diagnosed, histologically verified glioblastoma (WHO grade IV)
  • Aged ≥ 18 years
  • Total or subtotal resection:

    • Total resection: macroscopic complete resection as assessed by the neurosurgeon and absence of any residual contrast-enhancing mass on post-operative (≤ 72h) brain MRI
    • Subtotal resection: macroscopic complete resection as assessed by the neurosurgeon, but with residual contrast-enhancement ≤ 2 cm³ on post-operative (≤ 72h) brain MRI
  • Signed informed consent
  • Willing and able to comply with the protocol as judged by the Investigator
  • Estimated to start with chemoradiation ≥ 28 days and ≤ 49 days following surgical resection
  • Adequate hematologic, renal, and hepatic function at time of screening:

    • Hemoglobin ≥ 10 g/dL (transfusion is allowed to maintain or exceed this level)
    • Monocyte count (Mo) ≥ 0.2 x 10^9/L
    • Absolute neutrophil count (ANC) ≥ 1.0 x 10^9/L
    • Platelet count (PLT) ≥ 100 x 10^9/L
    • Serum creatinine ≤ 1.5 x the upper limit of normal (ULN)
    • Liver-function values < 3 x ULN
  • No corticosteroid treatment ≤ 1 week before apheresis
  • WHO performance status ≤ 2
  • Life expectancy ≥ 3 months as estimated by the Investigator

Exclusion Criteria:

  • History of another malignancy, except for adequately controlled basal cell skin carcinoma, squamous skin carcinoma, or carcinoma in situ of the uterine cervix
  • Prior radiation or chemotherapy
  • Any pre-existing contraindication for temozolomide treatment
  • Any pre-existing contraindication for contrast-enhanced brain MRI
  • Pregnant or breast-feeding
  • Documented immune deficiency or systemic immune-suppressive treatment
  • Positive viral serology for HIV, HBV, HCV, or syphilis at time of screening
  • Any other condition, either physical or psychological, or reasonable suspicion thereof on clinical or special investigation, which contraindicates the use of the vaccine, or may negatively affect patient compliance, or may place the patient at higher risk of potential treatment complications
  Contacts and Locations
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): NCT02649582


Contacts
Contact: Zwi N Berneman, MD, PhD 0032 3 821 39 15 zwi.berneman@uza.be
Contact: Pol Specenier, MD, PhD 0032 3 821 40 14 pol.specenier@uza.be

Locations
Belgium
Antwerp University Hospital Recruiting
Edegem, Antwerp, Belgium, 2650
Contact: Zwi N Berneman, MD, PhD       zwi.berneman@uza.be   
Contact: Pol Specenier, MD, PhD    038214014 ext 0032    pol.specenier@uza.be   
Sponsors and Collaborators
University Hospital, Antwerp
Investigators
Study Director: Zwi N Berneman, MD, PhD Antwerp University Hospital, Division of Hematology and Center for Cell Therapy and Regenerative Medicine
Principal Investigator: Pol Specenier, MD, PhD Antwerp University Hospital (UZA), Division of Oncology
Principal Investigator: Yannick Willemen, MD University of Antwerp, Laboratory of Experimental Hematology
Principal Investigator: Evelien LJ Smits, MSc, PhD University of Antwerp, Laboratory of Experimental Hematology
OverallOfficial: Barbara Stein, MSc Antwerp University Hospital, Division of Hematology
OverallOfficial: Eva Lion, MSc, PhD University of Antwerp, Laboratory of Experimental Hematology
  More Information

Publications:
Willemen Y, Huizing MT, Smits E, Anguille S, Nijs G, Stein B, Van Tendeloo V, Peeters M, Berneman Z. J Clin Oncol 30(suppl): abstr e13051, 2012.

Responsible Party: Zwi Berneman, Full Professor, University Hospital, Antwerp
ClinicalTrials.gov Identifier: NCT02649582     History of Changes
Other Study ID Numbers: CCRG14-001
First Submitted: January 23, 2015
First Posted: January 7, 2016
Last Update Posted: June 16, 2017
Last Verified: June 2017

Keywords provided by Zwi Berneman, University Hospital, Antwerp:
Dendritic cells
Chemoimmunotherapy
Adjuvant therapy

Additional relevant MeSH terms:
Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Vaccines
Temozolomide
Dacarbazine
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents