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A Randomized Phase 2 Trial of Combining Sipuleucel-T With Immediate vs. Delayed CTLA-4 Blockade for Prostate Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified May 2016 by University of California, San Francisco
Sponsor:
Collaborators:
M.D. Anderson Cancer Center
Bristol-Myers Squibb
Dendreon
Information provided by (Responsible Party):
University of California, San Francisco
ClinicalTrials.gov Identifier:
NCT01804465
First received: February 27, 2013
Last updated: May 22, 2016
Last verified: May 2016
  Purpose
The purpose of this study is to find out what effects taking ipilimumab, as an immediate or delayed treatment, following completion of sipuleucel-T (SipT) treatment, has on patients and their prostate cancer.

Condition Intervention Phase
Prostate Cancer
Drug: SipT Treatment
Drug: Ipilimumab
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomized Phase 2 Trial of Immediate vs. Delayed Anti-CTLA4 Blockade Following Sipuleucel-T Treatment for Prostate Cancer Immunotherapy

Resource links provided by NLM:


Further study details as provided by University of California, San Francisco:

Primary Outcome Measures:
  • Impact of the timing of ipilimumab administration on PAP/PA2024specific immune responses by SipT [ Time Frame: Up to 20 weeks ]
    To assess the impact of the timing of ipilimumab treatment on the induction of IG antibody responses by SipT, the proportion of patients on each study arm who achieve an immune response to PAP and/or PA2024at study week 20 will be determined.


Secondary Outcome Measures:
  • Prostate Specific Antigen (PSA) Measurements (patient response to therapy) [ Time Frame: Up to 3 weeks ]
    Patient response in this study is defined as a PSA decline

  • Radiographic Clinical Responses [ Time Frame: Up to 6 months ]
  • Modulation of Effector and Regulatory T Cells [ Time Frame: Up to 20 weeks ]
  • Safety assessment of combining ipilimumab with SipT [ Time Frame: up to 3 weeks ]
    Number of subjects with each toxicity and adverse event (AE) graded according to CTCAE v4 as well as immune related AEs


Other Outcome Measures:
  • Circulating Tumor Cells (CTC) [ Time Frame: Up to 16 weeks ]
  • T Cell Gene and MicroRNA Signatures [ Time Frame: Up to 20 weeks ]
    Descriptive statistics will be calculated to summarize the change in T cell signaling pathways in addition to the change in gene expression and microRNAs with therapy over time.


Estimated Enrollment: 54
Study Start Date: January 2014
Estimated Study Completion Date: December 2018
Estimated Primary Completion Date: December 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Immediate IpilimumabTreatment
Arm 1 (Immediate Treatment) Ipilimumab Q3wks x 4 started 1 day following the final dose of SipT.
Drug: SipT Treatment

All patients will receive standard of care SipT treatment every two weeks for a total of 3 treatments. The three treatments usually take about 30 days to complete.

SipT treatment is given in three 1 hour infusions. Each SipT treatment is generated from a standard blood cell-collection procedure (called leukapheresis) performed 2-3 days prior to the infusion.

Other Name: Provenge
Drug: Ipilimumab
Ipilimumab will be given by IV over 90 minutes every 3 weeks. Patients will be monitored during the infusion and up to 1 hour post-infusion.
Other Name: BMS-734016/MDX-010, anti-CTLA4
Experimental: Delayed IpilimumabTreatment
Arm 2 (Delayed Treatment) Ipilimumab Q3wks x 4 started 3 weeks following the final dose of SipT.
Drug: SipT Treatment

All patients will receive standard of care SipT treatment every two weeks for a total of 3 treatments. The three treatments usually take about 30 days to complete.

SipT treatment is given in three 1 hour infusions. Each SipT treatment is generated from a standard blood cell-collection procedure (called leukapheresis) performed 2-3 days prior to the infusion.

Other Name: Provenge
Drug: Ipilimumab
Ipilimumab will be given by IV over 90 minutes every 3 weeks. Patients will be monitored during the infusion and up to 1 hour post-infusion.
Other Name: BMS-734016/MDX-010, anti-CTLA4

Detailed Description:

This is an open-label randomized multicenter Phase 2 clinical trial combining SipT with ipilimumab in patients with chemotherapy-naïve metastatic castration resistant prostate cancer (CRPC).

All patients will be treated with standard SipT (Q2wks x 3). Patients will be randomized to one of two arms:

Arm 1 (Immediate Treatment): Ipilimumab Q3wks x 4 started 1 day following the final dose of SipT (Day 0).

Arm 2 (Delayed Treatment): Ipilimumab Q3wks x 4 started 3 weeks following the final dose of SipT (Day 0).

Following this ipilimumab treatment, patients will then be followed monthly for 3 months and then quarterly until disease progression. The definition of unacceptable toxicity is grade 3 or higher treatment-related toxicities (NCI CTCAE v4) excluding irAEs. The study will assess for the immunogenicity and clinical activity of sequential sipuleucel-T treatment followed by ipilimumab. Patients who experience an initial clinical response to ipilimumab followed by subsequent disease progression will be offered reinduction treatment with ipilimumab.

  Eligibility

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

Inclusion Criteria:

  1. Histologically confirmed, metastatic prostate adenocarcinoma (positive bone scan and/or measurable disease on CT scan and/or MRI of the abdomen and pelvis).
  2. Progressive disease after androgen deprivation, as defined by PSA Working Group 2 and/or RECIST criteria. Patients must have disease progression by one or both of the following:

    • For patients with measurable disease, progression is defined as at least a 20% increase in the sum of the longest diameter (LD) of target lesions or the appearance of one or more new lesions, as per RECIST criteria version 1.1.
    • For patients with no measurable disease, a positive bone scan and elevated PSA will be required. PSA evidence for progressive prostate cancer consists of a PSA level of at least 2 ng/ml, which has risen on at least 2 successive occasions, at least 1 week apart. If the confirmatory PSA value is not greater than the screening PSA value, then an additional test for rising PSA will be required to document progression.
    • If no prior orchiectomy has been performed, patients must remain on LHRH agonist or antagonist (e.g. degarelix) therapy. Patients who are receiving an antiandrogen as part of primary androgen ablation must demonstrate disease progression following discontinuation of the antiandrogen, defined as two consecutive rising PSA values, obtained at least two weeks apart, or documented osseous or soft tissue progression. At least one of the PSA values must be obtained at least four weeks (flutamide) or six weeks (bicalutamide or nilutamide) after discontinuation.
  3. Laboratory requirements:

    • Absolute neutrophil count (ANC) ≥ 1500/μL
    • Bilirubin < 1.5 x ULN
    • Hemoglobin ≥ 8 g/dL
    • PSA ≥ 2 ng/mL
    • Platelets ≥ 100,000/μL
    • AST and ALT less than or equal to 2.5 x ULN
    • Creatinine clearance ≥ 60mL/min by the Cockcroft Gault equation
    • Testosterone less than or equal to 50 ng/dL
  4. Eastern Cooperative Oncology Group (ECOG) performance status 0 - 1 and life expectancy ≥ 12 weeks.
  5. At least 18 years of age or older.
  6. Patients receiving any other hormonal therapy, including any dose of megestrol acetate (Megace), Proscar (finasteride), any herbal product known to decrease PSA levels (e.g. Saw Palmetto, PC-SPES), or any systemic corticosteroid, must discontinue the agent for at least four weeks prior to study treatment. Progressive disease as defined above must be documented after discontinuation of any hormonal therapy (with the exception of a LHRH agonist).
  7. Prior radiation therapy must be completed ≥ 4 weeks prior to enrollment and the patient must have recovered from all toxicity. Prior radiopharmaceuticals (strontium, samarium) must be completed ≥ 8 weeks prior to enrollment.
  8. Because of the unknown potential risk to a gamete and/or developing embryo from these investigational therapies, patients must agree to use adequate contraception (barrier method for males) for the duration of study participation, and for three months after discontinuing therapy.

Exclusion Criteria:

  1. Prior chemotherapy for prostate cancer, with the exception of neoadjuvant chemotherapy, because of the potential effect of chemotherapy on the immune system.
  2. Prior sipuleucel-T treatment or investigational immunotherapy.
  3. Prostate cancer pain requiring regularly scheduled narcotics.
  4. Current treatment with systemic steroid therapy (inhaled/topical steroids are acceptable). Systemic corticosteroids must be discontinued for at least 4 weeks prior to first treatment.
  5. History of autoimmune disease including, but not limited to:

    • Systemic lupus erythematosis (SLE), scleroderma, CREST syndrome, rheumatoid arthritis
    • Inflammatory bowel disease, celiac disease, primary biliary cirrhosis, autoimmune hepatitis
    • Dermatomyositis, polymyositis, giant cell arteritis
    • Autoimmune hemolytic anemia (AIHA), cryoglobulinemia, antiphospholipid antibody syndrome (APLS)
    • Diabetes mellitus type I, myasthenia gravis, Grave's disease
    • Wegener's granulomatosis or other vasculitis
    • A history of Hashimoto's thyroiditis, psoriasis, or eczema, any of which has been inactive for at least one year, or isolated Raynaud's phenomenon is acceptable
  6. Known central nervous system or visceral metastases.
  7. Medical or psychiatric illness that would, in the opinion of the investigator, preclude participation in the study or the ability of patients to provide informed consent for themselves.
  8. Cardiovascular disease that meets one of the following: congestive heart failure (New York Heart Association Class III or IV), active angina pectoris, or recent myocardial infarction (within the last 6 months).
  9. Concurrent or prior malignancy except for the following:

    • Adequately treated basal or squamous cell skin cancer
    • Adequately treated stage I or II cancer from which the patient is currently in complete remission
    • Any other cancer from which the patient has been disease-free for 5 years
  10. Known HIV or other history of immunodeficiency disorder.
  11. Prisoners or subjects who are compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or medical (e.g. infectious) illness.
  12. Any underlying medical or psychiatric condition, which in the opinion of the investigator will make the administration of ipilimumab hazardous or obscure the interpretation of AEs, such as a condition associated with frequent diarrhea.
  13. A history of prior treatment with ipilimumab or prior CD137 agonist or CTLA-4 inhibitor or agonist.
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01804465

Contacts
Contact: Paula Dutton 415-885-7871 walshp@medicine.ucsf.edu

Locations
United States, California
University of California San Francisco Recruiting
San Francisco, California, United States, 94115
Contact: Lawrence Fong, MD    415-514-3160    lfong@medicine.ucsf.edu   
Contact: Paula Dutton, BS    415-885-7871    walshp@medicine.ucsf.edu   
Principal Investigator: Lawrence Fong, MD         
United States, Texas
The University of Texas MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Contact: Padmanee Sharma, MD    713-792-2830    padsharma@mdanderson.org   
Principal Investigator: Padmanee Sharma, MD         
Sponsors and Collaborators
University of California, San Francisco
M.D. Anderson Cancer Center
Bristol-Myers Squibb
Dendreon
Investigators
Principal Investigator: Lawrence Fong, MD University of California, San Francisco
Principal Investigator: Padmanee Sharma, MD The University of Texas MD Anderson Cancer Center
  More Information

Responsible Party: University of California, San Francisco
ClinicalTrials.gov Identifier: NCT01804465     History of Changes
Other Study ID Numbers: CC#12557
Study First Received: February 27, 2013
Last Updated: May 22, 2016

Keywords provided by University of California, San Francisco:
castration resistant
prostate
cancer
ipilimumab
provenge
SipT

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Antibodies, Monoclonal
Immunologic Factors
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on March 24, 2017