Clinical Trials /

Multi-Epitope TARP Peptide Autologous Dendritic Cell Vaccination in Men With Stage D0 Prostate Cancer

NCT02362451

Description:

Background: - Men who continue to have an elevated or rising prostate specific antigen (PSA) level after their primary prostate cancer treatment are at increased risk for their cancer to progress. The time it takes to progress is highly variable. One way to predict this progression is based on the change in PSA levels over time. This is called the PSA doubling time (PSADT). Researchers want to test a vaccine on men with Stage D0 prostate cancer. Stage D0 means the PSA has become detectable again or has started to rise after primary treatment, but has not spread to other organs. Objectives: - To test a vaccine s effectiveness on the rate of PSA increase using PSADT and tumor growth rates. Eligibility: - Men with Stage D0 prostate cancer with a PSADT between 3 and 15 months. Design: - Participants will be screened with blood tests, scans, physical exam, and medical history. Their prostate cancer will be confirmed. - Participants will undergo apheresis. Blood will be removed with a needle from one arm. A machine will separate the white blood cells. The blood, minus the white cells, will be returned through a needle in the other arm. - Participants will have 14 visits. At each visit, they will have a physical exam and blood tests. They will discuss any side effects. - Participants will get injections of either the vaccine or placebo at weeks 3, 6, 9, 12, 15, and 24. Both will be made from the participants own cells. - Participants will be selected randomly to receive either active vaccine or placebo. For every two participants assigned to active vaccine, one participant will be assigned to placebo vaccine. - Participants will get a Vaccine Report Card to to complete after receiving vaccine. - The study lasts 96 weeks.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Multi-Epitope TARP Peptide Autologous Dendritic Cell Vaccination in Men With Stage D0 Prostate Cancer
  • Official Title: A Randomized, Placebo-Controlled Phase II Study of Multi-Epitope TARP Peptide Autologous Dendritic Cell Vaccination in Men With Stage D0 Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 150075
  • SECONDARY ID: 15-C-0075
  • NCT ID: NCT02362451

Conditions

  • Prostatic Neoplasms
  • Prostate Cancer

Interventions

DrugSynonymsArms
Autologus elutriated monocyte placebo vaccine3-Placebo
ME TARP vaccine1-Lead-in TARP DC vaccine treatment

Purpose

Background: - Men who continue to have an elevated or rising prostate specific antigen (PSA) level after their primary prostate cancer treatment are at increased risk for their cancer to progress. The time it takes to progress is highly variable. One way to predict this progression is based on the change in PSA levels over time. This is called the PSA doubling time (PSADT). Researchers want to test a vaccine on men with Stage D0 prostate cancer. Stage D0 means the PSA has become detectable again or has started to rise after primary treatment, but has not spread to other organs. Objectives: - To test a vaccine s effectiveness on the rate of PSA increase using PSADT and tumor growth rates. Eligibility: - Men with Stage D0 prostate cancer with a PSADT between 3 and 15 months. Design: - Participants will be screened with blood tests, scans, physical exam, and medical history. Their prostate cancer will be confirmed. - Participants will undergo apheresis. Blood will be removed with a needle from one arm. A machine will separate the white blood cells. The blood, minus the white cells, will be returned through a needle in the other arm. - Participants will have 14 visits. At each visit, they will have a physical exam and blood tests. They will discuss any side effects. - Participants will get injections of either the vaccine or placebo at weeks 3, 6, 9, 12, 15, and 24. Both will be made from the participants own cells. - Participants will be selected randomly to receive either active vaccine or placebo. For every two participants assigned to active vaccine, one participant will be assigned to placebo vaccine. - Participants will get a Vaccine Report Card to to complete after receiving vaccine. - The study lasts 96 weeks.

Detailed Description

      TARP

        -  T-cell receptor g alternate reading frame protein (TARP) is a 58 amino acid protein
           expressed by both normal and malignant prostate cancer tissue; 95% of prostate cancer
           specimens are positive for TARP expression. TARP is highly expressed in prostate cancers
           of all Gleason types, in primary as well as metastatic disease, and in hormone sensitive
           and castrate resistant prostate cancer. Therefore, TARP is an ideal tumor antigen target
           for a vaccine.

        -  A prospective, randomized pilot study of 1st generation TARP Peptide vaccination (NCI
           09-C-0139) utilizing TARP WT 27-35 and EE29-37-9V peptides was conducted in HLA-A
           0201positive men with stage D0 prostate cancer (PSA biochemical recurrence) and a PSA
           doubling time (PSADT) of greater than or equal to 3 months and less than or equal to 15
           months. TARP vaccination was found to be immunogenic, safe and well tolerated, with
           adverse events limited to injection site reactions less than or equal to Grade 2. TARP
           vaccination was also associated with a decreased slope log PSA compared to
           pre-vaccination baseline in 72% of subjects reaching 24 weeks and 74% reaching 48 weeks
           (p=0.0012 and p=0.0004 for overall changes in slope log PSA, respectively); TARP
           vaccination also resulted in a 50% decrease in calculated tumor growth rate constant:
           pre-vaccine g = 0.0042/day, post-vaccine g = 0.0021/day (p=0.003); TARP-specific IFN-g
           ELISPOT responses were detected in the majority of subjects but did not correlate with
           decreases in slope log (PSA).

      Multi-Epitope (ME) TARP Vaccine

        -  The vaccine platform includes the original two 9-mer HLA-A*0201 binding TARP peptide
           epitopes (WT27-35 and EE29-37-9V) utilized in NCI 09-C-0139 as well as an additional
           five 20-mer TARP peptides overlapping by 10 amino acids for a total of 7 peptides that
           span the amino acid sequence of the entire TARP protein.

        -  The advantage of this multi-epitope TARP peptide vaccine platform is that the
           overlapping epitopes cover the entire TARP protein, resulting in potential for induction
           of a multi-valent anti-TARP response. In addition, these longer synthetic peptides
           include TARP-specific MHC class II CD4+ T cell helper epitopes that will allow
           generation of better CD8+ T cell responses with improved functional avidity and
           longevity as well as humoral anti-TARP antibody responses.

      Study Objectives:

      Primary:

      -To assess the difference in the slope log (PSA) for Weeks3-24 minus that formed for the 12
      months prior to enrollment on study (referred to as slope324 pre-slope) as well as the slope
      log (PSA) for weeks 3-48 versus the same pre-treatment slope log (PSA) (referred to as slope
      348 preslope) in patients na(SqrRoot) ve to TARP vaccination receiving active, multi-epitope
      TARP vaccination vs. placebo.

      Eligibility:

        -  Males greater than or equal to 18 years of age with histologically confirmed
           adenocarcinoma of the prostate.

        -  Stage D0 disease with documented biochemical progression documented by rising PSA and no
           evidence of metastatic disease by physical examination, CT scan or bone scan.

        -  PSADT greater than or equal to 3 months and less than or equal to 15 months:

           ----Patients must have greater than or equal to 3 PSA measurements over greater than or
           equal to 3 months.

           --- The interval between PSA measurements must be greater than or equal to 4 weeks.

        -  Performance Status: ECOG 0-1 and life expectancy greater than or equal to 1 year.

        -  No other concurrent anticancer therapy or prior prostate cancer vaccines expressing
           TARP.

      Study Design:

        -  Phase II, prospective, single-blinded, randomized, placebo controlled study of 96 weeks
           duration in men with Stage D0 prostate cancer. Men with a PSADT greater than or equal to
           3 months and less than or equal to 15 months will be randomized 2:1 to receive ME TARP
           autologous DC vaccination or a control eleutriated monocyte vaccine placebo.

        -  An initial lead-in of 6 patientswill be enrolled to allow preliminary assessment of the
           safety of the ME TARP vaccine platform through 12 weeks before enrollment of
           prospectively randomized subjects blinded to treatment assignment begins.

        -  All patients will receive a total of 6 doses of vaccine (20 x10(6) viable cells/dose)
           delivered intradermally at Weeks 3, 6, 9, 12, 15, and 24. All patients will undergo a
           15-18L apheresis at Week 0 and restaging at Weeks 48 and 96 to confirm maintenance of
           Stage D0 disease.

      Sample size: N = 72 (6 lead-in patients for safety assessment, 2:1 randomization: TARP N =
      44; placebo N =22).
    

Trial Arms

NameTypeDescriptionInterventions
1-Lead-in TARP DC vaccine treatmentExperimentalAll patients to receive autologous multi-epitopeTARP DC vaccine before randomization
  • ME TARP vaccine
2-Active TARP DC vaccine treatmentExperimentalAutologous multi-epitope TARP DC vaccine afterrandomization
  • ME TARP vaccine
3-PlaceboPlacebo ComparatorAutologous elutriated monocyte vaccine placeboafter randomization
  • Autologus elutriated monocyte placebo vaccine

Eligibility Criteria

        -INCLUSION CRITERIA:

          1. Males greater than or equal to 18 years of age with histologically confirmed
             adenocarcinoma of the prostate.

          2. Must have completed and recovered from all prior definitive therapy (surgery,
             brachytherapy, cryotherapy or radiotherapy) for the primary tumor, or other
             definitiveintent local therapy.

          3. Stage D0 disease with documented biochemical progression documented by rising PSA and
             no evidence of metastatic disease by physical examination, CT scan or bone scan.

          4. PSADT greater than or equal to 3 months and less than or equal to 15 months:

               -  Patients must have greater than or equal to 3 PSA measurements over greater than
                  or equal to 3 months.

               -  The interval between PSA measurements must be greater than or equal to 4 weeks.

          5. For patients following definitive radiation therapy or cryotherapy: a rise in PSA of >
             2ng/mL above the nadir (per RTOG-ASSTRO consensus criteria).

          6. For patients following radical prostatectomy: 2 absolute PSA values > 0.2ng/ml.

          7. Non-castrate level of testosterone: greater than or equal to 50 ng/dL (prior ADT
             allowed; must be greater than or equal to 6 months since last dose of ADT).

          8. Performance Status: ECOG 0-1 and life expectancy greater than or equal to 1 year.

          9. Hemoglobin greater than or equal to 9.0 gm/dL, WBC greater than or equal to
             2,500/mm(3), ALC greater than or equal to 500/ mm(3), ANC greater than or equal to
             1,000/mm(3) platelet count greater than or equal to 75,000/mm(3), and PT/PTT less than
             or equal to 1.5 times ULN unless receiving clinically indicated anticoagulant therapy;
             SGPT/SGOT less than or equal to 3 times ULN, total bilirubin less than or equal to 1.5
             times ULN; creatinine less than or equal to 1.5 times ULN and estimated GFR (eGFR)
             greater than or equal to 60 ml/min.

         10. Hepatitis B and C negative (unless the result is consistent with prior vaccination or
             prior infection with full recovery); HIV negative.

         11. No use of investigational agents within 4 weeks of study enrollment or use of
             immunosuppressive or immunomodulating agents within 8 weeks of study entry.

         12. No other concurrent anticancer therapy or prior prostate cancer vaccines expressing
             TARP.

         13. No alternative medications or nutriceuticals known to alter PSA (e.g. phytoestrogens
             and saw palmetto). Note: patients receiving medications for urinary symptoms such as
             Flomax or 5-alpha reductase inhibitors (finasteride and dutasteride) on a chronic
             stable dose for at least 3 months prior to study enrollment are allowed.

        EXCLUSION CRITERIA:

          1. Patients with an active second malignancy other than adequately treated squamous or
             basal cell carcinoma of the skin.

          2. Patients with active infection.

          3. Patients on immunosuppressive therapy including:

             - Systemic corticosteroid therapy for any reason. Patients receiving inhaled or
             topical corticosteroids may participate.

          4. Other significant or uncontrolled medical illness. Patients with a remote history of
             asthma or active mild asthma may participate.

          5. Patients who, in the opinion of the Principal Investigator, have significant medical
             or psychosocial problems that warrant exclusion including:

               -  Other serious non-malignancy-associated medical conditions that may be expected
                  to limit life expectancy to less than 2 years.

               -  Any condition, medical, psychiatric or otherwise, that would preclude informed
                  consent, consistent follow-up, or compliance with any aspect of the study.
      
Maximum Eligible Age:99 Years
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Difference in rate of PSA change pre vs post treatment
Time Frame:One year pre-enrollment; weeks 3 - 24 post vaccine
Safety Issue:
Description:PSA Doubling Time (PSADT) andslope log (PSA) will be calculated at every study visit using the PSADT Memorial Sloane Kettering nomogram.

Secondary Outcome Measures

Measure:Progression free survival
Time Frame:Week 96 after initial vaccination
Safety Issue:
Description:PFS is defined as the duration of time from start of vaccine treatment to time of progression or death.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Dendritic Cell Vaccine
  • Multi Epitope Tarp Peptide
  • Autolougous Dendritic Cell
  • D0 Prostate Cancer
  • Vaccine Therapy

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