Clinical Trials /

PROSTVAC in Combination With Nivolumab in Men With Prostate Cancer

NCT02933255

Description:

Background: The immune system is the cells and organs in the body that recognize and fight infection and cancer. The PROSTVAC vaccine might teach the immune system to find and kill certain prostate cancer cells. Nivolumab is a drug that allows the immune system to fight tumors. Itmight help PROSTVAC work better. Objective: To test the safety and effectiveness of the combination of PROSTVAC and nivolumab. To test this for people with castration resistant prostate cancer and then for other people with localized prostate cancer who are candidates for surgical removal of the prostate. Eligibility: Men ages 18 and older with prostate cancer Design: Participants will be screened with: Medical history Physical exam Blood and urine tests Electrocardiogram Bone scan CT scan or MRI Tumor sample. This may be from a previous procedure. All participants will get a combination of the study drugs over 8 weeks. They will have 1 visit for the initial injection then 3 booster injection / nivolumab infusion visits. Blood will be tested at these visits. Over the next 4 weeks, some participants will have: An exam of the large intestine through the rectum. CT and bone scans Standard hormonal treatment Option to continue treatment every 3 weeks if their disease does not get worse. They will be have scans every 12 weeks. Other participants will have surgery to remove the prostate in week 9. Participants will have a safety visit about a month after their last treatment. This will include a physical exam, blood tests, and possibly scans. If their cancer progresses, participants will leave the study and may enroll in a long-term follow-up study. They will be contacted once a year to ask about their cancer and treatment.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: PROSTVAC in Combination With Nivolumab in Men With Prostate Cancer
  • Official Title: Phase I/II Study of PROSTVAC in Combination With Nivolumab in Men With Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: 170007
  • SECONDARY ID: 17-C-0007
  • NCT ID: NCT02933255

Conditions

  • Prostate Cancer

Interventions

DrugSynonymsArms
PROSTVAC-V/FLead-in mCRPC Cohort
NivolumabLead-in mCRPC Cohort

Purpose

Background: The immune system is the cells and organs in the body that recognize and fight infection and cancer. The PROSTVAC vaccine might teach the immune system to find and kill certain prostate cancer cells. Nivolumab is a drug that allows the immune system to fight tumors. Itmight help PROSTVAC work better. Objective: To test the safety and effectiveness of the combination of PROSTVAC and nivolumab. To test this for people with castration resistant prostate cancer and then for other people with localized prostate cancer who are candidates for surgical removal of the prostate. Eligibility: Men ages 18 and older with prostate cancer Design: Participants will be screened with: Medical history Physical exam Blood and urine tests Electrocardiogram Bone scan CT scan or MRI Tumor sample. This may be from a previous procedure. All participants will get a combination of the study drugs over 8 weeks. They will have 1 visit for the initial injection then 3 booster injection / nivolumab infusion visits. Blood will be tested at these visits. Over the next 4 weeks, some participants will have: An exam of the large intestine through the rectum. CT and bone scans Standard hormonal treatment Option to continue treatment every 3 weeks if their disease does not get worse. They will be have scans every 12 weeks. Other participants will have surgery to remove the prostate in week 9. Participants will have a safety visit about a month after their last treatment. This will include a physical exam, blood tests, and possibly scans. If their cancer progresses, participants will leave the study and may enroll in a long-term follow-up study. They will be contacted once a year to ask about their cancer and treatment.

Detailed Description

      Background:

        -  Immune checkpoint inhibitors interfere with the immune system s autoregulatory
           mechanisms, allowing for a potentially expanded and prolonged T-cell response with the
           possibility of greater antitumor effects.

        -  Nivolumab is a fully human IgG4 monoclonal antibody that targets the PD-1 protein.
           Specifically, the antibody binds to the PD-1 receptor and blocks its interaction with
           PD-L1 and PD-L2, thereby releasing PD-1 pathway-mediated inhibition of the immune
           response, including anti-tumor immune response.

        -  PROSTVAC (developed by the National Cancer Institute [NCI] and licensed to Bavarian
           Nordic Immunotherapeutics, Mountain View, CA) is a therapeutic cancer vaccine for
           prostate cancer. Early studies have demonstrated immunologic efficacy and suggested
           clinical benefit. A phase III trial has completed accrual.

        -  A previous study combining the immune checkpoint inhibitor ipilimumab and PROSTVAC
           suggested greater efficacy than PROSTVAC alone. Additional studies have demonstrated the
           potential efficacy of immunologic combination therapy with the immune checkpoint
           inhibitor nivolumab.

        -  This study will aim to evaluate the impact of the combination of PROSTVAC and the immune
           checkpoint inhibitor nivolumab on the tumor microenvironment focusing on immune cell
           infiltration as the primary endpoint.

        -  US-MRI imaging technology will be employed to sample the tumor before treatment and
           after radical prostatectomy.

        -  The findings from this study could serve as the basis for future studies with this
           combination in this population of patients and more advanced disease.

      Objectives:

        -  Safety (For castration resistant prostate cancer (CRPC) lead-in cohort)

        -  Evaluate changes in T-cell infiltration in the tumor after neoadjuvant treatment with
           PROSTVAC and nivolumab, relative to changes seen in a phase 2 trial with PROSTVAC alone
           in the neoadjuvant setting- NCT02153918 (For the neoadjuvant cohort).

      Eligibility:

        -  Patients must have histopathological documentation of adenocarcinoma of the prostate
           prior to starting this study and evaluable biopsy tissue (e.g., unstained slides or
           blocks) available for analysis.

        -  For the castration resistant lead in cohort, if histopathological documentation is
           unavailable, a rising PSA and a clinical course consistent with prostate cancer would be
           acceptable.

        -  Patients must have a performance status of 0 to 1 according to the ECOG criteria.

        -  Hematological eligibility parameters (within 16 days of starting therapy):

             -  Granulocyte count 1,500/mm^3

             -  Platelet count 100,000/mm^3

             -  Hgb greater than or equal to 8 g/dL

        -  Biochemical eligibility parameters (within 16 days of starting therapy):

             -  Hepatic function: Bilirubin < 1.5 mg/dl (OR in patients with Gilbert's syndrome,
                total bilirubin less than or equal to 3.0 mg/dL), AST and ALT less than or equal to
                2.5 times upper limit of normal.

             -  Creatinine less than or equal to 1.5 X ULN

      Design:

        -  The primary focus of this study will be to evaluate PROSTVAC and nivolumab in the
           neoadjuvant setting.

        -  Lead-in cohort evaluating the safety and tolerability of this combination in the
           castration resistant setting (CRPC cohort)

        -  Following this lead-in cohort in the CRPC setting, we will enroll a cohort in the
           neoadjuvant setting evaluating the combination of PROSTVAC and nivolumab.

        -  The lead-in safety cohort will require 10 patients and the neoadjuvant cohort will
           require 17 evaluable patients. In order to allow for a small number of inevaluable
           patients, the accrual ceiling will be set to 29 patients.
    

Trial Arms

NameTypeDescriptionInterventions
Lead-in mCRPC CohortExperimentalPROSTVAC-V on week 0 followed by booster injection called PROSTVAC-F on 2, 4, 6 and 8 weeks. When administered on the same day, the preferred order of administration is PROSTVAC first followed by nivolumab. Patients will undergo sigmoidoscopies on week 9 and restaging scans on week 11. If no PD, option to continue treatment every 3 weeks until intolerance or progression (evaluated radiographically every 12 weeks).
  • PROSTVAC-V/F
  • Nivolumab
Neoadjuvant CohortExperimentalPROSTVAC-V on week 0 followed by booster injection called PROSTVAC-F on 2, 4 and 8 weeks. When administered on the same day, the preferred order of administration is PROSTVAC first followed by nivolumab. Patients will undergo prostatectomy on week 9.
  • PROSTVAC-V/F
  • Nivolumab

Eligibility Criteria

        -  INCLUSION CRITERIA:

        For the neoadjuvant cohort, patients must have histopathological documentation of
        adenocarcinoma of the prostate prior to starting this study and evaluable biopsy tissue
        (e.g., unstained slides or blocks) available for analysis. If evaluable tissue is not
        available, the patient must agree to undergo a pre-vaccination prostate biopsy on study.
        For the CRPC lead in cohort, if histopathological documentation is unavailable, a rising
        PSA and a clinical course consistent with prostate cancer would be acceptable.

          -  Age greater than or equal to 18 years. Because no dosing or adverse event data are
             currently available on the use of PROSTVAC in combination with nivolumab, ipilimumab
             or both in patients <18 years of age, children are excluded from this study, but will
             be eligible for future pediatric trials.

          -  ECOG performance status of 0 or 1.

          -  Patients must not have other active invasive malignancies within the past 2 years
             (with the exception of non-melanoma skin cancers) (for CRPC cohort only).

          -  Patients must be willing to travel to the study site for follow-up visits

          -  All patients who have received prior vaccination with vaccinia virus (for smallpox
             immunization) must not have a history of serious adverse reaction to the vaccine.

          -  The effects of PROSTVAC in combination nivolumab, ipilimumab or both on the developing
             human fetus are unknown. For this reason men must agree to use adequate contraception
             (abstinence, vasectomy) or female partner must use (intrauterine device (IUD),
             hormonal [birth control, pills, injections, or implants], tubal ligation] prior to
             study entry and for up to 5 months after the last dose.

          -  Patients must understand and sign informed consent that explains the neoplastic nature
             of their disease, the procedures to be followed, the experimental nature of the
             treatment, alternative treatments, potential risks and toxicities, and the voluntary
             nature of participation.

          -  Patients must have normal organ and marrow function as defined below:

               -  hemoglobin greater than or equal to 8 g/dL

               -  granulocytes greater than or equal to 1,500/mcL

               -  platelets greater than or equal to 100,000/mcL

               -  total bilirubin < 1.5 mg/dL (or less than or equal to 3.0 mg/dL in patients with
                  Gilbert syndrome)

               -  AST(SGOT)/ALT(SGPT) less than or equal to 2.5 X institutional upper limit of
                  normal

               -  creatinine less than or equal to 1.5 X ULN

          -  For the lead in cohort:

               -  Castrate testosterone level (<50ng/dl or 1.7nmol /L)

               -  Progressive disease at study entry defined as one or more of the following
                  criteria occurring in the setting of castrate levels of testosterone:

                    -  Radiographic progression defined as any new or enlarging bone lesions or
                       growing lymph node disease, consistent with prostate cancer OR

                    -  PSA progression defined by sequence of rising values separated by >1 week (2
                       separate increasing values over a minimum of 2ng/ml (PCWG2 PSA eligibility
                       criteria). If patients had been on flutamide, PSA progression is documented
                       4 weeks or more after withdrawal. For patients on bicalutamide or nilutamide
                       disease progression is documented 6 or more weeks after withdrawal.

               -  Patients must agree to continue to continuation of androgen deprivation therapy
                  (ADT) with a gonadotropin-releasing hormone agonist/antagonist or bilateral
                  orchiectomy

          -  For all other cohorts:

               -  Patients must be a surgical candidate for radical prostatectomy based on standard
                  workup of PSA, biopsy results, and if necessary supplemental imaging.

               -  Patients must have chosen radical prostatectomy as their definitive treatment of
                  choice for management of their prostate cancer.

               -  No systemic steroid or steroid eye drop use within 2 weeks prior to initiation of
                  experimental therapy. Limited doses of systemic steroids to prevent IV contrast,
                  allergic reaction or anaphylaxis (in patients who have known contrast allergies)
                  are allowed.

        EXCLUSION CRITERIA:

          -  Prior splenectomy.

          -  The recombinant vaccinia vaccine should not be administered if the following apply to
             either recipients or, for at least 3 weeks after vaccination, their close household
             contacts (Close household contacts are those who share housing or have close physical
             contact):

               -  persons with active or a history of eczema or other eczematoid skin disorders

               -  those with other acute, chronic or exfoliative skin conditions (e.g., atopic
                  dermatitis, burns, impetigo, varicella zoster, severe acne or other open rashes
                  or wounds) until condition resolves

               -  pregnant or nursing women; children under 3 years of age

          -  Patients should have no evidence, as listed below, of being immunocompromised:

               -  HIV positivity due to the potential for decreased tolerance and risk for severe
                  side effects.

               -  Hepatitis B or C positivity.

          -  Concurrent use of systemic steroids or steroid eye drops. This is to avoid
             immunosuppression which may lead to potential complications with vaccinia (priming
             vaccination). Nasal, topical or inhaled steroid use is permitted.

          -  Patients with known allergy to eggs or to compounds with a similar chemical or
             biologic composition to PROSTVAC, ipilimumab or nivolumab.

          -  No prior immune checkpoint inhibitors (e.g., anti-CTLA4, anti-PD-1 or anti-PDL1) are
             allowed.

          -  Other serious intercurrent illness.

          -  Patients with a history of unstable or newly diagnosed angina pectoris, recent
             myocardial infarction (within 6 months of enrollment) or New York Heart Association
             class II IV congestive heart failure.

          -  Patients with significant autoimmune disease that is active or potentially life
             threatening if activated.

          -  Patients with clinically significant cardiomyopathy requiring treatment.

          -  Patients with ongoing toxicities related to prior therapies targeting T cell
             coregulatory proteins (immune checkpoints) such as anti-PD-1, anti-PD-L1, or
             anti-CTLA-4 antibody are excluded

          -  No transfusion of blood or blood products within 2 weeks and no G-CSF or GM-CSF within
             2 weeks prior to initiations of experimental therapy.

          -  Contraindication to biopsy or prostatectomy (for sequential neoadjuvant cohorts only):

               -  Bleeding disorders

               -  Artificial heart valve

               -  PT/PTT greater than or equal to 1.5 in patients not taking anticoagulation.
                  Patients on anticoagulation (e.g. enoxaparin, oral anticoagulants) are eligible
                  regardless of PT/PTT. Prior to biopsy, anticoagulation will be held per standard
                  practice.

          -  For patients with localized prostate cancer contraindication to MRI:

               -  Patients weighing >136 kilograms (weight limit for the scanner tables)

               -  Allergy to MR contrast agent

               -  Patients with pacemakers, cerebral aneurysm clips, shrapnel injury or implantable
                  electronic devices

          -  History of radiation proctitis (for lead-in CRPC cohort only)
      
Maximum Eligible Age:100 Years
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Safety - lead-in mCRPC cohort
Time Frame:After 10 patients
Safety Issue:
Description:

Secondary Outcome Measures

Measure:Determine the change in peripheral PSA-specific T cells in patients treated with PROSTVAC and nivolumab
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Document any intraprostatic Treg cell infiltration with CD4+FOX-P3staining
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Document any PSA changes secondary to vaccination, including rate of biochemical recurrence after prostatectomy
Time Frame:3-5 Years
Safety Issue:
Description:
Measure:Document any MRI changes secondary to treatment
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Evaluate changes in PDL-1 expression
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Document pathologic responses (including pathologic CR)
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Evaluate changes in immune cell subsets in the periphery
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Evaluate changes in soluble immune mediating factors (such as cytokines, etc.) in sera
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Evaluate changes in circulating tumor cells levels (for mCRPCcohort only)
Time Frame:3-5 years
Safety Issue:
Description:
Measure:Safety (for localized prostate cancer cohorts)
Time Frame:3-5 years
Safety Issue:
Description:

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Safety
  • Neoadjuvant
  • Prostatectomy
  • Immunotherapy
  • Vaccine

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