Description:
This is 3-arm, multicenter study that will be conducted through the Pacific Pediatric
Neuro-oncology Consortium (PNOC).
This study will assess the safety and immune activity of a synthetic peptide vaccine specific
for the H3.3.K27M epitope given in combination with poly-ICLC and the H3.3.K27M epitope given
in combination with poly-ICLC and the PD-1 inhibitor, nivolumab, in HLA-A2 (02:01)+ children
with newly diagnosed DIPG or other midline gliomas that are positive for H3.3K27M.
Title
- Brief Title: H3.3K27M Peptide Vaccine With Nivolumab for Children With Newly Diagnosed DIPG and Other Gliomas
- Official Title: H3.3K27M Specific Peptide Vaccine Combined With Poly-ICLC With and Without PD-1 Inhibition Using Nivolumab for the Treatment of Newly Diagnosed HLA-A2 (02:01)+ H3.3K27M Positive Diffuse Intrinsic Pontine Glioma (DIPG) and Newly Diagnosed HLA-A2 (02:01)+ H3.3K27M Positive Gliomas
Clinical Trial IDs
- ORG STUDY ID:
PNOC 007
- SECONDARY ID:
150819
- SECONDARY ID:
NCI-2017-01830
- SECONDARY ID:
CA209-8TX
- NCT ID:
NCT02960230
Conditions
- Diffuse Intrinsic Pontine Glioma
- Glioma
- Diffuse Midline Glioma, H3 K27M-Mutant
Interventions
Drug | Synonyms | Arms |
---|
K27M peptide | | Stratum A: Newly Diagnosed DIPG |
Nivolumab | | Stratum C: Newly Diagnosed DIPG or other Midline Glioma |
Purpose
This is 3-arm, multicenter study that will be conducted through the Pacific Pediatric
Neuro-oncology Consortium (PNOC).
This study will assess the safety and immune activity of a synthetic peptide vaccine specific
for the H3.3.K27M epitope given in combination with poly-ICLC and the H3.3.K27M epitope given
in combination with poly-ICLC and the PD-1 inhibitor, nivolumab, in HLA-A2 (02:01)+ children
with newly diagnosed DIPG or other midline gliomas that are positive for H3.3K27M.
Detailed Description
Subjects who are eligible will receive a specific peptide vaccine, along with a helper drug
called poly-ICLC, in combination with nivolumab, every 3 weeks for the first 6 months of
treatment. Subjects will be monitored routinely by laboratory assessments, physical
evaluation, vital signs, and MRI. Subjects who tolerate therapy well and have stable or
improved disease after 6 months of treatment can continue to receive treatment, nivolumab
continuing every 3 weeks but vaccine and poly-ICLC now every 6 weeks, for a total of 96 weeks
of treatment.
Trial Arms
Name | Type | Description | Interventions |
---|
Stratum A: Newly Diagnosed DIPG | Experimental | Newly diagnosed children with diffuse intrinsic pontine glioma who are positive for HLA-A2 and the H3.3K27M mutation that underwent radiation therapy will receive the specific H3.3K27M peptide vaccine, combined with the tetanus toxoid (TT) peptide, emulsified in Montanide. Poly-ICLC, which is a synthetic nucleic acid, will be given concurrently to improve the therapeutic effects of the vaccine. Vaccine will be given every 3 weeks for the first 24 weeks, then if there is stable or improved disease, will be given every 6 weeks for a total treatment period of 96 weeks. | |
Stratum B: Newly Diagnosed Glioma (non-DIPG) | Experimental | Newly diagnosed children with gliomas other than DIPG who are positive for HLA-A2 and the H3.3K27M mutation that underwent radiation therapy will receive the specific H3.3K27M peptide vaccine, combined with the tetanus toxoid peptide, emulsified in Montanide. Poly-ICLC, which is a synthetic nucleic acid, will be given concurrently to improve the therapeutic effects of the vaccine. Vaccine will be given every 3 weeks for the first 24 weeks, then if there is stable or improved disease, will be given every 6 weeks for a total treatment period of 96 weeks. | |
Stratum C: Newly Diagnosed DIPG or other Midline Glioma | Experimental | Newly diagnosed children with DIPG or other midline gliomas (excluding primary spinal cord tumors) who are positive for HLA-A2 (02:01) and the H3.3K27M mutation that underwent radiation therapy will receive the specific H3.3K27M peptide vaccine, combined with the tetanus toxoid peptide, emulsified in Montanide. Poly-ICLC, which is a synthetic nucleic acid, will be given concurrently to improve the therapeutic effects of the vaccine. Nivolumab will also be given via IV. Vaccine will be given every 3 weeks for the first 24 weeks, then if there is stable or improved disease, will be given every 6 weeks for a total treatment period of 96 weeks. Nivolumab will continue to be given every 3 weeks throughout all of treatment. | |
Eligibility Criteria
Inclusion Criteria:
- Stratum A:
• Newly diagnosed children (3-21 years old) with DIPG who are positive for the
H3.3K27M mutation (positive testing in Clinical Laboratory Improvement Amendments
(CLIA) laboratory) that underwent standard radiation therapy.
- Stratum B:
• Newly diagnosed children (3-21 years old) with diagnosis of glioma other than DIPG
who are positive for the H3.3K27M mutation (positive testing in CLIA laboratory)
including spinal cord gliomas that underwent standard radiation therapy.
- Stratum C:
- Newly diagnosed children 3-21 years of age with diagnosis of DIPG or midline
glioma other than DIPG (excluding primary spinal cord gliomas) who are positive
for the H3.3K27M mutation (positive testing from a CLIA or equivalent laboratory
required), that underwent standard radiation therapy.
The following eligibility criteria apply to strata A, B and C:
- The patient must test positive for HLA-A*02:01 (positive testing from a CLIA or
equivalent laboratory required; only the HLA A*02:01 subtype is eligible; other
subtypes are excluded)
- The patient must be either off systemic steroids or be on stable dose of dexamethasone
or equivalent (max 0.1 mg/kg/day; maximum 4mg/day) at time of enrollment.
- Patients must not have received any prior chemotherapy, immunotherapy or bone marrow
transplant for the treatment of their tumor. Prior use of temozolomide during
radiation at maximum of the standard pediatric dosing (defined as 90 mg/m^2/dose
continuously during radiation therapy for 42 days) or dexamethasone is allowed.
- Patients must have undergone radiation therapy and surgery as part of their standard
of care.
- Stratum A: Radiation therapy must have started within 4 weeks of diagnosis by
imaging or surgery, whichever is later.
- Stratum B: For subjects undergoing surgery for more extensive resection,
radiation therapy should be started within 4-6 weeks from surgery.
- Stratum C: Radiation therapy must have started within 4 weeks of diagnosis by
imaging or surgery, whichever is later. For subjects undergoing surgery for more
extensive resection, radiation therapy should be started within 4-6 weeks from
surgery.
- Karnofsky ≥ 50 for patients ≥ 16 years of age, and Lansky ≥ 50 for patients < 16 years
of age (See Appendix A). Patients who are unable to walk because of paralysis, but who
are up in a wheelchair, will be considered ambulatory for the purpose of assessing the
performance score.
- The patient must have adequate organ function defined as
Adequate Bone Marrow Function Defined as:
- Peripheral absolute neutrophil count (ANC) ≥ 1000/mm3 and
- Platelet count ≥ 100,000/mm3 (transfusion independent, defined as not receiving
platelet transfusions for at least 7 days prior to enrollment).
Adequate Renal Function Defined as:
- Creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 70 mL/min/1.73
m2 or
- A serum creatinine based on age/gender as follows:
Age Maximum Serum Creatinine (mg/dL) Male Female 3 to < 6 years 0.8 0.8 6 to < 10 years 1 1
10 to < 13 years 1.2 1.2 13 to < 16 years 1.5 1.4 The threshold creatinine values in this
table were derived from the Schwartz formula for estimating GFR utilizing child length and
stature data published by the Center for Disease Control (CDC).
Adequate Liver Function Defined as:
- Bilirubin (sum of conjugated + unconjugated) ≤ 1.5 x upper limit of normal (ULN) for
age and
- serum glutamic-pyruvic transaminase (SGPT)/ alanine aminotransferase (ALT) ≤ 110 U/L
and
- Serum albumin ≥ 2 g/dL.
Adequate Pancreatic Function Defined as:
• Serum lipase ≤ ULN at baseline.
Adequate Pulmonary Function Defined as:
• No evidence of dyspnea at rest, no exercise intolerance due to pulmonary insufficiency,
and a pulse oximetry of > 92% while breathing room air.
Adequate Neurologic Function Defined as:
- Patients with seizure disorder may be enrolled if seizure disorder is well controlled.
- The effects of the H3.3K27M vaccine and nivolumab on the developing human fetus are
unknown. For this reason, females of child-bearing potential and males must agree to
use adequate contraception. Adequate methods include: hormonal or barrier method of
birth control; or abstinence prior to study entry and for the duration of study
participation. Should a woman become pregnant or suspect she is pregnant while she or
her partner is participating in this study, she should inform her treating physician
immediately. Males treated or enrolled on this protocol must also agree to use
adequate contraception prior to the study and for the duration of study participation.
- Ability to understand a written informed consent document, and the willingness to sign
it. Assent will be obtained when appropriate based on the subjects age.
Exclusion Criteria:
- Investigational Drugs
- Patients who are currently receiving another investigational drug are not
eligible.
- Prior treatment with another investigational drug.
- Anti-cancer Agents
- Patients who are currently receiving other anti-cancer agents are not eligible.
- Prior treatment with other anti-cancer agents.
- Patients who have received a live / attenuated vaccine within 30 days of first
treatment.
- Patients with evidence of disseminated or leptomeningeal disease.
- Patients with a known disorder that affects their immune system, such as HIV or
Hepatitis B or C, or an auto-immune disorder requiring systemic cytotoxic or
immunosuppressive therapy are not eligible. Note: Patients that are currently using
inhaled, intranasal, ocular, topical or other non-oral or non-IV steroids are not
necessarily excluded from the study but need to be discussed with the study chair.
- Patients with a ≥ Grade 2 hypothyroidism due to history of autoimmunity are not
eligible. (Note: Hypothyroidism due to previous irradiation or thyroidectomy will not
impact eligibility).
- Patients who have received prior solid organ or bone marrow transplantation are not
eligible.
- Patients with uncontrolled infection.
- Female patients of childbearing potential must not be pregnant or breast-feeding.
Female patients of childbearing potential must have a negative serum or urine
pregnancy test prior to the start of therapy (as clinically indicated).
Maximum Eligible Age: | 21 Years |
Minimum Eligible Age: | 3 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of Participants with Adverse Events related to treatment |
Time Frame: | 24 months |
Safety Issue: | |
Description: | Safety of the vaccine (Strata A and B) or vaccine in combination with nivolumab (Stratum C) will be assessed by monitoring for adverse events (AEs), scheduled laboratory assessments, vital signs, & physical examinations for subjects who receive the vaccination. The severity of toxicities will be graded according to the NCI CTCAE v5.0. AEs & clinically significant lab abnormalities (meeting Grade 3, 4, or 5 criteria according to CTCAE) will be summarized by maximum intensity & relationship to study drug(s). Grade 1 & 2 AEs will be summarized if related to study therapy. Descriptive statistics will be utilized to display the data on toxicity seen. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Sabine Mueller, MD, PhD |
Trial Keywords
- peptide vaccine
- immunotherapy
- DIPG
- vaccine
- nivolumab
Last Updated
August 25, 2021