Description:
The purpose of this study is to test an approach of stimulating the body's immune system to
attack prostate cancer. This study will test injection of a substance polylysine and
carboxymethylcellulose (Poly-ICLC, Hiltonol®)through a needle guided by MRI (magnetic
resonance imaging) ultrasound fusion technology into the prostate gland. Poly ICLC has been
used to help the body in its fight against cancer. The first aim of the study is to determine
the highest dose of a substance Poly-ICLC (Hiltonol®) that can be safely tolerated by the
study participants. The second aim of the study is to find out the toxicity or side effects
of poly-ICLC.
Title
- Brief Title: Neoadjuvant Hiltonol® (PolyICLC) for Prostate Cancer
- Official Title: Phase I Study of In Situ Autologous Vaccination Against Prostate Cancer With Intratumoral and Systemic Hiltonol® (Poly-ICLC) Prior To Radical Prostatectomy
Clinical Trial IDs
- ORG STUDY ID:
GCO 15-2081
- NCT ID:
NCT03262103
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Intratumoral (IT) Poly ICLC 0.5 mg | | Cohort 1 |
Intratumoral (IT) Poly ICLC 1.0 mg | Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose | Cohort 3 |
Intramuscular (IM) Poly ICLC | Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose | Cohort 1 |
Purpose
The purpose of this study is to test an approach of stimulating the body's immune system to
attack prostate cancer. This study will test injection of a substance polylysine and
carboxymethylcellulose (Poly-ICLC, Hiltonol®)through a needle guided by MRI (magnetic
resonance imaging) ultrasound fusion technology into the prostate gland. Poly ICLC has been
used to help the body in its fight against cancer. The first aim of the study is to determine
the highest dose of a substance Poly-ICLC (Hiltonol®) that can be safely tolerated by the
study participants. The second aim of the study is to find out the toxicity or side effects
of poly-ICLC.
Detailed Description
This is a pilot dose escalation study of IT/IM Poly-ICLC in patients with high risk
clinically localized prostate cancer. The dose and frequency of IT injections will be
increased in successive cohorts to define a safe dose and schedule for further testing.
Intratumoral + intramuscular poly-ICLC in patients with clinical localized prostate cancer.
In the current pilot clinical trial, poly-ICLC will be administered intratumorally (Artemis
guided) and intramuscularly (e.g., deltoid muscle) prior to prostatectomy in patients with
clinically localized prostate cancer. Based on the available preclinical data exploring
intratumoral administration of PAMPs described above, we expect this approach will result in
three immunomodulatory steps26:
Immunomodulatory Step 1: Innate immune local tumor killing induced by intratumoral poly-ICLC
- the initial intratumoral injections are expected to induce activation/recruitment of IL-12,
TNF-α, and other cytokines and NK cells, resulting in early tumor killing and antigen
release.9-11 Poly-ICLC may also have a direct antiproliferative effect on tumor cells
mediated by interferon-inducible nuclear enzyme systems.
Immunomodulatory Step 2: Th1 and cytotoxic T lymphocyte priming as a result of the repeated
in-situ poly-ICLC 'danger signal' combined with the tumor antigens released in step 1 and
further processed and cross-presented by poly-ICLC-activated myeloid dendritic cells.7,8
Poly-ICLC is expected to recruit myeloid dendritic cells and macrophages to the tumor site
where they can load with antigens being released through the innate mechanisms, present them
Th1 cells, and cross-present them to CD8 T cells in the tumor or in the regional lymph nodes,
thus generating antigen specific cytotoxic T lymphocytes.
Immunomodulatory Step 3 (or "Boost" phase): Maintenance of the systemic anti-tumor immune
response and migration of cytotoxic T lymphocytes to remote metastases, through repeated
intramuscular poly-ICLC induction of chemokines, other costimulatory factors, and
inflammasome activation.23-25 The rationale for followup with intramuscular maintenance is
that as part of the comprehensive response, dsRNAs such as poly-ICLC induce various
chemokines and costimulatory factors that help target the response to tumor. For example, one
of these costimulatory factors is OX40, which belongs to the tumor necrosis factor family of
cytokines, and helps maintain cytotoxic lymphocyte longevity and action at the tumor and
metastatic sites.
Trial Arms
Name | Type | Description | Interventions |
---|
Cohort 1 | Experimental | Intratumoral (IT) Poly ICLC 0.5 mg IT once/week (week 1) Intramuscular (IM) Poly ICLC 1 mg IM twice weekly (weeks 3-6) Followed by Radical Prostatectomy at Week 10 | - Intratumoral (IT) Poly ICLC 0.5 mg
- Intramuscular (IM) Poly ICLC
|
Cohort 2 | Experimental | Intratumoral (IT) Poly ICLC 0.5 mg IT once/week (week 1+2) Intramuscular (IM) Poly ICLC 1 mg IM twice weekly (weeks 3-6) Followed by Radical Prostatectomy at Week 10 | - Intratumoral (IT) Poly ICLC 0.5 mg
- Intramuscular (IM) Poly ICLC
|
Cohort 3 | Experimental | Intratumoral (IT) Poly ICLC 1.0 mg IT once/week (week 1) Intramuscular (IM) Poly ICLC 1 mg IM twice weekly (weeks 3-6) Followed by Radical Prostatectomy at Week 10 | - Intratumoral (IT) Poly ICLC 1.0 mg
- Intramuscular (IM) Poly ICLC
|
Cohort 4 | Experimental | Intratumoral (IT) Poly ICLC 1.0 mg IT once/week (week 1+2) Intramuscular (IM) Poly ICLC 1 mg IM twice weekly (weeks 3-6) Followed by Radical Prostatectomy at Week 10 | - Intratumoral (IT) Poly ICLC 1.0 mg
- Intramuscular (IM) Poly ICLC
|
Eligibility Criteria
Inclusion Criteria:
1. Written informed consent and HIPAA authorization for release of personal health
information.
2. Age > 18 years at the time of consent.
3. ECOG Performance Status of 0-1 within 14 days prior to being registered for protocol
therapy (Study Procedure Manual).
4. Histologically confirmed adenocarcinoma of the prostate (with previous diagnostic
tissue available for tumor marker analysis).
5. Gleason 7 - 10, cT2a - cT3b adenocarcinoma of the prostate with plans for radical
prostatectomy
6. PSA ≥ 4 ng/ml
7. Tumor visible on multiparametric MRI
8. Tolerated previous transrectal ultrasound guided biopsy procedure under local
anesthetic
a. Uncomplicated previous TRUS biopsy procedure (i.e., no prior hospitalization due to
sepsis, prostatic abscess or severe hemorrhage following TRUS prostate biopsy)
9. Willing to undergo the intra-tumoral (IT) injection of the Poly-ICLC into the
prostatic tumor as per the protocol
10. No prior hormonal therapy with the exception of oral 5-alpha-reductase inhibitors
(finasteride, dutasteride, etc.). Patients who have received prior oral anti-androgen
therapies (bicalutamide, flutamide, nilutamide, etc.) must be off treatment for at
least 6 weeks prior to enrollment. Patients who have received prior LHRH agonist or
antagonist therapy (leuprolide, goserelin acetate, etc.) are eligible provided serum
testosterone is > 50 mg/dl.
11. No prior radiation therapy (external beam or brachytherapy) to the pelvis or prostate.
12. No clinically significant infections as judged by the treating investigator.
13. No characteristics suggesting a potential higher risk of infection with intraprostatic
injections:
1. Recurrent urinary tract infections or history of prostatitis within 3 months
prior to enrollment into the study.
2. Urine analysis positive for nitrites and leucocyte esterase. Such patients could
be considered for the study after treatment and resolution of the infection.
3. Active proctitis
4. History of prostatic abscess
5. Taking immunosuppressive medication including systemic corticosteroids
6. Active hematologic malignancy
14. No uncontrolled angina, congestive heart failure or MI within 6 months.
15. Patients with history of HIV (if CD4+ T cell counts are ≥350 cells/µL on established
ART therapy), Hepatitis B (with viral load below limits of quantification) or
Hepatitis C (who have completed a curative therapy and have a viral load below the
limit of quantification) are eligible for this study.
16. No treatment with any investigational agent for any medical condition within 28 days
prior to being registered for protocol therapy.
17. Adequate end organ function as determined by the following laboratory values:
- White blood cell count (WBC) > 2.5 k/mm3
- Absolute neutrophil count (ANC) > 1.5 k/mm3
- Hemoglobin (Hgb) > 8.0 g/dL
- Platelets > 100 k/mm3
- Calculated creatinine clearance of > 60 cc/min using the Cockcroft-Gault formula:
Males: (140 - Age in years) × Actual Body Weight in kg 72 × Serum Creatinine (mg/dL)
- Bilirubin < 2.0 x ULN
- Aspartate aminotransferase (AST) < 2.5 x ULN
- Alanine aminotransferase (ALT) < 2.5 x ULN
18. Able to speak, read and write in English.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | Male |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose-Limiting Toxicity level |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | 3+3 dose escalation rules to define a safe dose of preoperative intratumoral (IT) plus intramuscular (IM) Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC, Hiltonol®) prior to radical prostatectomy |
Secondary Outcome Measures
Measure: | Number of adverse events |
Time Frame: | Week 6 |
Safety Issue: | |
Description: | Safety as determined by the frequency of adverse events as per the Common Terminology for Adverse Events (CTCAE) version 4.0. |
Measure: | Time to PSA progression |
Time Frame: | up to Week 12 |
Safety Issue: | |
Description: | The time to prostate-specific antigen (PSA) progression will be defined as the time to PSA > 0.2 ng/mL |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Ashutosh Kumar Tewari |
Trial Keywords
- Prostate Cancer
- Gleason 7-10
- Immunotherapy
- Neoadjuvant
Last Updated
April 1, 2021