Description:
Background:
Exomes are the parts of deoxyribonucleic acid (DNA) that make proteins. Researchers are
finding a way to read the letters in the exome. Incorrect letters are called mutations.
Tumors contain specific mutations. Researchers can find these mutations in tumors to make
treatments. Researchers want to use pieces of participants tumors to find the tumor-specific
mutations. They also will take participants white blood cells to make a vaccine that they
hope will shrink the tumors.
Objectives:
To see if dendritic vaccine tumor-fighting cells are safe and can cause certain cancer tumors
to shrink.
Eligibility:
Adults ages 18-70 who have metastatic melanoma or metastatic epithelial cancer
Design:
The first part of this study was done under protocol 03-C-0277. In that study, white blood
cells and pieces of participants' tumors were taken to make a vaccine.
In this study, participants will get a vaccine every 2 weeks for 8 weeks. It will be given
both in a vein and under the skin. At each visit, participants will have a physical exam and
have blood taken. They will talk about any side effects they have.
After treatment ends, participants will have many follow-up visits for the first year, then
once each year after that. Visits will last up to 2 days each. They will include lab tests,
imaging studies, and a physical exam. Blood will be taken at each visit. At the first
follow-up visit, participants may have leukapheresis, which they also had as part of protocol
03-C-0277. Participants may not have to return to the Clinical Center for these visits.
Title
- Brief Title: Ability of a Dendritic Cell Vaccine to Immunize Melanoma or Epithelial Cancer Patients Against Defined Mutated Neoantigens Expressed by the Autologous Cancer
- Official Title: A Phase II Trial to Evaluate the Ability of a Dendritic Cell Vaccine to Immunize Melanoma or Epithelial Cancer Patients Against Defined Mutated Neoantigens Expressed by the Autologous Cancer
Clinical Trial IDs
- ORG STUDY ID:
170177
- SECONDARY ID:
17-C-0177
- NCT ID:
NCT03300843
Conditions
- Melanoma
- Gastrointestinal Cancer
- Breast Cancer
- Ovarian Cancer
- Pancreatic Cancer
Interventions
Drug | Synonyms | Arms |
---|
Peptide loaded dendritic cell vaccine | | Peptide loaded dendritic cell vaccine |
Purpose
Background:
Exomes are the parts of deoxyribonucleic acid (DNA) that make proteins. Researchers are
finding a way to read the letters in the exome. Incorrect letters are called mutations.
Tumors contain specific mutations. Researchers can find these mutations in tumors to make
treatments. Researchers want to use pieces of participants tumors to find the tumor-specific
mutations. They also will take participants white blood cells to make a vaccine that they
hope will shrink the tumors.
Objectives:
To see if dendritic vaccine tumor-fighting cells are safe and can cause certain cancer tumors
to shrink.
Eligibility:
Adults ages 18-70 who have metastatic melanoma or metastatic epithelial cancer
Design:
The first part of this study was done under protocol 03-C-0277. In that study, white blood
cells and pieces of participants' tumors were taken to make a vaccine.
In this study, participants will get a vaccine every 2 weeks for 8 weeks. It will be given
both in a vein and under the skin. At each visit, participants will have a physical exam and
have blood taken. They will talk about any side effects they have.
After treatment ends, participants will have many follow-up visits for the first year, then
once each year after that. Visits will last up to 2 days each. They will include lab tests,
imaging studies, and a physical exam. Blood will be taken at each visit. At the first
follow-up visit, participants may have leukapheresis, which they also had as part of protocol
03-C-0277. Participants may not have to return to the Clinical Center for these visits.
Detailed Description
Background:
- Therapeutic vaccination against cancer has proven very challenging with little clinical
benefit.
- Vaccines against non-viral tumors have mainly targeted differentiation antigens, cancer
testis antigens, and overexpressed antigens. However negative selection in the thymus
against these normal nonmutated antigens severely limits the ability to generate high
avidity anti-cancer T cells. Such depletion can impair their antitumor activity and
limit tumor elimination.
- The National Cancer Institute Surgery Branch (NCI SB) has developed a pipeline for the
identification of immunogenic T cell epitopes derived from neoantigens.
- In recent studies, we identified the neoantigens recognized by tumor infiltrating
lymphocytes (TIL) that mediated regression in patients with metastatic cancer. Using
whole exome sequencing of a resected metastatic nodule followed by high throughput
immunologic screening, we were able to demonstrate that tumor regressions were
associated with the recognition by the administered TIL of unique somatic mutations that
occurred in the cancer.
- We, therefore, aim to use this pipeline to identify immunogenic neoantigens from
epithelial cancer patients and to use these defined epitopes for a personalized
therapeutic dendritic cell (DC) vaccine.
Objectives:
-Primary objectives:
--To determine the clinical response rate in patients with metastatic melanoma or epithelial
cancer who receive this DC vaccine
Eligibility:
- Age greater than or equal to 18 and less than or equal to 70 years
- Eastern Cooperative Oncology Group (ECOG) 0 - 2
- Evaluable metastatic melanoma or epithelial cancer refractory to standard treatment
- Metastatic melanoma or epithelial cancer lesion(s) that is resectable for TIL or in
selected cases, available peripheral blood mononuclear cells (PBMC).
Design:
- Patients with metastatic melanoma or epithelial cancer will undergo surgical resection
of tumor followed by exome and ribonucleic acid (RNA) sequencing to identify expressed
mutations (CONDUCTED UNDER THE National Cancer Institute Surgery Branch (NCI SB)
COMPANION PROTOCOL 03-c-0277).
- Patients will undergo apheresis and DC will be cryopreserved for vaccine preparation.
- Immunogenic neoantigens will be identified from TIL and PBMC by high throughput
immunologic screening using long peptides and tandem minigenes covering all mutated
epitopes.
- Patient will be vaccinated with autologous mature dendritic cells loaded with long
peptides and minimal epitopes from defined neoantigens or highly expressed mutations in
tumor suppressor or driver genes.
- DC will be administered intravenously and subcutaneously for four cycles at biweekly
intervals.
- Blood samples will be taken every two weeks, and patients will be monitored for the
quantity and quality of circulating neoantigen-specific T cells.
Trial Arms
Name | Type | Description | Interventions |
---|
Peptide loaded dendritic cell vaccine | Experimental | Peptide loaded dendritic cell vaccine on days 0, 14, 28, and 42 | - Peptide loaded dendritic cell vaccine
|
Eligibility Criteria
- INCLUSION CRITERIA:
- Metastatic melanoma or epithelial cancer with at least one lesion that is resectable
or in selected cases, available peripheral blood mononuclear cells (PBMCs)
- Measurable and evaluable metastatic disease per Response Evaluation Criteria in Solid
Tumors (RECIST) 1.1 criteria
- Confirmation of the diagnosis of metastatic cancer by the Laboratory of Pathology of
National Cancer Institute (NCI).
- All patients must be refractory to approved standard systemic therapy.
- Patients with 3 or fewer brain metastases that are less than 1 cm in diameter and
asymptomatic are eligible. Lesions that have been treated with stereotactic
radiosurgery must be clinically stable for one month after treatment for the patient
to be eligible. Patients with surgically resected brain metastases are eligible.
- Greater than or equal to 18 years of age and less than or equal to 70 years of age.
- Clinical performance status of Eastern Cooperative Oncology Group (ECOG) 0, 1, 2
- Patients of both genders must be willing to practice birth control from the time of
enrollment on this study and for up to four months after treatment.
- Serology:
- Seronegative for Human Immunodeficiency Virus (HIV) antibody. (The experimental
treatment being evaluated in this protocol depends on an intact immune system.
Patients who are HIV seropositive can have decreased immune-competence and thus
are less responsive to the experimental treatment and more susceptible to its
toxicities.)
- Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody.
If hepatitis C antibody test is positive, then the patient must be tested for the
presence of antigen by reverse transcriptase polymerase chain reaction (RT-PCR)
and be hepatitis C virus ribonucleic acid (HCV RNA) negative.
- Hematology
- Absolute neutrophil count greater than 1000/mm^3 without the support of
filgrastim
- White blood cell (WBC) greater than or equal to 3000/mm^3
- Platelet count greater than or equal to 100,000/mm^3
- Hemoglobin > 8.0 g/dl. Subjects may be transfused to reach this cut-off.
- Cluster of differentiation 4 (CD4) count > 200/uL
- Chemistry:
- Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) less than
5.0 x ULN
- Serum Creatinine less than or equal to 1.6 mg/dl
- Total bilirubin less than or equal to 2.0 mg/dl, except in patients with
Gilbert's Syndrome, who must have a total bilirubin less than or equal to 3.0
mg/dl.
- More than four weeks must have elapsed since any prior systemic therapy at the time
the patient receives the vaccine, and patients toxicities must have recovered to a
grade 1 or less (except for toxicities such as alopecia or vitiligo).
Note: Patients may have undergone minor surgical procedures within the past 3 weeks, as
long as all toxicities have recovered to grade 1 or less.
- Ability of subject to understand and the willingness to sign a written informed
consent document.
- Subjects must be co-enrolled On protocol 03-C-0277.
EXCLUSION CRITERIA:
- Women of child-bearing potential who are pregnant or breastfeeding because of the
potentially dangerous effects of the treatment on the fetus or infant.
- Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency
Disease).
- Concurrent opportunistic infections (The experimental treatment being evaluated in
this protocol depends on an intact immune system. Patients who have decreased immune
competence may be less responsive to the experimental treatment and more susceptible
to its toxicities).
- Active systemic infections (requiring anti-infective treatment), coagulation disorders
or any other active or uncompensated major medical illnesses.
- Patients who are receiving any other investigational agents.
Maximum Eligible Age: | 70 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Percentage of Patients Who Had a Clinical Response (Complete Response (CR) + Partial Response (PR)) to Treatment |
Time Frame: | up to 6 months |
Safety Issue: | |
Description: | Response was assessed by the RECIST v1.1. Complete Response is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm. Partial Response is at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters. |
Secondary Outcome Measures
Measure: | Number of Participants With 2-3 Fold Increase From Baseline in Reactivity to Circulating Antigen-specific T Cells to the Mutated Peptide Compared to the Non-mutated Peptide |
Time Frame: | Day 0, Day 14 (± 5 d), Day 28 (± 5 d), and Day 42 (± 5 d) |
Safety Issue: | |
Description: | Enzyme-linked immunosorbent assay (ELISA) and enzyme-linked immune absorbent spot (ELISpot) assays assessed reactivity to the mutated peptide compared to the non-mutated peptide. Differences of 2-3 fold in these assays over the baseline measurement are indicative of true biologic differences. |
Measure: | Number of Participants With Serious and Non-serious Adverse Events |
Time Frame: | Date treatment consent signed to date off study, approximately 6 months and 11 days |
Safety Issue: | |
Description: | Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v5.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | National Cancer Institute (NCI) |
Trial Keywords
- Cell Therapy
- Immunotherapy
- Vaccines
Last Updated
December 13, 2019