Description:
This phase I trial studies the side effects and best dose of autologous dendritic
cell-adenovirus CCL21 vaccine (CCL21-gene modified dendritic cell vaccine) combined with
intravenous pembrolizumab, and to see how well they work in treating patients with stage IV
non-small cell lung cancer. Vaccines made from a gene-modified virus may help the body build
an effective immune response to kill tumor cells. Monoclonal antibodies, such as
pembrolizumab, may interfere with the ability of tumor cells to grow and spread. Giving
CCL21-gene modified dendritic cell vaccine with pembrolizumab may work better in treating
patients with stage IV non-small cell lung cancer.
Title
- Brief Title: CCL21-Gene Modified Dendritic Cell Vaccine and Pembrolizumab in Treating Patients With Stage IV Non-small Cell Lung Cancer
- Official Title: A Phase I Trial of Intratumoral Administration of CCL21-Gene Modified Dendritic Cell (Ad-CCL21-DC) Combined With Intravenous Pembrolizumab for Advanced NSCLC
Clinical Trial IDs
- ORG STUDY ID:
17-000174
- SECONDARY ID:
NCI-2018-01244
- SECONDARY ID:
HEMONC CIRM IST Lung
- SECONDARY ID:
K08CA245249
- NCT ID:
NCT03546361
Conditions
- Lung Non-Small Cell Carcinoma
- Stage IV Lung Cancer AJCC v8
- Stage IVA Lung Cancer AJCC v8
- Stage IVB Lung Cancer AJCC v8
Interventions
Drug | Synonyms | Arms |
---|
Autologous Dendritic Cell-Adenovirus CCL21 Vaccine | | Treatment (Ad-CCL21-DC vaccine, pembrolizumab) |
Pembrolizumab | Keytruda, Lambrolizumab, MK-3475, SCH 900475 | Treatment (Ad-CCL21-DC vaccine, pembrolizumab) |
Purpose
This phase I trial studies the side effects and best dose of autologous dendritic
cell-adenovirus CCL21 vaccine (CCL21-gene modified dendritic cell vaccine) combined with
intravenous pembrolizumab, and to see how well they work in treating patients with stage IV
non-small cell lung cancer. Vaccines made from a gene-modified virus may help the body build
an effective immune response to kill tumor cells. Monoclonal antibodies, such as
pembrolizumab, may interfere with the ability of tumor cells to grow and spread. Giving
CCL21-gene modified dendritic cell vaccine with pembrolizumab may work better in treating
patients with stage IV non-small cell lung cancer.
Detailed Description
PRIMARY OBJECTIVES:
I. Dose escalation: To determine the safety and maximum tolerated dose (MTD) of intratumoral
injection of autologous dendritic cell-adenovirus CCL21 vaccine (CCL21 gene-modified DC
[Ad-CCL21-DC]) when combined with intravenous pembrolizumab in 1) patients with advanced
non-small cell lung cancer (NSCLC) without a sensitizing epidermal growth factor receptor
(EGFR) mutation and/or anaplastic lymphoma kinase (ALK) gene rearrangement who have received
prior systemic anti-cancer therapy for advanced disease that includes a PD -1 and/or PD-L1
inhibitor or 2) patients who have sensitizing EGFR mutations and/or ALK gene rearrangements
and have received prior tyrosine kinase inhibitor therapy.
II. Dose expansion: To evaluate the objective response rate (ORR) in subjects treated with
the dose established during dose escalation (ExD) of intratumoral injection of Ad-CCL21-DC
when administered with intravenous pembrolizumab in 1) patients with advanced non-small cell
lung cancer (NSCLC) without a sensitizing epidermal growth factor receptor (EGFR) mutation
and/or anaplastic lymphoma kinase (ALK) gene rearrangement who have received prior systemic
anti-cancer therapy for advanced disease that includes a PD -1 and/or PD-L1 inhibitor or 2)
patients who have sensitizing EGFR mutations and/or ALK gene rearrangements and have received
prior tyrosine kinase inhibitor therapy.
SECONDARY OBJECTIVES:
I. To define the adverse event (AE) profile of intratumoral injection of Ad-CCL21-DC
(determined during dose escalation) when administered with intravenous pembrolizumab in 1)
patients with advanced non-small cell lung cancer (NSCLC) without a sensitizing epidermal
growth factor receptor (EGFR) mutation and/or anaplastic lymphoma kinase (ALK) gene
rearrangement who have received prior systemic anti-cancer therapy for advanced disease that
includes a PD -1 and/or PD-L1 inhibitor or 2) patients who have sensitizing EGFR mutations
and/or ALK gene rearrangements and have received prior tyrosine kinase inhibitor therapy.
II. To determine drug target activity by analyzing serial pre- and post-treatment biopsies
and blood specimens of intratumoral injection of Ad-CCL21-DC (determined during dose
escalation) when administered with intravenous pembrolizumab in 1) patients with advanced
non-small cell lung cancer (NSCLC) without a sensitizing epidermal growth factor receptor
(EGFR) mutation and/or anaplastic lymphoma kinase (ALK) gene rearrangement who have received
prior systemic anti-cancer therapy for advanced disease that includes a PD -1 and/or PD-L1
inhibitor or 2) patients who have sensitizing EGFR mutations and/or ALK gene rearrangements
and have received prior tyrosine kinase inhibitor therapy.
OUTLINE: This is a dose-escalation study of autologous dendritic cell-adenovirus CCL21
vaccine.
Patients receive pembrolizumab intravenously (IV) over 30 minutes followed by autologous
dendritic cell-adenovirus CCL21 vaccine by computed tomography (CT)-guided or bronchoscopic
intratumoral (IT) injection on days 0, 21, and 42. Patients then receive pembrolizumab every
3 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at day 63 and every 3 months
thereafter.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (Ad-CCL21-DC vaccine, pembrolizumab) | Experimental | Patients receive pembrolizumab IV over 30 minutes followed by autologous dendritic cell-adenovirus CCL21 vaccine by CT-guided or bronchoscopic IT injection on days 0, 21, and 42. Patients then receive pembrolizumab every 3 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity. | - Autologous Dendritic Cell-Adenovirus CCL21 Vaccine
- Pembrolizumab
|
Eligibility Criteria
Inclusion Criteria:
- Participants with histologically confirmed diagnosis of NSCLC will be enrolled in this
study.
- Stage IV pathologically proven NSCLC.
- The participant (or legally acceptable representative if applicable) provides written
informed consent for the trial.
- Must have received prior systemic anti-cancer therapy for advanced disease that
includes either:
- A PD-1 and/or PD-L1 inhibitor in patients without a sensitizing EGFR mutation
and/or ALK gene rearrangement or.
- Have received prior tyrosine kinase inhibitor therapy in patients with a
sensitizing EGFR mutation and/or ALK gene rearrangement. For patients with
sensitizing EGFR mutations, prior therapy must include osimertinib if a T790M
mutation in the EGFR gene has been documented, and for patients with ALK gene
rearrangements, prior therapy must include a second generation ALK inhibitor
(e.g. alectinib, brigatinib, ceritinib). Note: For this group, prior cytotoxic
chemotherapy is permitted, but prior therapy with a PD-1 or PD-L1 inhibitor is
not permitted.
- Measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version
(v)1.1.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1.
- Absolute neutrophil count (ANC) >= 1500/uL.
- Platelets >= 100,000/uL.
- Hemoglobin >= 9.0 g/dL or >= 5.6 mmol/L.
- Criteria must be met without erythropoietin dependency and without packed red
blood cell (pRBC) transfusion within last 2 weeks.
- Creatinine =< 1.5 x upper limit of normal (ULN) OR measured or calculated creatinine
clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or
creatinine clearance [CrCl]) >= 30mL/min for participant with creatinine levels >1.5 x
institutional ULN.
- Creatinine clearance (CrCl) should be calculated per institutional standard.
- Total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for participants with total
bilirubin levels > 1.5 x ULN.
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and
alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x
ULN (=< 5 x ULN for participants with liver metastases).
- International normalized ratio (INR) OR prothrombin time (PT) =< 1.5 x ULN unless
participant is receiving anticoagulant therapy as long as PT or activated partial
prothrombin time (aPTT) is within therapeutic range of intended use of anticoagulants.
- Activated partial thromboplastin time (aPTT) =< 1.5 x ULN unless participant is
receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of
intended use of anticoagulants.
- A lesion that either:
- Is intended to be accessed bronchoscopically OR.
- Is intended to be accessed with computed tomography (CT) guided transthoracic
injection and in the estimation of the radiologist performing the procedure will
not require transversing a bullae that significantly increases the risk of
pneumothorax.
- Male participants:
- A male participant must agree to use a contraception of this protocol during the
treatment period and for at least 4 months after the last dose of study treatment
and refrain from donating sperm during this period.
- Female participants:
- A female participant is eligible to participate if she is not pregnant, not
breastfeeding, and at least one of the following conditions applies:
- Not a woman of childbearing potential (WOCBP). OR
- A WOCBP who agrees to follow the contraceptive guidance during the treatment
period and for at least 4 months after the last dose of study treatment.
Exclusion Criteria:
- Comorbid disease or a medical or psychiatric condition that would impair the ability
of the patient to receive or comply with the study protocol.
- Any use of systemic corticosteroids within 10 days of treatment initiation.
- Respiratory failure (defined as oxygen saturation [SaO2] < 90% on room air; partial
pressure of carbon dioxide [PCO2] > 45 mmHg; or forced expiratory volume in one second
[FEV1] <1.0 liter).
- Acute viral, bacterial, or fungal infection, which requires specific therapy. Acute
therapy must have been completed at least 7 days prior to study treatment.
- Human immunodeficiency virus (HIV) infected patients (defined as HIV-1/HIV-2 antibody
positive).
- Patients with active hepatitis B or C. Active hepatitis B is defined as a known
positive hepatitis B virus surface antigen (HBsAg) result. Active hepatitis C is
defined by a known positive hepatitis (hep) C antibody (Ab) result and known
quantitative hepatitis C virus (HCV) ribonucleic acid (RNA) results greater than the
lower limits of detection of the assay.
- Hypersensitivity to any reagents used in the study.
- Pregnancy or inadequate contraception.
- Lactating females.
- Clinically active brain metastases, defined as untreated and symptomatic, or requiring
therapy with steroids or anticonvulsants to control associated symptoms. In patients
with brain metastases that have been treated with radiation therapy, treatment must
end at least 14 days prior to starting study treatment. History of leptomeningeal
disease is exclusionary regardless of prior therapy.
- Subjects with organ allografts.
- Previous or concurrent evidence of autoimmune disease requiring systemic steroids or
immunosuppressive agents. Subjects with vitiligo or resolved childhood asthma/atopy
would be an exception to this rule. Subjects that require inhaled steroid or local
steroid injections will not be excluded from the study. Subjects with hypothyroidism
who are managed by hormone replacement will not be excluded from the study.
- Patients with a history or current evidence of any condition, therapy, or laboratory
abnormality that might confound the results of the trial, interfere with the subject's
participation for the full duration of the trial, or is not in the best interest of
the subject to participate, in the opinion of the treating investigator.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Maximum tolerated dose (MTD)/maximum administered dose (MAD) (dose escalation) |
Time Frame: | At 28 days |
Safety Issue: | |
Description: | Demographic characteristics of patients including age, gender ethnicity, performance status, prior therapies and other baseline characteristics as collected on the case report form will be summarized by Ad-CCL21-DC dose cohort using descriptive statistics. For continuous variables, descriptive statistics (n, mean, standard deviation, standard error, median, minimum, and maximum) will be provided. For categorical variables, patient counts and percentages will be provided. Categories for missing data will be presented if necessary. The ORR will be summarized using descriptive statistics by dose level. The ORR will be analyzed using one-sample exact Binomial test for the patients treated at MTD or MAD in both the dose escalation phase and dose expansion phase. The 95% exact confidence interval (CI) will be provided. |
Secondary Outcome Measures
Measure: | Incidence of adverse events per Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0 |
Time Frame: | Up to 1 year |
Safety Issue: | |
Description: | |
Measure: | Biomarker assessment |
Time Frame: | Up to 1 year |
Safety Issue: | |
Description: | Immunohistochemistry (IHC) will be conducted to assess biomarkers including PD-1, PD-L1, CD8, and CD4 (DC) expression. All immunologic parameters will be summarized using mean, standard deviation, median, percentile for continuous variables, and frequency and percentage for categorical variables. The summary statistics will be tabulated by time and dose level. Several plots, such as stem-and-leaf plot and normal probability plot, will be constructed to check the distribution of each variable. Transformation will be applied if the distribution of the variable is not normal. For the tumor tissue immune parameters measured at different time points, the post- treatment values will be compared with the pre-treatment values using either paired t-test or Wilcoxon signed-rank test. Box plots for pre-treatment and post-treatment data will be presented. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Jonsson Comprehensive Cancer Center |
Last Updated
July 8, 2021