Clinical Trials /

Th-1 Dendritic Cell Immunotherapy Plus Standard Chemotherapy for Pancreatic Adenocarcinoma

NCT04157127

Description:

This is a phase 1, first in man, dose escalation study for safety and feasibility for administration of 3 doses of DC vaccine for pancreatic adenocarcinoma.

Related Conditions:
  • Pancreatic Adenocarcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Th-1 Dendritic Cell Immunotherapy Plus Standard Chemotherapy for Pancreatic Adenocarcinoma
  • Official Title: Phase I Study of Th-1 Dendritic Cell Immunotherapy in Combination With Standard Chemotherapy for the Adjuvant Treatment of Pancreatic Adenocarcinoma (DECIST)

Clinical Trial IDs

  • ORG STUDY ID: H-42434
  • NCT ID: NCT04157127

Conditions

  • Pancreatic Adenocarcinoma
  • Pancreatic Cancer

Interventions

DrugSynonymsArms
Autologous DC vaccineAutologous DC Vaccine Cohort 1

Purpose

This is a phase 1, first in man, dose escalation study for safety and feasibility for administration of 3 doses of DC vaccine for pancreatic adenocarcinoma.

Detailed Description

      The primary objective of this phase 1, first in man trial is to determine the safety,
      toxicity, and feasibility of delivering autologous dendritic cells (DCs) loaded with
      pancreatic adenocarcinoma lysate plus mRNA to pancreatic cancer patients as adjuvant therapy
      following completion of standard chemotherapy.

      Patients will first complete standard treatment for pancreatic adenocarcinoma which is
      surgically resectable or potentially resectable and then within 3 months of finishing
      standard treatment, they will have three doses of the dendritic cell vaccine by perinodal
      injection using ultrasound (US) or computed-tomography (CT) guidance.
    

Trial Arms

NameTypeDescriptionInterventions
Autologous DC Vaccine Cohort 1ExperimentalVaccine made from autologous dendritic cells loaded with tumor cell lysate and RNA. Subject will get 3 doses of DC vaccine (one every 14 days) and be monitored (vital signs every 30 minutes) for 2 hours after each dose. During treatment, subjects get weekly peg-interferon a-2b at 1.5 mcg/kg on the first day of vaccination up through 14 days after last vaccination. DC Vaccine dose evaluated in Cohort 1: st vaccine - 0.5 million cells nd vaccine - 1 million cells rd vaccine - 2 million cells At each dose level, the 1st subject should get all 3 vaccinations before the 2nd and 3rd subjects at that level receive their 1st vaccination. The 3rd subject can begin vaccination regardless of the time since the 2nd subject began vaccinations. All 3 subjects in cohort should get all 3 vaccinations before any subjects are treated in the next higher cohort. Because of this, the study may not progress to every dose level before MTD is found.
  • Autologous DC vaccine
Autologous DC Vaccine Cohort 2ExperimentalVaccine made from autologous dendritic cells loaded with tumor cell lysate and RNA. Subject will get 3 doses of DC vaccine (one every 14 days) and be monitored (vital signs every 30 minutes) for 2 hours after each dose. During treatment, subjects get weekly peg-interferon a-2b at 1.5 mcg/kg on the first day of vaccination up through 14 days after last vaccination. DC Vaccine dose evaluated in Cohort 2: st vaccine - 1 million cells nd vaccine - 2 million cells rd vaccine - 4 million cells At each dose level, the 1st subject should get all 3 vaccinations before the 2nd and 3rd subjects at that level receive their 1st vaccination. The 3rd subject can begin vaccination regardless of the time since the 2nd subject began vaccinations. All 3 subjects in cohort should get all 3 vaccinations before any subjects are treated in the next higher cohort. Because of this, the study may not progress to every dose level before MTD is found.
  • Autologous DC vaccine
Autologous DC Vaccine Cohort 3ExperimentalVaccine made from autologous dendritic cells loaded with tumor cell lysate and RNA. Subject will get 3 doses of DC vaccine (one every 14 days) and be monitored (vital signs every 30 minutes) for 2 hours after each dose. During treatment, subjects get weekly peg-interferon a-2b at 1.5 mcg/kg on the first day of vaccination up through 14 days after last vaccination. DC Vaccine dose evaluated in Cohort 3: st vaccine - 2 million cells nd vaccine - 4 million cells rd vaccine - 8 million cells At each dose level, the 1st subject should get all 3 vaccinations before the 2nd and 3rd subjects at that level receive their 1st vaccination. The 3rd subject can begin vaccination regardless of the time since the 2nd subject began vaccinations. All 3 subjects in cohort should get all 3 vaccinations before any subjects are treated in the next higher cohort. Because of this, the study may not progress to every dose level before MTD is found.
  • Autologous DC vaccine
Autologous DC Vaccine Cohort 4ExperimentalVaccine made from autologous dendritic cells loaded with tumor cell lysate and RNA. Subject will get 3 doses of DC vaccine (one every 14 days) and be monitored (vital signs every 30 minutes) for 2 hours after each dose. During treatment, subjects get weekly peg-interferon a-2b at 1.5 mcg/kg on the first day of vaccination up through 14 days after last vaccination. DC Vaccine dose evaluated in Cohort 4: st vaccine - 6 million cells nd vaccine - 6 million cells rd vaccine - 6 million cells At each dose level, the 1st subject should get all 3 vaccinations before the 2nd and 3rd subjects at that level receive their 1st vaccination. The 3rd subject can begin vaccination regardless of the time since the 2nd subject began vaccinations. All 3 subjects in cohort should get all 3 vaccinations before any subjects are treated in the next higher cohort. Because of this, the study may not progress to every dose level before MTD is found.
  • Autologous DC vaccine
Autologous DC Vaccine Cohort 5ExperimentalVaccine made from autologous dendritic cells loaded with tumor cell lysate and RNA. Subject will get 3 doses of DC vaccine (one every 14 days) and be monitored (vital signs every 30 minutes) for 2 hours after each dose. During treatment, subjects get weekly peg-interferon a-2b at 1.5 mcg/kg on the first day of vaccination up through 14 days after last vaccination. DC Vaccine dose evaluated in Cohort 5: st vaccine - 7 million cells nd vaccine - 7 million cells rd vaccine - 7 million cells At each dose level, the 1st subject should get all 3 vaccinations before the 2nd and 3rd subjects at that level receive their 1st vaccination. The 3rd subject can begin vaccination regardless of the time since the 2nd subject began vaccinations. All 3 subjects in cohort should get all 3 vaccinations before any subjects are treated in the next higher cohort. Because of this, the study may not progress to every dose level before MTD is found.
  • Autologous DC vaccine
Autologous DC Vaccine Cohort 6ExperimentalVaccine made from autologous dendritic cells loaded with tumor cell lysate and RNA. Subject will get 3 doses of DC vaccine (one every 14 days) and be monitored (vital signs every 30 minutes) for 2 hours after each dose. During treatment, subjects get weekly peg-interferon a-2b at 1.5 mcg/kg on the first day of vaccination up through 14 days after last vaccination. DC Vaccine dose evaluated in Cohort 6: st vaccine - 8 million cells nd vaccine - 8 million cells rd vaccine - 8 million cells At each dose level, the 1st subject should get all 3 vaccinations before the 2nd and 3rd subjects at that level receive their 1st vaccination. The 3rd subject can begin vaccination regardless of the time since the 2nd subject began vaccinations. All 3 subjects in cohort should get all 3 vaccinations before any subjects are treated in the next higher cohort. Because of this, the study may not progress to every dose level before MTD is found.
  • Autologous DC vaccine

Eligibility Criteria

        Step 1 Inclusion Criteria:

          -  Provision of signed and dated informed consent form for Step 1

          -  Male or female, aged 18 years and older

          -  Diagnosed with adenocarcinoma of the pancreas deemed to be potentially resectable and
             who are deemed to be good candidates for adjuvant and/or neoadjuvant chemotherapy.
             This may include patients whose tumors are deemed suitable for upfront resection as
             well as patients whose tumors are deemed borderline resectable and thus undergo
             neoadjuvant therapy prior to resection. Note: women of child-bearing potential must be
             on birth control for 30 days prior to first vaccination; it is recommended to discuss
             this requirement with subjects at Step 1.

        Step 1 Exclusion Criteria:

          -  Unresectable or metastatic (stage IV) pancreatic cancer

          -  Patients with known HIV positivity

          -  Patients with active HBV and HCV infection. Those who are Hepatitis B sAb positive as
             well as those who are Hepatitis C Ab positive but Hepatitis C RNA viral load negative
             will not be excluded.

          -  Patients with active of autoimmune disease or immune deficiency or previous
             Guillain-Barre syndrome. Patients with eczema, psoriasis, lichen simplex chronicus or
             vitiligo with dermatologic manifestations only (e.g. patient with psoriatic arthritis
             are excluded) are eligible provided all of the following conditions are met: rash must
             cover < 10% of body surface area; disease is well controlled at baseline and requires
             only low-potency topical corticosteroids; no occurrence of acute exacerbations of the
             underlying condition requiring psoralen plus ultraviolet A radiation, methotrexate,
             retinoids, biologic agents, oral calcineurin inhibitors, or high-potency or oral
             corticosteroids within the previous 12 months.

        Step 2 Inclusion Criteria:

          -  Provision of signed and dated informed consent form for Step 2

          -  Must have completed standard neo-adjuvant and/or adjuvant chemotherapy and surgery, as
             deemed by Investigator.

          -  Must have completed standard care within 6 weeks of step 2 registration.

          -  Must have adequate tissue obtained from surgery, as determined and confirmed by Dr.
             Decker.

          -  Adequate kidney, liver, bone marrow function, and immune function, as follows, within
             28 days prior to step 2 registration: Hemoglobin greater than/equal to 8 gm/dL;
             Absolute neutrophil count (ANC) greater than/equal to 1,500 cells/mm3; Platelet count
             greater than/equal to 75,000/mm3; Total bilirubin less than/equal to 1.5 times upper
             limit of normal (ULN); Aspartate transaminase AST (SGOT) and alanine aminotransferase
             ALT (SGPT) less than/equal to 2.5 times the ULN; TSH range between 0.4-4.0 mIU/L; RF
             less than/equal to 15 IU/ml; Peripheral CD4+ t-cell greater than 200/ul.

          -  Negative Hepatitis B and C serology. Positive HBs Ab indicating immunity is not
             exclusionary. Those who are Hepatitis B sAb positive as well as those who are
             Hepatitis C Ab positive but Hepatitis C RNA viral load negative will not be excluded.

          -  ECOG performance status less than/equal to 2

          -  For women of child bearing potential (WOCBP): At the time or (or prior to)
             registration to Step 2, use of highly effective contraception must be discussed with
             participant. NOTE: Patient must agree to start contraception at least 30 days before
             first vaccination and continue for at least 12 weeks after his/her last vaccination.

          -  WOCBP must have a negative serum pregnancy within 28 days of registration to step 2.

          -  For males of reproductive potential: use of condoms or other methods to ensure
             effective contraception with partner during study participation and for an additional
             12 weeks following discontinuations of last vaccination.

          -  Patient must agree to not donate blood for up to 90 days after last vaccination.

        Step 2 Exclusion Criteria:

          -  Use of nonstandard adjuvant chemotherapy regimen, as determined by the Investigator.

          -  Female patients who are pregnant, breast feeding, or of childbearing potential without
             a negative pregnancy test within 28 days of registration to Step 2 (or decline
             contraception requirements as outlined above). Post-menopausal women must be
             amenorrheic for at least 12 months to be considered of non-childbearing potential.

          -  Patients unwilling or unable to comply with the protocol or provide informed consent.

          -  Any severe or uncontrolled medical condition or other condition that could affect
             participation in this study (in the opinion of the investigator), including but not
             limited to: hyper/hypothyroidism, active systemic autoimmune disorders, untreated
             viral hepatitis or autoimmune hepatitis.

          -  Treatment with a systemic steroid or with any systemic immunosuppressive agent within
             7 days of step 2 registration.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:MTD of DC Vaccine
Time Frame:From treatment start until 6 weeks after.
Safety Issue:
Description:Maximum tolerated dose of dendritic cell vaccine following completion of surgery and standard adjuvant chemotherapy, as determined by BOIN design. DLTs were defined as shown in the subsequent Primary Outcome Measure.

Secondary Outcome Measures

Measure:Time to Recurrence
Time Frame:From surgery until recurrence or up to 3 years after surgery, whichever comes first.
Safety Issue:
Description:Measurement of time from resection surgery to recurrence of pancreatic adenocarcinoma.
Measure:Overall Survival
Time Frame:From surgery until death or up to 3 years after surgery, whichever comes first.
Safety Issue:
Description:Measurement of time from resection surgery to death.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Baylor College of Medicine

Trial Keywords

  • Immunotherapy
  • Adjuvant therapy

Last Updated

March 15, 2021