Clinical Trials /

HPV Vaccine PRGN-2009 Alone or in Combination With Anti-PDL1/TGF-Beta Trap (M7824) in Subjects With HPV Associated Cancers

NCT04432597

Description:

Background: For some cancers associated with human papillomavirus (HPV), standard treatments are not helpful. Researchers want to see if a vaccine for HPV combined with a drug called M7824 has a better effect on these cancers than when they work alone. Objective: To find a safe dose of HPV vaccine alone or combined with M7824. Also, to test if either HPV vaccine alone or combined with M7824 causes a better immune response. Eligibility: People ages 18 and older with locally advanced or metastatic HPV associated cancer (Phase I) or stage II or III p16-positive oropharyngeal cancer (Phase II) Design: Participants will be screened with: Medical history Physical exam Blood, urine, and heart tests Possible photos of skin lesions CT, MRI, or nuclear bone scan: Participants will lie in a machine that takes pictures of the body. For the CT scan, they may have a contrast agent injected into a vein. Participants may have up to 2 tumor biopsies. For participants in Phase II, this may be performed with a thin tube placed through the nose into the airway. Participants will receive the HPV vaccine alone or with M7824. For participants on the Phase II, they will receive two doses of HPV vaccine under the skin either alone or with M7824 as an infusion spaced two weeks apart. This will be done prior to their planned chemoradiation or surgery. For participants on the Phase I, they will get the HPV vaccine injected under the skin 2 to 3 times in the first month. Then they will have a booster every 4 weeks. They will receive M7824 as an infusion into a vein every 2 weeks. Treatment will last up to 1 year. After they stop treatment, participants will have a visit within 4 weeks. They will then be contacted for long-term follow-up every year, for the rest of their lives. ...

Related Conditions:
  • Anal Carcinoma
  • Cervical Carcinoma
  • Malignant Solid Tumor
  • Oropharyngeal Squamous Cell Carcinoma
  • Penile Carcinoma
  • Rectal Squamous Cell Carcinoma
  • Vaginal Carcinoma
  • Vulvar Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: HPV Vaccine PRGN-2009 Alone or in Combination With Anti-PDL1/TGF-Beta Trap (M7824) in Subjects With HPV Associated Cancers
  • Official Title: Phase I/II Trial of HPV Vaccine PRGN-2009 Alone or in Combination With Anti-PD-L1/TGF-Beta Trap (M7824) in Subjects With HPV Positive Cancers

Clinical Trial IDs

  • ORG STUDY ID: 200104
  • SECONDARY ID: 20-C-0104
  • NCT ID: NCT04432597

Conditions

  • HPV Positive Cancer
  • Vulvar, Vaginal, Penile, Rectal Cancer
  • Anal Cancer
  • Oropharyngeal Cancer
  • Cervical Cancer

Interventions

DrugSynonymsArms
PRGN-20091/Arm 1A
M78242/Arm 1B

Purpose

Background: For some cancers associated with human papillomavirus (HPV), standard treatments are not helpful. Researchers want to see if a vaccine for HPV combined with a drug called M7824 has a better effect on these cancers than when they work alone. Objective: To find a safe dose of HPV vaccine alone or combined with M7824. Also, to test if either HPV vaccine alone or combined with M7824 causes a better immune response. Eligibility: People ages 18 and older with locally advanced or metastatic HPV associated cancer (Phase I) or stage II or III p16-positive oropharyngeal cancer (Phase II) Design: Participants will be screened with: Medical history Physical exam Blood, urine, and heart tests Possible photos of skin lesions CT, MRI, or nuclear bone scan: Participants will lie in a machine that takes pictures of the body. For the CT scan, they may have a contrast agent injected into a vein. Participants may have up to 2 tumor biopsies. For participants in Phase II, this may be performed with a thin tube placed through the nose into the airway. Participants will receive the HPV vaccine alone or with M7824. For participants on the Phase II, they will receive two doses of HPV vaccine under the skin either alone or with M7824 as an infusion spaced two weeks apart. This will be done prior to their planned chemoradiation or surgery. For participants on the Phase I, they will get the HPV vaccine injected under the skin 2 to 3 times in the first month. Then they will have a booster every 4 weeks. They will receive M7824 as an infusion into a vein every 2 weeks. Treatment will last up to 1 year. After they stop treatment, participants will have a visit within 4 weeks. They will then be contacted for long-term follow-up every year, for the rest of their lives. ...

Detailed Description

      Background

        -  Metastatic HPV associated malignancies (cervical, anal, oropharyngeal cancers, etc.) are
           often incurable and poorly palliated by standard therapies.

        -  HPV-positive (p16+) oropharyngeal cancers are the most common HPV-associated malignancy
           in the United States and are increasing in incidence.

        -  Stage II and III HPV-positive oropharyngeal cancer is primarily treated with definitive
           therapy.

        -  Although the prognosis for stage I HPV+ oropharyngeal cancer is favorable, about 20
           percent of patients with stage II disease and 35 percent of patients with stage III
           disease will die within four years.

        -  Attempts to de-intensify treatment of HPV-positive oropharyngeal cancer by replacing
           highdose cisplatin with cetuximab concurrent with radiotherapy have failed.

        -  Induction and neoadjuvant immunotherapy are an area of active study in this type of
           cancer. The aims of induction immunotherapy are to induce antigen-specific immunity
           prior to definitive therapy and to reduce the risk of disease relapse for patients with
           stage II and III disease.

        -  Therapeutic vaccines targeting HPV alone or in combination with M7824 (dual PD-L1 and
           TGF beta inhibitor) have demonstrated induction of HPV antigen-specific responses and
           tumor growth inhibition in multiple pre-clinical models of HPV-positive malignancy.

        -  In clinical studies done in the CCR, M7824 as monotherapy has produced a notable
           objective response rate (35-40%) for metastatic HPV + cancers including Oropharyngeal
           Squamous Cell Carcinoma (OPSCC) and preclinical studies support the addition of an
           investigational HPV vaccine with therapeutic intent (PRGN-2009, a gorilla adenoviral
           based vaccine) to further increase anti-tumor efficacy.

      Objectives:

      Phase I in patients with recurrent/metastatic HPV positive cancer:

      -Primary objective: To determine the safety and recommended phase II dose (RP2D) of PRGN-2009
      (HPV vaccine) alone or in combination with M7824 administered at RP2D of 1200 mg q2w.

      Phase II in patients with newly diagnosed stage II/III p16-positive oropharyngeal cancer:

      -Primary objective: To determine if either HPV vaccine alone (Arm 2A) or in combination with
      M7824 (Arm 2B) is able to result in a ^3 2-fold increase in CD3+ tumor infiltrating T cells
      post treatment compared with pre-treatment.

      Eligibility:

      Phase I:

        -  Men or women of age >= 18 years old.

        -  Subjects with cytologically or histologically confirmed locally advanced or metastatic
           HPV associated malignancies:

             -  Cervical cancers;

             -  p16+ Oropharyngeal cancers;

             -  Anal cancers;

        -  Vulvar, vaginal, penile, and squamous cell rectal cancers;

        -  Other locally advanced or metastatic solid tumors (e.g. lung, esophagus) that are known
           HPV+.

        -  Prior first line systemic therapy is required unless the patient declines standard
           treatment after appropriate counseling has been provided.

      Phase II:

        -  Men or women of age >= 18 years old.

        -  Subjects with newly diagnosed stage II or III p16-positive oropharyngeal squamous cell
           carcinoma (OPSCC) planned for definitive therapy.

      Design:

      Phase I: Recurrent/metastatic HPV associated cancer:

        -  A 3+3 dose escalation design will be used which will evaluate PRGN-2009 (HPV vaccine) at
           two dose levels (1x10 to the 11th power and 5x10 to the 11th power viral particle (VP)
           units) given as monotherapy followed by a third dose level evaluating the RP2D dose of
           PRGN-2009 in combination with 1200 mg (RP2D) of M7824. In addition, the combination of
           PRGN-2009 at RP2D with 1200 mg of M7824 will be expanded to a total of 10 evaluable
           patients to gauge the preliminary efficacy of the combination of PRGN-2009 and M7824 in
           patients with advanced disease.

        -  There will be a 4-week DLT evaluation period for each dose level.

        -  It is expected that up to 22 patients may enroll in 6 months.

      Phase II: Newly diagnosed stage II/III p16-positive oropharyngeal cancer:

        -  Sequential two-arm evaluation of HPV vaccine alone (Arm 2A) or HPV vaccine plus M7824
           (Arm 2B) as neoadjuvant/ induction therapy before definitive standard of care therapy
           (20 patients each arm).

        -  Patients will receive neoadjuvant/ induction immunotherapy at NIH Clinical Center and
           then be referred back to their home institution for definitive standard of care therapy.

        -  It is expected that up to 40 patients may enroll in 2 years.
    

Trial Arms

NameTypeDescriptionInterventions
1/Arm 1AExperimentalHPV vaccine at 1x10(11) Viral Particles (VP) (DL1) and at 5x10(11) VP (DL2)
  • PRGN-2009
2/Arm 1BExperimentalHPV vaccine at RP2D plus M7824 at 1200 mg
  • PRGN-2009
  • M7824
3/Arm 2AExperimentalHPV vaccine at RP2D given as neoadjuvant or induction therapy
  • PRGN-2009
A/Arm 2BExperimentalHPV vaccine at RP2D plus M7824 at 1200 mg given as neoadjuvant or induction therapy
  • PRGN-2009
  • M7824

Eligibility Criteria

        -  INCLUSION CRITERIA:

          -  Subjects with cytologically or histologically confirmed locally advanced or metastatic
             HPV associated malignancies (Phase I only):

               -  Cervical cancers;

               -  p16+ Oropharyngeal cancers;

               -  Anal cancers;

               -  Vulvar, vaginal, penile, and squamous cell rectal cancers;

               -  Other locally advanced or metastatic solid tumors (e.g., lung, esophagus) that
                  are known HPV+.

          -  Subjects with cytologically or histologically confirmed newly diagnosed stage II or
             III p16-positive oropharyngeal squamous cell carcinoma planned for definitive therapy
             (Phase II only).

          -  Subjects must have measurable disease, per RECIST 1.1.

          -  Subjects must have received prior standard systemic therapy unless the patient is not
             eligible to receive standard therapy or declines standard treatment (Phase I only).
             Specifically, for patients enrolled to the phase I portion of the study with
             oropharyngeal cancer patients should have previously received platinum based
             chemotherapy and PD(L)1 inhibitor based therapy, for patients with enrolled to the
             phase I portion of the study with cervical, anal or penile cancer patients should have
             previously received platinum based chemotherapy, for other rare HPV associated cancers
             where standard of care first line therapy does not exist (e.g., vulvar, vaginal) prior
             first line therapy is not required.

          -  Men or Women; Age >=18 years.

          -  ECOG performance status =< 2

          -  Adequate hematologic function at screening, as follows:

               -  Absolute neutrophil count (ANC) >=1 x 109/L;

               -  Hemoglobin >= 9 g/dL;

               -  Platelets >= 75,000/microliter.

          -  Adequate renal and hepatic function at screening, as follows:

               -  Serum creatinine =< 1.5 x upper limit of normal (ULN) OR Measured or calculated
                  creatinine clearance >= 40 mL/min for participant with creatinine levels > 1.5 X
                  institutional ULN (GFR can also be used in place of creatinine or CrCl);

               -  Bilirubin =< 1.5 x ULN OR in subjects with Gilbert s syndrome, a total bilirubin
                  =< 3.0 x ULN;

               -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN,
                  unless liver metastases are present, then values must be =< 3 x ULN).

          -  The effects of the immunotherapies (PRGN-2009 vaccine and M7824) on the developing
             human fetus are unknown. For this reason and because M7824 and PRGN-2009 used in this
             trial are possibly teratogenic, women of child-bearing potential and men must agree to
             use highly effective contraception (hormonal or barrier method of birth control;
             abstinence) prior to study entry and up to 2 months following the last dose of M7824
             study treatment. 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.

          -  Patients serologically positive for HIV, Hep B, Hep C are eligible as long as the
             viral loads are undetectable by quantitative PCR. HIV positive patients must have CD4
             count >= 200 cells per cubic millimeter at enrollment, be on stable antiretroviral
             therapy for at least 4 weeks and have no reported opportunistic infections or
             Castleman s disease within 12 months prior to enrollment.

        EXCLUSION CRITERIA:

          -  Patients with prior investigational drug, live vaccine, chemotherapy, immunotherapy or
             any prior radiotherapy (except for palliative bone directed therapy) within the past
             28 days prior to the first drug administration except if the investigator has assessed
             that all residual treatment-related toxicities have resolved or are minimal and feel
             the patient is otherwise suitable for enrollment. Patients may continue adjuvant
             hormonal therapy in the setting of a definitively treated cancer (e.g. breast).

          -  Major surgery within 28 days prior to the first drug administration (minimally
             invasive procedures such as diagnostic biopsies are permitted).

          -  Known active brain or central nervous system metastasis (less than a month out from
             definitive radiotherapy or surgery), seizures requiring anticonvulsant treatment (<3
             months) or clinically significant cerebrovascular accident (<3 months). In order to be
             eligible patients must have repeated CNS imaging at least a month after definitive
             treatment showing stable CNS disease. Patients with evidence of intratumoral or
             peritumoral hemorrhage on baseline imaging are also excluded unless the hemorrhage is
             grade =< 1 and has been shown to be stable on two consecutive imaging scans.

          -  Pregnant women are excluded from this study because M7824 and PRGN-2009 vaccine have
             not been tested in pregnant women and there is potential for teratogenic or
             abortifacient effects. Because there is an unknown but potential risk for adverse
             events in nursing infants secondary to treatment of the mother with these
             immunotherapies, breastfeeding should be discontinued if the mother is treated on this
             protocol.

          -  Active autoimmune disease that might deteriorate when receiving an immunostimulatory
             agent with exception of:

               -  Diabetes type I, eczema, vitiligo, alopecia, psoriasis, hypo- or hyperthyroid
                  disease or other mild autoimmune disorders not requiring immunosuppressive
                  treatment;

               -  Administration of steroids for other conditions through a route known to result
                  in a minimal systemic exposure (topical, intranasal, intro-ocular, or inhalation)
                  is acceptable;

               -  Subjects on systemic intravenous or oral corticosteroid therapy with the
                  exception of

        physiologic doses of corticosteroids (=< the equivalent of prednisone 10 mg/day) or other
        immunosuppressors such as azathioprine or cyclosporin A are excluded on the basis of
        potential immune suppression. For these subjects these excluded treatments must be
        discontinued at least 1 weeks prior to enrollment for recent short course use (=< 14 days)
        or discontinued at least 4 weeks prior to enrollment for long term use (> 14 days). In
        addition, the use of corticosteroids as premedication for contrast-enhanced studies is
        allowed prior to enrollment and on study.

        - Subjects with a history of serious intercurrent chronic or acute illness, such as cardiac
        or pulmonary disease, hepatic disease, bleeding diathesis or recent (within 3 months)
        clinically significant bleeding events, known left ventricular ejection fraction <50%
        (confirmation of EF > 50% is not required for eligibility), history of myocarditis, or
        recent myocardial infarction (within 6 months), or other illness considered by the
        Investigator as high risk for M7824 drug treatment.

        History of second malignancy within 3 years of enrollment except for the following:
        adequately treated localized skin cancer, cervical carcinoma in situ, superficial bladder
        cancer, other localized malignancy which has been adequately treated or malignancy which
        does not require active systemic treatment (e.g., low risk CLL). For patients enrolled on
        the phase I portion of the protocol a second HPV driven malignancy is allowed.

          -  Subjects with a known severe hypersensitivity reaction to monoclonal antibodies or its
             excipients (grade >/= 3 NCI-CTCAE v5) will be evaluated by the allergy/immunology team
             prior to enrollment.

          -  Receipt of prior lymphodepleting chemotherapy (e.g., cyclophosphamide, fludarabine) or
             any organ transplantation requiring ongoing immunosuppression.

          -  For patients who may receive M7824, previous life-threatening side effects resulting
             from prior checkpoint inhibitor therapy.

          -  Subject with pulse oximetry < 92% on room air at screening.

          -  Participants unable to provide informed consent.

          -  Participants whose inclusion in the trail would in the judgement of the PI lead to
             time

        from diagnosis to initiation of curative treatment of >70 days (Arms 2A and 2B only).
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Safety and recommended phase II dose of PRGN-2009
Time Frame:one year
Safety Issue:
Description:Phase I: In patients with recurrent/metastatic HPV positive cancer - To determine the safety and recommended phase II dose (RP2D) of PRGN-2009 (HPV vaccine) alone or in combination with M7824 administered at RP2D of 1200 mg q2w.

Secondary Outcome Measures

Measure:overall response rate (ORR)
Time Frame:study end
Safety Issue:
Description:Phase 1: To assess overall response rate (ORR) according to RECIST 1.1.
Measure:progression-free survival time (PFS)
Time Frame:study end
Safety Issue:
Description:Phase 1: To assess progression-free survival time (PFS).
Measure:overall survival (OS)
Time Frame:study end
Safety Issue:
Description:Phase 1: To assess overall survival (OS).
Measure:duration of response
Time Frame:study end
Safety Issue:
Description:Phase 1: To assess duration of response.
Measure:ratio of patients that are hospitalized because of adverse events attributed to disease progression
Time Frame:study end
Safety Issue:
Description:Phase 1: To assess ratio of patients that are hospitalized because of adverse events attributed to disease progression.
Measure:increase in CD3+ tumor infiltrating lymphocytes
Time Frame:study end
Safety Issue:
Description:Phase II: To determine if the rate of 2-fold increase in CD3+ tumor infiltrating lymphocytes (TILs) by immunohistology following PRGN-2009 in combination with M7824 (Arm 2B) is significantly more than the rate with PRGN-2009 alone (Arm 2A).
Measure:does the use of PRGN-2009 alone or in combination with M7824 result in significantly prolonged survival
Time Frame:study end
Safety Issue:
Description:Phase II: To determine if the use of PRGN-2009 alone or in combination with M7824 results in significantly prolonged survival as compared to the expected 80% three-year historical survival for this population.
Measure:3-year overall and relapse free survival rate for PRGN-2009 alone or PRGN-2009 plus M7824
Time Frame:study end
Safety Issue:
Description:year overall and relapse-free survival rate for PRGN-2009 alone (Arm 2A) or PRGN-2009 plus M7824 (Arm 2B) as neoadjuvant/ induction therapy before definitive standard of care therapy.
Measure:assess the safety of the recommended phase II dose (RP2D) of PRGN-2009 (HPV vaccine) alone or in combination with the RP2D of M7824
Time Frame:study end
Safety Issue:
Description:Phase II: To assess the safety of the recommended phase II dose (RP2D) of PRGN-2009 (HPV vaccine) alone or in combination with the RP2D of M7824 in this patient population.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • HPV Associated Malignancy
  • Immunotherapy
  • HPV Vaccine
  • PRGN-2009
  • M7824

Last Updated

June 25, 2020