This research study is studying the drugs called NeoVax (a new type of personalized
neoantigen vaccine) in combination with CDX-301 and Nivolumab as a possible treatment for
melanoma.
The names of the study drugs involved in this study are:
- Personalized Neoantigen peptides (which combined with poly-ICLC make the vaccine NeoVax)
- Poly-ICLC (Hiltonol)
- CDX-301
- Nivolumab (Opdivo)
The purpose of this Phase I study is to determine if it is possible to safely administer a
personalized neoantigen vaccine (NeoVax) in combination with the study drug CDX-301 and
Nivolumab against melanoma by using information gained from specific characteristics of
someone's own melanoma. The study will also be determining what the appropriate dose of
CDX-301 to be given in combination with NeoVax and Nivolumab.
The FDA (the U.S. Food and Drug Administration) has not approved personalized neoantigen
peptides, poly-ICLC , or CDX-301 as a treatment for any disease.
The FDA has approved Nivolumab as a treatment option for metastatic melanoma.
It is known that melanoma cancers have mutations (changes in genetic material) that are
specific to an individual patient and tumor. These mutations can cause the tumor cells to
produce proteins that appear very different from the body's own cells.It is possible that
these proteins used in a vaccine may induce strong immune responses, which may help someone's
body fight any tumor cells that could cause the melanoma to come back in the future.
The personalized Neovax vaccine will be made of protein fragments, called peptides, from an
individual's mutated melanoma tumor cells mixed with Poly-ICLC. Poly-ICLC is a drug that
binds proteins on the surface of certain immune cells and helps to activate the immune
system.
CDX-301 is a drug involved in regulating the activity and proliferation of a type of cell
named dendritic cell. Dendritic cells are key in enhancing the activation of the immune
system in response to the NeoVax vaccine, so the immune system has a better chance to
recognize the tumor cells and attack them.
Nivolumab is an antibody that prevents cancer cells from suppressing one's immune response so
that their body can attack and kill the cancer.
The research study procedures include: screening for eligibility and study treatment
including evaluations and follow up visits.
Participants will receive study treatment for as long as they do not have serious side
effects and their disease does not get worse for a maximum of 2 years and will be followed
for 5 years since study therapy initiation
It is expected that about 20 people will take part in this research study
Celldex Therapeutics is supporting this research by providing CDX-301.
Inclusion Criteria:
Eligibility to participate will be assessed at two timepoints: prior to initial core
needle/surgical biopsy (Initial Registration) and prior to the first vaccination (Secondary
Registration).
- Eligibility Criteria for Initial Registration
- Participant is willing and able to give written informed consent
- Participants must have histologically confirmed cutaneous melanoma (mucosal
melanoma or uveal melanoma are excluded) that is unresectable stage III or stage
IV; at least one site of disease must be resectable, partially-resectable, or
amenable to core biopsies to provide tumor tissue for sequence analysis
- Participants must have measurable disease by RECIST v1.1 that has not been
treated with local therapy within the last 12 months of study treatment. The
measurable lesion and the lesion used for surgical or core biopsies can be
identical as long as it remains measurable after biopsy
- Age ≥ 18 years
- ECOG performance status of 0 or 1
- Recovered from all toxicities associated with prior treatment, to acceptable
baseline status (as to Lab toxicity see below limits for inclusion) or a National
Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE)
version 5.0, Grade of 0 or 1, except for toxicities not considered a safety risk,
such as alopecia or vitiligo
- Participants must have normal organ and marrow function as defined below:
- WBC ≥3,000/µL
- ANC ≥1,500/µL
- Platelets ≥100,000/µL
- Hemoglobin ˃ 9.0 g/dL
- Total Bilirubin ≤ 1.5 x ULN (except subjects with Gilbert Syndrome, who can
have total bilirubin < 3.0 mg/dL)
- AST(SGOT)/ALT(SGPT) ≤ 3 x ULN
- Creatinine ≤ 1.5 x ULN OR
- Creatinine clearance ≥40 mL/min/1.73 m2 for participants with creatinine
levels above institutional normal (if using the Cockcroft-Gault formula
below):
Female CrCl = (140 - age in years) x weight in kg x 0.85 72 x serum creatinine in mg/dL
Male CrCl = (140 - age in years) x weight in kg x 1.00 72 x serum creatinine in mg/dL
- Women of childbearing potential (WOCBP) should have a negative serum pregnancy test
(minimum sensitivity 25 IU/L or equivalent units of HCG) within 24 hours prior to the
start of Nivolumab, because the effects of NeoVax plus Montanide and Nivolumab on the
developing human fetus are unknown
- Because there is an unknown but potential risk for adverse events in nursing infants
secondary to treatment of the mother with study agents, breastfeeding should be
discontinued if the mother is treated Nivolumab, Personalized Neoantigen vaccine, and
CDX-301
- Female participants enrolled in the study, who are not free from menses for >2 years,
post hysterectomy / oophorectomy, or surgically sterilized, should be willing to use
either 2 adequate barrier methods or a barrier method plus a hormonal method of
contraception to prevent pregnancy or to abstain from sexual activity throughout the
study, starting with visit 1 through 5 months after the last dose of study therapy.
Approved contraceptive methods include for example: intra uterine device, diaphragm
with spermicide, cervical cap with spermicide, male condoms, or female condom with
spermicide. Spermicides alone are not an acceptable method of contraception. 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.The
investigational product will be permanently discontinued in an appropriate manner.
- Male participants should agree to use an adequate method of contraception starting
with visit 1 through 7 months after the last dose of study therapy
Exclusion Criteria:
- Prior immunotherapy for metastatic melanoma except anti-CTLA-4. Patients who have
received PD-1 inhibition therapy as adjuvant therapy and stopped receiving PD-1
inhibition for a period of ≥ 6 months before starting treatment with Nivolumab are
allowed to participate.
- Concomitant therapy with any anti-cancer agents, other investigational anti-cancer
therapies, or immunosuppressive agents including but not limited to methotrexate,
chloroquine, azathioprine, etc. within six months of study participation
- Active brain metastases or leptomeningeal metastases
- Has received a live vaccine within 30 days of planned start of study therapy. Examples
of live vaccines include, but are not limited to, the following: measles, mumps,
rubella, varicella/zoster, yellow fever, rabies, BCG, and typhoid vaccine.
Note: Seasonal influenza vaccines for injection are generally inactivated flu vaccines and
are allowed; however intranasal influenza vaccines (e.g., Flu-Mist®) are live attenuated
vaccines, and are not allowed.
- History of severe allergic reactions attributed to any vaccine therapy for the
prevention of infectious diseases
- Active, known or suspected autoimmune disease. Subjects are permitted to enroll if
they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to
autoimmune condition only requiring hormone replacement, psoriasis not requiring
systemic treatment, or conditions not expected to recur in the absence of an external
trigger
- A condition requiring systemic treatment with either corticosteroids (> 10 mg daily
prednisone equivalents) or other immunosuppressive medications within 14 days of study
drug administration. Inhaled or topical steroids and adrenal replacement doses > 10 mg
daily prednisone equivalents are permitted in the absence of active autoimmune
disease. Corticosteroids used as pre-medication for imaging studies are allowed.
- Test positive for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus
ribonucleic acid (HCV antibody) indicating acute or chronic infection
- Known history of testing positive for human immunodeficiency virus (HIV) or known
acquired immunodeficiency syndrome (AIDS).
- Known sensitivity or allergy to Nivolumab or CDX-301
- Uncontrolled intercurrent illness including, but not limited to ongoing or active
infection requiring treatment, symptomatic
- Any underlying medical condition, psychiatric condition or social situation that in
the opinion of the investigator would compromise study administration as per protocol
or compromise the assessment of AEs
- Planned major surgery
- Patients with known mutations/amplifications in Flt-3
- Pregnant women are excluded from this study because Nivolumab, personalized neoantigen
peptides and poly-ICLC are agents with unknown risks to the developing fetus. Because
there is an unknown but potential risk of adverse events in nursing infants secondary
to treatment of the mother with Nivolumab, personalized neoantigen peptides and
poly-ICLC, nursing women are excluded from this study
- Individuals with a history of an invasive malignancy are ineligible except for the
following circumstances: a) individuals with a history of invasive malignancy are
eligible if they have been disease-free for at least 3 years and are deemed by the
investigator to be at low risk for recurrence of that malignancy; b) individuals with
the following cancers are eligible if diagnosed and treated - carcinoma in situ of the
breast, oral cavity or cervix, localized prostate cancer, basal cell or squamous cell
carcinoma of the skin
- Prisoners, or subjects who are compulsory detained are not eligible to participate