Clinical Trials /

Androgen Deprivation, With or Without pTVG-AR, and With or Without Nivolumab, in Patients With Newly Diagnosed, High-Risk Prostate Cancer

NCT04989946

Description:

The current protocol will examine the use of a plasmid DNA vaccine encoding AR, alone or with nivolumab, to induce and/or augment therapeutic T-cells following androgen deprivation in patients with newly diagnosed prostate cancer scheduled to undergo prostatectomy. Patients without evidence of metastatic disease, with tissue remaining from a pre-treatment biopsy, and who are being considered for standard treatment by prostatectomy, will be invited to participate and will be on study for up to 15 months.

Related Conditions:
  • Prostate Adenocarcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Androgen Deprivation, With or Without pTVG-AR, and With or Without Nivolumab, in Patients With Newly Diagnosed, High-Risk Prostate Cancer
  • Official Title: Phase I/II Trial of Androgen Deprivation, With or Without pTVG-AR, and With or Without Nivolumab, in Patients With Newly Diagnosed, High-Risk Prostate Cancer

Clinical Trial IDs

  • ORG STUDY ID: UW21015
  • SECONDARY ID: Protocol Version 6/15/2021
  • SECONDARY ID: 2021-0575
  • SECONDARY ID: W81XWH2110270
  • SECONDARY ID: A534260
  • SECONDARY ID: SMPH/MEDICINE/HEM-ONC
  • NCT ID: NCT04989946

Conditions

  • Prostate Cancer

Interventions

DrugSynonymsArms
DegarelixDegarelix
pTVG-ARDegarelix and pTVG-AR
NivolumabOpdivoDegarelix and pTVG-AR and Nivolumab

Purpose

The current protocol will examine the use of a plasmid DNA vaccine encoding AR, alone or with nivolumab, to induce and/or augment therapeutic T-cells following androgen deprivation in patients with newly diagnosed prostate cancer scheduled to undergo prostatectomy. Patients without evidence of metastatic disease, with tissue remaining from a pre-treatment biopsy, and who are being considered for standard treatment by prostatectomy, will be invited to participate and will be on study for up to 15 months.

Detailed Description

      The current protocol will examine the use of a plasmid DNA vaccine encoding Androgen Receptor
      (AR), alone or with nivolumab, to induce and/or augment therapeutic T-cells following
      androgen deprivation in participants with newly diagnosed prostate cancer scheduled to
      undergo prostatectomy. All participants will receive treatment with degarelix for 8 weeks
      prior to prostatectomy. Participants will be also be randomized to receive either no
      additional treatment, a DNA vaccine encoding AR, or a DNA vaccine encoding AR and nivolumab.

      Participants receiving vaccination will begin that treatment prior to degarelix, based on
      preclinical findings that this may be a preferred sequence of treatment. The overall goal is
      to determine whether a DNA vaccine can augment the number of prostate tumor-specific
      infiltrating CD8+ T cells elicited with androgen deprivation, and whether this might be
      further augmented by combination with PD-1 blockade.

      Because these cells should have cytolytic effector function, the primary clinical endpoint is
      pathological response (pCR and secondarily MRD) at the time of prostatectomy. This endpoint
      was chosen based on observations from previous clinical trials evaluating androgen
      deprivation therapies alone in this setting.

      Safety will also be a primary objective of the current study, as this vaccine and nivolumab
      have not been previously used in this early stage population. An additional secondary
      clinical endpoint will be 1-year PSA progression-free survival, after completion of all
      therapy, and with evidence of testosterone recovery.

      Laboratory and correlative endpoints will include whether vaccination, with or without
      concurrent PD-1 blockade, elicits greater numbers of CD8+ tumor-infiltrating lymphocytes, and
      whether AR-specific prostate tissue-infiltrating CD8+ T cells and persistent systemic
      immunity are detectable after treatment with vaccination. Other correlative studies will
      evaluate FLT PET/CT as an investigational means of specifically identifying tumor
      infiltration by proliferating T cells as an early marker of treatment response, and whether
      uptake in other normal tissues is associated with autoimmune toxicity. While this is a
      relatively small trial, given a focus on correlative endpoints, a phase 2 expansion design
      was chosen to further evaluate the safety and clinical efficacy if pathological responses are
      observed in the initial part of the trial. If pathological responses exceeding 20% are
      observed, this will be considered significantly different from what has been historically
      observed, and would justify proceeding with future larger studies evaluating these
      combination approaches in the neoadjuvant stage of prostate cancer.

      Primary Objectives:

        1. To evaluate the safety of androgen deprivation and pTVG-AR DNA vaccine, alone or in
           combination with nivolumab, in patients with newly diagnosed prostate cancer

        2. To determine if pathological complete responses or minimal residual disease (MRD) can
           occur in patients with prostate cancer treated with androgen deprivation and pTVG-AR,
           alone or in combination with nivolumab, prior to definitive surgery

      Secondary Clinical Objective:

        1. To determine 1-year PSA progression-free survival (post-prostatectomy)

        2. To determine whether treatment with androgen deprivation and pTVG-AR DNA vaccine, alone
           or in combination with nivolumab, leads to residual cancer burden (RCB) <0.25 cm3 at the
           time of prostatectomy

      Laboratory / Correlative Objectives:

        1. To determine whether treatment with pTVG-AR elicits persistent systemic AR-specific
           Th1-biased T-cell responses

        2. To determine whether treatment with androgen deprivation and pTVG-AR elicits greater
           numbers of prostate tissue-infiltrating CD8+ T cells compared with androgen deprivation
           alone, and whether this is augmented with nivolumab

        3. To determine if vaccination with pTVG-AR elicits AR-specific tumor-infiltrating CD8+ T
           cells

        4. To determine whether PD-1 blockade treatment with androgen deprivation and vaccine
           increases the frequency of CD8+ T cells with memory and effector function, relative to
           exhausted phenotype, compared with androgen deprivation and vaccine alone

        5. To determine whether treatment elicits changes detectable by FLT PET imaging
    

Trial Arms

NameTypeDescriptionInterventions
DegarelixActive ComparatorDegarelix 240 mg s.c. day 29, 80 mg s.c. day 57
  • Degarelix
Degarelix and pTVG-ARExperimentalDegarelix 240 mg s.c. day 29, 80 mg s.c. day 57 pTVG-AR (100 µg) administered intradermally (i.d.) at days 1, 8, 15, 22, 29, 43, 57 and 71
  • Degarelix
  • pTVG-AR
Degarelix and pTVG-AR and NivolumabExperimentalDegarelix 240 mg s.c. day 29, 80 mg s.c. day 57 pTVG-AR (100 µg) administered intradermally (i.d.) at days 1, 8, 15, 22, 29, 43, 57 and 71 Nivolumab 240 mg IV administered at days 29, 43, 57 and 71
  • Degarelix
  • pTVG-AR
  • Nivolumab

Eligibility Criteria

        Inclusion Criteria:

          -  Histologically confirmed adenocarcinoma of the prostate

          -  Patients must be considered candidates for prostatectomy as per standard of care

          -  High-risk patients for recurrent disease, with high risk defined based on one of the
             following criteria:

               -  Gleason score 7 and baseline serum prostate specific antigen (PSA) > 20 ng/mL

               -  Gleason score > 7

          -  Life expectancy of at least 12 months at screening

          -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

          -  Adequate hematologic, renal and liver function as evidenced by the following within 4
             weeks of day 1:

               -  Absolute neutrophil count (ANC) > 1000 / mm3

               -  HgB > 9.0 gm/dL independent of transfusion

               -  Platelets > 100,000 / mm3

               -  Creatinine < 2.0 mg/dL

               -  Aspartate aminotransferase (AST), Alanine transaminase (ALT) < 2.5 x
                  institutional upper limit of normal (ULN)

               -  Total bilirubin < 2x institutional ULN (NOTE: in subjects with Gilbert's
                  syndrome, if total bilirubin is >2x ULN, measure direct and indirect bilirubin
                  and if direct bilirubin is within normal range, subject may be eligible)

          -  No known history of HIV 1 and 2, HTLV-1, or active Hepatitis B or Hepatitis C

          -  Must have adequate tissue (ten 5µm unstained formalin-fixed paraffin-embedded (FFPE)
             sections containing prostate cancer) remaining from pre-treatment diagnostic prostate
             biopsy for research purposes

          -  Patients must be willing to undergo large-volume blood draws (up to 200mL per time
             point) for the investigational component of this trial

          -  For those patients who are sexually active, they must be willing to use barrier
             contraceptive methods during the period of treatment on this trial

          -  Patients must be informed of the experimental nature of the study and its potential
             risks, and must sign an IRB-approved written informed consent form indicating such an

          -  Ability to comply with all study procedures and willingness to remain supine for 120
             minutes during imaging

        Exclusion Criteria:

          -  Small cell or other variant (non-adenocarcinoma) prostate cancer histology

          -  Prior treatment for prostate cancer, including androgen deprivation therapy (ADT),
             orchiectomy, antiandrogens, ketoconazole, abiraterone acetate or enzalutamide

          -  Prior radiation to the prostate

          -  Patients may not be receiving other investigational agents or be receiving concurrent
             anticancer therapy other than the treatment-prescribed androgen deprivation therapy

          -  Treatment with any of the following medications while on study is prohibited, washout
             period not required except as indicated:

               -  Systemic corticosteroids (at doses over the equivalent of 10 mg prednisone daily)
                  - not permitted within 3 months of registration; inhaled, intranasal or topical
                  corticosteroids are acceptable

               -  PC-SPES

               -  Herbal supplements that have been shown to modulate testosterone or androgen
                  signaling (e.g. Saw Palmetto) are not allowed while on study

               -  Megestrol

               -  Ketoconazole

               -  5-α-reductase inhibitors - patients already taking 5-α-reductase inhibitors prior
                  to 28 days prior to registration may stay on these agents throughout the course
                  of therapy, but these should not be started while patients are on study

               -  Diethylstilbesterol

               -  Any other non-study hormonal agent or supplement being used with the intent of
                  cancer treatment

          -  Major surgery within 4 weeks of registration is prohibited

          -  Active cardiac disease defined as active angina, symptomatic congestive heart failure,
             or myocardial infarction within 6 months of registration

          -  Patients with known psychological or sociological conditions, addictive disorders or
             family problems, which would preclude compliance with the protocol

          -  Patients with a history of life-threatening autoimmune disease

          -  Patients who have undergone splenectomy

          -  Patients must not have other active malignancies other than non-melanoma skin cancers
             or carcinoma in situ of the bladder. Subjects with a history of other cancers who have
             been adequately treated and have been recurrence-free for > 3 years are eligible.

          -  Any other medical intervention or condition, which, in the opinion of the principle
             investigator (PI) or treating physician, could compromise patient safety or adherence
             with the study requirements (including leukapheresis or biopsy procedures) over the
             primary 3-6 month treatment period.

          -  Patients cannot have concurrent enrollment on other phase I, II, or III
             investigational treatment studies

          -  Patients who have received a live vaccine within 14 days prior to the first dose of
             study treatment. Examples of live vaccines include, but are not limited to, the
             following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever,
             rabies, Bacillus Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza
             vaccines for injection are generally killed virus vaccines and are allowed; however,
             intranasal influenza vaccines (eg, FluMist®) are live attenuated vaccines and are not
             allowed

          -  Patients with active autoimmune disease that has required systemic treatment in the
             past 2 years (i.e. with use of disease modifying agents, corticosteroids or
             immunosuppressive drugs). Replacement therapy (eg., thyroxine, insulin, or physiologic
             corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is
             not considered a form of systemic treatment

          -  Patients with a history of non-infectious pneumonitis that required corticosteroid
             treatment, or has current pneumonitis

          -  Patients with a history of allergic reactions to the tetanus vaccine
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:Male
Healthy Volunteers:No

Primary Outcome Measures

Measure:Pathological Complete Response Rate (pCR)
Time Frame:at prostatectomy (up to 3 months)
Safety Issue:
Description:The pathological complete response will be estimated for each arm and reported along with the corresponding 95% confidence interval which will be constructed using the Wilson score method. Formal comparisons between arms will be conducted using Fisher's exact test. Participants in this study with unknown pathological response will be treated as non-responders in the primary analysis.

Secondary Outcome Measures

Measure:Progression-Free Survival (PSA) at 1-year
Time Frame:up to 15 months on study (1 year after prostatectomy)
Safety Issue:
Description:Defined as a serum PSA <0.2 ng/mL at 1 year after prostatectomy, in patients with non-castrate (>25 ng/dL) testosterone levels.
Measure:Residual Cancer Burden (RCB)
Time Frame:at prostatectomy (up to 3 months)
Safety Issue:
Description:RCB will be determined using three-dimensional volume estimation based on the largest cross-sectional tumor dimension and number of cross-sections involved by tumor, corrected for tumor cellularity. The amount of RCB will be summarized for each arm in terms of medians and ranges. Comparisons between arms will be conducted using a nonparametric Wilcoxon rank sum test. Linear regression analysis will be conducted to evaluate whether AR-specific immune response is associated with RCB.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:University of Wisconsin, Madison

Last Updated

August 17, 2021