Adjuvant Tumor Lysate Vaccine and Iscomatrix With or Without Metronomic Oral Cyclophosphamide and Celecoxib in Patients With Malignancies Involving Lungs, Esophagus, Pleura, or Mediastinum
- -INCLUSION CRITERIA: 1. Patients with histologically or cytologically proven lung or esophageal cancers, thymic or mediastinal germ cell tumors, malignant pleural mesotheliomas, or primary thoracic sarcomas, as well as patients with sarcomas, melanomas, germ cell tumors, or epithelial malignancies metastatic to the lungs, mediastinum, or pleura that have no clinical evidence of active disease (NED) or minimal residual disease (MRD) not readily accessible by non-invasive biopsy or resection/radiation following standard therapy. 2. Diagnosis must be confirmed by the NCI Laboratory of Pathology. 3. Patients must be enrolled within 56 weeks following completion of therapy. 4. Patients must have completed standard therapy for their malignancy and recovered from all toxicities to less than or equal to Grade 2 within 3 weeks prior to enrollment. 5. Patients with intracranial metastases, which have been treated by surgery or radiation therapy, may be eligible for study provided there is no evidence of active disease and no requirement for anticonvulsant therapy or steroids following treatment. 6. Patients must have an ECOG performance status of 0 2 7. Patients must be 18 years of age or older due to the unknown effects of immunologic responses to this vaccine during childhood and adolescent development. 8. Patients must have evidence of adequate bone marrow reserve, hepatic and renal function as evidenced by the following laboratory parameters: - Absolute neutrophil count greater than 1500/mm3 - Platelet count greater than 100,000/mm3 - Hemoglobin greater than 8g/dl (patients may receive transfusions to meet this parameter) - PT within 2 seconds of the ULN - Total bilirubin <1.5 x upper limits of normal - Serum creatinine less than or equal to 1.6 mg/ml or the creatinine clearance must be greater than 70 ml/min/1.73m2. 9. Seronegative for HIV antibody. Note: The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who are HIV seropositive may have decreased immune competence and thus may be less responsive to the experimental treatment. 10. Seronegative for active hepatitis B, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then patient must be tested for the presence of antigen by RT-PCR and be HCV RNA negative. 11. The effects of the study treatment on the developing human fetus are unknown; thus, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) within 28 days prior to study entry, for the duration of study participation and up to 120 days after the last dose of the drug. 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. 12. Patients must be willing to sign an informed consent. 13. Ability and willingness to co-enroll on the screening and tissue collection protocol 06C0014, 'Prospective Evaluation of Genetic and Epigenetic Alterations in Patients with Thoracic Malignancies'. EXCLUSION CRITERIA: 1. Patients who are initially rendered NED or have MRD following standard therapy but exhibit disease progression prior to initiation of vaccination will be excluded from the study. 2. Patients requiring chronic systemic treatment with steroids will be excluded. 3. Patients receiving warfarin anticoagulation, who cannot be transitioned to other agents such as enoxaparin or dabigatran, and for whom anticoagulants cannot be held for up to 24 hours will be excluded. 4. Patients with uncontrolled hypertension (>160/95), unstable coronary disease evidenced by uncontrolled arrhythmias, unstable angina, decompensated CHF (>NYHA Class II), or myocardial infarction within 6 months of study will be excluded. 5. Patients with other cardiac diseases may be excluded at the discretion of the PI following consultation with Cardiology consultants. 6. Patients with any of the following pulmonary function abnormalities will be excluded: FEV, < 30% predicted; DLCO < 30% predicted (post-bronchodilator); oxygen saturation less than 92% on room air. 7. Female patients who are pregnant or breastfeeding. Because there is unknown, potentially harmful effects of immune response to CT-X antigens and stem cell proteins that may be expressed in placenta, fetus, and neonates. 8. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations 3 months prior to enrollment that would limit compliance with study requirements.
During recent years, cancer-testis (CT) antigens (CTA), particularly those encoded by genes
on the X chromosome (CT-X genes), have emerged as attractive targets for cancer
immunotherapy. Whereas malignancies of diverse histologies express a variety of CTAs, immune
responses to these proteins appear uncommon in cancer patients, possibly due to low-level,
heterogeneous antigen expression, as well as immunosuppressive regulatory T cells present
within tumor sites and systemic circulation of these individuals. Conceivably, vaccination of
cancer patients with tumor cells expressing high levels of CTAs in combination with regimens
that deplete or inhibit T regulatory cells will induce broad immunity to these antigens. In
order to examine this issue, patients with primary lung and esophageal cancers, pleural
mesotheliomas, thoracic sarcomas, thymic neoplasms and mediastinal germ cell tumors, as well
as sarcomas, melanomas, germ cell tumors, or epithelial malignancies metastatic to lungs,
pleura or mediastinum with no evidence of disease (NED) or minimal residual disease (MRD)
following standard multidisciplinary therapy will be vaccinated with H1299 tumor cell lysates
with Iscomatrix (Trademark) adjuvant. Vaccines will be administered with or without
metronomic oral cyclophosphamide (50 mg PO BID x 7d q 14d), and celecoxib (400 mg PO BID).
Serologic responses to a variety of recombinant CTAs as well as immunologic responses to
autologous tumor or epigenetically modified autologous EBVtransformed lymphocytes will be
assessed before and after receiving 6 vaccines.
-To assess the frequency of immunologic responses to CTAs in patients with thoracic
malignancies following vaccinations with H1299 cell lysate/Iscomatrix (Trademark) vaccines
alone in comparison to patients with thoracic malignancies following vaccinations with H1299
cell lysate/Iscomatrix (Trademark) vaccines in combination with metronomic cyclophosphamide
-Patients with histologically or cytologically proven small cell or non-small cell lung
cancer (SCLC;NSCLC), esophageal cancer (EsC), malignant pleural mesothelioma (MPM) , thymic
or mediastinal germ cell tumors, thoracic sarcomas, or melanomas, sarcomas, or
epithelial malignancies metastatic to lungs, pleura or mediastinum who have no clinical
evidence of active disease (NED), or minimal residual disease (MRD) not readily accessible by
non-invasive biopsy or resection/radiation following standard therapy completed within the
past 56 weeks.
- Patients must be 18 years or older with an ECOG performance status of 0 - 2.
- Patients must have adequate bone marrow, kidney, liver, lung and cardiac function.
- Patients may not be on systemic immunosuppressive medications at time vaccinations
- Following recovery from surgery, chemotherapy, or chemo/XRT, patients with NED or MRD
will be vaccinated via deep subcutaneous (SQ) injection with H1299 cell lysates and
Iscomatrix (Trademark) adjuvant monthly until 6 vaccinations have been given.
- Vaccines will be administered with or without with metronomic oral cyclophosphamide and
- Systemic toxicities and immunologic response to therapy will be recorded. Pre and post
vaccination serologic and cell mediated responses to a standard panel of CT antigens as
well as autologous tumor cells (if available) and EBV-transformed lymphocytes will be
assessed before and after vaccination.
- Numbers/percentages and function of T regulatory cells in peripheral blood will be
assessed before, during, and after vaccinations.
- Patients will be followed in the clinic with routine staging scans until disease
- The trial will randomize 28 evaluable patients per arm to either receive vaccine alone
or vaccine plus chemotherapy in order to have 80% power to determine if the frequency of
immune responses on the combination arm exceeds that of the vaccine alone arm, if the
expected frequencies of immune responses on the two arms were 20% and 50%, using a
one-sided 0.10 alpha level Fisher s exact test.
- Approximately 60 patients will be accrued to this trial.
Trial Phase Phase I/II
Trial Type Treatment
National Cancer Institute
David S. Schrump
- Primary ID 140053
- Secondary IDs NCI-2019-00040, 14-C-0053, NCI-2014-02465
- Clinicaltrials.gov ID NCT02054104