Combination Immunotherapy in Subjects With Advanced HPV Associated Malignancies
- -INCLUSION CRITERIA: 1. 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+. 2. Subjects must have measurable disease, per RECIST 1.1. 3. Subjects must have received prior first line systemic therapy unless the patient is not eligible to receive standard therapy or declines standard treatment. 4. Age >= 18 years. 5. ECOG performance status <= 2. 6. Adequate hematologic function at screening, as follows: - Absolute neutrophil count (ANC) >=1 x 10^9/L; - Hemoglobin >= 9 g/dL; - Platelets >=75,000/microliter. 7. 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). 8. The effects of the immunotherapies on the developing human fetus are unknown. For this reason and because immunotherapeutic agents as well as other therapeutic agents used in this trial are known to be 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 for two months after 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. 9. 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: 1. Patients with prior investigational drug, 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 cancer). 2. Known intolerance to or life threatening side effects resulting from prior checkpoint inhibitor therapy. 3. Major surgery within 28 days prior to the first drug administration (minimally invasive procedures such as diagnostic biopsies are permitted). 4. 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 repeat 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. 5. Pregnant women are excluded from this study because these drugs 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. 6. 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; - Subjects requiring hormone replacement with corticosteroids are eligible if the steroids are administered only for the purpose of hormonal replacement and at doses <= 10 mg of prednisone or equivalent per day; - 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 immunosuppressives 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. 7. 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, or other illness considered by the Investigator as high risk for investigational drug treatment. 8. History of non-HPV associated second malignancy within 3 years of enrollment except localized malignancy which has been adequately treated or malignancy which does not require active systemic treatment (e.g,, low risk CCL). Patients taking adjuvant hormonal therapy for definitively treated cancers (e.g. breast cancer) are eligible. 9. Subjects with a known severe hypersensitivity reaction to a monoclonal antibodies (grade >/= 3 NCI-CTCAE v5) will be evaluated by the allergy/immunology team prior to enrollment. 10. Receipt of prior lymphodepleting chemotherapy (e.g. cyclophosphamide, fludarabine) or any organ transplantation requiring ongoing immunosuppression.
Background: - Metastatic or refractory/recurrent HPV associated malignancies (cervical, anal, oropharyngeal cancers etc.) are poorly palliated by standard therapies. There is an unmet need for active treatments for these tumors. - In a phase I trial of M7824 (NCT02517398) 15 out of 43 (34.9%) patients with HPV associated malignancies had radiographic tumor responses according to RECIST 1.1 or iRECIST. - While the response rate observed with M7824 appears to be higher than single agent PD-1 inhibitors alone (15-20%), the majority of patients with these diseases still do not seem to benefit from immunotherapy. - Preclinical studies suggest that the use of a combination of multiple immunotherapy agents may have improved anti-tumor efficacy. - Specifically, preclinical studies have shown that the combination of three immunotherapy agents (1) a therapeutic vaccine against HPV positive cancers (PDS0101), (2) a bifunctional fusion protein targeting PD-L1 and TGF beta (M7824), and (3) a tumor targeted immunocytokine (NHS-IL12) produces greater anti-tumor activity than any single or dual combination of these agents. Objectives: - To evaluate the objective response rate (ORR) according to Response Evaluation Criteria (RECIST 1.1) of the combination of (1) a therapeutic vaccine against HPV positive cancers (PDS0101), (2) a tumor targeted immunocytokine (NHS-IL12) and (3) a bifunctional fusion protein targeting PD-L1 and TGF beta (M7824) in subjects with checkpoint naive advanced HPV associated malignancies. Eligibility: - 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. - Subjects must have measurable disease. Design: - This is a phase I/II trial of combination immunotherapy. - The trial will be conducted using a Simon optimal two-stage design. - Patients will receive HPV vaccine + NHS-IL12 + M7824. - The first six patient will be evaluable for dose limiting toxicities (DLTs) and accrual will only continue to 8 patients if less than 2 out of the first 6 pts experience a DLT. - If three or more out of eight patients have objective responses accrual will be expanded to enroll 20 evaluable patients.
Trial Phase Phase I/II
Trial Type Treatment
National Cancer Institute
Julius Y. Strauss
- Primary ID 200045
- Secondary IDs NCI-2020-01539, 20-C-0045
- Clinicaltrials.gov ID NCT04287868