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Personalized Vaccine (PANDA-VAC) and Pembrolizumab for the Treatment of Squamous Cell Non-Small Cell Lung Cancer or Squamous Cell Head and Neck Cancer

Trial Status: Approved

This phase I trial studies the side effects of a personalized vaccine (PANDA-VAC) when giving together with pembrolizumab in treating patients with squamous cell non-small cell lung cancer or squamous cell head and neck cancer. Abnormal cells, such as cancer cells, have special substances on their surface (called neoantigens) that are not found in normal cells. The personalized vaccine is a mix of neoantigens that are specific to the person's cancer. Vaccines work to boost the immune response in fighting abnormal cells. Immune cells can recognize these neoantigen substances and destroy the abnormal cells that carry them. After this, the immune system has a “memory” that helps it respond to those substances in the future. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving PANDA-VAC in combination with pembrolizumab may help strengthen the way the immune system responds to squamous cell non-small cell lung cancer and squamous cell head and neck cancer.

Inclusion Criteria

  • VACCINE GENERATION: Subject must sign an Institutional Review Board (IRB) approved informed consent to undergo tissue procurement and Health Insurance Portability and Accountability Act (HIPAA) authorization for release of personal health information
  • VACCINE GENERATION: Subject must have a previously treated, histologically confirmed squamous non-small cell lung cancer and head and neck squamous cell carcinoma where cure is either not possible or curative modality therapy is declined by the subject
  • VACCINE GENERATION: Subject has adequate archival tumor tissue for sequencing for vaccine generation
  • VACCINE GENERATION: Subject has Eastern Cooperative Oncology Group (ECOG) performance status of =< 1
  • VACCINE GENERATION: Absolute neutrophil count (ANC) >=1.5 x 10^9/L
  • VACCINE GENERATION: Absolute lymphocyte count (ALC) >= 1.0 x 10^9/L
  • VACCINE GENERATION: Hemoglobin >= 8 g/dL (use of transfusion to reach this threshold prior to study initiation is acceptable)
  • VACCINE GENERATION: Platelet count >= 100 x 10^9/L
  • VACCINE GENERATION: Subject has radiographically measurable according to RECIST 1.1 and iRECIST
  • VACCINE GENERATION: Subjects must per RECIST 1.1 have stable disease, mixed response, oligoprogressive state (defined as disease progression at a limited number of anatomic sites, with continued response or stable disease at other sites of disease) or non-threatening progression (progression that fits a clinical pattern where the treating physician believes that PD-1 therapy post-progression is appropriate (e.g. multiple sub-centimeter nodules that do not compromise the bronchus)) on a PD-1, PD-L1 or PD-1/L containing regimen
  • VACCINE GENERATION: For squamous non-small cell lung cancer (NSCLC): * Tumor expressing PD-L1 (Tumor Proportion Score/TPS >= 1%) as determined by a Food and Drug Administration (FDA)-approved test, with no EGFR or ALK genomic tumor aberrations * Subjects with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations
  • VACCINE GENERATION: For squamous cell carcinoma of head and neck (SCCHN): * As 1st line treatment for tumors expressing PD-L1 (Combined Positive Score [CPS] >= 1) as determined by an FDA-approved test • As non-1st line treatment for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) with disease progression on or after platinum containing chemotherapy
  • VACCINE GENERATION: Female subject of childbearing potential must agree to use adequate contraception during the study. Adequate contraception is defined by the concomitant use of at least 2 effective methods of contraception from the time of informed consent until 90 days after pembrolizumab or PANDA-VAC discontinuation, whichever is longer. The two contraception methods can be comprised of two barrier methods, or a barrier method plus a hormonal method or an intrauterine device that meets <1% failure rate for protection from pregnancy in the product label. Females of non-childbearing potential are those who are postmenopausal greater than 1 year or who have had a bilateral tubal ligation or hysterectomy or bilateral oophorectomy. Female subjects must refrain from egg cell donation while on pembrolizumab or PANDA-VAC and for at least 90 days after the last dose of investigational product, based on whichever product was last given
  • VACCINE GENERATION: Male subjects with female partners must have had a prior vasectomy or agree to use an adequate method of contraception (i.e., double barrier method: condom plus spermicidal agent) starting with the first dose of pembrolizumab through 90 days after the last dose of pembrolizumab or PANDA-VAC, whichever is longer. Male subjects should agree to refrain from sperm donation while taking pembrolizumab and/or PANDA-VAC and for at least 90 days after the last dose of pembrolizumab or PANDA-VAC, whichever is longer. Should a female partner of a male subject become pregnant or suspect she is pregnant while participating in the study, he should inform his treating physician and the female partner should call her physician immediately
  • VACCINE GENERATION: Subject is willing and able to comply with the protocol including undergoing treatment and scheduled visits and examinations
  • VACCINE GENERATION: Subject is willing to consent to study-required blood draws and consent for the use of any residual material from biopsy or prior resections for vaccine generation and correlative studies
  • VACCINE GENERATION: Subject is willing to consent to a mandatory biopsy that is required for adapted vaccine generation and correlative studies if the subject has partial response, stable disease, mixed response, or oligoprogressive state following the full series of five priming and two booster vaccinations
  • VACCINE GENERATION: Subject must have recovered from all reversible acute toxic effects of the previous cancer treatment regimen (other than alopecia) to grade =< 1 or baseline
  • VACCINATION: Subject must sign written informed consent to enroll in the PANDA-VAC therapy trial
  • VACCINATION: Subject must have completed at least two cycles of standard of care therapy with pembrolizumab
  • VACCINATION: Subject has Eastern Cooperative Oncology Group (ECOG) performance status of =< 2
  • VACCINATION: Subject has radiographically measurable disease according to RECIST 1.1 and iRECIST
  • VACCINATION: Subjects must per RECIST 1.1 have stable disease, mixed response, oligoprogressive state (defined as disease progression at a limited number of anatomic sites, with continued response or stable disease at other sites of disease) or progressive disease
  • VACCINATION: Absolute neutrophil count (ANC) >=1.5 x 10^9/L
  • VACCINATION: Absolute lymphocyte count (ALC) >= 0.5 x 10^9/L
  • VACCINATION: Hemoglobin >= 8 g/dL (use of transfusion to reach this threshold prior to study initiation is acceptable)
  • VACCINATION: Platelet count >= 50 x 10^9/L
  • VACCINATION: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) (unless liver metastases are present, in which case they must be =< 5 x ULN)
  • VACCINATION: Total serum bilirubin =< 1.5 mg/dL (subjects with Gilbert's syndrome may be enrolled despite a total bilirubin level > 1.5 mg/dL if their conjugated bilirubin is <1.5 x ULN)
  • VACCINATION: Creatinine clearance (CrCl) > 40 mL/min as measured according to Cockcroft-Gault equation
  • VACCINATION: Subject has negative serum beta-hCG pregnancy test within 72 hours of day 1 of initial administration of vaccine in women of childbearing potential
  • VACCINATION: Subject does not have active infection requiring systemic therapy (In the case of such infection, it is acceptable to delay vaccine administration. The use of additional interim pembrolizumab prior to vaccine administration will be at the discretion of the treating physician)

Exclusion Criteria

  • VACCINE GENERATION EXCLUSION CRITERIA:
  • Subject is currently participating in or has participated in a study of an investigational agent within 4 weeks of study pembrolizumab treatment initiation
  • Subject has active infection requiring systemic therapy
  • Subject is pregnant or breastfeeding (Note: breast milk cannot be stored for future use while the mother is being treated on the study)
  • Subject has a known additional malignancy that is active and/or progressive requiring treatment; exceptions include basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the subject has been disease-free for at least five years
  • Subject has active central nervous system (CNS) metastases. Treated metastases without evidence of progression will be allowed. Asymptomatic, subcentimeter metastases not requiring treatment will be allowed. Any leptomeningeal disease will be excluded
  • Subject is currently using systemic corticosteroids at doses >= 10mg prednisone daily or its equivalent, or other immunosuppressive medications including, but not limited to methotrexate, azathioprine, calcineurin inhibitor, and TNF-alpha blockers
  • Subject has known human immunodeficiency virus (HIV), hepatitis C virus (HCV) or evidence of active hepatitis B virus (HBV)
  • Subject has a history of primary immunodeficiency
  • Subject has a history of organ transplant, bone marrow transplant or hematopoietic stem cell transplantation
  • Subject has 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 (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
  • Subject has received a live attenuated vaccines within 30 days of on study pembrolizumab dosing. Inactivated vaccines, such as the injectable influenza vaccine, are permitted
  • Subject has any condition that, in the opinion of the investigator, would interfere with evaluation of study treatment or interpretation of subject safety or study results
  • Subject is not a good candidate for treatment with pembrolizumab and PANDA-VAC per investigator’s discretion

North Carolina

Chapel Hill
UNC Lineberger Comprehensive Cancer Center
Status: APPROVED
Contact: Jared M. Weiss
Phone: 919-966-3856

PRIMARY OBJECTIVE:

I. To estimate the unacceptable toxicity rate of personalized and dose adjusted antitumor peptide vaccine (PANDA-VAC) administered concomitantly with pembrolizumab in subjects with advanced squamous non-small cell lung cancer, and head and neck squamous cell carcinoma.

SECONDARY OBJECTIVES:

I. To estimate response rate based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and Immune-Modified Response Evaluation Criteria in Solid Tumors (iRECIST) in subjects with advanced squamous non-small cell lung cancer, and head and neck squamous cell carcinoma treated with PANDA-VAC and pembrolizumab.

II. To estimate overall survival of subjects with advanced squamous non-small cell lung cancer, and head and neck squamous cell carcinoma treated with PANDA-VAC and pembrolizumab.

III. To estimate progression-free survival of subjects with advanced squamous non-small cell lung cancer, and head and neck squamous cell carcinoma treated with PANDA-VAC and pembrolizumab.

EXPLORATORY OBJECTIVES:

I. To measure functional frequency of T cells reactive to vaccine component neoantigens in the subject’s peripheral circulation over time while on therapy.

II. To evaluate phenotypic changes in T cell populations with therapeutic neoantigen vaccine therapy.

III. To evaluate T cell receptor repertoire pre- and post-therapy.

IV. To analyze cytokine profiles pre- and post-therapy.

OUTLINE:

PART I: Patients undergo collection of buccal sample for vaccine preparation. Patients also receive pembrolizumab intravenously (IV) over 30 minutes. Cycles repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients may transition to every 6 weeks with pembrolizumab, if after one scan, they achieve a partial response or better, or after two scans with stable disease or better.

PART II: Patients receive PANDA-VAC subcutaneously (SC) on days 1 and 4 of week 1, day 1 of weeks 2-4, and the booster vaccines on day 1 of weeks 13 and 22. Patients also continue receiving pembrolizumab IV over 30 minutes on day 1. Cycles with pembrolizumab repeat every 3 weeks for up to 2 years in the absence of disease progression or unacceptable toxicity. Patients may transition to every 6 weeks with pembrolizumab, if after one scan, they achieve a partial response or better, or after two scans with stable disease or better.

After completion of study treatment, patients are followed up at 30 days, every 12 weeks for 1 year, and then periodically for up to 10 years.

Trial Phase Phase I

Trial Type Treatment

Lead Organization
UNC Lineberger Comprehensive Cancer Center

Principal Investigator
Jared M. Weiss

  • Primary ID LCCC1804
  • Secondary IDs NCI-2020-04787
  • Clinicaltrials.gov ID NCT04266730