A Vaccine (pp65 Loaded DC Vaccine) with or without Varlilumab in Treating Patients with Glioblastoma
This phase II trial studies how well a vaccine (pp65 loaded DC vaccine) with or without varlilumab works in treating patients with glioblastoma. Vaccines made from a person's white blood cells mixed with tumor proteins may help the body build an effective immune response to kill tumor cells. Pre-conditioning the vaccination site with varlilumab may help the pp65 loaded DC vaccine stimulate the immune system to kill tumor cells and extend survival in patients with glioblastoma.
Inclusion Criteria
- Glioblastoma with definitive resection prior to enrollment, with residual radiographic contrast enhancing disease on the post-operative computed tomography (CT) or magnetic resonance imaging (MRI) of < 1 cm in maximal diameter in any axial plane
- Enough tumor tissue available for determination of MGMT gene promoter status
- Cytomegalovirus (CMV) seropositive
- Karnofsky performance status (KPS) of >= 80%
- Hemoglobin >= 9.0 g/dl
- Absolute neutrophil count (ANC) >= 1,500 cells/ul
- Platelets >= 100,000 cells/ul
- Serum creatinine =< 1.5 mg/dl
- Serum glutamic-oxaloacetic transaminase (SGOT) =< 1.5 times upper limit of normal
- Serum bilirubin =< 1.5 times upper limit of normal
- Signed informed consent approved by the Institutional Review Board
- Female patients must not be pregnant or breast-feeding. Female patients of childbearing potential (defined as < 2 years after last menstruation or not surgically sterile) must use a highly effective contraceptive method (allowed methods of birth control, [i.e. with a failure rate of < 1% per year] are implants, injectables, combined oral contraceptives, intra-uterine device [IUD; only hormonal], sexual abstinence or vasectomized partner) during the trial and for a period of > 6 months following the last administration of trial drug(s). Female patients with an intact uterus (unless amenorrhea for the last 24 months) must have a negative serum pregnancy test within 48 hours prior to first study treatment
- Fertile male patients must agree to use a highly effective contraceptive method (allowed methods of birth control [i.e. with a failure rate of < 1% per year] include a female partner using implants, injectables, combined oral contraceptives, IUDs [only hormonal], sexual abstinence or prior vasectomy) during the trial and for a period of > 6 months following the last administration of trial drugs
Exclusion Criteria
- Pregnant or breast-feeding
- Women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
- Patients with known potentially anaphylactic allergic reactions to gadolinium-diethylene triamine pentaacetic acid (DTPA)
- Patients who cannot undergo MRI or single photon emission computed tomography (SPECT) due to obesity or to having certain metal in their bodies (specifically pacemakers, infusion pumps, metal aneurysm clips, metal prostheses, joints, rods, or plates)
- Patients with evidence of tumor in the brainstem, cerebellum, or spinal cord, radiological evidence of (actively growing) multifocal disease, or leptomeningeal disease
- Severe, active comorbidity, including any of the following: * Unstable angina and/or congestive heart failure requiring hospitalization; * Transmural myocardial infarction within the last 6 months; * Acute bacterial or fungal infection requiring intravenous antibiotics at the time of study initiation; * Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy; * Known hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; * Known human immunodeficiency virus (HIV) and hepatitis C positive status; * Major medical illnesses or psychiatric impairments that, in the investigator's opinion, will prevent administration or completion of protocol therapy; * Active connective tissue disorders, such as lupus or scleroderma that, in the opinion of the treating physician, may put the patient at high risk for radiation toxicity
- Co-medication that may interfere with study results; e.g. immuno-suppressive agents other than corticosteroids
- Prior, unrelated malignancy requiring current active treatment with the exception of cervical carcinoma in situ and adequately treated basal cell or squamous cell carcinoma of the skin. (Treatment with tamoxifen or aromatase inhibitors or other hormonal therapy that may be indicated in prevention of prior cancer disease recurrence, are not considered current active treatment)
- Patients are not permitted to have had any other conventional therapeutic intervention other than steroids prior to enrollment outside of standard of care chemoradiation and tumor-treating fields during chemoradiation. Patients who receive previous inguinal lymph node dissection, radiosurgery, brachytherapy, or radiolabeled monoclonal antibodies will be excluded
- Current, recent (within 4 weeks of the administration of this study agent), or planned participation in an experimental drug study
- Known history of autoimmune disease (with the exceptions of medically-controlled hypothyroidism and type I diabetes mellitus)
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT03688178.
PRIMARY OBJECTIVES:
I. To confirm that tetanus and diphtheria toxoids adsorbed (Td) preconditioning of autologous CMV-pp65-flLAMP mRNA loaded dendritic cell vaccine (pp65 loaded DC vaccination) extends overall survival.
II. To assess the safety of administering varlilumab in conjunction with pp65 loaded DC vaccination and Td preconditioning.
III. To examine the effect of adding varlilumab on regulatory T-cells (TReg) depletion among glioblastoma (GBM) patients treated with pp65 loaded DC vaccination and Td pre-conditioning.
SECONDARY OBJECTIVES:
I. To describe the survival of patients treated with pp65-loaded DC vaccine, varlilumab, and Td preconditioning.
II. To examine the impact of Td preconditioning with and without varlilumab on progression-free survival.
III. To confirm previous findings that Td pre-conditioning and DC vaccination increase DC migration to the draining lymph nodes.
IV. To confirm previous findings that Td pre-conditioning increases serum CCL3.
EXPLORATORY OBJECTIVES:
I. To assess whether functional vaccine-induced pp65-specific CD4+ T cells and CD8+ are increased by varlilumab.
II. To assess the impact of varlilumab on Td-specific memory T cells, and to examine intracellular levels of CCL3 from peripheral blood mononuclear cells (PBMC) collected before and after Td pre-conditioning.
OUTLINE: Patients are randomized to 1 of 3 groups.
All patients undergo standard of care radiation therapy and receive temozolomide intravenously (IV). Treatment continues for 4 weeks (as 1 cycle) for patients with unmethylated MGMT, and repeats every 4 weeks for up to 12 cycles for patients with methylated MGMT in the absence of disease progression or unacceptable toxicity.
GROUP I: Patients receive pp65 loaded DC vaccine intradermally (ID) every 2 weeks for up to 20 vaccinations in the absence of disease progression or unacceptable toxicity. The day prior to the 4th vaccine, patients receive saline intradermally. Patients then receive indium (In) 111-autologous CMV-pp65-LAMP mRNA loaded dendritic cells (111 In labeled DCs) ID as the 4th vaccine.
GROUP II: Patients receive pp65 loaded DC vaccine ID every 2 weeks for up to 20 vaccinations in the absence of disease progression or unacceptable toxicity. The day prior to the 4th vaccine, patients receive a single dose of tetanus and diphtheria toxoids adsorbed ID and saline ID. Patients then receive 111 In labeled DCs ID as the 4th vaccine.
GROUP III: Patients receive varlilumab IV 7 days before vaccines except the 2nd vaccine. Patients also receive pp65 loaded DC vaccine ID every 2 weeks for up to 20 vaccinations in the absence of disease progression or unacceptable toxicity. The day prior to the 4th vaccine, patients receive a single dose of tetanus and diphtheria toxoids adsorbed ID and saline ID. Patients then receive 111 In labeled DCs ID as the 4th vaccine.
After completion of study treatment, patients are followed up periodically.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationDuke University Medical Center
Principal InvestigatorAnnick Desjardins
- Primary IDPro00082570
- Secondary IDsNCI-2019-05126
- ClinicalTrials.gov IDNCT03688178