Rilimogene Galvacirepvec/Rilimogene Glafolivec and Ipilimumab Alone or in Combination in Treating Patients with Prostate Cancer Undergoing Radical Prostatectomy
This randomized phase II trial studies how well rilimogene galvacirepvec/rilimogene glafolivec and ipilimumab work alone or in combination in treating patients with prostate cancer who are undergoing radical prostatectomy. Vaccines like rilimogene galvacirepvec/rilimogene glafolivec made from a gene-modified virus may help the body build an effective immune response to kill tumor cells. Immunotherapy with monoclonal antibodies, such as ipilimumab, may help the body’s immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether giving rilimogene galvacirepvec/rilimogene glafolivec and ipilimumab alone or in combination may work better in treating patients with prostate cancer.
Inclusion Criteria
- Patients must have histologically confirmed adenocarcinoma of the prostate without previous therapy for PC * Treatment-naive AND * Undergoing RP as initial, locally definitive therapy for PC AND * Eligible for RP in a 3 month timeframe AND * Able to consent for RP
- Subject’s archival prostate biopsy specimen is available, and subject consents to provide tissue for study endpoint analysis; the prostate biopsy slides or blocks must be available prior to starting any study treatment
- Subject has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- White blood cell (WBC) count >= 3,000/mcL
- Absolute neutrophil count (ANC) >= 1,500/mcL
- Platelet count >= 100,000/mcL
- Hemoglobin (Hgb) >= 10.0 g/dL
- Creatinine =< 1.5 x institutional upper limit of normal (ULN)
- Total bilirubin =< 1.5 x institutional ULN
- Alanine aminotransferase (ALT) =< 1.5 x institutional ULN
- Aspartate aminotransferase (AST) =< 1.5 x institutional ULN
- No known history of human immunodeficiency virus (HIV) 1 and 2, human T-cell lymphotropic virus (HTLV)-I/II, and hepatitis B and C
- Ability to understand a written informed consent document, and the willingness to sign it
- Subjects must agree to use adequate contraception (i.e. barrier method) for the duration of study participation, and for three months after discontinuing therapy
Exclusion Criteria
- Subject’s biopsy specimen reveals neuroendocrine or small cell features
- Subject has any evidence of metastatic disease (pre-operative staging will be undertake per urologic standard of care) as deemed by the Investigator
- Subject has prior use of any hormones, including luteinizing hormone-releasing hormone (LHRH) agonists, ketoconazole, antiandrogens (such as bicalutamide, flutamide, or nilutamide), or 5-alpha-reductase inhibitors
- Subject has prior use of any anti-cancer treatment or product, such as PC-SPES (or any other PC-x product: PC-HOPE, PC-CARE, PC-PLUS, etc)
- Subject has received prior radiation therapy or chemotherapy for prostate cancer
- Chronic administration (defined as daily or every other day for continuous use > 14 days) of systemic corticosteroids within 28 days of the first planned dose off PROSTVAC; use of inhaled steroids, nasal sprays, and topical creams for small body areas are allowed
- Active atopic dermatitis or skin condition that disrupts the epidermis
- Inflammatory eye disease requiring steroid treatment
- History of prior solid organ or bone marrow transplant
- Previous history of hypersensitivity to eggs or allergy or untoward reaction to prior vaccinia (smallpox) vaccination
- Splenectomy
- Subject, or subject’s close household contacts (defined as those who share housing or have close physical contact) have any of the following conditions during the screening and/or treatment periods: * Active or a history of atopic dermatitis, eczema or other eczematoid skin disorders that disrupt the epidermis * Other acute, chronic or exfoliative skin conditions (e.g., burns, impetigo, varicella zoster, severe acne or other open rashes or wounds) until condition resolves * Pregnant or nursing * Immunodeficient or immunosuppressed (by disease or therapy), including human immunodeficiency virus (HIV) infection
- Subject’s close household contacts include children less than the age of three
- History of, or active autoimmune disease (e.g., autoimmune neutropenia, thrombocytopenia, or hemolytic anemia, systemic lupus erythematosus, Sjogren´s syndrome, scleroderma, myasthenia gravis, Goodpasture´s syndrome, Addison´s disease, Hashimoto’s thyroiditis, or Grave's disease) as determined by the treating medical oncologist * Persons with vitiligo are not excluded * Persons with a history of type 1 diabetes are not excluded if the condition is well controlled: ** Hemoglobin A1C < 7.0, and ** No evidence of end-organ damage due to diabetes, such as diabetic retinopathy, nephropathy, or neuropathy ** Persons with type 2 diabetes are not excluded since this is not an autoimmune disease, and do not need to meet these criteria * Persons with hypothyroidism are not excluded if condition is well controlled, and condition is due to a non-autoimmune etiology
- Subject has received treatment with any investigational immunotherapy within 2 years prior to study screening or has received treatment with any other investigational product within 28 days prior to study screening
- Subject has participated in any previous study involving PROSTVAC, Sipuleucel-T or ipilimumab, regardless of whether the subject received PROSTVAC, Sipuleucel-T or ipilimumab
- Subject has a history of allergic reactions attributed to compounds of similar chemical or biologic composition to PROSTVAC or ipilimumab
- Subject has a history of stage III or greater cancer, excluding prostate cancer; subjects with a history of basal or squamous cell skin cancers are allowed, provided that the subject was adequately treated and is disease-free at the time of study screening; subjects with a history of stage I or II cancer must have been adequately treated and been disease-free for >= 3 years prior to study screening
- Subject has any uncontrolled, concurrent illness including, but not limited to the following: ongoing or active infection (bacterial, viral, or fungal), symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, stroke or myocardial infarction within 6 months, or psychiatric illness that would limit compliance with study requirements
- Subject requires any medical intervention(s) or has any other condition(s) that, in the Investigator’s opinion, will 1) make the administration of PROSTVAC or ipilimumab hazardous, 2) obscure the interpretation of adverse events (AEs), 3) compromise adherence with study requirements, or 4) otherwise compromise the study’s objectives
- Subject has high-risk features (e.g., based on Gleason score, PSA, clinical stage, % positive biopsies), and the treating physician feels the subject should undergo radical prostatectomy sooner than planned within the protocol
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT02506114.
PRIMARY OBJECTIVES:
I. To assess the immunologic impact induced within the prostate by neoadjuvant rilimogene galvacirepvec/rilimogene glafolivec (PROSTVAC) or ipilimumab or the combination in men with localized prostate cancer (PC) undergoing radical prostatectomy (RP), as measured by CD3+ T cell tumor infiltration.
SECONDARY OBJECTIVES:
I. To characterize T cell subsets and natural killer (NK) cells infiltrating the prostate after neoadjuvant PROSTVAC or ipilimumab or the combination.
II. To measure the treatment-induced effects on circulating effector and regulatory T cells following neoadjuvant PROSTVAC or ipilimumab or the combination.
III. To assess the safety of PROSTVAC or ipilimumab or the combination in the neoadjuvant setting.
TERTIARY OBJECTIVES:
I. To examine the effects of neoadjuvant PROSTVAC or ipilimumab or the combination on systemic antigen-specific immune responses.
II. To assess various immune monitoring parameters of cellular and humoral immune response following neoadjuvant PROSTVAC or ipilimumab or the combination blood and in the tumor.
III. To determine the impact of neoadjuvant PROSTVAC or ipilimumab or the combination on PD-L1 expression in patients with localized PC.
IV. To determine the clinical benefit of neoadjuvant PROSTVAC or ipilimumab or the combination in patients with localized prostate cancer measured by: prostate specific antigen (PSA) response, pathologic response.
OUTLINE: Patients are randomized into 1 of 3 arms.
ARM A: Patients receive rilimogene galvacirepvec/rilimogene glafolivec subcutaneously (SC) on days 1, 15, and 36 in the absence of disease progression or unaccepted toxicity. Patients undergo RP on day 57.
ARM B: Patients receive ipilimumab intravenously (IV) over 90 minutes on days 1 and 22 in the absence of disease progression or unaccepted toxicity. Patients undergo RP on day 43.
ARM C: Patients receive rilimogene galvacirepvec/rilimogene glafolivec SC as in Arm A and ipilimumab IV over 90 minutes on days 15 and 36 in the absence of disease progression or unaccepted toxicity. Patients undergo RP on day 57.
After completion of study treatment, patients are followed up at 9 weeks and 6 and 12 months.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationUCSF Medical Center-Mount Zion
Principal InvestigatorLawrence Fong
- Primary ID14559
- Secondary IDsNCI-2017-01679, 14-15211
- ClinicalTrials.gov IDNCT02506114