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Vaccine Therapy Combined With Adjuvant Chemoradiotherapy in Treating Patients With Resected Stage I or Stage II Adenocarcinoma (Cancer) of the Pancreas

Primary Purpose

Pancreatic Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
GVAX pancreatic cancer vaccine
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatic Cancer focused on measuring stage I pancreatic cancer, stage II pancreatic cancer, duct cell adenocarcinoma of the pancreas

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed invasive ductal adenocarcinoma of the head, neck, and uncinate process of the pancreas Mixed adenocarcinoma tumors allowed if the predominant invasive component of the tumor is adenocarcinoma Stage I or II (clinical stage T1-3, N0-1, M0) disease Has undergone pancreaticoduodenectomy at the Johns Hopkins Hospital within the past 8-10 weeks Completely resected (R0) or microscopic residual (R1) disease No diagnosis other than ductal adenocarcinoma, including any of the following: Adenosquamous Squamous cell Colloid Islet cell Non-invasive intraductal papillary mucinous neoplasms Serous or mucinous cystadenoma or cystadenocarcinoma Carcinoid Small or large cell carcinoma Intraductal oncocytic papillary neoplasms Osteoclast-like giant cell tumors Acinar cell carcinoma Pancreatoblastoma Solid pseudopapillary tumors Undifferentiated small cell carcinoma Non-epithelial tumors (sarcoma, gastrointestinal stromal tumor, or lymphoma) Adenocarcinoma of the ampulla Adenocarcinoma of the distal bile duct Adenocarcinoma of the duodenum No recurrent disease No metastatic disease, including peritoneal implants or liver and/or lung involvement PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-1 Life expectancy Not specified Hematopoietic Absolute neutrophil count >/= 1,500/mm^3 Platelet count >/= 100,000/mm^3 Hemoglobin >/= 10 g/dL Hepatic Bilirubin </= 2 mg/dL AST/ALT </= 2 times upper limit of normal (ULN) Alkaline phosphatase </= 5 times ULN Renal Creatinine </= 2 mg/dL Pulmonary No asthma or chronic obstructive pulmonary disease requiring systemic corticosteroids Immunologic HIV negative No active infection No prior or concurrent autoimmune disease requiring treatment with systemic immunosuppressants, including any of the following: Inflammatory bowel disease Systemic vasculitis Scleroderma Psoriasis Multiple sclerosis Hemolytic anemia or immune thrombocytopenia Rheumatoid arthritis Systemic lupus erythematosus Sjogren's syndrome Sarcoidosis Negative results to viral delayed-type hypersensitivity serology testing if autologous tumor cells are available Other No postoperative complications (e.g., inability to take oral nutrition >/= 1,500 calories/day, ongoing requirement for long-term biliary stenting, or persistence of wound infection) No other malignancy within the past 5 years except nonmelanoma skin cancer No uncontrolled medical conditions that would preclude study participation No other major active medical or psychosocial problem that could be exacerbated by study treatment Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 4 weeks after study participation PRIOR CONCURRENT THERAPY: Biologic therapy More than 1 month since prior biologic therapy No other concurrent biologic therapy, immunotherapy, or gene therapy for pancreatic cancer Chemotherapy More than 1 month since prior chemotherapy No other concurrent chemotherapy for pancreatic cancer Endocrine therapy More than 28 days since prior systemic steroids No concurrent systemic corticosteroids Radiotherapy More than 1 month since prior radiotherapy No other concurrent radiotherapy for pancreatic cancer Surgery See Disease Characteristics Recovered from prior surgery Other More than 1 month since prior participation in an investigational new drug trial No other concurrent investigational therapy for pancreatic cancer

Sites / Locations

  • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

GVAX pancreatic cancer vaccine

Arm Description

5E8 vaccine cells. The first vaccination is administered 6-8 weeks after surgery. Four to eight weeks following the completion of the last cycle of adjuvant radiation and chemotherapy (chemo-radiation therapy is standard of care and not part of the protocol) eligible patients will receive three additional vaccinations at one month intervals. Patients who continue to remain disease-free will receive a fifth "booster" vaccination, six months following the fourth vaccination

Outcomes

Primary Outcome Measures

Overall Survival
Overall survival in patients treated with adjuvant chemoradiotherapy in sequence with the irradiated allogeneic GM-CSF transfected pancreatic tumor cell lines. Overall survival is defined as time from surgery until death, regardless of cause.
Disease-free Survival
Disease-free Survival in Patients Treated With Adjuvant Chemoradiotherapy in Sequence With the Irradiated Allogeneic GM-CSF Transfected Pancreatic Tumor Cell Lines. DFS is defined as time from surgery until clinical evidence of disease (eg, CT scan) or death due to any cause.

Secondary Outcome Measures

To Further Identify and Characterize Toxicities Associated With Intradermal Injections of the Vaccine That Were Initially Reported in the Phase 1 Trial.
Estimate the Association of Specific in Vivo Parameters of Immune Response With Clinical Responses in Patients Treated With Combination Chemoradiotherapy Together With the Irradiated Allogeneic GM-CSF Transfected Pancreatic Tumor Cell Lines.
The specific immune parameters include: post-vaccination delayed type hypersensitivity reactions to autologous tumor and the degree of local eosinophil, macrophage, and T cell infiltration at the vaccine site, and mesothelin-specific T cell responses.

Full Information

First Posted
June 10, 2004
Last Updated
July 17, 2013
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00084383
Brief Title
Vaccine Therapy Combined With Adjuvant Chemoradiotherapy in Treating Patients With Resected Stage I or Stage II Adenocarcinoma (Cancer) of the Pancreas
Official Title
A Safety and Efficacy Trial of Lethally Irradiated Allogeneic Pancreatic Tumor Cells Transfected With the GM-CSF Gene in Combination With Adjuvant Chemoradiotherapy for the Treatment of Adenocarcinoma of the Pancreas
Study Type
Interventional

2. Study Status

Record Verification Date
July 2013
Overall Recruitment Status
Completed
Study Start Date
January 2002 (undefined)
Primary Completion Date
December 2005 (Actual)
Study Completion Date
July 2006 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Vaccines made from gene-modified pancreatic cancer cells may make the body build an immune response to kill tumor cells. Drugs used in chemotherapy, such as fluorouracil, work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Giving vaccine therapy together with chemotherapy and radiation therapy after surgery may kill any remaining tumor cells. PURPOSE: This phase II trial is studying how well giving vaccine therapy together with adjuvant chemoradiotherapy works in treating patients with resected stage I or stage II adenocarcinoma (cancer) of the pancreas.
Detailed Description
OBJECTIVES: Primary Determine overall and disease-free survival of patients with resected stage I or II adenocarcinoma of the pancreas treated with adjuvant chemoradiotherapy in combination with GVAX pancreatic cancer vaccine. Secondary Correlate specific in vivo parameters of immune response (post-vaccination delayed-type hypersensitivity reactions to autologous tumor, mesothelin-specific T-cell response, and the degree of local eosinophil, macrophage, and T-cell infiltration at the vaccine site) with clinical responses in patients treated with this regimen. Determine the toxic effects associated with intradermal injections of this vaccine in these patients. OUTLINE: This is an open-label study. Post surgery vaccination: Within 8-10 weeks after pancreaticoduodenectomy, patients receive GVAX pancreatic cancer vaccine intradermally (ID) on day 0. Adjuvant chemoradiotherapy: Within 16-28 days after the first vaccination, patients receive fluorouracil (5-FU) IV continuously for 3 weeks. Approximately 1-2 weeks after completion of 5-FU, patients receive chemoradiotherapy comprising radiotherapy daily and 5-FU IV continuously for 26-28 weeks. Approximately 3-5 weeks after completion of chemoradiotherapy, patients receive 5-FU IV continuously for 4 weeks. 5-FU repeats every 6 weeks for 2 courses. Post chemoradiotherapy vaccination: Within 4-8 weeks after the completion of chemoradiotherapy, patients receive GVAX pancreatic cancer vaccine ID on days 0, 28, 56, and 196. Treatment continues in the absence of unacceptable toxicity. Patients are followed every 3 months for 1 year and then every 6 months thereafter. PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Cancer
Keywords
stage I pancreatic cancer, stage II pancreatic cancer, duct cell adenocarcinoma of the pancreas

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
GVAX pancreatic cancer vaccine
Arm Type
Experimental
Arm Description
5E8 vaccine cells. The first vaccination is administered 6-8 weeks after surgery. Four to eight weeks following the completion of the last cycle of adjuvant radiation and chemotherapy (chemo-radiation therapy is standard of care and not part of the protocol) eligible patients will receive three additional vaccinations at one month intervals. Patients who continue to remain disease-free will receive a fifth "booster" vaccination, six months following the fourth vaccination
Intervention Type
Biological
Intervention Name(s)
GVAX pancreatic cancer vaccine
Intervention Description
Patients will receive vaccinations consisting of 5E8 vaccine cells. The first vaccination is administered 6-8 weeks after surgery. Four to eight weeks following the completion of the last cycle of adjuvant radiation and chemotherapy (chemo-radiation therapy is standard of care and not part of the protocol) eligible patients will receive three additional vaccinations at one month intervals. Patients who continue to remain disease-free will receive a fifth "booster" vaccination, six months following the fourth vaccination.
Primary Outcome Measure Information:
Title
Overall Survival
Description
Overall survival in patients treated with adjuvant chemoradiotherapy in sequence with the irradiated allogeneic GM-CSF transfected pancreatic tumor cell lines. Overall survival is defined as time from surgery until death, regardless of cause.
Time Frame
Participants were followed for the duration of the study, an average of 2 years
Title
Disease-free Survival
Description
Disease-free Survival in Patients Treated With Adjuvant Chemoradiotherapy in Sequence With the Irradiated Allogeneic GM-CSF Transfected Pancreatic Tumor Cell Lines. DFS is defined as time from surgery until clinical evidence of disease (eg, CT scan) or death due to any cause.
Time Frame
Participants were followed for the duration of the study, an average of 2 years
Secondary Outcome Measure Information:
Title
To Further Identify and Characterize Toxicities Associated With Intradermal Injections of the Vaccine That Were Initially Reported in the Phase 1 Trial.
Time Frame
4 years
Title
Estimate the Association of Specific in Vivo Parameters of Immune Response With Clinical Responses in Patients Treated With Combination Chemoradiotherapy Together With the Irradiated Allogeneic GM-CSF Transfected Pancreatic Tumor Cell Lines.
Description
The specific immune parameters include: post-vaccination delayed type hypersensitivity reactions to autologous tumor and the degree of local eosinophil, macrophage, and T cell infiltration at the vaccine site, and mesothelin-specific T cell responses.
Time Frame
Continuous

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed invasive ductal adenocarcinoma of the head, neck, and uncinate process of the pancreas Mixed adenocarcinoma tumors allowed if the predominant invasive component of the tumor is adenocarcinoma Stage I or II (clinical stage T1-3, N0-1, M0) disease Has undergone pancreaticoduodenectomy at the Johns Hopkins Hospital within the past 8-10 weeks Completely resected (R0) or microscopic residual (R1) disease No diagnosis other than ductal adenocarcinoma, including any of the following: Adenosquamous Squamous cell Colloid Islet cell Non-invasive intraductal papillary mucinous neoplasms Serous or mucinous cystadenoma or cystadenocarcinoma Carcinoid Small or large cell carcinoma Intraductal oncocytic papillary neoplasms Osteoclast-like giant cell tumors Acinar cell carcinoma Pancreatoblastoma Solid pseudopapillary tumors Undifferentiated small cell carcinoma Non-epithelial tumors (sarcoma, gastrointestinal stromal tumor, or lymphoma) Adenocarcinoma of the ampulla Adenocarcinoma of the distal bile duct Adenocarcinoma of the duodenum No recurrent disease No metastatic disease, including peritoneal implants or liver and/or lung involvement PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-1 Life expectancy Not specified Hematopoietic Absolute neutrophil count >/= 1,500/mm^3 Platelet count >/= 100,000/mm^3 Hemoglobin >/= 10 g/dL Hepatic Bilirubin </= 2 mg/dL AST/ALT </= 2 times upper limit of normal (ULN) Alkaline phosphatase </= 5 times ULN Renal Creatinine </= 2 mg/dL Pulmonary No asthma or chronic obstructive pulmonary disease requiring systemic corticosteroids Immunologic HIV negative No active infection No prior or concurrent autoimmune disease requiring treatment with systemic immunosuppressants, including any of the following: Inflammatory bowel disease Systemic vasculitis Scleroderma Psoriasis Multiple sclerosis Hemolytic anemia or immune thrombocytopenia Rheumatoid arthritis Systemic lupus erythematosus Sjogren's syndrome Sarcoidosis Negative results to viral delayed-type hypersensitivity serology testing if autologous tumor cells are available Other No postoperative complications (e.g., inability to take oral nutrition >/= 1,500 calories/day, ongoing requirement for long-term biliary stenting, or persistence of wound infection) No other malignancy within the past 5 years except nonmelanoma skin cancer No uncontrolled medical conditions that would preclude study participation No other major active medical or psychosocial problem that could be exacerbated by study treatment Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 4 weeks after study participation PRIOR CONCURRENT THERAPY: Biologic therapy More than 1 month since prior biologic therapy No other concurrent biologic therapy, immunotherapy, or gene therapy for pancreatic cancer Chemotherapy More than 1 month since prior chemotherapy No other concurrent chemotherapy for pancreatic cancer Endocrine therapy More than 28 days since prior systemic steroids No concurrent systemic corticosteroids Radiotherapy More than 1 month since prior radiotherapy No other concurrent radiotherapy for pancreatic cancer Surgery See Disease Characteristics Recovered from prior surgery Other More than 1 month since prior participation in an investigational new drug trial No other concurrent investigational therapy for pancreatic cancer
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel A. Laheru, MD
Organizational Affiliation
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21217520
Citation
Lutz E, Yeo CJ, Lillemoe KD, Biedrzycki B, Kobrin B, Herman J, Sugar E, Piantadosi S, Cameron JL, Solt S, Onners B, Tartakovsky I, Choi M, Sharma R, Illei PB, Hruban RH, Abrams RA, Le D, Jaffee E, Laheru D. A lethally irradiated allogeneic granulocyte-macrophage colony stimulating factor-secreting tumor vaccine for pancreatic adenocarcinoma. A Phase II trial of safety, efficacy, and immune activation. Ann Surg. 2011 Feb;253(2):328-35. doi: 10.1097/SLA.0b013e3181fd271c.
Results Reference
derived

Learn more about this trial

Vaccine Therapy Combined With Adjuvant Chemoradiotherapy in Treating Patients With Resected Stage I or Stage II Adenocarcinoma (Cancer) of the Pancreas

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