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Vaccine Therapy in Treating Patients With Metastatic Melanoma

Primary Purpose

Recurrent Melanoma, Stage IV Melanoma

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
recombinant fowlpox-TRICOM vaccine
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Melanoma

Eligibility Criteria

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

Inclusion Criteria: Histologically or cytologically confirmed melanoma Stage IV disease Measurable disease At least 1 cutaneous or lymph node mass ≥ 1 cm AND amenable to biopsy and percutaneous injection AND can be accurately measured with standard calipers Must be tested for expression of HLA-A2 prior to study Must have 1 of the following criteria: Circulating melanoma-specific CD8-positive T cells against ≥ 1 defined antigen (Melan-A, gp100 antigen, tyrosinase, MAGE-A10, Trp-2, or NA17) as measured by tetramer or ELISpot directly ex-vivo or after a 10 day in vitro expansion Detectable intratumoral T cells measured in the index lesion that is to be injected with rF-TRICOMTM by immunohistochemistry (IHC) for CD4, CD8 or another T cell marker, or by real time RT-PCR for CD8a, CD4, or other T cell transcripts No untreated or edematous brain metastases or leptomeningeal disease Treated CNS disease allowed provided patient remains stable off corticosteroid therapy Performance status - Karnofsky 70-100% More than 12 weeks WBC ≥ 3,000/mm^3 Platelet count ≥ 100,000/mm^3 No uncontrolled bleeding disorder that would increase the risk of bleeding from the injected lesion No active thrombotic thrombocytopenic purpura within the past 2 years PT/PTT ≤ 1.25 times upper limit of normal (ULN) AST and ALT ≤ 1.5 times ULN Bilirubin ≤ 1.5 times ULN No chronic hepatitis B or C Creatinine ≤ 2.0 mg/dL Creatinine clearance ≥ 60 mL/min No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia HIV negative No prior significant allergic reaction or hypersensitivity to eggs or egg products No disease that limits the function of the spleen (e.g., sickle cell disease) No uncontrolled active or chronic infection No active autoimmune disorders or disease No immunosuppression, defined as concurrent or possible requirement for systemic corticosteroids Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 4 weeks after study participation Able to avoid direct contact of the immunization site with the following individuals: Children < 3 years of age Immunocompromised individuals (including those on systemic corticosteroids) Pregnant women Individuals with extensive skin disease No active seizure disorder No skin disease and/or open unhealing wounds No psychiatric illness or social situation that would preclude study compliance No other significant medical illness that would significantly increase the risk associated with immunotherapy No other active malignancy requiring concurrent therapy except squamous cell or basal cell skin cancer or undetectable hormone-responsive prostate cancer (as measured by normal prostate-specific antigen) No other concurrent uncontrolled illness that would preclude study participation No prior fowlpox virus-based therapy No prior B7-1, intercellular adhesion molecule-1 (ICAM-1), or leukocyte function-associated antigen-3 (LFA-3) More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered See Disease Characteristics Concurrent adjuvant hormonal therapy for early-stage or high-risk breast cancer allowed No concurrent corticosteroids More than 2 weeks since prior radiotherapy and recovered More than 2 weeks since prior surgery and recovered No prior splenectomy No concurrent therapeutic anticoagulation therapy that would increase the risk of bleeding from injected lesion No other concurrent immunosuppressive drugs No other concurrent investigational agents No other concurrent anticancer therapy

Sites / Locations

  • University of Chicago

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (recombinant fowlpox-TRICOM vaccine)

Arm Description

Patients receive fowlpox-TRICOM intratumorally on day 1 of weeks 1, 4, and 7 (maximum of 3 injections for a single lesion) (course 1). After 3 injections (course 1), patients with stable or responding disease receive additional injections into new lesions following the same schedule as above. Treatment repeats every 9 weeks for a maximum total of 9 injections (3 injections total into a maximum of 3 different tumors) (total of 3 courses) in the absence of disease progression or unacceptable toxicity

Outcomes

Primary Outcome Measures

Local response defined as complete response (CR), a partial response (PR) stable disease (SD), or progressive disease (PD) in the injected lesion according to RECIST criteria
Overall clinical response (CR or PR) as measured by RECIST criteria

Secondary Outcome Measures

Change in mRNA expression of B7-1, LFA-3, and/or ICAM-1in the tumor microenvironment
Changes in laboratory correlates pre- versus post- treatment will be analyzed using a paired t-test. The association between changes in these measurements and tumor response will be assessed by comparing the changes in responders and non-responders using a Wilcoxon rank-sum test.
Changes in tumor associated T cells
Changes in laboratory correlates pre- versus post- treatment will be analyzed using a paired t-test. The association between changes in these measurements and tumor response will be assessed by comparing the changes in responders and non-responders using a Wilcoxon rank-sum test.
Time to tumor progression
Time to tumor progression will be analyzed by the Kaplan-Meier method.

Full Information

First Posted
July 8, 2004
Last Updated
June 6, 2014
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00087373
Brief Title
Vaccine Therapy in Treating Patients With Metastatic Melanoma
Official Title
Phase II Study of Intratumoral Injection of rF-TRICOMTM in Patients With Metastatic Melanoma Who Have Detectable Tumor Associated T Cells
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Terminated
Study Start Date
June 2004 (undefined)
Primary Completion Date
February 2006 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
Vaccines may make the body build an immune response to kill tumor cells. Injecting a vaccine directly into a tumor may cause a stronger immune response and kill more tumor cells. This phase II trial is studying how well vaccine therapy works in treating patients with metastatic melanoma.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the safety and tolerability of intratumoral fowlpox-TRICOM in patients with metastatic melanoma. II. Determine the local response rate in patients treated with this agent. III. Determine systemic clinical response in patients treated with this agent. SECONDARY OBJECTIVES: I. Determine the increase in transgene expression of B7-1, leukocyte function-associated antigen-3 (LFA-3), and intercellular adhesion molecule-1 (ICAM-1) in patients treated with this agent. II. Determine the effects of this agent on CD8-positive antitumor T-cell frequency as measured by tetramer and ELISpot in patients who are HLA-A2 positive. III. Correlate transgene expression of B7-1, LFA-3, and ICAM-1 by tumor cells with changes in function or number of melanoma antigen-specific CD8-positive T lymphocytes in patients treated with this agent. OUTLINE: This is a multicenter study. Patients receive fowlpox-TRICOM intratumorally on day 1 of weeks 1, 4, and 7 (maximum of 3 injections for a single lesion) (course 1). After 3 injections (course 1), patients with stable or responding disease receive additional injections into new lesions following the same schedule as above. Treatment repeats every 9 weeks for a maximum total of 9 injections (3 injections total into a maximum of 3 different tumors) (total of 3 courses) in the absence of disease progression or unacceptable toxicity. Patients are followed every 3 months until disease progression and then approximately every 6 months for 5-15 years. PROJECTED ACCRUAL: A total of 14-28 patients will be accrued for this study within 14-28 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Melanoma, Stage IV Melanoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment (recombinant fowlpox-TRICOM vaccine)
Arm Type
Experimental
Arm Description
Patients receive fowlpox-TRICOM intratumorally on day 1 of weeks 1, 4, and 7 (maximum of 3 injections for a single lesion) (course 1). After 3 injections (course 1), patients with stable or responding disease receive additional injections into new lesions following the same schedule as above. Treatment repeats every 9 weeks for a maximum total of 9 injections (3 injections total into a maximum of 3 different tumors) (total of 3 courses) in the absence of disease progression or unacceptable toxicity
Intervention Type
Biological
Intervention Name(s)
recombinant fowlpox-TRICOM vaccine
Other Intervention Name(s)
rF-TRICOM (B7.1.iCAM1-LFA3-Fowlpox)
Intervention Description
Given intratumorally
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Local response defined as complete response (CR), a partial response (PR) stable disease (SD), or progressive disease (PD) in the injected lesion according to RECIST criteria
Time Frame
Up to 15 years
Title
Overall clinical response (CR or PR) as measured by RECIST criteria
Time Frame
Up to 15 years
Secondary Outcome Measure Information:
Title
Change in mRNA expression of B7-1, LFA-3, and/or ICAM-1in the tumor microenvironment
Description
Changes in laboratory correlates pre- versus post- treatment will be analyzed using a paired t-test. The association between changes in these measurements and tumor response will be assessed by comparing the changes in responders and non-responders using a Wilcoxon rank-sum test.
Time Frame
Baseline and week 10
Title
Changes in tumor associated T cells
Description
Changes in laboratory correlates pre- versus post- treatment will be analyzed using a paired t-test. The association between changes in these measurements and tumor response will be assessed by comparing the changes in responders and non-responders using a Wilcoxon rank-sum test.
Time Frame
Baseline and week 10
Title
Time to tumor progression
Description
Time to tumor progression will be analyzed by the Kaplan-Meier method.
Time Frame
Up to 15 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed melanoma Stage IV disease Measurable disease At least 1 cutaneous or lymph node mass ≥ 1 cm AND amenable to biopsy and percutaneous injection AND can be accurately measured with standard calipers Must be tested for expression of HLA-A2 prior to study Must have 1 of the following criteria: Circulating melanoma-specific CD8-positive T cells against ≥ 1 defined antigen (Melan-A, gp100 antigen, tyrosinase, MAGE-A10, Trp-2, or NA17) as measured by tetramer or ELISpot directly ex-vivo or after a 10 day in vitro expansion Detectable intratumoral T cells measured in the index lesion that is to be injected with rF-TRICOMTM by immunohistochemistry (IHC) for CD4, CD8 or another T cell marker, or by real time RT-PCR for CD8a, CD4, or other T cell transcripts No untreated or edematous brain metastases or leptomeningeal disease Treated CNS disease allowed provided patient remains stable off corticosteroid therapy Performance status - Karnofsky 70-100% More than 12 weeks WBC ≥ 3,000/mm^3 Platelet count ≥ 100,000/mm^3 No uncontrolled bleeding disorder that would increase the risk of bleeding from the injected lesion No active thrombotic thrombocytopenic purpura within the past 2 years PT/PTT ≤ 1.25 times upper limit of normal (ULN) AST and ALT ≤ 1.5 times ULN Bilirubin ≤ 1.5 times ULN No chronic hepatitis B or C Creatinine ≤ 2.0 mg/dL Creatinine clearance ≥ 60 mL/min No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia HIV negative No prior significant allergic reaction or hypersensitivity to eggs or egg products No disease that limits the function of the spleen (e.g., sickle cell disease) No uncontrolled active or chronic infection No active autoimmune disorders or disease No immunosuppression, defined as concurrent or possible requirement for systemic corticosteroids Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for at least 4 weeks after study participation Able to avoid direct contact of the immunization site with the following individuals: Children < 3 years of age Immunocompromised individuals (including those on systemic corticosteroids) Pregnant women Individuals with extensive skin disease No active seizure disorder No skin disease and/or open unhealing wounds No psychiatric illness or social situation that would preclude study compliance No other significant medical illness that would significantly increase the risk associated with immunotherapy No other active malignancy requiring concurrent therapy except squamous cell or basal cell skin cancer or undetectable hormone-responsive prostate cancer (as measured by normal prostate-specific antigen) No other concurrent uncontrolled illness that would preclude study participation No prior fowlpox virus-based therapy No prior B7-1, intercellular adhesion molecule-1 (ICAM-1), or leukocyte function-associated antigen-3 (LFA-3) More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered See Disease Characteristics Concurrent adjuvant hormonal therapy for early-stage or high-risk breast cancer allowed No concurrent corticosteroids More than 2 weeks since prior radiotherapy and recovered More than 2 weeks since prior surgery and recovered No prior splenectomy No concurrent therapeutic anticoagulation therapy that would increase the risk of bleeding from injected lesion No other concurrent immunosuppressive drugs No other concurrent investigational agents No other concurrent anticancer therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Thomas Gajewski
Organizational Affiliation
University of Chicago
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States

12. IPD Sharing Statement

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Vaccine Therapy in Treating Patients With Metastatic Melanoma

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