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Bevacizumab, Autologous Tumor/DC Vaccine, IL-2 and IFNα-2b in Metastatic Renal Cell Carcinoma (RCC) Patients

Primary Purpose

Metastatic Renal Cell Carcinoma

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
DC vaccine
Bevacizumab
IL-2
IFN
Sponsored by
Dartmouth-Hitchcock Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Renal Cell Carcinoma focused on measuring Renal Cell Carcinoma

Eligibility Criteria

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

Inclusion Criteria:

  1. Histologically confirmed metastatic renal cell carcinoma with measurable disease.
  2. Adequate tumor tissue properly stored and available to produce lysate for a minimum of three vaccine preparations.
  3. Patients must be at least 4 weeks from their last therapy (tyrosine kinase inhibitors, immunotherapy, radiation, surgery or chemotherapy (6 weeks for nitrosureas) and recovered from all ill effects.
  4. Have measurable disease.
  5. Patients must be at least 4 weeks from major surgery, 1 week from minor surgery, and recovered from all ill effects.
  6. Karnofsky Performance Status ≥80%.
  7. Adequate end organ function:
  8. Women should not be lactating and, if of childbearing age, have a negative pregnancy test within two weeks of entry to the study.
  9. Appropriate contraception in both genders.
  10. The patient must be competent and have signed informed consent.
  11. Patients may have received one prior therapy with targeted therapies (e.g. sorafenib and sunitinib).

Exclusion Criteria:

  1. Patients who have previously received bevacizumab or IL-2 are not eligible.
  2. Concomitant second malignancy except for non-melanoma skin cancer, and non-invasive cancer such as cervical CIS, superficial bladder cancer without local recurrence or breast CIS.
  3. In patients with a prior history of invasive malignancy, less than five years in complete remission.
  4. Positive serology for HIV, hepatitis B or hepatitis C which should be confirmed with antigenemia.
  5. Significant co-morbid illness such as uncontrolled diabetes or active infection that would preclude treatment on this regimen.
  6. Use of corticosteroids or other immunosuppression (if patient had been taking steroids, at least 2 weeks must have passed since the last dose). Inhaled steroids > 1000mcg beclomethasone per day or its equivalent.
  7. History of inflammatory bowel disease or other serious autoimmune disease. (Not including thyroiditis and rheumatoid arthritis).
  8. Patients with organ allografts.
  9. Uncontrolled hypertension (BP >150/100 mmHg).
  10. Proteinuria dipstick > 3+ or > 2gm/24 hours, or a urine protein:creatinine ratio > 1.0 at screening.
  11. Major surgery, open biopsy, significant traumatic injury within 28 days of starting treatment or anticipation of need for major surgical procedure during the course of the study.
  12. Minor surgical procedures, fine needle aspirations or core biopsies within 7 days prior to starting treatment. Central venous catheter placements are permitted.
  13. History of abdominal fistula, gastrointestinal perforation, or intrabdominal abscess within 6 months prior to starting treatment.
  14. Serious, non-healing wound, ulcer, or bone fracture.
  15. History of tumor-related or other serious hemorrhage, bleeding diathesis, or underlying coagulopathy.
  16. History of deep venous thrombosis, or other thrombotic event within the past six months or clinically significant peripheral vascular disease.
  17. Inability to comply with study and/or follow-up procedures.

Sites / Locations

  • Dartmouth-Hitchcock Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

bevacizumab,IL-2, IFN, DC vaccine

Arm Description

Patients will be dosed with bevacizumab (10mg/kg) intravenously every two weeks beginning four weeks prior to the first vaccine. Each treatment week includes ultrasound guided intranodal DC-vaccine injection (1 X 107 cells/1mL), followed by 5 days of continuous intravenous infusion of IL-2 (18 MiU/m2), and three subcutaneous injections of IFNa-2b (6 MiU) (every other day)

Outcomes

Primary Outcome Measures

Progression Free Survival
median progression free survival

Secondary Outcome Measures

To Characterize the Number of Participants With Clinical and Autoimune Related Toxicity of Treatment
To characterize the clinical and autoimmune related toxicity profile of the combined treatment regimen using CTCAE 3. Toxicity reported are those expected from high dose IL-2 and were not considered adverse events.

Full Information

First Posted
June 2, 2009
Last Updated
October 28, 2015
Sponsor
Dartmouth-Hitchcock Medical Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00913913
Brief Title
Bevacizumab, Autologous Tumor/DC Vaccine, IL-2 and IFNα-2b in Metastatic Renal Cell Carcinoma (RCC) Patients
Official Title
A Phase II Study of VEGF Blockade With Bevacizumab Combined With Autologous Tumor/Dendritic Cell Vaccine (DC Vaccine), Interleukin-2 (IL-2) and Interferon-α-2b (IFNα-2b) in Patients With Metastatic Renal Cell Carcinoma (RCC)
Study Type
Interventional

2. Study Status

Record Verification Date
February 2014
Overall Recruitment Status
Terminated
Why Stopped
low accrual not allowing site to meeting statistical endpoints
Study Start Date
February 2009 (undefined)
Primary Completion Date
January 2013 (Actual)
Study Completion Date
January 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Dartmouth-Hitchcock Medical Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Immune therapies, such as a IL-2, for metastatic renal cell carcinoma (mRCC) are designed to mobilize immune effector cells that recognize and destroy cancer. The investigators have recently observed a 50% objective response rate (16% CR) in mRCC patients treated with autologous tumor lysate -dendritic cell (DC)-vaccine, IL-2 and interferon alfa (IFN). New agents inhibiting vascular endothelial growth factor (VEGF) pathways have demonstrated significant benefit in mRCC patients as well, but rarely induce CRs. High blood VEGF is associated with poor response to IL-2 and can cause tumor specific immune dysregulation. To test whether complementary mechanisms of immune activation and disruption of regulatory pathways enhance outcome the investigators plan to treat 24 mRCC patients in a phase II trial using bevacizumab, DC vaccine, IL-2, and IFN. Observations from this project will be used in the development of novel cancer therapies which, if successful, will decrease the burden of cancer on the public. The investigators propose to determine 1) the objective clinical response rate to treatment and progression free survival, 2) the clinical and autoimmune related toxicity profile of therapy, and 3) the treatment related tumor-specific immune response and the relationship of tumor-specific immune response and objective clinical response.
Detailed Description
All eligible patients will receive a total of five treatment weeks, each consisting of approximately 5 days. Prior to therapy, patients will undergo apheresis for DC preparation. DC-Tumor vaccines will be frozen in 90% pooled human AB serum/ 10% DMSO to be used for treatment Patients will be dosed with bevacizumab (10mg/kg, Genentech) intravenously every two weeks beginning four weeks prior to the first vaccine. Each treatment week includes ultrasound guided intranodal DC-vaccine injection (1 X 107 cells/1mL), followed by 5 days of continuous intravenous infusion of IL-2 (18 MiU/m2, Novartis), and three subcutaneous injections of IFNa-2b (6 MiU, Schering -Plough Corp.) (every other day). The first two treatment weeks, the induction phase, will be separated by a 9 day rest. Three additional treatment weeks, the maintenance phase, will be separated by 23 rest days.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Renal Cell Carcinoma
Keywords
Renal Cell Carcinoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
bevacizumab,IL-2, IFN, DC vaccine
Arm Type
Experimental
Arm Description
Patients will be dosed with bevacizumab (10mg/kg) intravenously every two weeks beginning four weeks prior to the first vaccine. Each treatment week includes ultrasound guided intranodal DC-vaccine injection (1 X 107 cells/1mL), followed by 5 days of continuous intravenous infusion of IL-2 (18 MiU/m2), and three subcutaneous injections of IFNa-2b (6 MiU) (every other day)
Intervention Type
Biological
Intervention Name(s)
DC vaccine
Intervention Description
DC Vaccine therapy 10E7 intranodally every cycle
Intervention Type
Drug
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Avastin
Intervention Description
Bevacizumab 10mg/kg iv every 2 weeks
Intervention Type
Biological
Intervention Name(s)
IL-2
Intervention Description
IL-2 18 MiU/m2 CI 5 days
Intervention Type
Biological
Intervention Name(s)
IFN
Intervention Description
IFN 6 MiU subc TIW
Primary Outcome Measure Information:
Title
Progression Free Survival
Description
median progression free survival
Time Frame
5 years
Secondary Outcome Measure Information:
Title
To Characterize the Number of Participants With Clinical and Autoimune Related Toxicity of Treatment
Description
To characterize the clinical and autoimmune related toxicity profile of the combined treatment regimen using CTCAE 3. Toxicity reported are those expected from high dose IL-2 and were not considered adverse events.
Time Frame
5 years
Other Pre-specified Outcome Measures:
Title
Measure of Percent of CD4 and CD8 Lymphocyte Subsets
Description
percent of CD4 and CD8 positive lymphocyte subsets
Time Frame
Baseline, day 28, day 70
Title
Clinical Response
Description
clinical response by RECIST 1.1
Time Frame
Day 70

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed metastatic renal cell carcinoma with measurable disease. Adequate tumor tissue properly stored and available to produce lysate for a minimum of three vaccine preparations. Patients must be at least 4 weeks from their last therapy (tyrosine kinase inhibitors, immunotherapy, radiation, surgery or chemotherapy (6 weeks for nitrosureas) and recovered from all ill effects. Have measurable disease. Patients must be at least 4 weeks from major surgery, 1 week from minor surgery, and recovered from all ill effects. Karnofsky Performance Status ≥80%. Adequate end organ function: Women should not be lactating and, if of childbearing age, have a negative pregnancy test within two weeks of entry to the study. Appropriate contraception in both genders. The patient must be competent and have signed informed consent. Patients may have received one prior therapy with targeted therapies (e.g. sorafenib and sunitinib). Exclusion Criteria: Patients who have previously received bevacizumab or IL-2 are not eligible. Concomitant second malignancy except for non-melanoma skin cancer, and non-invasive cancer such as cervical CIS, superficial bladder cancer without local recurrence or breast CIS. In patients with a prior history of invasive malignancy, less than five years in complete remission. Positive serology for HIV, hepatitis B or hepatitis C which should be confirmed with antigenemia. Significant co-morbid illness such as uncontrolled diabetes or active infection that would preclude treatment on this regimen. Use of corticosteroids or other immunosuppression (if patient had been taking steroids, at least 2 weeks must have passed since the last dose). Inhaled steroids > 1000mcg beclomethasone per day or its equivalent. History of inflammatory bowel disease or other serious autoimmune disease. (Not including thyroiditis and rheumatoid arthritis). Patients with organ allografts. Uncontrolled hypertension (BP >150/100 mmHg). Proteinuria dipstick > 3+ or > 2gm/24 hours, or a urine protein:creatinine ratio > 1.0 at screening. Major surgery, open biopsy, significant traumatic injury within 28 days of starting treatment or anticipation of need for major surgical procedure during the course of the study. Minor surgical procedures, fine needle aspirations or core biopsies within 7 days prior to starting treatment. Central venous catheter placements are permitted. History of abdominal fistula, gastrointestinal perforation, or intrabdominal abscess within 6 months prior to starting treatment. Serious, non-healing wound, ulcer, or bone fracture. History of tumor-related or other serious hemorrhage, bleeding diathesis, or underlying coagulopathy. History of deep venous thrombosis, or other thrombotic event within the past six months or clinically significant peripheral vascular disease. Inability to comply with study and/or follow-up procedures.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc S Ernstoff, MD
Organizational Affiliation
Dartmouth-Hitchcock Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dartmouth-Hitchcock Medical Center
City
Lebanon
State/Province
New Hampshire
ZIP/Postal Code
03756
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
17255302
Citation
Ernstoff MS, Crocenzi TS, Seigne JD, Crosby NA, Cole BF, Fisher JL, Uhlenhake JC, Mellinger D, Foster C, Farnham CJ, Mackay K, Szczepiorkowski ZM, Webber SM, Schned AR, Harris RD, Barth RJ Jr, Heaney JA, Noelle RJ. Developing a rational tumor vaccine therapy for renal cell carcinoma: immune yin and yang. Clin Cancer Res. 2007 Jan 15;13(2 Pt 2):733s-740s. doi: 10.1158/1078-0432.CCR-06-2064.
Results Reference
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Learn more about this trial

Bevacizumab, Autologous Tumor/DC Vaccine, IL-2 and IFNα-2b in Metastatic Renal Cell Carcinoma (RCC) Patients

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