Decitabine, Vaccine Therapy, and Pegylated Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Peritoneal Cancer
Primary Purpose
Recurrent Fallopian Tube Cancer, Recurrent Ovarian Epithelial Cancer, Recurrent Primary Peritoneal Cavity Cancer
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
decitabine
NY-ESO-1 peptide vaccine
pegylated liposomal doxorubicin hydrochloride
sargramostim
incomplete Freund's adjuvant
immunohistochemistry staining method
liquid chromatography
mass spectrometry
reverse transcriptase-polymerase chain reaction
laboratory biomarker analysis
DNA methylation analysis
enzyme-linked immunosorbent assay
Sponsored by
About this trial
This is an interventional treatment trial for Recurrent Fallopian Tube Cancer
Eligibility Criteria
Inclusion Criteria:
- Subjects with relapsed epithelial ovarian cancer (including fallopian tube and primary peritoneal cancer) who will receive liposomal doxorubicin as salvage therapy for recurrent disease
- Patients may have received up to four previous lines of chemotherapy
- The relapse may be defined by an increase in CA125; there may or may not be either measurable or symptomatic disease
- Any human leukocyte antigen (HLA) type
- No requirement for tumor expression of NY-ESO-1
- Karnofsky performance status of > 70%
- Not previously treated with doxorubicin
- Life expectancy >= 6 months
- Hematology and biochemistry laboratory results within the limits normally expected for the patient population, without evidence of major organ failure
- No immunodeficiency
- Have been informed of other treatment options
- Able and willing to give valid written informed consent
- Neutrophil count >= 1.5 x 10^9
- Platelet count >= 100 x 10^9
- Serum creatinine =< 2.1 mg/dL
- Serum bilirubin =< 2 mg/dL
- Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.6 x upper limit of normal (ULN) (normal ranges: AST 15-46 U/L; ALT 11-66 U/L)
Exclusion Criteria:
- Metastatic disease to the central nervous system for which other therapeutic options, including radiotherapy, may be available
- Other serious illnesses (e.g., serious infections requiring antibiotics, bleeding disorders)
- History of autoimmune disease (e.g., thyroiditis, lupus) except vitiligo
- Concomitant systemic treatment with corticosteroids, anti-histamine or non-steroidal anti-inflammatory drugs; specific CQX-2 inhibitors are permitted
- Chemotherapy, radiation therapy, or immunotherapy within 4 weeks prior to first dosing of study agent (6 weeks for nitrosoureas)
- Known human immunodeficiency virus (HIV) positivity
- Known allergy or history of life threatening reaction to GM-CSF
- Myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, chest pain or shortness of breath with activity, or other heart conditions being treated by a doctor
- Participation in any other clinical trial involving another investigational agent within 4 weeks prior to first dosing of study agent
- Mental impairment that may compromise the ability to give informed consent and comply with the requirements of the study
- Lack of availability of a patient for immunological and clinical follow-up assessment
Sites / Locations
- Roswell Park Cancer Institute
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Treatment (chemotherapy and vaccine therapy)
Arm Description
Patients receive decitabine IV over 3 hours on day 1, pegylated liposomal doxorubicin hydrochloride IV on day 8, and NY-ESO-1 peptide vaccine emulsified in incomplete Freund's adjuvant and sargramostim subcutaneously on day 15. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Outcomes
Primary Outcome Measures
Toxicity as assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v3.0
Estimated with a one-sided, 95%, Wilson score binomial confidence interval.
Secondary Outcome Measures
NY-ESO-1 specific cellular and humoral immunity as assessed by NY-ESO-1-specific CD8+ and CD4+ T cells and antibodies and frequency of CD4+ CD25+ FOXP3+ regulatory T cells
Will be summarized by quartiles. Also, confidence intervals will be constructed for the median and the mean.
NY-ESO-l expression using Q-RT-PCR and IHC
Time to progression
Summarized by a Kaplan-Meier survival curve.
NY-ESO-l promoter DNA methylation using pyrosequencing
Global genomic DNA methylation using liquid chromatography-mass spectrometry (LC-MS) and LINE-l pyrosequencing
Full Information
NCT ID
NCT01673217
First Posted
August 22, 2012
Last Updated
July 27, 2022
Sponsor
Roswell Park Cancer Institute
Collaborators
Eisai Inc.
1. Study Identification
Unique Protocol Identification Number
NCT01673217
Brief Title
Decitabine, Vaccine Therapy, and Pegylated Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Peritoneal Cancer
Official Title
A Phase I Clinical Trial of NY-ESO-1 Protein Immunization in Combination With 5-AZA-2'-Deoxycytidine (Decitabine) in Patients Receiving Liposomal Doxorubicin for Recurrent Epithelial Ovarian or Primary Peritoneal Carcinoma
Study Type
Interventional
2. Study Status
Record Verification Date
July 2022
Overall Recruitment Status
Completed
Study Start Date
April 2009 (undefined)
Primary Completion Date
October 2011 (Actual)
Study Completion Date
June 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Roswell Park Cancer Institute
Collaborators
Eisai Inc.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This phase I trial is studying the side effects and best dose of decitabine when given together with pegylated liposomal doxorubicin hydrochloride and vaccine therapy in treating patients with recurrent ovarian epithelial cancer, fallopian tube cancer, or peritoneal cancer. Drugs used in chemotherapy, such as decitabine and pegylated liposomal doxorubicin hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Vaccines made from a peptide or antigen may help the body build an effective immune response to kill tumor cells. Giving combination chemotherapy together with vaccine therapy may kill more tumor cells
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the safety of 5-aza-2'-deoxycytidine (decitabine) in combination with immunization with NYESO-I protein mixed with montanide and granulocyte-macrophage colony stimulating factor (GM-CSF) in patients scheduled to receive liposomal doxorubicin for recurrent epithelial ovarian, fallopian tube or primary peritoneal carcinoma.
SECONDARY OBJECTIVES:
I. To evaluate NY-ESO-l specific cellular and humoral immunity by determination of NY-ESO-I specific antibody, CD8+ and CD4+ T-cells following immunization with NY-ESO-l protein mixed with montanide and GM-CSF in combination with 5-aza-2' -deoxycytidine (decitabine) in patients receiving liposomal doxorubicin for recurrent epithelial ovarian, fallopian tube or primary peritoneal carcinoma.
II. To determine the impact of 5-aza-2'-deoxycytidine on NY-ESO-I specific expression, NY-ESO-l promoter methylation, and global DNA methylation.
III. To compare the time to progression (ttp) for the proposed therapy with the ttp for standard therapy (historical studies).
OUTLINE: This is a dose escalation study of decitabine.
Patients receive decitabine intravenously (IV) over 3 hours on day 1, pegylated liposomal doxorubicin hydrochloride IV on day 8, and NY-ESO-1 peptide vaccine emulsified in incomplete Freund's adjuvant and sargramostim subcutaneously on day 15. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 6 months.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Fallopian Tube Cancer, Recurrent Ovarian Epithelial Cancer, Recurrent Primary Peritoneal Cavity Cancer
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
18 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Treatment (chemotherapy and vaccine therapy)
Arm Type
Experimental
Arm Description
Patients receive decitabine IV over 3 hours on day 1, pegylated liposomal doxorubicin hydrochloride IV on day 8, and NY-ESO-1 peptide vaccine emulsified in incomplete Freund's adjuvant and sargramostim subcutaneously on day 15. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
decitabine
Other Intervention Name(s)
5-aza-dCyd, 5AZA, DAC
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
NY-ESO-1 peptide vaccine
Other Intervention Name(s)
ESO-1 Peptide Vaccine
Intervention Description
Given SC
Intervention Type
Drug
Intervention Name(s)
pegylated liposomal doxorubicin hydrochloride
Other Intervention Name(s)
CAELYX, Dox-SL, DOXIL, doxorubicin hydrochloride liposome, LipoDox
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
sargramostim
Other Intervention Name(s)
GM-CSF, Leukine, Prokine
Intervention Description
Given SC
Intervention Type
Biological
Intervention Name(s)
incomplete Freund's adjuvant
Other Intervention Name(s)
IFA, ISA-51, Montanide ISA 51
Intervention Description
Given SC
Intervention Type
Other
Intervention Name(s)
immunohistochemistry staining method
Other Intervention Name(s)
immunohistochemistry
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
liquid chromatography
Other Intervention Name(s)
LC
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
mass spectrometry
Intervention Description
Correlative studies
Intervention Type
Genetic
Intervention Name(s)
reverse transcriptase-polymerase chain reaction
Other Intervention Name(s)
RT-PCR
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Intervention Type
Genetic
Intervention Name(s)
DNA methylation analysis
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
enzyme-linked immunosorbent assay
Other Intervention Name(s)
ELISA
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Toxicity as assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v3.0
Description
Estimated with a one-sided, 95%, Wilson score binomial confidence interval.
Time Frame
Up to 6 months
Secondary Outcome Measure Information:
Title
NY-ESO-1 specific cellular and humoral immunity as assessed by NY-ESO-1-specific CD8+ and CD4+ T cells and antibodies and frequency of CD4+ CD25+ FOXP3+ regulatory T cells
Description
Will be summarized by quartiles. Also, confidence intervals will be constructed for the median and the mean.
Time Frame
Up to 6 months
Title
NY-ESO-l expression using Q-RT-PCR and IHC
Time Frame
Days 1, 8, 15, 36, 43, 64, 71, 92, and 99
Title
Time to progression
Description
Summarized by a Kaplan-Meier survival curve.
Time Frame
Up to 6 months
Title
NY-ESO-l promoter DNA methylation using pyrosequencing
Time Frame
Days 1, 8, 15, 36, 43, 64, 71, 92, and 99
Title
Global genomic DNA methylation using liquid chromatography-mass spectrometry (LC-MS) and LINE-l pyrosequencing
Time Frame
Days 1, 8, 15, 36, 43, 64, 71, 92, and 99
10. Eligibility
Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Subjects with relapsed epithelial ovarian cancer (including fallopian tube and primary peritoneal cancer) who will receive liposomal doxorubicin as salvage therapy for recurrent disease
Patients may have received up to four previous lines of chemotherapy
The relapse may be defined by an increase in CA125; there may or may not be either measurable or symptomatic disease
Any human leukocyte antigen (HLA) type
No requirement for tumor expression of NY-ESO-1
Karnofsky performance status of > 70%
Not previously treated with doxorubicin
Life expectancy >= 6 months
Hematology and biochemistry laboratory results within the limits normally expected for the patient population, without evidence of major organ failure
No immunodeficiency
Have been informed of other treatment options
Able and willing to give valid written informed consent
Neutrophil count >= 1.5 x 10^9
Platelet count >= 100 x 10^9
Serum creatinine =< 2.1 mg/dL
Serum bilirubin =< 2 mg/dL
Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.6 x upper limit of normal (ULN) (normal ranges: AST 15-46 U/L; ALT 11-66 U/L)
Exclusion Criteria:
Metastatic disease to the central nervous system for which other therapeutic options, including radiotherapy, may be available
Other serious illnesses (e.g., serious infections requiring antibiotics, bleeding disorders)
History of autoimmune disease (e.g., thyroiditis, lupus) except vitiligo
Concomitant systemic treatment with corticosteroids, anti-histamine or non-steroidal anti-inflammatory drugs; specific CQX-2 inhibitors are permitted
Chemotherapy, radiation therapy, or immunotherapy within 4 weeks prior to first dosing of study agent (6 weeks for nitrosoureas)
Known human immunodeficiency virus (HIV) positivity
Known allergy or history of life threatening reaction to GM-CSF
Myocardial infarction, angina, congestive heart failure, cardiomyopathy, stroke or transient ischemic attack, chest pain or shortness of breath with activity, or other heart conditions being treated by a doctor
Participation in any other clinical trial involving another investigational agent within 4 weeks prior to first dosing of study agent
Mental impairment that may compromise the ability to give informed consent and comply with the requirements of the study
Lack of availability of a patient for immunological and clinical follow-up assessment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kunle Odunsi
Organizational Affiliation
Roswell Park Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Roswell Park Cancer Institute
City
Buffalo
State/Province
New York
ZIP/Postal Code
14263
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Decitabine, Vaccine Therapy, and Pegylated Liposomal Doxorubicin Hydrochloride in Treating Patients With Recurrent Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Peritoneal Cancer
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