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Pilot Study of SBRT and CDX-1127 in Prostate Cancer (Prostate-04)

Primary Purpose

Prostatic Neoplasms, Prostate Cancer

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
CDX1127
SBRT
Sponsored by
James Larner, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostatic Neoplasms

Eligibility Criteria

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

MAIN INCLUSION CRITERIA

Males, Age ≥ 18 years.

Participants must have histologically-proven prostrate adenocarcinoma that is castrate-resistant. Progressive disease is defined by one or more of the following:

  • A rise in PSA on two successive determinations at least one week apart and PSA level ≥2ng/ml.
  • Soft-tissue progression defined by RECIST 1.1.
  • Bone disease progression defined by PCWG2 with two or more new lesions on bone scan.

Patients must have castrate levels of testosterone (<50 ng/dl [1.74 nmol/l]).

Patients must have undergone orchiectomy, or have been on LHRH agonists or antagonists, for at least 3 months prior to drug initiation. Patients on LHRH agonists/antagonists must remain on these agents for the duration of the study.

Clinical metastases must be present and confirmed on imaging studies.

Participants for whom radiation therapy is recommended for the prostate gland (or prostate bed nodule) and/or bone or soft tissue metastases.

SBRT may be administered to 1-4 sites and the treatment sites can include prostate gland (or prostate bed nodule for post-prostatectomy patients), bone metastases, and soft tissue metastases. Participants must have at least one site of disease that will be both irradiated with SBRT and biopsied to evaluate immunological outcomes.

ECOG performance status 0-2.

Adequate hepatic and renal function.

MAIN EXCLUSION CRITERIA

Prior malignancies, that will affect the completion and interpretation of the study.

Patients with active CNS metastases from prostate cancer.

Patients who are currently receiving systemic cytotoxic chemotherapy, radiation, or other experimental therapy, or who have received this therapy within the preceding 4 weeks. Patients who are currently receiving nitrosoureas or who have received this therapy within the preceding 6 weeks are excluded.

Patients who are currently receiving systemic cytotoxic chemotherapy, radiation, or other experimental therapy, or who have received this therapy within the preceding 4 weeks.

Major surgery within 4 weeks prior to the start of study treatment.

Patients who are receiving or have previously been treated CDX-1127.

HIV positivity

Evidence of active Hepatitis B virus or Hepatitis C virus.

Patients receiving the following medications at study entry or within the preceding 4 weeks (or longer, if otherwise specified) are excluded:

  1. Checkpoint inhibitors (within the preceding12 weeks)
  2. Allergy desensitization injections
  3. Systemic corticosteroids of more than 10 mg per day of prednisone (or equivalent), administered parenterally or orally, except for physiologic replacement. Inhaled steroids (e.g. Advair®, Flovent®, Azmacort®) are not permitted. Topical corticosteroids are acceptable, including steroids with very low solubility administered nasally for local effects only (e.g. Nasonex®)
  4. Any growth factors (e.g. GM-CSF, G-CSF, erythropoietin).
  5. Interferon or interleukin therapy
  6. Other Agents with putative immunomodulating activity. (e.g. sipuleucel-T (Provenge ®))

Other investigational drugs or investigational therapy if the patient is currently taking those drugs/therapy, or if they have received the drugs/therapy within 4 weeks prior to the start of study treatment.

Participants must not have had prior autoimmune disorders requiring cytotoxic or immunosuppressive therapy, or autoimmune disorders with visceral involvement.

Significant cardiovascular disease.

Active bleeding disorders or evidence of chronic or acute disseminated intravascular coagulation (DIC).

Concomitant therapeutic anticoagulation (i.e., warfarin) for reasons other than venous catheter patency.

Sites / Locations

  • University of Virginia

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Arm A: CDX1127 & SBRT Concurrent

Arm B: CDX1127 & SBRT Sequential; CDX1127 upfront

Arm C: CDX1127 & SBRT Sequential; SBRT upfront

Arm Description

SBRT will be administered to the primary tumor and/or site of metastatic disease over a period of 5 days (Days 1-5) at a constant dose for 1-4 sites of prostate cancer involvement:30 Gy in 5 fractions of 6 Gy each for prostate gland; 25 Gy in 5 fractions for bone and/or soft tissue metastases). Subjects will receive four doses of CDX-1127(3 mg/kg) (Days 1, 43, 64, 85). The study drug will be administered intravenously over a 90-minute time period and will be followed by a 2-hour observation period. A subject's dose of CDX-1127 will be calculated based on their actual body weight at the time of screening. A subject's dose of CDX-1127 will remain constant at each time point, unless they experience a greater than 10% change in body weight.

SBRT will be administered to the primary tumor and/or sites of metastatic disease over a period of 5 days (Days 22-26) at a constant dose for 1-4 sites of prostate cancer involvement:30 Gy in 5 fractions of 6 Gy each for prostate gland; 25 Gy in 5 fractions for bone and/or soft tissue metastases). Subjects will receive four doses of CDX-1127(3 mg/kg) (Days 1, 43, 64, 85). The study drug will be administered intravenously over a 90-minute time period and will be followed by a 2-hour observation period. A subject's dose of CDX-1127 will be calculated based on their actual body weight at the time of screening. A subject's dose of CDX-1127 will remain constant at each time point, unless they experience a greater than 10% change in body weight.

SBRT will be administered to the primary tumor and/or sites of metastatic disease over a period of 5 days (Days 1-5) at a constant dose for 1-4 sites of prostate cancer involvement:30 Gy in 5 fractions of 6 Gy each for prostate gland; 25 Gy in 5 fractions for bone and/or soft tissue metastases). Subjects will receive four doses of CDX-1127(3 mg/kg) (Days 22, 43, 64, 85). The study drug will be administered intravenously over a 90-minute time period and will be followed by a 2-hour observation period. A subject's dose of CDX-1127 will be calculated based on their actual body weight at the time of screening. A subject's dose of CDX-1127 will remain constant at each time point, unless they experience a greater than 10% change in body weight.

Outcomes

Primary Outcome Measures

Number of adverse events
Immunologic (CD8+ T cell and T regulatory cell (Treg) infiltration)
• Estimate the effect of SBRT, CDX-1127 and the combination of SBRT and CDX- 1127 on CD8+ T cell and T regulatory cell (Treg) infiltration in prostate tumors.

Secondary Outcome Measures

Immunologic (lymphocyte composition of blood over time).
• Estimate the effect of SBRT, CDX-1127, and the combination of SBRT and CDX-1127 on the lymphocyte composition of blood over time.

Full Information

First Posted
October 29, 2014
Last Updated
May 16, 2018
Sponsor
James Larner, MD
Collaborators
Celldex Therapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT02284971
Brief Title
Pilot Study of SBRT and CDX-1127 in Prostate Cancer
Acronym
Prostate-04
Official Title
A Pilot Study to Assess the Combination of Stereotactic Body Radiation Therapy and CDX-1127 in Modulating Local and Systemic T-cell Responses Against Prostate Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
May 2018
Overall Recruitment Status
Terminated
Why Stopped
Low accruals
Study Start Date
November 2014 (undefined)
Primary Completion Date
April 7, 2016 (Actual)
Study Completion Date
April 7, 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
James Larner, MD
Collaborators
Celldex Therapeutics

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study evaluates the combination of stereotactic body radiation therapy (SBRT) and CDX-1127 in subjects with castration resistant prostate cancer. Subjects will be randomized to one of three arms to receive SBRT prior to, after, or in conjunction with the first dose of CDX-1127.
Detailed Description
This pilot study will be conducted in subjects with metastatic prostate cancer in order to define whether inclusion of immune regulation agents such as CDX-1127 augments immune responses to SBRT-treated primary tumors or metastases, and whether inclusion of CDX-1127 in the treatment regimen results in immune responses in untreated metastases.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostatic Neoplasms, Prostate Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
2 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A: CDX1127 & SBRT Concurrent
Arm Type
Experimental
Arm Description
SBRT will be administered to the primary tumor and/or site of metastatic disease over a period of 5 days (Days 1-5) at a constant dose for 1-4 sites of prostate cancer involvement:30 Gy in 5 fractions of 6 Gy each for prostate gland; 25 Gy in 5 fractions for bone and/or soft tissue metastases). Subjects will receive four doses of CDX-1127(3 mg/kg) (Days 1, 43, 64, 85). The study drug will be administered intravenously over a 90-minute time period and will be followed by a 2-hour observation period. A subject's dose of CDX-1127 will be calculated based on their actual body weight at the time of screening. A subject's dose of CDX-1127 will remain constant at each time point, unless they experience a greater than 10% change in body weight.
Arm Title
Arm B: CDX1127 & SBRT Sequential; CDX1127 upfront
Arm Type
Experimental
Arm Description
SBRT will be administered to the primary tumor and/or sites of metastatic disease over a period of 5 days (Days 22-26) at a constant dose for 1-4 sites of prostate cancer involvement:30 Gy in 5 fractions of 6 Gy each for prostate gland; 25 Gy in 5 fractions for bone and/or soft tissue metastases). Subjects will receive four doses of CDX-1127(3 mg/kg) (Days 1, 43, 64, 85). The study drug will be administered intravenously over a 90-minute time period and will be followed by a 2-hour observation period. A subject's dose of CDX-1127 will be calculated based on their actual body weight at the time of screening. A subject's dose of CDX-1127 will remain constant at each time point, unless they experience a greater than 10% change in body weight.
Arm Title
Arm C: CDX1127 & SBRT Sequential; SBRT upfront
Arm Type
Experimental
Arm Description
SBRT will be administered to the primary tumor and/or sites of metastatic disease over a period of 5 days (Days 1-5) at a constant dose for 1-4 sites of prostate cancer involvement:30 Gy in 5 fractions of 6 Gy each for prostate gland; 25 Gy in 5 fractions for bone and/or soft tissue metastases). Subjects will receive four doses of CDX-1127(3 mg/kg) (Days 22, 43, 64, 85). The study drug will be administered intravenously over a 90-minute time period and will be followed by a 2-hour observation period. A subject's dose of CDX-1127 will be calculated based on their actual body weight at the time of screening. A subject's dose of CDX-1127 will remain constant at each time point, unless they experience a greater than 10% change in body weight.
Intervention Type
Biological
Intervention Name(s)
CDX1127
Other Intervention Name(s)
Varlilumab
Intervention Type
Radiation
Intervention Name(s)
SBRT
Primary Outcome Measure Information:
Title
Number of adverse events
Time Frame
Up to day 270
Title
Immunologic (CD8+ T cell and T regulatory cell (Treg) infiltration)
Description
• Estimate the effect of SBRT, CDX-1127 and the combination of SBRT and CDX- 1127 on CD8+ T cell and T regulatory cell (Treg) infiltration in prostate tumors.
Time Frame
Up to day 43
Secondary Outcome Measure Information:
Title
Immunologic (lymphocyte composition of blood over time).
Description
• Estimate the effect of SBRT, CDX-1127, and the combination of SBRT and CDX-1127 on the lymphocyte composition of blood over time.
Time Frame
Up to day 270

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
MAIN INCLUSION CRITERIA Males, Age ≥ 18 years. Participants must have histologically-proven prostrate adenocarcinoma that is castrate-resistant. Progressive disease is defined by one or more of the following: A rise in PSA on two successive determinations at least one week apart and PSA level ≥2ng/ml. Soft-tissue progression defined by RECIST 1.1. Bone disease progression defined by PCWG2 with two or more new lesions on bone scan. Patients must have castrate levels of testosterone (<50 ng/dl [1.74 nmol/l]). Patients must have undergone orchiectomy, or have been on LHRH agonists or antagonists, for at least 3 months prior to drug initiation. Patients on LHRH agonists/antagonists must remain on these agents for the duration of the study. Clinical metastases must be present and confirmed on imaging studies. Participants for whom radiation therapy is recommended for the prostate gland (or prostate bed nodule) and/or bone or soft tissue metastases. SBRT may be administered to 1-4 sites and the treatment sites can include prostate gland (or prostate bed nodule for post-prostatectomy patients), bone metastases, and soft tissue metastases. Participants must have at least one site of disease that will be both irradiated with SBRT and biopsied to evaluate immunological outcomes. ECOG performance status 0-2. Adequate hepatic and renal function. MAIN EXCLUSION CRITERIA Prior malignancies, that will affect the completion and interpretation of the study. Patients with active CNS metastases from prostate cancer. Patients who are currently receiving systemic cytotoxic chemotherapy, radiation, or other experimental therapy, or who have received this therapy within the preceding 4 weeks. Patients who are currently receiving nitrosoureas or who have received this therapy within the preceding 6 weeks are excluded. Patients who are currently receiving systemic cytotoxic chemotherapy, radiation, or other experimental therapy, or who have received this therapy within the preceding 4 weeks. Major surgery within 4 weeks prior to the start of study treatment. Patients who are receiving or have previously been treated CDX-1127. HIV positivity Evidence of active Hepatitis B virus or Hepatitis C virus. Patients receiving the following medications at study entry or within the preceding 4 weeks (or longer, if otherwise specified) are excluded: Checkpoint inhibitors (within the preceding12 weeks) Allergy desensitization injections Systemic corticosteroids of more than 10 mg per day of prednisone (or equivalent), administered parenterally or orally, except for physiologic replacement. Inhaled steroids (e.g. Advair®, Flovent®, Azmacort®) are not permitted. Topical corticosteroids are acceptable, including steroids with very low solubility administered nasally for local effects only (e.g. Nasonex®) Any growth factors (e.g. GM-CSF, G-CSF, erythropoietin). Interferon or interleukin therapy Other Agents with putative immunomodulating activity. (e.g. sipuleucel-T (Provenge ®)) Other investigational drugs or investigational therapy if the patient is currently taking those drugs/therapy, or if they have received the drugs/therapy within 4 weeks prior to the start of study treatment. Participants must not have had prior autoimmune disorders requiring cytotoxic or immunosuppressive therapy, or autoimmune disorders with visceral involvement. Significant cardiovascular disease. Active bleeding disorders or evidence of chronic or acute disseminated intravascular coagulation (DIC). Concomitant therapeutic anticoagulation (i.e., warfarin) for reasons other than venous catheter patency.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James Larner, MD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States

12. IPD Sharing Statement

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Pilot Study of SBRT and CDX-1127 in Prostate Cancer

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