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Vaccine Therapy for the Treatment of Newly Diagnosed Glioblastoma Multiforme (ATTAC-II)

Primary Purpose

Glioblastoma Multiforme, Glioblastoma, Malignant Glioma

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
pp65-shLAMP DC with GM-CSF
unpulsed PBMC and saline
Td
Saline
pp65-flLAMP DC with GM-CSF
Sponsored by
Immunomic Therapeutics, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma Multiforme

Eligibility Criteria

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

Abbreviated Inclusion Criteria:

To be assessed at study enrollment prior to standard of care chemo-radiation therapy:

  • Age ≥ 18 years.
  • Histopathologically proven newly-diagnosed de novo GBM (WHO Grade IV glioma)
  • The tumor must have a supratentorial component.
  • Must have undergone definitive surgical resection of tumor with less than approximately 3cm x 3cm residual enhancing tumor as product of longest perpendicular planes by MRI.
  • Recovery from the effects of surgery, postoperative infection, and other complications.
  • Diagnostic contrast-enhanced MRI or CT scan of the brain preoperatively and postoperatively.
  • Karnofsky Performance Status of ≥ 70.
  • Signed informed consent.
  • For females of childbearing potential, negative serum pregnancy test.
  • Women of childbearing potential and male participants must be willing to practice adequate contraception throughout the study and for at least 24 weeks after the last dose of study drug.

To be assessed prior to initiation of adjuvant TMZ:

  • Must have completed RT (targeted total dose of 59.4-60.0 Gy over ≤ 7 weeks) and concomitant TMZ (targeted dose of 75mg/m2/d for ≤ 49 days) therapy without significant toxicity that persisted over 4 weeks.
  • History & physical with neurologic examination prior to initiation of adjuvant TMZ.
  • For patients receiving steroids, daily dose must be ≤ 4 mg.
  • CBC with differential with adequate bone marrow function.
  • Adequate renal function.
  • Adequate hepatic function.

Abbreviated Exclusion Criteria:

To be verified in order to randomize subject:

  • Prior invasive malignancy unless disease free for ≥ 3 years.
  • Metastases detected below the tentorium or beyond the cranial vault and leptomeningeal involvement.
  • Recurrent or multifocal malignant gliomas.
  • HIV, Hepatitis B, or Hepatitis C seropositive.
  • Known active infection or immunosuppressive disease.
  • Prior chemotherapy or radiosensitizers (including Gliadel wafers) for cancers of the head and neck region.
  • Prior radiotherapy to the head or neck, resulting in overlap of radiation fields.
  • Severe, active co-morbidity.
  • Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception for the entire study period.
  • Pregnant or lactating women.
  • Prior allergic reaction to temozolomide, GM-CSF or Td.
  • Prior history of brachial neuritis or Guillain-Barré syndrome.
  • Patients treated on any other therapeutic clinical protocols within 30 days prior to study entry.

To be assessed prior to initiation of adjuvant TMZ:

  • Did not start radiation therapy and temozolomide within 7 weeks of surgery.
  • Progression of disease as defined by modified RANO criteria.
  • More than 45 days after completion of radiation therapy and temozolomide

Sites / Locations

  • University of Florida
  • Orlando Health
  • Duke University Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Placebo Comparator

Arm Label

pp65-shLAMP DC with GM-CSF and Td

pp65-flLAMP DC with GM-CSF and Td

unpulsed PBMC and Saline

Arm Description

Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.

Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.

Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Change in median overall survival

Secondary Outcome Measures

Changes in immune response
Parameters include ELISPOT for evaluation of cellular immune responses is a sensitive detection assay for evaluation of antigen specific cytokine producing T cells
Change in progression-free survival
Changes in immune response
Parameters include peak antibody titers to the CMV pp65, reported as humoral response to the specific antigens.
Changes in immune response
Parameters include Cytokine Bead Array analysis to detect multiple cytokines secreted by lymphocytes after in vitro stimulation with specific and control antigens, examine the spectrum of Type 0,1,2, and 3 cytokines secreted by T cells after stimulation with overlapping peptides spanning CMV pp65, PHA, and control peptides
Changes in immune response
Parameters include cytokine flow cytometric analysis which involves the rapid early detection and analysis of the production of IFN, TNF, and IL-2 prior to cellular secretion following antigen-specific stimulation in vitro as determined by CFC

Full Information

First Posted
May 27, 2015
Last Updated
September 15, 2023
Sponsor
Immunomic Therapeutics, Inc.
Collaborators
University of Florida, National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02465268
Brief Title
Vaccine Therapy for the Treatment of Newly Diagnosed Glioblastoma Multiforme
Acronym
ATTAC-II
Official Title
A Phase II Randomized, Blinded, and Placebo-controlled Trial of CMV RNA-Pulsed Dendritic Cells With Tetanus-Diphtheria Toxoid Vaccine in Patients With Newly-Diagnosed Glioblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 2016 (undefined)
Primary Completion Date
September 1, 2024 (Anticipated)
Study Completion Date
September 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Immunomic Therapeutics, Inc.
Collaborators
University of Florida, National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this research study is to determine if an investigational dendritic cell vaccine, called pp65 DC, is effective for the treatment of a specific type of brain tumor called glioblastoma (GBM) when given with stronger doses of routine chemotherapy.
Detailed Description
Dendritic cells (DC) are involved in activating, or turning-on, your body's immune system. Your immune system helps guard your body from germs, viruses, and other threats. Although dendritic cells are very strong, the number of them in the body is not high enough to cause a powerful immune response; therefore, more DC are made in a laboratory with cells collected from an individual's blood. In this study, we will make a vaccine that we hope will educate immune cells to target the pp65 antigen, a type of immune marker in GBM, thus resulting in what we call the pp65 DC vaccine. Use of a vaccine that activates your immune system is a type of immunotherapy. It is hoped that by giving the pp65 DC vaccine as a shot under the skin, the immune system will be activated to attack tumor cells in the brain while leaving normal cells alone. To see if the pp65 DC vaccine is effective for the treatment of GBM, subjects will be assigned to different treatment groups. Two groups of subjects will receive the pp65 DC vaccine and one group will receive a placebo.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma Multiforme, Glioblastoma, Malignant Glioma, Astrocytoma, Grade IV, GBM

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
175 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
pp65-shLAMP DC with GM-CSF and Td
Arm Type
Experimental
Arm Description
Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.
Arm Title
pp65-flLAMP DC with GM-CSF and Td
Arm Type
Experimental
Arm Description
Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.
Arm Title
unpulsed PBMC and Saline
Arm Type
Placebo Comparator
Arm Description
Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.
Intervention Type
Biological
Intervention Name(s)
pp65-shLAMP DC with GM-CSF
Other Intervention Name(s)
pp65-shLAMP mRNA DCs with GM-CSF
Intervention Type
Biological
Intervention Name(s)
unpulsed PBMC and saline
Other Intervention Name(s)
Peripheral Blood Mononuclear Cells
Intervention Type
Drug
Intervention Name(s)
Td
Other Intervention Name(s)
Tetanus and Diphtheria Toxoid
Intervention Description
All subjects will receive a Td booster before study drug dose #1. Subjects in the experimental arms will receive Td skin prep before study drug doses #3, #6, and #9.
Intervention Type
Drug
Intervention Name(s)
Saline
Other Intervention Name(s)
Normal Saline
Intervention Type
Biological
Intervention Name(s)
pp65-flLAMP DC with GM-CSF
Other Intervention Name(s)
pp65-flLAMP mRNA DCs with GM-CSF
Primary Outcome Measure Information:
Title
Change in median overall survival
Time Frame
From date of randomization until the date of death, assessed up to 24 months
Secondary Outcome Measure Information:
Title
Changes in immune response
Description
Parameters include ELISPOT for evaluation of cellular immune responses is a sensitive detection assay for evaluation of antigen specific cytokine producing T cells
Time Frame
Change between baseline and vaccine #3, assessed up to 4 weeks
Title
Change in progression-free survival
Time Frame
From randomization until first documentation of either disease progression or recurrence assessed up to 24 months
Title
Changes in immune response
Description
Parameters include peak antibody titers to the CMV pp65, reported as humoral response to the specific antigens.
Time Frame
Change between baseline and vaccine #3, assessed up to 4 weeks
Title
Changes in immune response
Description
Parameters include Cytokine Bead Array analysis to detect multiple cytokines secreted by lymphocytes after in vitro stimulation with specific and control antigens, examine the spectrum of Type 0,1,2, and 3 cytokines secreted by T cells after stimulation with overlapping peptides spanning CMV pp65, PHA, and control peptides
Time Frame
Change between baseline and vaccine #3, assessed up to 4 weeks
Title
Changes in immune response
Description
Parameters include cytokine flow cytometric analysis which involves the rapid early detection and analysis of the production of IFN, TNF, and IL-2 prior to cellular secretion following antigen-specific stimulation in vitro as determined by CFC
Time Frame
Change between baseline and vaccine #3, assessed up to 4 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Abbreviated Inclusion Criteria: To be assessed at study enrollment prior to standard of care chemo-radiation therapy: Age ≥ 18 years. Histopathologically proven newly-diagnosed de novo GBM (WHO Grade IV glioma) The tumor must have a supratentorial component. Must have undergone definitive surgical resection of tumor with less than approximately 3cm x 3cm residual enhancing tumor as product of longest perpendicular planes by MRI. Recovery from the effects of surgery, postoperative infection, and other complications. Diagnostic contrast-enhanced MRI or CT scan of the brain preoperatively and postoperatively. Karnofsky Performance Status of ≥ 70. Signed informed consent. For females of childbearing potential, negative serum pregnancy test. Women of childbearing potential and male participants must be willing to practice adequate contraception throughout the study and for at least 24 weeks after the last dose of study drug. To be assessed prior to initiation of adjuvant TMZ: Must have completed RT (targeted total dose of 59.4-60.0 Gy over ≤ 7 weeks) and concomitant TMZ (targeted dose of 75mg/m2/d for ≤ 49 days) therapy without significant toxicity that persisted over 4 weeks. History & physical with neurologic examination prior to initiation of adjuvant TMZ. For patients receiving steroids, daily dose must be ≤ 4 mg. CBC with differential with adequate bone marrow function. Adequate renal function. Adequate hepatic function. Abbreviated Exclusion Criteria: To be verified in order to randomize subject: Prior invasive malignancy unless disease free for ≥ 3 years. Metastases detected below the tentorium or beyond the cranial vault and leptomeningeal involvement. Recurrent or multifocal malignant gliomas. HIV, Hepatitis B, or Hepatitis C seropositive. Known active infection or immunosuppressive disease. Prior chemotherapy or radiosensitizers (including Gliadel wafers) for cancers of the head and neck region. Prior radiotherapy to the head or neck, resulting in overlap of radiation fields. Severe, active co-morbidity. Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception for the entire study period. Pregnant or lactating women. Prior allergic reaction to temozolomide, GM-CSF or Td. Prior history of brachial neuritis or Guillain-Barré syndrome. Patients treated on any other therapeutic clinical protocols within 30 days prior to study entry. To be assessed prior to initiation of adjuvant TMZ: Did not start radiation therapy and temozolomide within 7 weeks of surgery. Progression of disease as defined by modified RANO criteria. More than 45 days after completion of radiation therapy and temozolomide
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Duane Mitchell, MD, PhD
Organizational Affiliation
University of Florida
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Maryam Rahman, MD
Organizational Affiliation
University of Florida
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32610
Country
United States
Facility Name
Orlando Health
City
Orlando
State/Province
Florida
ZIP/Postal Code
32806
Country
United States
Facility Name
Duke University Medical Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Vaccine Therapy for the Treatment of Newly Diagnosed Glioblastoma Multiforme

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