PEP-CMV in Recurrent MEdulloblastoma/Malignant Glioma (PRiME)
Primary Purpose
Recurrent Medulloblastoma, Recurrent Brain Tumor, Childhood, Malignant Glioma
Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
PEP-CMV
Sponsored by
About this trial
This is an interventional treatment trial for Recurrent Medulloblastoma focused on measuring Glioma, Medulloblastoma, PRiME, Pro00079843, Thompson, Pediatric, Landi
Eligibility Criteria
Inclusion Criteria:
- Patients who are 3 - 35 years old
- Histopathologically proven previous diagnosis of medulloblastoma or Grade III or IV glioma.
- Radiology evidence of recurrent medulloblastoma (reMB) or recurrent Grade III and IV glioma. Patients will be considered for a biopsy or resection of the recurrent/progressive tumor at the discretion of the treating neurosurgeon and neuro-oncologist.
- Brain MRI within one month prior to enrollment.
- Received prior therapy for their initial diagnosis prior to recurrence/progression or who are unable to receive radiation therapy due to genetic disorders that put them at significant risk for radiation-induced secondary malignancies (i.e. Gorlin's syndrome or NF1 mutation).
- Patients with neurological deficits should have deficits that are stable for a minimum of 2 weeks prior to registration.
- Karnofsky Performance Status (KPS) of ≥ 60% (KPS for > 10 years of age) or Lansky performance Score (LPS) of ≥ 60 (LPS for ≤ 10 years of age) assessed within 2 weeks prior to registration. Patients who are unable to walk because of paralysis but who are up in a wheel chair will be considered ambulatory for the purposes of the performance score.
Bone Marrow:
- ANC (Absolute neutrophil count) ≥ 1000/µl (unsupported)*.
- Platelets ≥ 100,000/µl (unsupported)*.
- Hemoglobin > 8 g/dL (may be supported).
Renal:
• Serum creatinine ≤ upper limit of institutional normal.
Hepatic:
- Bilirubin ≤ 1.5 times upper limit of normal for age.
- SGPT (ALT) ≤ 3 times institutional upper limit of normal for age.
- SGOT (AST) ≤ 3 times institutional upper limit of normal for age.
- Patients of childbearing or child-fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while being treated on this study.
- Signed informed consent according to institutional guidelines must be obtained prior to registration.
- Any prior chemoradiotherapy is allowed.
Exclusion Criteria:
- Pregnant or need to breast feed during the study period (Negative serum pregnancy test required).
- Active infection requiring treatment or an unexplained febrile (> 101.5 degrees F) illness.
- Known immunosuppressive disease or human immunodeficiency virus infection.
- Patients with active renal, cardiac (congestive cardiac failure, myocardial infarction, myocarditis), or pulmonary disease.
- Patients receiving concomitant immunosuppressive agents for medical condition.
- Patients who need definitive radiotherapy for treatment of recurrent MB or recurrent Grade III or IV glioma.
- Patients receiving any other investigational drug therapy.
- Patients on corticosteroids > 0.1 mg/Kg/day (i.e. > the maximum dose of 4 mg/day).
- Patients with any clinically significant unrelated systemic illness (serious infections or significant cardiac, pulmonary, hepatic or other organ dysfunction).
- Patients with inability to return for follow-up visits or obtain follow-up studies required to assess toxicity to therapy.
Sites / Locations
- Duke University Medical Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
PEP-CMV
Arm Description
Cytomegalovirus (CMV)-specific peptide vaccine (PEP-CMV)
Outcomes
Primary Outcome Measures
Proportion of patients with unacceptable toxicity
Evaluate the safety of PEP-CMV in pediatric patients with recurrent MB or recurrent Grade III/IV glioma
Secondary Outcome Measures
Mean or median change from baseline at each follow-up assessment in ELISPOT (IFN-γ)
Quantitate the immune response to the components of the PEP-CMV vaccine by ELISPOT
Mean or median change from baseline at each follow-up assessment in ELISA (gB-KLH)
Quantitate the immune response to the components of the PEP-CMV vaccine by ELISA
Full Information
NCT ID
NCT03299309
First Posted
September 27, 2017
Last Updated
May 17, 2023
Sponsor
Daniel Landi
Collaborators
Pediatric Brain Tumor Foundation, Annias Immunotherapeutics, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT03299309
Brief Title
PEP-CMV in Recurrent MEdulloblastoma/Malignant Glioma
Acronym
PRiME
Official Title
The PRiME Study: PEP-CMV in Recurrent MEdulloblastoma/Malignant Glioma
Study Type
Interventional
2. Study Status
Record Verification Date
May 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
June 29, 2018 (Actual)
Primary Completion Date
April 27, 2023 (Actual)
Study Completion Date
April 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Daniel Landi
Collaborators
Pediatric Brain Tumor Foundation, Annias Immunotherapeutics, Inc.
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 primary goal of this prospective clinical trial is to evaluate the safety of PEP-CMV in patients with recurrent medulloblastoma and malignant glioma. Patients with histologically-proven medulloblastoma or malignant glioma who had received prior therapy for their initial diagnosis and subsequently had tumor recurrence/progression may be enrolled any time after recurrence/progression regardless of prior adjuvant therapy. PEP-CMV is a vaccine comprised of Component A, a synthetic long peptide (SLP) of 26 amino acid residues from human pp65. In May 2021, enrollment on the study was temporarily suspended due to delays in vialing the PEP-CMV study vaccine.
Detailed Description
Once a patient has enrolled onto this study, prior therapy will be terminated and patients will receive temozolomide 200 mg/m2/day x 5 days. If they are receiving bevacizumab at the time of enrollment, they will continue bevacizumab 10 mg/Kg every 14 days.
Patients who are ≥ 18 years of age will receive a tetanus (Td) booster at the time of enrollment. Immunotherapy begins with a Tetanus (Td) pre-conditioning vaccine delivered intradermally (i.d.) in the right groin at the site of the vaccine injection 6-24 hours prior to the first vaccine on day 21. The PEP-CMV vaccine will be administered as follows: PEP-CMV Component A mixed with Montanide ISA-51 (1:1 volume ratio) intradermally administered half in the RIGHT groin and half in the LEFT groin.
The first 3 PEP-CMV vaccines will occur every 2 weeks, then PEP-CMV vaccines will continue monthly (+/- 2 weeks) for no more than 10 years. Blood will be obtained for immune system monitoring.
In May 2021, enrollment on the study was temporarily suspended due to delays in vialing the PEP-CMV study vaccine.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Medulloblastoma, Recurrent Brain Tumor, Childhood, Malignant Glioma
Keywords
Glioma, Medulloblastoma, PRiME, Pro00079843, Thompson, Pediatric, Landi
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)
8. Arms, Groups, and Interventions
Arm Title
PEP-CMV
Arm Type
Experimental
Arm Description
Cytomegalovirus (CMV)-specific peptide vaccine (PEP-CMV)
Intervention Type
Drug
Intervention Name(s)
PEP-CMV
Other Intervention Name(s)
PEP-CMV vaccine
Intervention Description
Patients receive temozolomide (TMZ) 200 mg/m2/day x 5 days. On day 20, patients will receive a Tetanus-diphtheria pre-conditioning vaccination with Td (tetanus, diphtheria toxoid, adsorbed). Immunotherapy begins the following day, on day 21, with injection of the PEP-CMV vaccine as follows: PEP-CMV Component A mixed with Montanide ISA-51 intradermally administered half in the RIGHT groin and half in the LEFT groin.
Primary Outcome Measure Information:
Title
Proportion of patients with unacceptable toxicity
Description
Evaluate the safety of PEP-CMV in pediatric patients with recurrent MB or recurrent Grade III/IV glioma
Time Frame
2 weeks after the 3rd PEP-CMV vaccine on the last enrolled patient
Secondary Outcome Measure Information:
Title
Mean or median change from baseline at each follow-up assessment in ELISPOT (IFN-γ)
Description
Quantitate the immune response to the components of the PEP-CMV vaccine by ELISPOT
Time Frame
24 months
Title
Mean or median change from baseline at each follow-up assessment in ELISA (gB-KLH)
Description
Quantitate the immune response to the components of the PEP-CMV vaccine by ELISA
Time Frame
24 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
3 Years
Maximum Age & Unit of Time
35 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients who are 3 - 35 years old
Histopathologically proven previous diagnosis of medulloblastoma or Grade III or IV glioma.
Radiology evidence of recurrent medulloblastoma (reMB) or recurrent Grade III and IV glioma. Patients will be considered for a biopsy or resection of the recurrent/progressive tumor at the discretion of the treating neurosurgeon and neuro-oncologist.
Brain MRI within one month prior to enrollment.
Received prior therapy for their initial diagnosis prior to recurrence/progression or who are unable to receive radiation therapy due to genetic disorders that put them at significant risk for radiation-induced secondary malignancies (i.e. Gorlin's syndrome or NF1 mutation).
Patients with neurological deficits should have deficits that are stable for a minimum of 2 weeks prior to registration.
Karnofsky Performance Status (KPS) of ≥ 60% (KPS for > 10 years of age) or Lansky performance Score (LPS) of ≥ 60 (LPS for ≤ 10 years of age) assessed within 2 weeks prior to registration. Patients who are unable to walk because of paralysis but who are up in a wheel chair will be considered ambulatory for the purposes of the performance score.
Bone Marrow:
ANC (Absolute neutrophil count) ≥ 1000/µl (unsupported)*.
Platelets ≥ 100,000/µl (unsupported)*.
Hemoglobin > 8 g/dL (may be supported).
Renal:
• Serum creatinine ≤ upper limit of institutional normal.
Hepatic:
Bilirubin ≤ 1.5 times upper limit of normal for age.
SGPT (ALT) ≤ 3 times institutional upper limit of normal for age.
SGOT (AST) ≤ 3 times institutional upper limit of normal for age.
Patients of childbearing or child-fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while being treated on this study.
Signed informed consent according to institutional guidelines must be obtained prior to registration.
Any prior chemoradiotherapy is allowed.
Exclusion Criteria:
Pregnant or need to breast feed during the study period (Negative serum pregnancy test required).
Active infection requiring treatment or an unexplained febrile (> 101.5 degrees F) illness.
Known immunosuppressive disease or human immunodeficiency virus infection.
Patients with active renal, cardiac (congestive cardiac failure, myocardial infarction, myocarditis), or pulmonary disease.
Patients receiving concomitant immunosuppressive agents for medical condition.
Patients who need definitive radiotherapy for treatment of recurrent MB or recurrent Grade III or IV glioma.
Patients receiving any other investigational drug therapy.
Patients on corticosteroids > 0.1 mg/Kg/day (i.e. > the maximum dose of 4 mg/day).
Patients with any clinically significant unrelated systemic illness (serious infections or significant cardiac, pulmonary, hepatic or other organ dysfunction).
Patients with inability to return for follow-up visits or obtain follow-up studies required to assess toxicity to therapy.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Daniel Landi, MD
Organizational Affiliation
Duke University
Official's Role
Principal Investigator
Facility Information:
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
Links:
URL
https://tischbraintumorcenter.duke.edu/
Description
The Preston Robert Tisch Brain Tumor Center at Duke
URL
http://www.dukecancerinstitute.org/
Description
Duke Cancer Institute
Learn more about this trial
PEP-CMV in Recurrent MEdulloblastoma/Malignant Glioma
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