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A Phase II Clinical Trial of Chemo-radiotherapy in Combination With INO-3112 in Patients With Locally Advanced Cervical Cancer

Primary Purpose

Uterine Cervical Neoplasms

Status
Withdrawn
Phase
Phase 2
Locations
Switzerland
Study Type
Interventional
Intervention
INO-3112 vaccine
Radiotherapy (Extrernal beam radiotherapy + brachytherapy)
Cisplatin chemotherapy
Sponsored by
European Organisation for Research and Treatment of Cancer - EORTC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Uterine Cervical Neoplasms

Eligibility Criteria

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

Main inclusion criteria:

Registration step

  • Age 18 years or older;
  • Newly diagnosed locally advanced cervical cancer defined as FIGO 2009: stage IB2, IIA&IIB, IIIA&IIIB or IVA disease;
  • No evidence of distant metastases (Stage IVB);
  • Histological diagnosis of squamous cell carcinoma, adenocarcinoma or adenosquamous cell carcinoma of the cervix is accepted. Not accepted are small cell, clear cell and other rare variants of the classical adenocarcinoma;
  • Availability of HPV 16 and HPV 18 testing;
  • No HIV seropositive, Hepatitis B or C (unless sustained virologic response achieved by anti-HCV therapy);
  • Written informed consent must be given according to ICH/GCP, and national/local regulations

Randomization step

  • Positive for HPV 16 and/or HPV 18 as assessed by central lab;
  • WHO/ECOG performance status 0 - 2
  • Adequate hematological, liver and renal functions
  • ECG with no clinically significant findings as assessed by the investigator performed within 30 days of signing the informed consent form
  • Absence of current malignancies at other sites, with the exception of adequately treated basal or squamous cell carcinoma of the skin. Cancer survivors, who have undergone potentially curative therapy for a prior malignancy, who have no evidence of that disease for five years and are deemed at low risk for recurrence, are eligible for the study;
  • No prior history of clinically significant autoimmune disease, Crohn's disease, ulcerative colitis;
  • No history of previous therapeutic HPV vaccination (individuals who have been immunized with licensed prophylactic HPV vaccines (e.g. Silgard®, Cervarix®, Gardasil®) are not excluded);
  • No known or suspected hypersensitivity to component(s) of investigational product or cisplatin contraindication (e.g. peripheral neuropathy ≤ grade 2 or ototoxicity ≤ grade 2 as per CTCAE v4);
  • No previous pelvic RT;
  • No previous chemotherapy for this tumor;
  • No patients who have undergone a previous hysterectomy or will have a hysterectomy as part of their initial cervical cancer therapy;
  • No receipt of any immunotherapy within 4 weeks of start of protocol treatment;
  • No prior major surgery within 4 weeks of randomization from which the patient has not recovered.

Sites / Locations

  • Centre Hospitalier Universitaire Vaudois

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Active Comparator

Arm Label

Arm A: Immunotherapy during and after CRT + vaccine boost

Arm B: Immunotherapy during CRT + vaccine boost

CRT without immunotherapy

Arm Description

INO-3112 dosing during chemoradiotherapy plus immunotherapy dosing after chemoradiotherapy in an adjuvant setting and vaccine boost one year after last vaccine dosing.

INO-3112 dosing during chemoradiotherapy, and vaccine boost one year after last vaccine dosing.

Standard chemoradiotherapy without immunotherapy

Outcomes

Primary Outcome Measures

Occurence of Adverse Events
In order to ensure adequate safety of the combination treatment, a safety run-in will be performed. This safety run-in phase will include the first 3 patients treated in each of the experimental arms (arms A & B) exposed to at least two immunotherapy doses. The acute safety of the combination of INO-3112 with concomitant CRT will be evaluated similar to a phase I "3+3" safety design. The safety evaluation will be done by the Data Safety Monitoring Board who will invoke an IDMC evaluation of the whole study if undue safety signals are observed. Acute toxicity is defined as a grade 3 or more related AEs occurring between the first dose of vaccine administration and up to 14 days after the second dose of immunotherapy. Adverse events are graded according to the NCI CTCAE v4.0. Use of narcotics will be reviewed on case-to-case basis by a medical review team to assess its relevance towards the safety evaluation
Progression free survival (PFS) at 18 months assessed by RECIST
Progression Free Survival at 18 months assessed by local investigator

Secondary Outcome Measures

Full Information

First Posted
July 7, 2015
Last Updated
May 12, 2016
Sponsor
European Organisation for Research and Treatment of Cancer - EORTC
Collaborators
Inovio Pharmaceuticals, Centre Hospitalier Universitaire Vaudois
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1. Study Identification

Unique Protocol Identification Number
NCT02501278
Brief Title
A Phase II Clinical Trial of Chemo-radiotherapy in Combination With INO-3112 in Patients With Locally Advanced Cervical Cancer
Official Title
A Phase II Clinical Trial of Chemo-radiotherapy in Combination With INO-3112 in Patients With Locally Advanced Cervical Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
May 2016
Overall Recruitment Status
Withdrawn
Why Stopped
company (Inovio) is no longer able to support the study
Study Start Date
May 2016 (undefined)
Primary Completion Date
May 2019 (Anticipated)
Study Completion Date
May 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
European Organisation for Research and Treatment of Cancer - EORTC
Collaborators
Inovio Pharmaceuticals, Centre Hospitalier Universitaire Vaudois

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The aim of this study is to assess the potential benefit of the addition of immunotherapy with VGX-3100 and INO-9012 (i.e. INO-3112) to concomitant CRT or, to concomitant CRT and continued as adjuvant in patients with locally advanced cervical cancer. Safety run-in: To test the safety of CRT combined with immunotherapy with INO-3112. This safety run-in phase will include the first 3 patients treated in each of the two INO-3112 combination arms who are exposed to at least two immunotherapy doses and evaluate whether the combination does not pose undue immediate risks to the patients further enrolled in the trial. Phase II:To demonstrate sufficient activity in the experimental combination arms to warrant a further phase III conclusive trial based on progression free survival (PFS) at 18 months assessed by RECIST by the local investigator. The efficacy will be assessed within each experimental arm while the standard arm will serve as a reference arm to check the reliability of the results.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Uterine Cervical Neoplasms

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm A: Immunotherapy during and after CRT + vaccine boost
Arm Type
Experimental
Arm Description
INO-3112 dosing during chemoradiotherapy plus immunotherapy dosing after chemoradiotherapy in an adjuvant setting and vaccine boost one year after last vaccine dosing.
Arm Title
Arm B: Immunotherapy during CRT + vaccine boost
Arm Type
Experimental
Arm Description
INO-3112 dosing during chemoradiotherapy, and vaccine boost one year after last vaccine dosing.
Arm Title
CRT without immunotherapy
Arm Type
Active Comparator
Arm Description
Standard chemoradiotherapy without immunotherapy
Intervention Type
Biological
Intervention Name(s)
INO-3112 vaccine
Intervention Description
INO-3112 i.e. the combination of VGX-3100 and INO-9012, specifically: VGX-3100 (HPV16 and HPV18 E6-E7 DNA vaccine) will be administered at 3 mg per plasmid (6 mg total DNA) INO-9012 (IL-12 DNA plasmid) will be administered at 1 mg per dose will be administered using the CELLECTRA® electoporation device
Intervention Type
Radiation
Intervention Name(s)
Radiotherapy (Extrernal beam radiotherapy + brachytherapy)
Intervention Description
The whole pelvis will be irradiated with 45 - 50.4 Gy in 25-28 fractions in fractions of 1.8 Gy over 5 weeks daily. Those patients with pelvis positive and/or para-aortic positive lymph nodes should be treated with an elective dose to the para-aortic area of 45 Gy in fractions of 1.6-1.8 Gy in 25-28 fractions. Pelvic and para-aortic nodes known to contain gross/macroscopically visible disease and heavily involved parametria or tumor areas that may lie beyond the high-dose range of brachytherapy should be treated with additional small volume boost of EBRT to a total dose of 60-65 Gy using a combination of either sequential and/or concomitant boost. Fractions of 1.8-2 Gy can be used in the sequential boost.
Intervention Type
Drug
Intervention Name(s)
Cisplatin chemotherapy
Intervention Description
Cisplatin chemotherapy will be administered i.v. at a dose of 40 mg/m2 (total 5 cycles during week 1-5) weekly in concomitance with RT with the total dose not to exceed 70 mg per week.
Primary Outcome Measure Information:
Title
Occurence of Adverse Events
Description
In order to ensure adequate safety of the combination treatment, a safety run-in will be performed. This safety run-in phase will include the first 3 patients treated in each of the experimental arms (arms A & B) exposed to at least two immunotherapy doses. The acute safety of the combination of INO-3112 with concomitant CRT will be evaluated similar to a phase I "3+3" safety design. The safety evaluation will be done by the Data Safety Monitoring Board who will invoke an IDMC evaluation of the whole study if undue safety signals are observed. Acute toxicity is defined as a grade 3 or more related AEs occurring between the first dose of vaccine administration and up to 14 days after the second dose of immunotherapy. Adverse events are graded according to the NCI CTCAE v4.0. Use of narcotics will be reviewed on case-to-case basis by a medical review team to assess its relevance towards the safety evaluation
Time Frame
6 months
Title
Progression free survival (PFS) at 18 months assessed by RECIST
Description
Progression Free Survival at 18 months assessed by local investigator
Time Frame
18 months

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Main inclusion criteria: Registration step Age 18 years or older; Newly diagnosed locally advanced cervical cancer defined as FIGO 2009: stage IB2, IIA&IIB, IIIA&IIIB or IVA disease; No evidence of distant metastases (Stage IVB); Histological diagnosis of squamous cell carcinoma, adenocarcinoma or adenosquamous cell carcinoma of the cervix is accepted. Not accepted are small cell, clear cell and other rare variants of the classical adenocarcinoma; Availability of HPV 16 and HPV 18 testing; No HIV seropositive, Hepatitis B or C (unless sustained virologic response achieved by anti-HCV therapy); Written informed consent must be given according to ICH/GCP, and national/local regulations Randomization step Positive for HPV 16 and/or HPV 18 as assessed by central lab; WHO/ECOG performance status 0 - 2 Adequate hematological, liver and renal functions ECG with no clinically significant findings as assessed by the investigator performed within 30 days of signing the informed consent form Absence of current malignancies at other sites, with the exception of adequately treated basal or squamous cell carcinoma of the skin. Cancer survivors, who have undergone potentially curative therapy for a prior malignancy, who have no evidence of that disease for five years and are deemed at low risk for recurrence, are eligible for the study; No prior history of clinically significant autoimmune disease, Crohn's disease, ulcerative colitis; No history of previous therapeutic HPV vaccination (individuals who have been immunized with licensed prophylactic HPV vaccines (e.g. Silgard®, Cervarix®, Gardasil®) are not excluded); No known or suspected hypersensitivity to component(s) of investigational product or cisplatin contraindication (e.g. peripheral neuropathy ≤ grade 2 or ototoxicity ≤ grade 2 as per CTCAE v4); No previous pelvic RT; No previous chemotherapy for this tumor; No patients who have undergone a previous hysterectomy or will have a hysterectomy as part of their initial cervical cancer therapy; No receipt of any immunotherapy within 4 weeks of start of protocol treatment; No prior major surgery within 4 weeks of randomization from which the patient has not recovered.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Fernanda Herrera
Organizational Affiliation
Centre hospitalier universitaire vaudois, Lausanne
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
George Coukos
Organizational Affiliation
Centre hospitalier universitaire vaudois, Lausanne
Official's Role
Study Chair
Facility Information:
Facility Name
Centre Hospitalier Universitaire Vaudois
City
Lausanne
Country
Switzerland

12. IPD Sharing Statement

Learn more about this trial

A Phase II Clinical Trial of Chemo-radiotherapy in Combination With INO-3112 in Patients With Locally Advanced Cervical Cancer

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