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A Vaccine (PDS0101) and Chemoradiation for the Treatment of Stage IB3-IVA Cervical Cancer, the IMMUNOCERV Trial

Primary Purpose

Locally Advanced Cervical Squamous Cell Carcinoma, Not Otherwise Specified, Stage IB3 Cervical Cancer FIGO 2018, Stage II Cervical Cancer FIGO 2018

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cisplatin
Liposomal HPV-16 E6/E7 Multipeptide Vaccine PDS0101
Radiation Therapy
Sponsored by
M.D. Anderson Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Locally Advanced Cervical Squamous Cell Carcinoma, Not Otherwise Specified

Eligibility Criteria

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

Inclusion Criteria:

  • Newly diagnosed locally advanced squamous cell carcinoma of cervix (Federation of Gynecology and Obstetrics [FIGO] 2018 stage IB3-IVA with primary tumor >= 5 cm and/or positive pelvic or periaortic nodal disease assessed by imaging)
  • Histologic diagnosis of squamous cell carcinoma of the cervix
  • Written informed consent before initiation of any study-related procedures
  • World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  • Alanine aminotransferase (ALT) =< 2-fold the upper limit of normal
  • Aspartate aminotransferase (AST) =< 2-fold the upper limit of normal
  • Alkaline phosphatase (alk phos) =< 2-fold the upper limit of normal
  • Total bilirubin (total bili) =< 2-fold the upper limit of normal
  • Creatinine =< 1.5
  • Electrocardiogram (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, except for 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 5 years and who are deemed at low risk for recurrence are eligible for the study

Exclusion Criteria:

  • Human immunodeficiency virus (HIV) infection, cellular immune deficiencies, hypogammaglobulinemia or dysgammaglobulinemia, or hereditary or congenital immunodeficiencies
  • Prior diagnosis of hepatitis B or C (unless anti-hepatitis C therapy has produced a sustained virologic response)
  • History of clinically significant autoimmune disease, Crohn's disease, or ulcerative colitis
  • Serious concomitant disorder, including active systemic infection requiring treatment, as judged by the investigator
  • Receipt of immunotherapy (e.g., interferons [IFNs], check-point inhibitors, tumor necrosis factor, interleukins, etc.) or biological response modifiers (granulocyte-macrophage colony-stimulating factor [GM-CSF], granulocyte colony-stimulating factor, macrophage colony-stimulating factor) within 4 weeks before the first study vaccination
  • Receipt of chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug

    • Current or recent use of physiologic doses of intra-articular, topical, or inhaled corticosteroids is acceptable
  • History of previous therapeutic HPV vaccination (individuals who have been immunized with licensed prophylactic HPV vaccines [e.g., Silgard, Cervarix, Gardasil are not excluded)
  • Known or suspected hypersensitivity to any component of the investigational product or contraindications to cisplatin (e.g., peripheral neuropathy grade =< 2 or ototoxicity =< grade 2 per Common Terminology Criteria for Adverse Events [CTCAE] version [v]5.0)
  • Previous pelvic radiation therapy (RT)
  • Previous chemotherapy for the cervix tumor
  • Previous hysterectomy or will have a hysterectomy as part of their initial cervical cancer therapy
  • Prior major surgery within 4 weeks of enrollment from which the patient has not recovered
  • Other condition or prior therapy that, in the opinion of the Investigator, compromises the subject's welfare or may confound study results
  • Concurrent participation in another therapeutic investigational study or use of another investigational drug within 6 months before the first study vaccination
  • Previous enrollment in this study
  • HPV genotyping is to be done from cervical swab samples. Enrollment will not require HPV testing
  • Pregnancy: a female subject defined as a women of childbearing potential (WOCBP) who has a positive urine pregnancy test (e.g. within 72 hours) prior to treatment. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required

Sites / Locations

  • M D Anderson Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (radiation therapy, cisplatin, PDS0101)

Arm Description

Patients undergo radiation therapy over 1 hour 5 days per week (Monday-Friday) for 5-7 weeks and receive cisplatin IV over 4 hours QW during the 5 weeks of radiation therapy in the absence of disease progression and unacceptable toxicity. Patients also receive PDS0101 SC on days -10, 7, 28, 49, and 170 in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Rate of grade >= 3 acute toxicity
Measured from first vaccine injection up to 30 days following completion of chemoradiotherapy (chemoRT). Adverse events (AEs) will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Any AE that occurs between the first day of PDS0101 injection and up to 30 days following completion of chemoRT (~Day 80) will be considered as acute toxicity (AT).

Secondary Outcome Measures

Rate of complete metabolic response
Measured by positron emission tomography computed tomography (PET CT).
Rate of >= 90% gross tumor volume reduction
Measured by magnetic resonance imaging (MRI).
Rates of local control
Will be represented by Kaplan-Meier curves.
Rates of progression-free survival
Will be represented by Kaplan-Meier curves.
Rates of overall survival
Will be represented by Kaplan-Meier curves.
Rate of grade >= 3 chronic toxicity
AEs will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Chronic toxicity (CT) is any toxicity that occurs outside of the AT window (between Days 81 and study completion of the study).

Full Information

First Posted
October 5, 2020
Last Updated
March 31, 2022
Sponsor
M.D. Anderson Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT04580771
Brief Title
A Vaccine (PDS0101) and Chemoradiation for the Treatment of Stage IB3-IVA Cervical Cancer, the IMMUNOCERV Trial
Official Title
IMMUNOCERV: Evaluating the Safety of Chemoradiation Combined With PDS0101 Immunotherapy in Treating Locally Advanced Cervical Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Recruiting
Study Start Date
October 14, 2020 (Actual)
Primary Completion Date
March 8, 2024 (Anticipated)
Study Completion Date
March 8, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
M.D. Anderson Cancer Center
Collaborators
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
No

5. Study Description

Brief Summary
This phase IIA trial studies the effect of a vaccine (PDS0101) when given together with chemotherapy and radiation therapy (chemoradiation) in treating patients with stage IB3-IVA cervical cancer. Chemotherapy drugs, such as cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. PDS0101 is a type of vaccine that is intended to help the immune system respond to human papillomavirus (HPV16)-infected cervical tumor cells. PDS0101 contains two active components: the first is called R-DOTAP (Versamune) and is included in the vaccine to boost the immune system's response against the HPV viral proteins and the second group of active components are selected small pieces of proteins (called peptides) taken from the HPV virus. Giving PDS0101 in combination with chemoradiation may work help to control cervical cancer.
Detailed Description
PRIMARY OBJECTIVE: I. Evaluate the safety and toxicity profile of delivering the immune nanoparticle liposomal HPV-16 E6/E7 multipeptide vaccine PDS0101 (PDS0101) with standard-of-care chemoradiation (chemoRT) in patients with locally advanced cervical cancer. SECONDARY OBJECTIVES: I. Rate of complete metabolic response on day 170 (+/- 14 days) positron emission tomography computed tomography (PET CT). II. Rate of >= 90% gross tumor volume reduction day 35 magnetic resonance imaging (MRI) (+/- 5 days). III. Report rates of local control (LC), progression-free survival (PFS), and overall survival (OS) at 12 and 18 months following chemoRT completion. IV. Long-term safety: rate of grade >= 3 chronic toxicity (from day 81 to completion of trial). EXPLORATORY HPV-SPECIFIC IMMUNE RESPONSE OBJECTIVES: I. Enzyme-linked immunosorbent spot (ELISpot) assays on interferon-gamma and granzyme B levels in E6/7-specific T cells isolated from peripheral blood mononuclear cells (PBMCs). II. Compare intratumoral T-cell receptor (TCR) clonality at baseline and end of treatment by TCR sequencing. III. Measure CD4+ and CD8+ tumor-infiltrating lymphocytes (TILs) from cervical brush samples by using markers of T-cell exhaustion (PD1, CTLA4) and T cell-activation (granzyme B, CD69+). IV. Assess the intestinal and cervical microbiome by analyzing rectal and cervical swab samples with 16s ribosomal ribonucleic acid (rRNA) sequencing. V. Additional assays such as circulating tumor cells, circulating cell-free tumor deoxyribonucleic acid (DNA) (ccfDNA), and other assays will be performed at the discretion of the principal investigator. OUTLINE: Patients undergo radiation therapy over 1 hour 5 days per week (Monday-Friday) for 5-7 weeks and receive cisplatin intravenously (IV) over 4 hours once per week (QW) during the 5 weeks of radiation therapy in the absence of disease progression and unacceptable toxicity. Patients also receive PDS0101 subcutaneously (SC) on days -10, 7, 28, 49, and 170 in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 30 days, 1, 4, 6, 12, and 18 weeks, and 18 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Locally Advanced Cervical Squamous Cell Carcinoma, Not Otherwise Specified, Stage IB3 Cervical Cancer FIGO 2018, Stage II Cervical Cancer FIGO 2018, Stage IIA Cervical Cancer FIGO 2018, Stage IIA1 Cervical Cancer FIGO 2018, Stage IIA2 Cervical Cancer FIGO 2018, Stage IIB Cervical Cancer FIGO 2018, Stage III Cervical Cancer FIGO 2018, Stage IIIA Cervical Cancer FIGO 2018, Stage IIIB Cervical Cancer FIGO 2018, Stage IIIC Cervical Cancer FIGO 2018, Stage IIIC1 Cervical Cancer FIGO 2018, Stage IIIC2 Cervical Cancer FIGO 2018, Stage IVA Cervical Cancer FIGO 2018

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
35 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment (radiation therapy, cisplatin, PDS0101)
Arm Type
Experimental
Arm Description
Patients undergo radiation therapy over 1 hour 5 days per week (Monday-Friday) for 5-7 weeks and receive cisplatin IV over 4 hours QW during the 5 weeks of radiation therapy in the absence of disease progression and unacceptable toxicity. Patients also receive PDS0101 SC on days -10, 7, 28, 49, and 170 in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Other Intervention Name(s)
Abiplatin, Blastolem, Briplatin, CDDP, Cis-diammine-dichloroplatinum, Cis-diamminedichloridoplatinum, Cis-diamminedichloro Platinum (II), Cis-diamminedichloroplatinum, Cis-dichloroammine Platinum (II), Cis-platinous Diamine Dichloride, Cis-platinum, Cis-platinum II, Cis-platinum II Diamine Dichloride, Cismaplat, Cisplatina, Cisplatinum, Cisplatyl, Citoplatino, Citosin, Cysplatyna, DDP, Lederplatin, Metaplatin, Neoplatin, Peyrone''s Chloride, Peyrone''s Salt, Placis, Plastistil, Platamine, Platiblastin, Platiblastin-S, Platinex, Platinol, Platinol- AQ, Platinol-AQ, Platinol-AQ VHA Plus, Platinoxan, Platinum, Platinum Diamminodichloride, Platiran, Platistin, Platosin
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
Liposomal HPV-16 E6/E7 Multipeptide Vaccine PDS0101
Other Intervention Name(s)
mmunoMAPK-RDOTAP /HPV-16 E6/E7 Peptide Antigen Vaccine, PDS0101
Intervention Description
Given SC
Intervention Type
Radiation
Intervention Name(s)
Radiation Therapy
Other Intervention Name(s)
Cancer Radiotherapy, Irradiate, Irradiated, Irradiation, Radiation, Radiation Therapy, NOS, Radiotherapeutics, Radiotherapy, RT, Therapy, Radiation
Intervention Description
Undergo radiation therapy
Primary Outcome Measure Information:
Title
Rate of grade >= 3 acute toxicity
Description
Measured from first vaccine injection up to 30 days following completion of chemoradiotherapy (chemoRT). Adverse events (AEs) will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Any AE that occurs between the first day of PDS0101 injection and up to 30 days following completion of chemoRT (~Day 80) will be considered as acute toxicity (AT).
Time Frame
Day -10 to day 80
Secondary Outcome Measure Information:
Title
Rate of complete metabolic response
Description
Measured by positron emission tomography computed tomography (PET CT).
Time Frame
Day 170
Title
Rate of >= 90% gross tumor volume reduction
Description
Measured by magnetic resonance imaging (MRI).
Time Frame
Day 35
Title
Rates of local control
Description
Will be represented by Kaplan-Meier curves.
Time Frame
At 12 and 18 months
Title
Rates of progression-free survival
Description
Will be represented by Kaplan-Meier curves.
Time Frame
At 12 and 18 months
Title
Rates of overall survival
Description
Will be represented by Kaplan-Meier curves.
Time Frame
At 12 and 18 months
Title
Rate of grade >= 3 chronic toxicity
Description
AEs will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Chronic toxicity (CT) is any toxicity that occurs outside of the AT window (between Days 81 and study completion of the study).
Time Frame
Day 81 to completion of trial

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Newly diagnosed locally advanced squamous cell carcinoma of cervix (Federation of Gynecology and Obstetrics [FIGO] 2018 stage IB3-IVA with primary tumor >= 5 cm and/or positive pelvic or periaortic nodal disease assessed by imaging) Histologic diagnosis of squamous cell carcinoma of the cervix Written informed consent before initiation of any study-related procedures World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) performance status 0-2 Alanine aminotransferase (ALT) =< 2-fold the upper limit of normal Aspartate aminotransferase (AST) =< 2-fold the upper limit of normal Alkaline phosphatase (alk phos) =< 2-fold the upper limit of normal Total bilirubin (total bili) =< 2-fold the upper limit of normal Creatinine =< 1.5 Electrocardiogram (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, except for 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 5 years and who are deemed at low risk for recurrence are eligible for the study Exclusion Criteria: Human immunodeficiency virus (HIV) infection, cellular immune deficiencies, hypogammaglobulinemia or dysgammaglobulinemia, or hereditary or congenital immunodeficiencies Prior diagnosis of hepatitis B or C (unless anti-hepatitis C therapy has produced a sustained virologic response) History of clinically significant autoimmune disease, Crohn's disease, or ulcerative colitis Serious concomitant disorder, including active systemic infection requiring treatment, as judged by the investigator Receipt of immunotherapy (e.g., interferons [IFNs], check-point inhibitors, tumor necrosis factor, interleukins, etc.) or biological response modifiers (granulocyte-macrophage colony-stimulating factor [GM-CSF], granulocyte colony-stimulating factor, macrophage colony-stimulating factor) within 4 weeks before the first study vaccination Receipt of chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study drug Current or recent use of physiologic doses of intra-articular, topical, or inhaled corticosteroids is acceptable History of previous therapeutic HPV vaccination (individuals who have been immunized with licensed prophylactic HPV vaccines [e.g., Silgard, Cervarix, Gardasil are not excluded) Known or suspected hypersensitivity to any component of the investigational product or contraindications to cisplatin (e.g., peripheral neuropathy grade =< 2 or ototoxicity =< grade 2 per Common Terminology Criteria for Adverse Events [CTCAE] version [v]5.0) Previous pelvic radiation therapy (RT) Previous chemotherapy for the cervix tumor Previous hysterectomy or will have a hysterectomy as part of their initial cervical cancer therapy Prior major surgery within 4 weeks of enrollment from which the patient has not recovered Other condition or prior therapy that, in the opinion of the Investigator, compromises the subject's welfare or may confound study results Concurrent participation in another therapeutic investigational study or use of another investigational drug within 6 months before the first study vaccination Previous enrollment in this study HPV genotyping is to be done from cervical swab samples. Enrollment will not require HPV testing Pregnancy: a female subject defined as a women of childbearing potential (WOCBP) who has a positive urine pregnancy test (e.g. within 72 hours) prior to treatment. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ann H. Klopp
Phone
713-563-2444
Email
aklopp@mdanderson.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ann H Klopp
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ann H. Klopp
Phone
713-563-2444
First Name & Middle Initial & Last Name & Degree
Ann H. Klopp

12. IPD Sharing Statement

Links:
URL
http://www.mdanderson.org
Description
University of Texas MD Anderson Cancer Center Website

Learn more about this trial

A Vaccine (PDS0101) and Chemoradiation for the Treatment of Stage IB3-IVA Cervical Cancer, the IMMUNOCERV Trial

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