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Phase II Intratumoral IL12 Plasmid Electroporation in Cutaneous Lymphoma (CTCL)

Primary Purpose

Cutaneous T Cell Lymphomas (CTCL), Mycosis Fungoides (MF)

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Tavokinogene Telseplasmid (tavo)
OncoSec Medical System (OMS)
Sponsored by
OncoSec Medical Incorporated
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cutaneous T Cell Lymphomas (CTCL)

Eligibility Criteria

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

Inclusion Criteria

  1. Biopsy confirmed mycosis fungoides of stage IB - IIIB;
  2. Participants must have failed or have been intolerant to at least one standard of care therapy;
  3. Participants must have a minimum of one lesion, or affected area in erythrodermic patients (T4/stage III), that meets all following criteria:

    • Accessible for pIL-12 electroporation;
    • Adequate size such that 6-mm biopsy can be collected prior to treatment;
  4. Participants must have one additional lesion, or affected area in erythrodermic patients, that remains untreated for the duration of the study;
  5. Age ≥ 18 years old;
  6. Participants must have Eastern Cooperative Oncology Group (ECOG) performance status 0-2;
  7. Required wash out period of 4 weeks from last dose for the following prior therapies:

    • Topical therapy;
    • Radiotherapy (including photo therapy);
    • Multi-agent chemotherapy;
    • Systemic biological therapy;
    • Histone deacetylase inhibitors (HDAC) inhibitors;
    • Interferon alpha and other investigational therapies;
  8. For women of childbearing potential, negative pregnancy serum test within 14 days to the first study drug administration, and use of birth control from 30 days prior to the first day study drug administration and 30 days following last day study drug administration;
  9. Male participants must be surgically sterile, or must agree to use contraception during the study and at least 30 days following the last day of study drug administration.
  10. Life expectancy of at least 6 months;
  11. The patient must have adequate renal and hepatic function as assessed by standard laboratory criteria within 4 weeks prior to enrollment:

    • Creatinine < 2 x upper limit of normal (ULN);
    • Serum bilirubin within institutional normal limits;
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 1.5 x ULN;
    • Absolute neutrophil count (ANC) > 1000/mm;
    • Platelet count > 100,000 /mm;
  12. Able to give informed consent and able to follow guidelines given in the study.

Exclusion Criteria

  1. Prior therapy with IL-12 or prior gene therapy;
  2. Prior treatment with Campath (alemtuzumab) within 1 year of enrollment;
  3. Concurrent immunotherapy, chemotherapy, or radiation therapy for duration of patient participation on study;
  4. Concurrent steroid therapy;
  5. Concurrent anticoagulant therapy (acetylsalicylic acid [ASA]≤ 325mg/day allowed);
  6. Evidence of significant active infection (e.g., pneumonia, cellulitis, wound abscess, etc.) at time of study enrollment;
  7. Patients with current evidence of large cell transformation (LCT) with aggressive disease at study entry (patients with a history of LCT are eligible if pathologic evidence at study entry indicates there is no presence of LCT);
  8. Known history of human immunodeficiency virus (HIV), Human T-cell leukemia virus (HTLV) -1/2 infection, hepatitis B or hepatitis C (active, prior treatment, or both);
  9. No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for 2 years;
  10. Significant cardiovascular disease (i.e. New York Heart Association [NYHA] class 3 congestive heart failure; myocardial infarction within the past 6 months; unstable angina; coronary angioplasty with the past 6 months; uncontrolled atrial or ventricular cardiac arrhythmias);
  11. Any other medical history, including laboratory results, deemed by the investigator to be likely to interfere with patient's participation in the study, or to interfere with the interpretation of the results;
  12. Participants with electronic pacemakers or defibrillators are excluded from this study as the effect of electroporation on these devices is unknown;
  13. Pregnant and breast-feeding women are excluded from the study as effects on the fetus are unknown and there may be a risk of increased fetal wastage.

Sites / Locations

  • UCSF Helen Diller Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment

Arm Description

Participants received up to 4 cycles of treatment (3 daily treatments on Days 1, 5 and 8, in a 12-week cycle) of intratumoral injection(s) of tavo at a concentration of 1.0 mg/mL (maximum volume of 1 mL/day distributed over 2-4 lesions), followed immediately by electrical discharge around the tumor site resulting in electroporation of plasmid deoxyribonucleic acid (DNA) into tumor cells.

Outcomes

Primary Outcome Measures

Objective Response Rate Assessed by Modified Severity Weighted Assessment Tool (mSWAT) Score in the Skin
ORR is defined as the percentage of participants that achieved a complete response (CR) or partial response (PR) as assessed by mSWAT score. The mSWAT defines 3 lesion types and assigns each a weighing factor: patch (no induration or significant elevation)=1; plaque (induration, crusting, ulceration or poikiloderma)=2; tumor (solid or nodular ≥ 1 cm in diameter with evidence of deep infiltration and/or vertical growth)=4. Lesions are assessed by body surface area (BSA) where palm + fingers = approximately 1% BSA in each of 12 areas (head, neck, anterior trunk, arms, forearms, hands, posterior trunk, buttocks, thighs, legs, feet, groin), and the sum of each area of BSA is multiplied by its weighing factor. An overall sum of each subtotal represents the mSWAT score (0=no lesions; 400=lesions covering all areas). CR=100% clearance of skin lesions; PR= 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease.
Objective Response Rate Assessed by Modified Severity Weighted Assessment Tool (mSWAT) Composite Global Score
ORR is defined as the percentage of participants that achieved a complete response (CR) or partial response (PR) as assessed by mSWAT Composite Global Score. This assessment evaluated skin, lymph node, blood and visceral involvement. The response generated in each category was used to determine the Global ORR: CR=complete disappearance of all clinical evidence of disease or, no involvement of disease at baseline through time of response evaluation (NI); PR=regression of measurable disease as follows: 100% clearance of skin lesions, all other categories do not have CR/NI and no category has progressive disease (PD) -OR- 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease, and if any other category was involved at baseline, at least one has CR/PR and no category has PD.

Secondary Outcome Measures

Percentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
An AE was any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product, medical treatment or procedure and which did not necessarily have to have had a causal relationship with this treatment. An adverse event could have, therefore, been any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, medical treatment or procedure whether or not considered related to the medicinal product. An SAE was defined an any untoward medical occurrence that at any dosage resulted in one or more of the following: death, A life-threatening adverse event (real risk of dying), inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability/incapacity, congenital anomaly, required intervention to prevent permanent impairment of damage.
Duration of Overall Objective Response Assessed by mSWAT Skin Score
Duration of overall objective response (CR or PR) is defined as the number of days from the initial documentation of an objective response to the most current evaluation of that response or to documentation of progression assessed by mSWAT Skin Score: CR=100% clearance of skin lesions; PR= 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease.
Time to Overall Objective Response Assessed by mSWAT Skin Score
Time to overall objective response (CR or PR) is the number of days from the start of therapy to the first documentation of objective response assessed by mSWAT Skin Score: CR=100% clearance of skin lesions; PR= 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease.
Quality of Life (QoL)
Participants were to complete the following QoL assessments prior to clinical evaluations every 4 weeks: Skindex29, FACT-G (Functional Assessment of Cancer Therapy -General) and VAS-P (Visual Analog for Pruritus) questionnaires.

Full Information

First Posted
April 15, 2012
Last Updated
May 11, 2023
Sponsor
OncoSec Medical Incorporated
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1. Study Identification

Unique Protocol Identification Number
NCT01579318
Brief Title
Phase II Intratumoral IL12 Plasmid Electroporation in Cutaneous Lymphoma
Acronym
CTCL
Official Title
A Multicenter Phase II Trial of Intratumoral IL12 Plasmid Electroporation in Cutaneous Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Terminated
Why Stopped
Due to company resource constraints
Study Start Date
June 8, 2012 (Actual)
Primary Completion Date
June 3, 2014 (Actual)
Study Completion Date
June 3, 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
OncoSec Medical Incorporated

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
A single arm, open label, multi-center, phase 2 study to assess the safety and anti-tumor activity of ImmunoPulse IL-12® in participants with stage IB to IIIB mycosis fungoides. ImmunPulseIL12® is the combination of intrtumoral interleukin-12 gene (also known as tavokinogene telseplasmid [tavo]) and in vivo electroporation-mediated plasmid deoxyribonucleic acid [DNA] vaccine therapy (tavo-EP) administered using the OncoSec Medical System (OMS). All participants may receive up to four cycles of treatment consisting of three treatment days, Days 1, 5 and 8, in a 12-week cycle as per Protocol version 6 (see Limitations and Caveats section of this record for protocol version information). Patients will receive intra-tumoral injection of tavo at a concentration of 1.0 mg/mL (maximum volume of 1 mL/day distributed over 2-4 lesions), followed immediately by electrical discharge around the tumor site resulting in electroporation of plasmid deoxyribonucleic acid (DNA) into tumor cells.
Detailed Description
This is a single arm, open label, multi-center phase 2 study to assess the safety and anti-tumor activity of intratumoral tavo electroporation in participants with stage IB to IIIB mycosis fungoides. All participants received up to four cycles of treatment consisting of three treatment days, Days 1, 5 and 8, in a 12-week cycle. Patients will receive intra-tumoral injection of tavo at a concentration of 1.0 mg/mL (maximum volume of 1 mL/day distributed over 2-4 lesions), followed immediately by electrical discharge around the tumor site resulting in electroporation of plasmid deoxyribonucleic acid (DNA) into tumor cells. Prior to the first cycle of treatment, the investigator will select at least one lesion, or affected area in erythrodermic patients, to be left untreated for the duration of the study to allow for clinical observation of an untreated site. Participants will be followed for safety and clinical evaluation every 4 weeks. Quality of Life will be assessed using the Skindex29, Functional Assessment of Cancer Therapy - General (FACT-G) and Visual Analog Scale for Pruritus (VAS-P) instruments. Survival follow up will occur at 3-month intervals over 2 years following end of study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cutaneous T Cell Lymphomas (CTCL), Mycosis Fungoides (MF)

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Treatment
Arm Type
Experimental
Arm Description
Participants received up to 4 cycles of treatment (3 daily treatments on Days 1, 5 and 8, in a 12-week cycle) of intratumoral injection(s) of tavo at a concentration of 1.0 mg/mL (maximum volume of 1 mL/day distributed over 2-4 lesions), followed immediately by electrical discharge around the tumor site resulting in electroporation of plasmid deoxyribonucleic acid (DNA) into tumor cells.
Intervention Type
Biological
Intervention Name(s)
Tavokinogene Telseplasmid (tavo)
Other Intervention Name(s)
interleukin-12 gene, IL-12 gene, pIL-12, plasmid DNA encoding human interleukin-12, plasmid IL-12
Intervention Description
Patients received intratumoral injection(s) of tavo.
Intervention Type
Device
Intervention Name(s)
OncoSec Medical System (OMS)
Other Intervention Name(s)
MedPulser
Intervention Description
Electroporation via OMS was performed immediately following intratumoral injection of tavo. A sterile applicator containing 6 stainless steel electrodes arranged in a circle were placed around the tumor. The applicator was connected to the OMS power supply and six pulseswere administered to each tumor lesion at the approximate point of tavo injection.
Primary Outcome Measure Information:
Title
Objective Response Rate Assessed by Modified Severity Weighted Assessment Tool (mSWAT) Score in the Skin
Description
ORR is defined as the percentage of participants that achieved a complete response (CR) or partial response (PR) as assessed by mSWAT score. The mSWAT defines 3 lesion types and assigns each a weighing factor: patch (no induration or significant elevation)=1; plaque (induration, crusting, ulceration or poikiloderma)=2; tumor (solid or nodular ≥ 1 cm in diameter with evidence of deep infiltration and/or vertical growth)=4. Lesions are assessed by body surface area (BSA) where palm + fingers = approximately 1% BSA in each of 12 areas (head, neck, anterior trunk, arms, forearms, hands, posterior trunk, buttocks, thighs, legs, feet, groin), and the sum of each area of BSA is multiplied by its weighing factor. An overall sum of each subtotal represents the mSWAT score (0=no lesions; 400=lesions covering all areas). CR=100% clearance of skin lesions; PR= 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease.
Time Frame
Every 28 days for the first 24-weeks of treatment
Title
Objective Response Rate Assessed by Modified Severity Weighted Assessment Tool (mSWAT) Composite Global Score
Description
ORR is defined as the percentage of participants that achieved a complete response (CR) or partial response (PR) as assessed by mSWAT Composite Global Score. This assessment evaluated skin, lymph node, blood and visceral involvement. The response generated in each category was used to determine the Global ORR: CR=complete disappearance of all clinical evidence of disease or, no involvement of disease at baseline through time of response evaluation (NI); PR=regression of measurable disease as follows: 100% clearance of skin lesions, all other categories do not have CR/NI and no category has progressive disease (PD) -OR- 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease, and if any other category was involved at baseline, at least one has CR/PR and no category has PD.
Time Frame
Every 28 days for the first 24-weeks of treatment
Secondary Outcome Measure Information:
Title
Percentage of Participants With Adverse Events (AEs) and Serious Adverse Events (SAEs)
Description
An AE was any untoward medical occurrence in a patient or clinical investigation participant administered a pharmaceutical product, medical treatment or procedure and which did not necessarily have to have had a causal relationship with this treatment. An adverse event could have, therefore, been any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a medicinal product, medical treatment or procedure whether or not considered related to the medicinal product. An SAE was defined an any untoward medical occurrence that at any dosage resulted in one or more of the following: death, A life-threatening adverse event (real risk of dying), inpatient hospitalization or prolongation of existing hospitalization, persistent or significant disability/incapacity, congenital anomaly, required intervention to prevent permanent impairment of damage.
Time Frame
From the start of study treatment up to 340 days
Title
Duration of Overall Objective Response Assessed by mSWAT Skin Score
Description
Duration of overall objective response (CR or PR) is defined as the number of days from the initial documentation of an objective response to the most current evaluation of that response or to documentation of progression assessed by mSWAT Skin Score: CR=100% clearance of skin lesions; PR= 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease.
Time Frame
From first documented response until disease progression (Up to 340 days)
Title
Time to Overall Objective Response Assessed by mSWAT Skin Score
Description
Time to overall objective response (CR or PR) is the number of days from the start of therapy to the first documentation of objective response assessed by mSWAT Skin Score: CR=100% clearance of skin lesions; PR= 50%-99% clearance of skin disease from baseline without new tumors ( ≥1.0 cm in diameter) in patients with T1, T2 or T4 only skin disease.
Time Frame
From start of study treatment until overall objective response (Up to 340 days)
Title
Quality of Life (QoL)
Description
Participants were to complete the following QoL assessments prior to clinical evaluations every 4 weeks: Skindex29, FACT-G (Functional Assessment of Cancer Therapy -General) and VAS-P (Visual Analog for Pruritus) questionnaires.
Time Frame
Every 28 days for up to 340 days
Other Pre-specified Outcome Measures:
Title
Immunologic Effects of IL-12 Plasmid Electroporation in Tissue
Description
This outcome measure was erroneously entered as secondary but is truly an exploratory endpoint. Planned analyses were: Transcriptional analysis of interferon pathway activation, antigen presentation and processing machinery (APM) upregulation, and immune cell infiltration in tissue at baseline and post-treatment. Changes in the characterization of local tissue effects, proportion and phenotype, of intratumoral leukocyte subsets post-treatment. Changes in T cell receptor clonal expansion and persistence of initial clones post- treatment. Changes in FOXP3 methylation and quantification of regulatory T cells post- treatment.
Time Frame
2 years
Title
Immunologic Effects of IL-12 Plasmid Electroporation in Peripheral Blood
Description
This outcome measure was erroneously entered as secondary but is truly an exploratory endpoint. Planned analyses were: Changes in the proportion of circulating regulatory and effector T cells in peripheral blood. Changes in phenotype of leukocyte subsets and T cell receptor clonal expansion
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria Biopsy confirmed mycosis fungoides of stage IB - IIIB; Participants must have failed or have been intolerant to at least one standard of care therapy; Participants must have a minimum of one lesion, or affected area in erythrodermic patients (T4/stage III), that meets all following criteria: Accessible for pIL-12 electroporation; Adequate size such that 6-mm biopsy can be collected prior to treatment; Participants must have one additional lesion, or affected area in erythrodermic patients, that remains untreated for the duration of the study; Age ≥ 18 years old; Participants must have Eastern Cooperative Oncology Group (ECOG) performance status 0-2; Required wash out period of 4 weeks from last dose for the following prior therapies: Topical therapy; Radiotherapy (including photo therapy); Multi-agent chemotherapy; Systemic biological therapy; Histone deacetylase inhibitors (HDAC) inhibitors; Interferon alpha and other investigational therapies; For women of childbearing potential, negative pregnancy serum test within 14 days to the first study drug administration, and use of birth control from 30 days prior to the first day study drug administration and 30 days following last day study drug administration; Male participants must be surgically sterile, or must agree to use contraception during the study and at least 30 days following the last day of study drug administration. Life expectancy of at least 6 months; The patient must have adequate renal and hepatic function as assessed by standard laboratory criteria within 4 weeks prior to enrollment: Creatinine < 2 x upper limit of normal (ULN); Serum bilirubin within institutional normal limits; Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 1.5 x ULN; Absolute neutrophil count (ANC) > 1000/mm; Platelet count > 100,000 /mm; Able to give informed consent and able to follow guidelines given in the study. Exclusion Criteria Prior therapy with IL-12 or prior gene therapy; Prior treatment with Campath (alemtuzumab) within 1 year of enrollment; Concurrent immunotherapy, chemotherapy, or radiation therapy for duration of patient participation on study; Concurrent steroid therapy; Concurrent anticoagulant therapy (acetylsalicylic acid [ASA]≤ 325mg/day allowed); Evidence of significant active infection (e.g., pneumonia, cellulitis, wound abscess, etc.) at time of study enrollment; Patients with current evidence of large cell transformation (LCT) with aggressive disease at study entry (patients with a history of LCT are eligible if pathologic evidence at study entry indicates there is no presence of LCT); Known history of human immunodeficiency virus (HIV), Human T-cell leukemia virus (HTLV) -1/2 infection, hepatitis B or hepatitis C (active, prior treatment, or both); No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for 2 years; Significant cardiovascular disease (i.e. New York Heart Association [NYHA] class 3 congestive heart failure; myocardial infarction within the past 6 months; unstable angina; coronary angioplasty with the past 6 months; uncontrolled atrial or ventricular cardiac arrhythmias); Any other medical history, including laboratory results, deemed by the investigator to be likely to interfere with patient's participation in the study, or to interfere with the interpretation of the results; Participants with electronic pacemakers or defibrillators are excluded from this study as the effect of electroporation on these devices is unknown; Pregnant and breast-feeding women are excluded from the study as effects on the fetus are unknown and there may be a risk of increased fetal wastage.
Facility Information:
Facility Name
UCSF Helen Diller Comprehensive Cancer Center
City
San Francisco
State/Province
California
ZIP/Postal Code
94115
Country
United States

12. IPD Sharing Statement

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Phase II Intratumoral IL12 Plasmid Electroporation in Cutaneous Lymphoma

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