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Phase I/II Study of Immunotherapy Combination BN-Brachyury Vaccine, M7824, N-803 and Epacadostat (QuEST1)

Primary Purpose

Metastatic Prostate Cancer, Prostate Cancer, Prostate Neoplasm

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
M7824
N-803
MVA-BN-Brachyury
FPV-Brachyury
Epacadostat
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Prostate Cancer focused on measuring Immunotherapy, Combined Treatment, PD-1/PD-L1, Tumor-Specific T Cells, Novel Cancer Vaccine

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

Participants must have histologically or cytologically confirmed any solid tumor (Cohort 1) or castration-resistant prostate cancer (CRPC, Cohorts 2A, 2D and 2R).

For the Cohort 1, eligible participants must have a histologically, cytologically or radiographically proven metastatic or locally advanced solid tumor of any type, for which there is no curative standard therapy or standard therapy has failed.

Castrate testosterone level (less than 50ng/dl or 1.7nmol /L). (Participants with a malignancy other than prostate cancer are excluded from this criterion).

Radiological confirmation of metastatic disease, or

Progressive disease at study entry defined as one or more of the following criteria occurring in the setting of castrate levels of testosterone:

--Radiographic progression defined as any new or enlarging bone lesions or growing lymph node disease, consistent with prostate cancer

OR

--PSA progression defined by sequence of rising values separated by greater than 1 week (2 separate increasing values over a minimum of 1 ng/ml (PCWG3 PSA eligibility criteria). If participants had been on flutamide, PSA progression is documented 4 weeks or more after withdrawal. For participants on bicalutamide or nilutamide disease progression is documented 6 or more weeks after withdrawal. The requirement for a 4-6 week withdrawal period following discontinuation of flutamide, nilutamide or bicalutamide only applies to participants who have been on these drugs for at least the prior 6 months. For all other participants they must stop bicalutamide, nilutamide or flutamide the day prior to enrollment.

Asymptomatic or mildly symptomatic form prostate cancer; no use of regularly scheduled opiate analgesics for prostate cancer-related pain. (Participants with a malignancy other than prostate cancer are excluded from this criterion).

Participants must agree to continuation of androgen deprivation therapy (ADT) with a gonadotropin-releasing hormone analogue/antagonist or bilateral orchiectomy. (Participants with a malignancy other than prostate cancer are excluded from this criterion). Participants may also continue oral androgen receptor antagonist/anti-androgen therapy (e.g. enzalutamide or abiraterone) unless enrolling to Arm 2.3A or 2.3B due to concerns regarding CYPmediated drug-drug interactions epacadostat.

Participants must have had the following prior therapy:

Testosterone lowering therapy for CRPC

In addition to continuation of ADT (unless status post bilateral orchiectomy) eligible patients must have received and had PSA or radiographic progression on enzalutamide (or other oral androgen receptor antagonist e.g. darolutamide or apalutamdide) or abiraterone acetate.

Participants who have tumors known to be microsatellite instability high/mismatch repair deficient or tumor mutational burden high must have received prior pembrolizumab.

Participants with known pathogenic homologous recombination repair mutations for which there is evidence of benefit with PARP inhibitors (e.g. BRCA1. BRCA2, ATM) must have received prior PARP inhibitor.

Age greater than or equal to 18 years.

ECOG performance status less than or equal to 1

Participants must have adequate organ and marrow function as defined below:

  • Absolute neutrophil count greater than or equal to 1000/mcL
  • Platelets greater than or equal to 100,000/mcL
  • Hemoglobin greater than or equal to 9.0 g/dL
  • Total bilirubin within normal institutional limits; in participants with Gilbert s, less than or equal to 3.0 mg/dL
  • AST (AGOT)/ALT (AGPT) less than or equal to 2.5X upper limit of normal. For subjects with liver involvement in their tumor, AST less than or equal to 3.5. X ULN, ALT less than or equal to 3.5 X ULN, and bilirubin less than or equal to 3.0 is acceptable
  • Creatinine within 1.5X upper limit of normal institutional limits

The effects of BN-Brachyury, M7824, N-803, and Epacadostat on the developing human fetus are unknown. For this reason, men and women must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, during the study and maintain such contraception until 4 months following the last dose of any study agent. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her partner s treating physician immediately.

Ability of subject to understand and the willingness to sign a written informed consent document.

Participants with successfully treated HCV are eligible if HCV viral load is undetectable.

EXCLUSION CRITERIA:

Participants who are immunocompromised as follows:

  • Human immunodeficiency virus positivity due to the potential for decreased tolerance, and potential to be at risk for severe side effects with immunotherapies. These concerns are relevant to all drugs, as drug-drug interactions among antiretrovirals and immunotherapies are yet uncharacterized.
  • Chronic administration (defined as daily or every other day for continued use greater than 14 days) of systemic corticosteroids or other immune suppressive drugs, within 28 days before treatment on study. Nasal, or inhaled steroid, topical steroid creams and eye drops for small body areas are allowed. Physiologic doses of steroids are permitted, e.g. a participant taking hydrocortisone for adrenal insufficiency or a patient recently on abiraterone (administered with 10 mg of prednisone daily) who is tapering off of prednisone is allowed to continue that taper.
  • Participants who have undergone allogeneic peripheral stem cell transplantation, or solid organ transplantation requiring immunosuppression

    • Active autoimmune disease, except participants with type 1 diabetes mellitus, vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring current immunosuppression, or with other endocrine disorders on replacement hormones or are not excluded if the condition is well controlled.

Prostate cancer participants with a history of brain/leptomeningeal metastasis, since these participants have a very poor prognosis and immunotherapy may take time to lead to beneficial clinical effects. Participants with brain or CNS metastases enrolling to arm 1.1 are eligible if they are status post definitive radiotherapy or surgery, and are asymptomatic

History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agents to be used in the cohort the subject will be enrolled into.

Known allergy to eggs, egg products, aminoglycoside antibiotics (for example, gentamicin or tobramycin).

Any condition which, in the opinion of the investigator, would prevent full participation in this trial (including the long-term follow-up), or would interfere with the evaluation of the trial endpoints.

Participants with prior investigational drug, chemotherapy, immunotherapy or any prior radiotherapy (except for palliative bone directed therapy) within the past 28 days prior to enrollment, except if the investigator has assessed that all residual treatment-related toxicities have resolved or are minimal and feel the participant is otherwise suitable for enrollment.

Uncontrolled intercurrent acute or chronic illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (>New York Heart Association Class I), hepatic disease, unstable angina pectoris, serious cardiac arrhythmia, requiring medication, uncontrolled hypertension (SBP>170/ DBP>105) or psychiatric illness/social situations within 12 months that would limit compliance with study requirements.

Use of herbal products that may decrease PSA levels (e.g. saw palmetto)

Participants who have had cytotoxic chemotherapy for metastatic castration-resistant prostate cancer within the past 3 months. (Participants who have had docetaxel for metastatic castration sensitive per CHAARTED data may enroll as long as they did not have progressive disease while on docetaxel and are 3 months removed from treatment, with all treatment related toxicities resolving to at least grade 1.)

Participants who have undergone major surgery within 4 weeks of enrollment. A biopsy will not preclude a participant from starting study.

Participants with a history of hepatitis B (HBV) are excluded due to potential risk for viral reactivation and resulting liver injury in persons with latent HBV

Subjects unwilling to accept blood products or blood transfusions as medically indicated. As there is a risk of severe bleeding with M7824, participants must be willing to receive blood transfusions if medically necessary for their own safety

For participants enrolling in Arm 2.3A and for participants who may be randomized to Arm 2.3B, the following additional exclusion criteria will apply:

  • Subjects receiving Monoamine Oxidase Inhibitors (MAOIs) or a drug which has significant MAOI activity (meperidine, linezolid, methylene blue) within the 21 days before initiation of study therapy are excluded.
  • Since epacadostat s metabolism may be altered by drugs that inhibit UDP- glucuronosyltransferase UGT1A9 (see Appendix D), Participants receiving such drugs within 21 days of initiation of study therapy are excluded.
  • Participants receiving agents that are substrates of CYP1A2, CYP2C8, and CYP2C19 or affected by OATP1B1 or OATP1B3 within 21 days of initiation of study therapy or 5 half lives of the agent (whichever is shorter) are excluded. Participants receiving medications that are substrates of these enzymes/transporters but are not listed in the appendix or participants receiving substrates of CYP2B6 and CYP3A will be evaluated on a case-by-case basis prior to enrollment. Participants who consume caffeine are eligible but must agree to moderate consumption.
  • Subjects receiving coumarin-based anticoagulants (e. Coumadin) are excluded.
  • Subjects having any history of Serotonin Syndrome (SS) after receiving serotonergic drugs are excluded.

    --Participants with a QTcF interval > 480 milliseconds at the screening are excluded. In the event that a single QTcF is > 480 milliseconds, the subject may enroll if the average QTcF for the 3 ECGs is < 480 milliseconds. For subjects with an intraventricular conduction delay (QRS interval > 120 milliseconds), the JTc interval may be used in place of the QTc. The JTc must be < 340 milliseconds if JTc is used in place of the QTc. QTc prolongation due to pacemaker may enroll if the JTc is normal.

  • Subjects with left bundle branch block are excluded.
  • Pregnant women are excluded from this study because investigational agents used in this study (BN-Brachyury, M7824, N-803, and/or Epacadostat) could have teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with these investigational agen s, breastfeeding should be discontinued if the mother is treated with either of them.

Sites / Locations

  • National Institutes of Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

Arm 1.1

Arm 2.1A

Arm 2.1B

Arm 2.2A

Arm 2.2B

Arm 2.3A

Arm 2.3B

Arm Description

M7824 + N-803

M7824 + BN-Brachyury during phase IIA

M7824 + BN-Brachyury during phase IIB

M7824 + BN-Brachyury + N-803 during phase IIA

M7824 + BN-Brachyury + N-803 during phase IIB

M7824 + BN-Brachyury + N-803 + Epacadostat during phase IIA

M7824 + BN-Brachyury + N-803 + Epacadostat during phase IIB

Outcomes

Primary Outcome Measures

To determine if there is clinical benefit to any of a set of 3 possible treatments for patients with mCRPC
Best treatment combination for patients with CRPC

Secondary Outcome Measures

Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824
Progression free survival until progression or death without progression
Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 + N-803
Progression free survival until progression or death without progression
Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 + N-803 + Epacadostat
Progression free survival until progression or death without progression
To characterize the safety profile of the above combinations and M7824 + N-803
Safety

Full Information

First Posted
April 10, 2018
Last Updated
September 30, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03493945
Brief Title
Phase I/II Study of Immunotherapy Combination BN-Brachyury Vaccine, M7824, N-803 and Epacadostat (QuEST1)
Official Title
A Phase I/II Study of Immunotherapy Combination BN-Brachyury Vaccine, M7824, N-803 and Epacadostat (QuEST1)
Study Type
Interventional

2. Study Status

Record Verification Date
August 30, 2023
Overall Recruitment Status
Recruiting
Study Start Date
May 1, 2018 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

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

5. Study Description

Brief Summary
Background: Immunotherapy drugs help the body to fight cancer. Scientists think that combining some of these drugs will make them work better than when used alone. This may be true for many types of cancer, including castration-resistant prostate cancer (CRPC). Objective: To test if the combination of the drugs BN-brachyury, M7824, N-803, and Epacadostat is safe and shrinks tumors. Eligibility: People ages 18 and older with CRPC or another metastatic cancer Design: Participants will be screened with: Medical history Physical exam CT or MRI scans Possible bone imaging Blood, urine, and heart tests Possible tumor biopsy Participants will be treated with a 2-, 3- or 4-drug combinations of the following study drugs in 2-week cycles: Participants will receive M7824 by IV once every 2 weeks. Participants will receive N-803 by injection once every 2 weeks. They will record any skin changes at the injection site in a diary. Participants will receive BN-brachyury as 4 injections to different limbs. They will get the first 3 doses 2 weeks apart. Then they will get doses every 4 weeks for 6 months, then every 3 months for 2 years, then every 6 months. Participants will take Epacadostat orally every 12 hours. They will keep a pill diary. Participants will have physical exams and blood and urine tests at the start of each cycle. They may have scans every 12 weeks. Participants will continue treatment until their disease gets worse or they cannot tolerate the side effects. Participants will have a follow-up visit 4-5 weeks after they stop treatment. They will have a physical exam and blood tests. They may be asked to return for scans every 3 months.
Detailed Description
Background: PD-1/PD-L1 signaling appears to be a major inhibitor of activated T cell anti-tumor immune responses. The rapid, deep and durable responses seen in various malignancies with PD-1/PD-L1 targeted agents demonstrate that blockade of this axis is key to facilitating immune responses within the tumor microenvironment (TME). Prostate cancer is poorly recognized by T cells. Lack of an immune response is one explanation for the lower response rates (<15%) observed with anti-PD-1/PD-L1 therapies for prostate cancer. Increasing response rates will likely require therapeutic nullification of multiple immune deficits by combining immunotherapies that generate tumor-specific T cells (vaccine), dampen the inhibitory milieu of the TME, and enhance T and NK cell activity within the TME. A quick efficacy seeking trial, utilizing sequential arms offers a means to identify signals of activity for combinations of immunotherapy, added sequentially, in castration resistant prostate cancer (CRPC) participants. BN-Brachyury is a novel recombinant vector-based therapeutic cancer vaccine designed to induce an enhanced immune response against brachyury, which is overexpressed in many solid tumor types, including prostate adenocarcinoma. BN-Brachyury collectively refers to the priming doses (MVA-BN-Brachyury) and the boost doses (FPV-Brachyury) of the vaccine platform. M7824 is a bifunctional fusion protein consisting of an anti-programmed death ligand 1 (PD-L1) antibody and the extracellular domain of transforming growth factor beta (TGF- beta) receptor type 2, a TGF-beta trap. M7824 can also mediate antibody-dependent cellular cytotoxicity in vitro. N-803 is an IL-15/IL-15R alpha superagonist complex that can enhance NK cell mediated ADCC and T-cell cytotoxicity. Synergistic anti-tumor effects have been observed in vitro when combining M7824 and N-803, and in vivo when combining these agents with tumor vaccine in animal models. IDO1 is overexpressed in many solid tumors and can contribute to immune escape by tumor cells. INCB024360 (Epacadostat) is an IDO1 inhibitor under investigation in combination with different immunotherapies in treatment of various malignancies. In treating of CRPC, we hypothesize that these agents and their effects will be complementary. Tumor-specific T cells generated by vaccine may become more functional in a TME following treatment with M7824 and Epacadostat. N-803 can further enhance the activity of antigen-specific T cells as well as NK cells. Objective: -To determine if there is clinical benefit to any of a set of 3 possible treatments for participants with CRPC: BN-Brachyury + M7824 BN-Brachyury + M7824 + N-803 BN-Brachyury + M7824 + N-803 + Epacadostat Eligibility: Adults with histologically proven CRPC, or metastatic solid tumor of any type for which there is no standard treatment or standard treatment has failed. Adequate organ function as defined by liver, kidney, and hematologic laboratory testing. Participants with acquired immune defects, active systemic autoimmune disease, history of organ transplant, history of chronic infections, or history of active inflammatory bowel disease are excluded. Design: Open label Phase I/II trial with following randomization during the expansion. Phase I: Cohort 1, Arm 1.1 -Up to 18 participants with any solid tumor will be enrolled in dose escalation Cohort 1 for treatment in Arm 1.1 (flat dose of M7824 + different dose levels of N-803). Phase IIA: expansion with sequential enrollment into Cohort 2A, Arms 2.1A, 2.2A and 2.3 A Concurrently with the enrollment to Arm 1.1, 13 participants with CRPC will start enrollment in Cohort 2A for treatment in Arm 2.1A (M7824 + BN-Brachyury). When safe dosing of N-803 is identified during Phase I, 13 participants have enrolled in arm 2.1A and the first 6 participants, treated in Arm 2.1A, have met safety requirements, 13 participants with CRPC will start enrollment in Cohort 2A for treatment in Arm 2.2A (M7824 + BN-Brachyury + N-803). When 13 participants have enrolled in Arm 2.2A and the first 6 participants, treated in Arm 2.2A, have met safety requirements, 13 participants with CRPC will start enrollment in Cohort 2A for treatment in Arm 2.3A (M7824 + BN-Brachyury + N-803 + Epacadostat). Phase IIB: expansion with randomized enrollment into Cohorts 2D and 2R, Arms 2.1B, 2.2B. and 2.3B Each Arm in Cohorts 2D and 2R: 2.1B, 2.2B and 2.3B will be open for additional enrollment (25 evaluable participants total) when the initial 13 participants have accrued, safety requirements are meet and a positive signal (defined as Objective Response by RECIST 1.1 or sustained PSA decrease >= 30% sustained for > 21 days) in >= 2 participants is shown. If only one arm is open for additional enrollment, participants will be directly assigned to this arm. If 2 arms are open for additional enrollment, participants will be randomized between these 2 open arms. If 3 arms are open for additional enrollment, participants will be randomized among these 3 open arms. If there are >= 6 of 25 participants with a positive signal of activity in any expansion arm, that arm will be considered of interest for future studies.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Prostate Cancer, Prostate Cancer, Prostate Neoplasm, Advanced Solid Tumor, Solid Tumor
Keywords
Immunotherapy, Combined Treatment, PD-1/PD-L1, Tumor-Specific T Cells, Novel Cancer Vaccine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
113 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm 1.1
Arm Type
Experimental
Arm Description
M7824 + N-803
Arm Title
Arm 2.1A
Arm Type
Experimental
Arm Description
M7824 + BN-Brachyury during phase IIA
Arm Title
Arm 2.1B
Arm Type
Experimental
Arm Description
M7824 + BN-Brachyury during phase IIB
Arm Title
Arm 2.2A
Arm Type
Experimental
Arm Description
M7824 + BN-Brachyury + N-803 during phase IIA
Arm Title
Arm 2.2B
Arm Type
Experimental
Arm Description
M7824 + BN-Brachyury + N-803 during phase IIB
Arm Title
Arm 2.3A
Arm Type
Experimental
Arm Description
M7824 + BN-Brachyury + N-803 + Epacadostat during phase IIA
Arm Title
Arm 2.3B
Arm Type
Experimental
Arm Description
M7824 + BN-Brachyury + N-803 + Epacadostat during phase IIB
Intervention Type
Biological
Intervention Name(s)
M7824
Intervention Description
1,200 mg IV once every 2 weeks
Intervention Type
Drug
Intervention Name(s)
N-803
Intervention Description
8-15 mcg/kg subcutaneous every 2 weeks
Intervention Type
Biological
Intervention Name(s)
MVA-BN-Brachyury
Intervention Description
MVA-BN-Brachyury will be administered subcutaneously (2 doses 2 weeks apart).
Intervention Type
Biological
Intervention Name(s)
FPV-Brachyury
Intervention Description
FPV-Brachyury will be given 2 weeks after second dose of MVA-BN-Brachyury, then every 4 weeks until 6 months, then every 3 months for 2 years, then every 6 month.
Intervention Type
Drug
Intervention Name(s)
Epacadostat
Intervention Description
600 mg orally twice daily (1200 MG total)
Primary Outcome Measure Information:
Title
To determine if there is clinical benefit to any of a set of 3 possible treatments for patients with mCRPC
Description
Best treatment combination for patients with CRPC
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824
Description
Progression free survival until progression or death without progression
Time Frame
6-month
Title
Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 + N-803
Description
Progression free survival until progression or death without progression
Time Frame
6-month
Title
Evaluate PFS in CRPC patients treated with BN-Brachyury + M7824 + N-803 + Epacadostat
Description
Progression free survival until progression or death without progression
Time Frame
6-month
Title
To characterize the safety profile of the above combinations and M7824 + N-803
Description
Safety
Time Frame
3 weeks DLT period

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Participants must have histologically or cytologically confirmed any solid tumor (Cohort 1) or castration-resistant prostate cancer (CRPC, Cohorts 2A, 2D and 2R). For the Cohort 1, eligible participants must have a histologically, cytologically or radiographically proven metastatic or locally advanced solid tumor of any type, for which there is no curative standard therapy or standard therapy has failed. Castrate testosterone level (less than 50ng/dl or 1.7nmol /L). (Participants with a malignancy other than prostate cancer are excluded from this criterion). Radiological confirmation of metastatic disease, or Progressive disease at study entry defined as one or more of the following criteria occurring in the setting of castrate levels of testosterone: --Radiographic progression defined as any new or enlarging bone lesions or growing lymph node disease, consistent with prostate cancer OR --PSA progression defined by sequence of rising values separated by greater than 1 week (2 separate increasing values over a minimum of 1 ng/ml (PCWG3 PSA eligibility criteria). If participants had been on flutamide, PSA progression is documented 4 weeks or more after withdrawal. For participants on bicalutamide or nilutamide disease progression is documented 6 or more weeks after withdrawal. The requirement for a 4-6 week withdrawal period following discontinuation of flutamide, nilutamide or bicalutamide only applies to participants who have been on these drugs for at least the prior 6 months. For all other participants they must stop bicalutamide, nilutamide or flutamide the day prior to enrollment. Asymptomatic or mildly symptomatic form prostate cancer; no use of regularly scheduled opiate analgesics for prostate cancer-related pain. (Participants with a malignancy other than prostate cancer are excluded from this criterion). Participants must agree to continuation of androgen deprivation therapy (ADT) with a gonadotropin-releasing hormone analogue/antagonist or bilateral orchiectomy. (Participants with a malignancy other than prostate cancer are excluded from this criterion). Participants may also continue oral androgen receptor antagonist/anti-androgen therapy (e.g. enzalutamide or abiraterone) unless enrolling to Arm 2.3A or 2.3B due to concerns regarding CYPmediated drug-drug interactions epacadostat. Participants must have had the following prior therapy: Testosterone lowering therapy for CRPC In addition to continuation of ADT (unless status post bilateral orchiectomy) eligible patients must have received and had PSA or radiographic progression on enzalutamide (or other oral androgen receptor antagonist e.g. darolutamide or apalutamdide) or abiraterone acetate. Participants who have tumors known to be microsatellite instability high/mismatch repair deficient or tumor mutational burden high must have received prior pembrolizumab. Participants with known pathogenic homologous recombination repair mutations for which there is evidence of benefit with PARP inhibitors (e.g. BRCA1. BRCA2, ATM) must have received prior PARP inhibitor. Age greater than or equal to 18 years. ECOG performance status less than or equal to 1 Participants must have adequate organ and marrow function as defined below: Absolute neutrophil count greater than or equal to 1000/mcL Platelets greater than or equal to 100,000/mcL Hemoglobin greater than or equal to 9.0 g/dL Total bilirubin within normal institutional limits; in participants with Gilbert s, less than or equal to 3.0 mg/dL AST (AGOT)/ALT (AGPT) less than or equal to 2.5X upper limit of normal. For subjects with liver involvement in their tumor, AST less than or equal to 3.5. X ULN, ALT less than or equal to 3.5 X ULN, and bilirubin less than or equal to 3.0 is acceptable Creatinine within 1.5X upper limit of normal institutional limits The effects of BN-Brachyury, M7824, N-803, and Epacadostat on the developing human fetus are unknown. For this reason, men and women must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, during the study and maintain such contraception until 4 months following the last dose of any study agent. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her partner s treating physician immediately. Ability of subject to understand and the willingness to sign a written informed consent document. Participants with successfully treated HCV are eligible if HCV viral load is undetectable. EXCLUSION CRITERIA: Participants who are immunocompromised as follows: Human immunodeficiency virus positivity due to the potential for decreased tolerance, and potential to be at risk for severe side effects with immunotherapies. These concerns are relevant to all drugs, as drug-drug interactions among antiretrovirals and immunotherapies are yet uncharacterized. Chronic administration (defined as daily or every other day for continued use greater than 14 days) of systemic corticosteroids or other immune suppressive drugs, within 28 days before treatment on study. Nasal, or inhaled steroid, topical steroid creams and eye drops for small body areas are allowed. Physiologic doses of steroids are permitted, e.g. a participant taking hydrocortisone for adrenal insufficiency or a patient recently on abiraterone (administered with 10 mg of prednisone daily) who is tapering off of prednisone is allowed to continue that taper. Participants who have undergone allogeneic peripheral stem cell transplantation, or solid organ transplantation requiring immunosuppression Active autoimmune disease, except participants with type 1 diabetes mellitus, vitiligo, psoriasis, hypo- or hyperthyroid disease not requiring current immunosuppression, or with other endocrine disorders on replacement hormones or are not excluded if the condition is well controlled. Prostate cancer participants with a history of brain/leptomeningeal metastasis, since these participants have a very poor prognosis and immunotherapy may take time to lead to beneficial clinical effects. Participants with brain or CNS metastases enrolling to arm 1.1 are eligible if they are status post definitive radiotherapy or surgery, and are asymptomatic History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agents to be used in the cohort the subject will be enrolled into. Known allergy to eggs, egg products, aminoglycoside antibiotics (for example, gentamicin or tobramycin). Any condition which, in the opinion of the investigator, would prevent full participation in this trial (including the long-term follow-up), or would interfere with the evaluation of the trial endpoints. Participants with prior investigational drug, chemotherapy, immunotherapy or any prior radiotherapy (except for palliative bone directed therapy) within the past 28 days prior to enrollment, except if the investigator has assessed that all residual treatment-related toxicities have resolved or are minimal and feel the participant is otherwise suitable for enrollment. Uncontrolled intercurrent acute or chronic illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure (>New York Heart Association Class I), hepatic disease, unstable angina pectoris, serious cardiac arrhythmia, requiring medication, uncontrolled hypertension (SBP>170/ DBP>105) or psychiatric illness/social situations within 12 months that would limit compliance with study requirements. Use of herbal products that may decrease PSA levels (e.g. saw palmetto) Participants who have had cytotoxic chemotherapy for metastatic castration-resistant prostate cancer within the past 3 months. (Participants who have had docetaxel for metastatic castration sensitive per CHAARTED data may enroll as long as they did not have progressive disease while on docetaxel and are 3 months removed from treatment, with all treatment related toxicities resolving to at least grade 1.) Participants who have undergone major surgery within 4 weeks of enrollment. A biopsy will not preclude a participant from starting study. Participants with a history of hepatitis B (HBV) are excluded due to potential risk for viral reactivation and resulting liver injury in persons with latent HBV Subjects unwilling to accept blood products or blood transfusions as medically indicated. As there is a risk of severe bleeding with M7824, participants must be willing to receive blood transfusions if medically necessary for their own safety For participants enrolling in Arm 2.3A and for participants who may be randomized to Arm 2.3B, the following additional exclusion criteria will apply: Subjects receiving Monoamine Oxidase Inhibitors (MAOIs) or a drug which has significant MAOI activity (meperidine, linezolid, methylene blue) within the 21 days before initiation of study therapy are excluded. Since epacadostat s metabolism may be altered by drugs that inhibit UDP- glucuronosyltransferase UGT1A9 (see Appendix D), Participants receiving such drugs within 21 days of initiation of study therapy are excluded. Participants receiving agents that are substrates of CYP1A2, CYP2C8, and CYP2C19 or affected by OATP1B1 or OATP1B3 within 21 days of initiation of study therapy or 5 half lives of the agent (whichever is shorter) are excluded. Participants receiving medications that are substrates of these enzymes/transporters but are not listed in the appendix or participants receiving substrates of CYP2B6 and CYP3A will be evaluated on a case-by-case basis prior to enrollment. Participants who consume caffeine are eligible but must agree to moderate consumption. Subjects receiving coumarin-based anticoagulants (e. Coumadin) are excluded. Subjects having any history of Serotonin Syndrome (SS) after receiving serotonergic drugs are excluded. --Participants with a QTcF interval > 480 milliseconds at the screening are excluded. In the event that a single QTcF is > 480 milliseconds, the subject may enroll if the average QTcF for the 3 ECGs is < 480 milliseconds. For subjects with an intraventricular conduction delay (QRS interval > 120 milliseconds), the JTc interval may be used in place of the QTc. The JTc must be < 340 milliseconds if JTc is used in place of the QTc. QTc prolongation due to pacemaker may enroll if the JTc is normal. Subjects with left bundle branch block are excluded. Pregnant women are excluded from this study because investigational agents used in this study (BN-Brachyury, M7824, N-803, and/or Epacadostat) could have teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with these investigational agen s, breastfeeding should be discontinued if the mother is treated with either of them.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Erica Y Redmond
Phone
(240) 858-3783
Email
erica.redmond@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
James L Gulley, M.D.
Phone
(301) 480-7164
Email
gulleyj@mail.nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James L Gulley, M.D.
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
For more information at the NIH Clinical Center contact National Cancer Institute Referral Office
Phone
888-624-1937

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.All IPD recorded in the medical record will be shared with intramural investigators upon request. In addition, all large scale genomic sequencing data will be shared with subscribers to dbGaP.
IPD Sharing Time Frame
Clinical data available during the study and indefinitely. Genomic data are available once genomic data are uploaded per protocol GDS plan for as long as database is active.
IPD Sharing Access Criteria
Clinical data will be made available via subscription to BTRIS and with the permission of the study PI. Genomic data are made available via dbGaP through requests to the data custodians.
Citations:
PubMed Identifier
33602696
Citation
Fabian KP, Padget MR, Fujii R, Schlom J, Hodge JW. Differential combination immunotherapy requirements for inflamed (warm) tumors versus T cell excluded (cool) tumors: engage, expand, enable, and evolve. J Immunother Cancer. 2021 Feb;9(2):e001691. doi: 10.1136/jitc-2020-001691.
Results Reference
derived
PubMed Identifier
30227893
Citation
Redman JM, Steinberg SM, Gulley JL. Quick efficacy seeking trial (QuEST1): a novel combination immunotherapy study designed for rapid clinical signal assessment metastatic castration-resistant prostate cancer. J Immunother Cancer. 2018 Sep 18;6(1):91. doi: 10.1186/s40425-018-0409-8.
Results Reference
derived
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2018-C-0078.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Phase I/II Study of Immunotherapy Combination BN-Brachyury Vaccine, M7824, N-803 and Epacadostat (QuEST1)

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