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Vaccine Therapy in Treating Patients With Liver or Lung Metastases From Colorectal Cancer

Primary Purpose

Colorectal Cancer, Metastatic Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
falimarev
inalimarev
sargramostim
therapeutic autologous dendritic cells
Sponsored by
Michael Morse, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Colorectal Cancer focused on measuring liver metastases, adenocarcinoma of the colon, recurrent colon cancer, stage IV colon cancer, adenocarcinoma of the rectum, recurrent rectal cancer, stage IV rectal cancer, lung metastases

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed hepatic or pulmonary metastases secondary to adenocarcinoma of the colon and rectum Must have undergone complete resection of hepatic or pulmonary metastases with curative intent No evidence of gross residual disease after surgery One or more resected and ablated lesions allowed provided all gross residual tumor was destroyed by ablation Repeated resections of hepatic metastatic disease or resections of extrahepatic metastases prior to resection of the hepatic metastases allowed provided the most recent hepatic metastatic resection included total disease resection and/or ablation Must have received at least 2 months of perioperative systemic chemotherapy (including preoperative and/or postoperative chemotherapy) that was completed at least 1 month ago PATIENT CHARACTERISTICS: Age At least 18 Performance status Karnofsky 70-100% Life expectancy At least 6 months Hematopoietic Platelet count ≥ 75,000/mm^3 Hemoglobin ≥ 8.5 g/dL (transfusion or epoetin alfa allowed) Hepatic Bilirubin ≤ 2.0 mg/dL Hepatitis B surface antigen negative Hepatitis C antibody negative No other serious chronic or acute hepatic disease Renal Creatinine ≤ 1.5 mg/dL OR Creatinine clearance > 60 mL/min Cardiovascular No New York Heart Association class III or IV cardiac disease No other serious chronic or acute cardiac disease Pulmonary No asthma No chronic obstructive pulmonary disease No other serious chronic or acute pulmonary disease Immunologic No history of autoimmune disease, including, but not limited to, any of the following: Inflammatory bowel disease Systemic lupus erythematosus Ankylosing spondylitis Scleroderma Multiple sclerosis No human immunodeficiency virus (HIV) infection by enzyme-linked immunosorbent assay (ELISA) and western blot Not immunocompromised (by disease or therapy) No allergy to eggs or any component of the study vaccine No history of allergy or untoward reaction to prior vaccinia (smallpox) vaccination No allergy or untoward reaction to sargramostim (GM-CSF) No active acute or chronic infection, including urinary tract infection within the past 72 hours No inflammatory bowel conditions, including, but not limited to, the following: Active infectious enteritis Eosinophilic enteritis No acute, chronic, or exfoliative skin disorders, including any of the following: Extensive psoriasis Burns Impetigo Disseminated zoster Varicella zoster Severe acne Other open rashes or wounds Other Not pregnant or nursing Fertile patients must use effective contraception Able to avoid close contact or household contact for 3 weeks after each vaccination with the following individuals: Children under 5 years of age Pregnant or nursing women Individuals with prior or concurrent extensive eczema, other eczematoid skin disorders, or other acute or chronic skin conditions Immunosuppressed or immunodeficient individuals No medical or psychological condition that would preclude study compliance No extensive eczema No other serious chronic or acute illness that would preclude study participation No other malignancy within the past 5 years except nonmelanoma skin cancer, controlled superficial bladder cancer, or previously treated carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: Biologic therapy No other concurrent immunotherapy Chemotherapy See Disease Characteristics No concurrent chemotherapy Endocrine therapy More than 6 weeks since prior and no concurrent steroid therapy Radiotherapy No concurrent radiotherapy Surgery See Disease Characteristics Other No other concurrent immunosuppressants (e.g., azathioprine or cyclosporine)

Sites / Locations

  • Lombardi Comprehensive Cancer Center at Georgetown University Medical Center
  • H. Lee Moffitt Cancer Center and Research Institute at University of South Florida
  • Duke Comprehensive Cancer Center
  • Wake Forest University Baptist Medical Center
  • Providence Cancer Center at Providence Portland Medical Center
  • Hollings Cancer Center at Medical University of South Carolina

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

PANVAC-V + PANVAC-F + DC

PANVAC-V + PANVAC-F + GM-CSF

Arm Description

Patients undergo leukapheresis to obtain leukocytes for generation of autologous dendritic cells (DC). Patients then receive autologous DC loaded with vaccinia-CEA-MUC-1-TRICOM (PANVAC-V) vaccine subcutaneously (SC) and intradermally (ID) on day 1 and autologous DC loaded with fowlpox-CEA-MUC-1-TRICOM (PANVAC-F) vaccine SC and ID on days 28, 56, and 84.

Patients receive PANVAC-V SC on day 1 and PANVAC-F SC on days 28, 56, and 84. Patients also receive sargramostim (GM-CSF) SC into the same injection site once daily on days 0-3, 28-31, 56-59, and 84-87.

Outcomes

Primary Outcome Measures

Recurrence-free Survival at 2 Years
Recurrence-free survival for randomized patients receiving dendritic cells (DC) loaded with PANVAC or PANVAC plus Granulocyte-macrophage colony-stimulating factor (GM-CSF) measured from the date of metastasectomy, with relapse defined as documented disease recurrence at any site.

Secondary Outcome Measures

Positive Immune Response as Measured by (Enzyme-linked Immunosorbent Spot) ELISpot Assay
CEA-Specific Immune Responders by enzyme-linked immunosorbent spot (ELISpot). The ELISPOT assay is considered positive for a subject if the mean number of spots with CEA exceeds the number of spots with control by a magnitude of 10 and the difference between CEA and control is statistically significant at a level of p=0.05 by the t-test.

Full Information

First Posted
February 7, 2005
Last Updated
October 11, 2015
Sponsor
Michael Morse, MD
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00103142
Brief Title
Vaccine Therapy in Treating Patients With Liver or Lung Metastases From Colorectal Cancer
Official Title
A Phase II Study of Active Immunotherapy With PANVAC or Autologous, Cultured Dendritic Cells Infected With PANVAC After Complete Resection of Hepatic or Pulmonary Metastases of Colorectal Carcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Completed
Study Start Date
February 2005 (undefined)
Primary Completion Date
June 2009 (Actual)
Study Completion Date
March 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Michael Morse, MD
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Vaccines made from a gene-modified virus and a person's white blood cells may make the body build an effective immune response to kill tumor cells. Biological therapies, such as Granulocyte-macrophage colony-stimulating factor (GM-CSF), may stimulate the immune system in different ways and stop tumor cells from growing. Combining different types of biological therapies may kill more tumor cells. PURPOSE: This randomized phase II trial is studying giving vaccine therapy together with dendritic cells to see how well it works compared to giving vaccine therapy together with GM-CSF in treating patients with liver or lung metastases from colorectal cancer removed by surgery.
Detailed Description
OBJECTIVES: Primary Compare 2-year disease-free survival of patients with completely resected hepatic or pulmonary metastases secondary to colorectal cancer treated with adjuvant vaccine therapy comprising vaccinia-Carcinoembryonic antigen (CEA)-mucin 1 (MUC-1)- Triad of costimulatory molecules TRICOM vaccine (PANVAC-V) and fowlpox-CEA-MUC-1-TRICOM vaccine (PANVAC-F) administered with autologous dendritic cells or with sargramostim (GM-CSF). Secondary Compare the rate and magnitude of immune response, as determined by enzyme-linked immunosorbent spot (ELISpot), in patients treated with these regimens. OUTLINE: This is a randomized study. Patients are randomized to 1 of 2 treatment arms. Arm I: Patients undergo leukapheresis to obtain leukocytes for generation of autologous dendritic cells (DC). Patients then receive autologous DC loaded with vaccinia-CEA-MUC-1-TRICOM (PANVAC-V) vaccine subcutaneously (SC) and intradermally (ID) on day 1 and autologous DC loaded with fowlpox-CEA-MUC-1-TRICOM (PANVAC-F) vaccine subcutaneously (SC) and intradermally (ID) on days 28, 56, and 84. Arm II: Patients receive PANVAC-V SC on day 1 and PANVAC-F SC on days 28, 56, and 84. Patients also receive sargramostim (GM-CSF) SC into the same injection site once daily on days 0-3, 28-31, 56-59, and 84-87. After completion of study treatment, patients are followed for 2 years. PROJECTED ACCRUAL: A total of 72 patients (36 per treatment arm) will be accrued for this study within 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Metastatic Cancer
Keywords
liver metastases, adenocarcinoma of the colon, recurrent colon cancer, stage IV colon cancer, adenocarcinoma of the rectum, recurrent rectal cancer, stage IV rectal cancer, lung metastases

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
PANVAC-V + PANVAC-F + DC
Arm Type
Experimental
Arm Description
Patients undergo leukapheresis to obtain leukocytes for generation of autologous dendritic cells (DC). Patients then receive autologous DC loaded with vaccinia-CEA-MUC-1-TRICOM (PANVAC-V) vaccine subcutaneously (SC) and intradermally (ID) on day 1 and autologous DC loaded with fowlpox-CEA-MUC-1-TRICOM (PANVAC-F) vaccine SC and ID on days 28, 56, and 84.
Arm Title
PANVAC-V + PANVAC-F + GM-CSF
Arm Type
Experimental
Arm Description
Patients receive PANVAC-V SC on day 1 and PANVAC-F SC on days 28, 56, and 84. Patients also receive sargramostim (GM-CSF) SC into the same injection site once daily on days 0-3, 28-31, 56-59, and 84-87.
Intervention Type
Biological
Intervention Name(s)
falimarev
Intervention Description
Given subcutaneously and intradermally
Intervention Type
Biological
Intervention Name(s)
inalimarev
Intervention Description
Given subcutaneously and intradermally
Intervention Type
Biological
Intervention Name(s)
sargramostim
Intervention Description
Given subcutaneously
Intervention Type
Biological
Intervention Name(s)
therapeutic autologous dendritic cells
Intervention Description
Given subcutaneously and intradermally
Primary Outcome Measure Information:
Title
Recurrence-free Survival at 2 Years
Description
Recurrence-free survival for randomized patients receiving dendritic cells (DC) loaded with PANVAC or PANVAC plus Granulocyte-macrophage colony-stimulating factor (GM-CSF) measured from the date of metastasectomy, with relapse defined as documented disease recurrence at any site.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Positive Immune Response as Measured by (Enzyme-linked Immunosorbent Spot) ELISpot Assay
Description
CEA-Specific Immune Responders by enzyme-linked immunosorbent spot (ELISpot). The ELISPOT assay is considered positive for a subject if the mean number of spots with CEA exceeds the number of spots with control by a magnitude of 10 and the difference between CEA and control is statistically significant at a level of p=0.05 by the t-test.
Time Frame
13 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed hepatic or pulmonary metastases secondary to adenocarcinoma of the colon and rectum Must have undergone complete resection of hepatic or pulmonary metastases with curative intent No evidence of gross residual disease after surgery One or more resected and ablated lesions allowed provided all gross residual tumor was destroyed by ablation Repeated resections of hepatic metastatic disease or resections of extrahepatic metastases prior to resection of the hepatic metastases allowed provided the most recent hepatic metastatic resection included total disease resection and/or ablation Must have received at least 2 months of perioperative systemic chemotherapy (including preoperative and/or postoperative chemotherapy) that was completed at least 1 month ago PATIENT CHARACTERISTICS: Age At least 18 Performance status Karnofsky 70-100% Life expectancy At least 6 months Hematopoietic Platelet count ≥ 75,000/mm^3 Hemoglobin ≥ 8.5 g/dL (transfusion or epoetin alfa allowed) Hepatic Bilirubin ≤ 2.0 mg/dL Hepatitis B surface antigen negative Hepatitis C antibody negative No other serious chronic or acute hepatic disease Renal Creatinine ≤ 1.5 mg/dL OR Creatinine clearance > 60 mL/min Cardiovascular No New York Heart Association class III or IV cardiac disease No other serious chronic or acute cardiac disease Pulmonary No asthma No chronic obstructive pulmonary disease No other serious chronic or acute pulmonary disease Immunologic No history of autoimmune disease, including, but not limited to, any of the following: Inflammatory bowel disease Systemic lupus erythematosus Ankylosing spondylitis Scleroderma Multiple sclerosis No human immunodeficiency virus (HIV) infection by enzyme-linked immunosorbent assay (ELISA) and western blot Not immunocompromised (by disease or therapy) No allergy to eggs or any component of the study vaccine No history of allergy or untoward reaction to prior vaccinia (smallpox) vaccination No allergy or untoward reaction to sargramostim (GM-CSF) No active acute or chronic infection, including urinary tract infection within the past 72 hours No inflammatory bowel conditions, including, but not limited to, the following: Active infectious enteritis Eosinophilic enteritis No acute, chronic, or exfoliative skin disorders, including any of the following: Extensive psoriasis Burns Impetigo Disseminated zoster Varicella zoster Severe acne Other open rashes or wounds Other Not pregnant or nursing Fertile patients must use effective contraception Able to avoid close contact or household contact for 3 weeks after each vaccination with the following individuals: Children under 5 years of age Pregnant or nursing women Individuals with prior or concurrent extensive eczema, other eczematoid skin disorders, or other acute or chronic skin conditions Immunosuppressed or immunodeficient individuals No medical or psychological condition that would preclude study compliance No extensive eczema No other serious chronic or acute illness that would preclude study participation No other malignancy within the past 5 years except nonmelanoma skin cancer, controlled superficial bladder cancer, or previously treated carcinoma in situ of the cervix PRIOR CONCURRENT THERAPY: Biologic therapy No other concurrent immunotherapy Chemotherapy See Disease Characteristics No concurrent chemotherapy Endocrine therapy More than 6 weeks since prior and no concurrent steroid therapy Radiotherapy No concurrent radiotherapy Surgery See Disease Characteristics Other No other concurrent immunosuppressants (e.g., azathioprine or cyclosporine)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael A. Morse, MD
Organizational Affiliation
Duke Cancer Institute
Official's Role
Study Chair
Facility Information:
Facility Name
Lombardi Comprehensive Cancer Center at Georgetown University Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20007
Country
United States
Facility Name
H. Lee Moffitt Cancer Center and Research Institute at University of South Florida
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612-9497
Country
United States
Facility Name
Duke Comprehensive Cancer Center
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States
Facility Name
Wake Forest University Baptist Medical Center
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States
Facility Name
Providence Cancer Center at Providence Portland Medical Center
City
Portland
State/Province
Oregon
ZIP/Postal Code
97213-2967
Country
United States
Facility Name
Hollings Cancer Center at Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
23657083
Citation
Morse MA, Niedzwiecki D, Marshall JL, Garrett C, Chang DZ, Aklilu M, Crocenzi TS, Cole DJ, Dessureault S, Hobeika AC, Osada T, Onaitis M, Clary BM, Hsu D, Devi GR, Bulusu A, Annechiarico RP, Chadaram V, Clay TM, Lyerly HK. A randomized phase II study of immunization with dendritic cells modified with poxvectors encoding CEA and MUC1 compared with the same poxvectors plus GM-CSF for resected metastatic colorectal cancer. Ann Surg. 2013 Dec;258(6):879-86. doi: 10.1097/SLA.0b013e318292919e.
Results Reference
derived

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Vaccine Therapy in Treating Patients With Liver or Lung Metastases From Colorectal Cancer

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