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VXM01 Phase I Pilot Study in Patients With Operable Recurrence of a Glioblastoma

Primary Purpose

Glioblastoma

Status
Completed
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
VXM01
Sponsored by
Vaximm GmbH
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma

Eligibility Criteria

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

Inclusion Criteria:

  1. Written informed consent, signed and dated
  2. Histologically diagnosed intracranial supratentorial malignant glioma (contrast-enhancing anaplastic astrocytoma WHO Grade III or glioblastoma WHO Grade IV).
  3. Male or female patients who must be post-menopausal for at least 2 years or surgically sterile.
  4. Age ≥18 years
  5. Evidence of tumor progression following at least one therapy regimen that must have contained radiation and chemotherapy with temozolamid, as measured by MRI
  6. Candidates for a tumor reoperation
  7. Neurosurgical intervention should be postponable for 30 days
  8. Laboratory results (clinical chemistry, hematology, urine, liver enzymes, creatinine) without clinically relevant abnormalities
  9. Patients must be able to undergo MRI
  10. No concomitant medication with dexamethasone at the time of vaccination
  11. No active infection at the time of vaccination
  12. Karnofsky performance status >70
  13. Appropriate hematologic parameters (for immunomonitoring): leukocytes ≥4.0 x 109 / L, lymphocytes ≥0.6 x 109 / L
  14. Tumor samples available for pathology review, central detection of T-cell responses in the peripheral blood and in the tumor tissue
  15. No medical or social conditions that may interfere with study outcome and follow-up

Exclusion Criteria:

  1. Treatment in any other clinical trial within 30 days before screening
  2. Known positive test results for Hepatitis B surface antigen , hepatitis C virus antibodies, human immunodeficiency virus antibodies -1/-2
  3. Any other condition or treatment that, in the opinion of the investigator, might interfere with the study or current drug or substance abuse
  4. Inability to understand the protocol requirements, instructions and study-related restrictions, the nature, scope, and possible consequences of the study
  5. Unlikely to comply with the protocol requirements, instructions and study-related restrictions; e.g., uncooperative attitude, inability to return for follow-up visits, and improbability of completing the study
  6. Pregnancy or breast feeding
  7. Positive for anti-typhoid IgG/IgM antibodies according to the onsite test on Day 0
  8. Cardiovascular disease defined as:

    Uncontrolled hypertension (systolic blood pressure >160 mmHg or diastolic blood pressure >100 mmHg)

    Arterial thromboembolic event within 6 months before randomization including:

    • Myocardial infarction
    • Unstable angina pectoris
    • Cerebrovascular accident
    • Transient ischemic attack
  9. Congestive heart failure New York Heart Association grade III to IV
  10. Serious ventricular arrhythmia requiring medication
  11. Clinically significant peripheral artery disease > grade 2b according to Fontaine
  12. Intracranial ischemic stroke within 6 months before randomization
  13. History of intracranial hemorrhage
  14. Hemoptysis within 6 months before randomization
  15. Esophageal varices
  16. Upper or lower gastrointestinal bleeding within 6 months before inclusion (Day 0)
  17. Significant traumatic injury or surgery within 4 weeks before randomization
  18. Non-healing wound, incomplete wound healing, bone fracture or any history of gastrointestinal ulcers within three years before inclusion, or positive gastroscopy within 3 months before inclusion
  19. Gastrointestinal fistula
  20. Thrombolysis therapy within 4 weeks before randomization
  21. Presence of any acute or chronic systemic infection
  22. Major surgical procedures, or open biopsy within 4 weeks before randomization
  23. Chronic concurrent therapy within 2 weeks before and during the treatment period up to Day 35 with:

    • Corticosteroids (except steroids for adrenal failure or emesis prophylaxis up to 4 mg daily dose) or immunosuppressive agents
    • Antibiotics
    • Bevacizumab
    • Any cancer anti-angiogenic treatment
  24. Chemotherapy from screening until reoperation (Day 35)
  25. Known multi-drug resistant gram-negative germ
  26. History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect the interpretation of the study results or render the patient at high risk for treatment complications
  27. Women of childbearing potential
  28. Any condition which results in an undue risk for the patient during the study participation according to the investigator

Sites / Locations

  • Neurology Clinic and National Center for Tumor Diseases

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

VXM01

Arm Description

VXM01 10E6 or 10E7 CFU

Outcomes

Primary Outcome Measures

Safety and tolerability taking into account treatment-limiting toxicities (TLTs)
AEs listed together with information on onset, duration, severity, seriousness, relationship to the study drug, relationship to chemotherapy and to the underlying disease, outcome, and action taken. Frequency tables by System Organ Class and preferred term.

Secondary Outcome Measures

Immune Response by Enzyme Linked Immuno Spot (ELISpot)
Patient-individual VEGFR-2 specific T cell responses will be determined by ELISpot using cryopreserved peripheral blood mononuclear cells
Serum biomarker Response by Enzyme Linked Immuno Sorbent Assay (ELISA)
Biomarkers including VEGF A and Collagen IV determined from periphaeral blood samples
Vascular normalization index (VNI) including tumor perfusion acc. to Sorensen 2009
Determined by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) (ktrans), dynamic susceptibility contrast imaging (DSC), blood volume maps (cerebral blood volume [CBV] of smaller vessels) and collagen IV
Tumor immune cell infiltration by tumor tissue immunohistochemistry
Tumor tissue immunohistochemistry staining including Evaluations of effector T cell infiltration, regulatory T-cells (Treg), myeloid derived suppressor cells (MDSC)
Tumor response or progression on MRI acc. to Response Assessment in Neuro-Oncology (RANO) criteria
MRI comprising the National Brain Tumor Society /EORTC protocol for gliomas
Clinical Response including time to progression, progression free survival, overall survival
Biodistribution and shedding of VXM01 bacteria
Bacterial vector tissue biodistribution, persistence, and shedding of viable Ty21a bacteria (VXM01) determined by cultivation of stool samples

Full Information

First Posted
March 16, 2016
Last Updated
October 17, 2018
Sponsor
Vaximm GmbH
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1. Study Identification

Unique Protocol Identification Number
NCT02718443
Brief Title
VXM01 Phase I Pilot Study in Patients With Operable Recurrence of a Glioblastoma
Official Title
VXM01 Phase I Pilot Study in Patients With Operable Recurrence of a Glioblastoma to Examine Safety, Tolerability, Immune and Biomarker Response to the Investigational VEGFR-2 DNA Vaccine VXM01
Study Type
Interventional

2. Study Status

Record Verification Date
October 2018
Overall Recruitment Status
Completed
Study Start Date
May 2016 (undefined)
Primary Completion Date
August 2017 (Actual)
Study Completion Date
July 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Vaximm GmbH

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
VXM01 phase I pilot study in patients with operable recurrence of a glioblastoma to examine safety, tolerability, immune and biomarker response to the investigational VEGFR-2 DNA vaccine VXM01

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
14 (Actual)

8. Arms, Groups, and Interventions

Arm Title
VXM01
Arm Type
Experimental
Arm Description
VXM01 10E6 or 10E7 CFU
Intervention Type
Drug
Intervention Name(s)
VXM01
Intervention Description
Oral immunotherapy targeting VEGFR2
Primary Outcome Measure Information:
Title
Safety and tolerability taking into account treatment-limiting toxicities (TLTs)
Description
AEs listed together with information on onset, duration, severity, seriousness, relationship to the study drug, relationship to chemotherapy and to the underlying disease, outcome, and action taken. Frequency tables by System Organ Class and preferred term.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Immune Response by Enzyme Linked Immuno Spot (ELISpot)
Description
Patient-individual VEGFR-2 specific T cell responses will be determined by ELISpot using cryopreserved peripheral blood mononuclear cells
Time Frame
12 months
Title
Serum biomarker Response by Enzyme Linked Immuno Sorbent Assay (ELISA)
Description
Biomarkers including VEGF A and Collagen IV determined from periphaeral blood samples
Time Frame
12 months
Title
Vascular normalization index (VNI) including tumor perfusion acc. to Sorensen 2009
Description
Determined by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) (ktrans), dynamic susceptibility contrast imaging (DSC), blood volume maps (cerebral blood volume [CBV] of smaller vessels) and collagen IV
Time Frame
12 months
Title
Tumor immune cell infiltration by tumor tissue immunohistochemistry
Description
Tumor tissue immunohistochemistry staining including Evaluations of effector T cell infiltration, regulatory T-cells (Treg), myeloid derived suppressor cells (MDSC)
Time Frame
35 days
Title
Tumor response or progression on MRI acc. to Response Assessment in Neuro-Oncology (RANO) criteria
Description
MRI comprising the National Brain Tumor Society /EORTC protocol for gliomas
Time Frame
12 months
Title
Clinical Response including time to progression, progression free survival, overall survival
Time Frame
12 months
Title
Biodistribution and shedding of VXM01 bacteria
Description
Bacterial vector tissue biodistribution, persistence, and shedding of viable Ty21a bacteria (VXM01) determined by cultivation of stool samples
Time Frame
10 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent, signed and dated Histologically diagnosed intracranial supratentorial malignant glioma (contrast-enhancing anaplastic astrocytoma WHO Grade III or glioblastoma WHO Grade IV). Male or female patients who must be post-menopausal for at least 2 years or surgically sterile. Age ≥18 years Evidence of tumor progression following at least one therapy regimen that must have contained radiation and chemotherapy with temozolamid, as measured by MRI Candidates for a tumor reoperation Neurosurgical intervention should be postponable for 30 days Laboratory results (clinical chemistry, hematology, urine, liver enzymes, creatinine) without clinically relevant abnormalities Patients must be able to undergo MRI No concomitant medication with dexamethasone at the time of vaccination No active infection at the time of vaccination Karnofsky performance status >70 Appropriate hematologic parameters (for immunomonitoring): leukocytes ≥4.0 x 109 / L, lymphocytes ≥0.6 x 109 / L Tumor samples available for pathology review, central detection of T-cell responses in the peripheral blood and in the tumor tissue No medical or social conditions that may interfere with study outcome and follow-up Exclusion Criteria: Treatment in any other clinical trial within 30 days before screening Known positive test results for Hepatitis B surface antigen , hepatitis C virus antibodies, human immunodeficiency virus antibodies -1/-2 Any other condition or treatment that, in the opinion of the investigator, might interfere with the study or current drug or substance abuse Inability to understand the protocol requirements, instructions and study-related restrictions, the nature, scope, and possible consequences of the study Unlikely to comply with the protocol requirements, instructions and study-related restrictions; e.g., uncooperative attitude, inability to return for follow-up visits, and improbability of completing the study Pregnancy or breast feeding Positive for anti-typhoid IgG/IgM antibodies according to the onsite test on Day 0 Cardiovascular disease defined as: Uncontrolled hypertension (systolic blood pressure >160 mmHg or diastolic blood pressure >100 mmHg) Arterial thromboembolic event within 6 months before randomization including: Myocardial infarction Unstable angina pectoris Cerebrovascular accident Transient ischemic attack Congestive heart failure New York Heart Association grade III to IV Serious ventricular arrhythmia requiring medication Clinically significant peripheral artery disease > grade 2b according to Fontaine Intracranial ischemic stroke within 6 months before randomization History of intracranial hemorrhage Hemoptysis within 6 months before randomization Esophageal varices Upper or lower gastrointestinal bleeding within 6 months before inclusion (Day 0) Significant traumatic injury or surgery within 4 weeks before randomization Non-healing wound, incomplete wound healing, bone fracture or any history of gastrointestinal ulcers within three years before inclusion, or positive gastroscopy within 3 months before inclusion Gastrointestinal fistula Thrombolysis therapy within 4 weeks before randomization Presence of any acute or chronic systemic infection Major surgical procedures, or open biopsy within 4 weeks before randomization Chronic concurrent therapy within 2 weeks before and during the treatment period up to Day 35 with: Corticosteroids (except steroids for adrenal failure or emesis prophylaxis up to 4 mg daily dose) or immunosuppressive agents Antibiotics Bevacizumab Any cancer anti-angiogenic treatment Chemotherapy from screening until reoperation (Day 35) Known multi-drug resistant gram-negative germ History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect the interpretation of the study results or render the patient at high risk for treatment complications Women of childbearing potential Any condition which results in an undue risk for the patient during the study participation according to the investigator
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wolfgang Wick, MD
Organizational Affiliation
Neurology Clinic and National Center for Tumor Diseases
Official's Role
Principal Investigator
Facility Information:
Facility Name
Neurology Clinic and National Center for Tumor Diseases
City
Heidelberg
ZIP/Postal Code
69120
Country
Germany

12. IPD Sharing Statement

Plan to Share IPD
Yes

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VXM01 Phase I Pilot Study in Patients With Operable Recurrence of a Glioblastoma

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