A Cancer Research UK Phase I Trial of IMA950 (A Novel Multi-Peptide Vaccine) Plus GM-CSF in Patients With Newly Diagnosed Glioblastoma
18 Years
N/A
Both
Brain and Central Nervous System Tumors
Trial Information
A Cancer Research UK Phase I Trial of IMA950 (A Novel Multi-Peptide Vaccine) Plus GM-CSF in Patients With Newly Diagnosed Glioblastoma
OBJECTIVES:
Primary
- To assess the safety and tolerability of glioblastoma multiform multi-antigen vaccine
IMA950 plus sargramostim (GM-CSF) in combination with standard chemoradiotherapy
comprising temozolomide and radiotherapy followed by adjuvant temozolomide in patients
with newly diagnosed glioblastoma multiforme.
- To determine the immunogenicity of this regimen in these patients.
Secondary
- To determine the anti-tumor effect of this regimen in these patients.
- To determine the effect of pre-treatment levels of regulatory T-cells on the
immunogenicity of this regimen in these patients. (Exploratory)
- To evaluate the potential effect of steroid dose on the immunological response to
glioblastoma multiform multi-antigen vaccine IMA950 plus GM-CSF.
Tertiary
- To assess the level of O6-methyl-DNA-methyltransferase (MGMT) promoter methylation in
tumor tissue and any potential association with any observed anti-tumor effect.
- To evaluate the kinetics of the observed immunogenicity of glioblastoma multiform
multi-antigen vaccine IMA950 plus GM-CSF.
- To explore the possible biomarker signatures that may predict immunological response to
glioblastoma multiform multi-antigen vaccine IMA950 plus GM-CSF. (Exploratory)
- To explore the possible effects of this regimen on any observed pseudo-progression and
pseudo-regression in these patients. (exploratory)
OUTLINE: This is a multicenter study. Patients are recruited to cohort 1 or 2 with priority
recruitment to cohort 1. All patients undergo standard chemoradiotherapy followed by
adjuvant temozolomide as planned.
- Standard therapy (chemoradiotherapy and adjuvant temozolomide): Beginning after
surgery, patients receive chemoradiotherapy comprising oral temozolomide daily for 6
weeks and radiotherapy once daily, 5 days a week for 6 weeks. Beginning 35 days after
completion of radiotherapy, patients receive adjuvant oral temozolomide alone on days
1-5. Treatment with temozolomide repeats every 28 days for 6 courses.
- Vaccine therapy: Patients also receive vaccine therapy beginning at one of two time
points. Patients are recruited into 1 of 2 cohorts that differ in the timing of the
vaccination schedule in relation to a patient's standard therapy.
- Cohort 1: Vaccination begins 7-14 days prior to chemoradiotherapy.
- Induction phase: Patients receive the first 6 doses of sargramostim
intradermally (ID) followed by glioblastoma multiform multi-antigen vaccine
IMA950 ID on days 1, 2, 3, 8, 15, and 22 in the absence of disease
progression or unacceptable toxicity.
- Maintenance phase: Patients receive sargramostim followed by glioblastoma
multiform multi-antigen vaccine IMA950 ID on days 50 and 78 and then on day
21 of each adjuvant temozolomide course, beginning in course 1, for 3 courses
in the absence of disease progression or unacceptable toxicity.
- Cohort 2: Vaccination begins at least 7 days after chemoradiotherapy and 28 days
prior to adjuvant temozolomide.
- Induction phase: Patients receive the first 6 doses of sargramostim followed
by glioblastoma multiform multi-antigen vaccine IMA950 ID as in cohort 1
induction phase, beginning at a different time point.
- Maintenance phase: Patients receive sargramostim followed by glioblastoma
multiform multi-antigen vaccine IMA950 ID on day 21 of each adjuvant
temozolomide course, beginning in course 1, for 5 courses in the absence of
disease progression or unacceptable toxicity.
Blood samples are collected periodically for pharmacodynamic, biomarker, and immunologic
studies.
After completion of study treatment, patients are followed at 41 weeks.
Peer Reviewed and Funded or Endorsed by Cancer Research UK
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically or cytologically confirmed glioblastoma multiforme (astrocytoma WHO
grade IV disease)
- Newly diagnosed disease
- Resectable tumor (not including patients undergoing biopsy only or tumors
involving the brain stem or cerebellum)
- Meets 1 of the following criteria regarding standard chemoradiotherapy:
- Cohort 1
- Eligible for standard chemoradiotherapy with temozolomide followed by
adjuvant temozolomide
- Has undergone surgical resection before study enrollment
- Cohort 2
- Completed standard chemoradiotherapy with temozolomide with no subsequent
progression of disease
- Expected to complete standard chemoradiotherapy and 6 courses of adjuvant
temozolomide
- HLA-A*02 positive
PATIENT CHARACTERISTICS:
- WHO performance status 0-1
- Life expectancy ≥ 30 weeks
- Hemoglobin ≥ 9.0 g/dL
- Absolute neutrophil count ≥ 1.5 x 10^9/L
- Lymphocyte count ≥ 1.0 x 10^9/L (cohort 1) OR ≥ 0.35 x 10^9/L post-chemoradiotherapy
and ≥ 1.0 x 10^9/L prior to the start of chemoradiotherapy (cohort 2)
- Serum bilirubin ≤ 1.5 times upper limit of normal (ULN)
- ALT or AST ≤ 3.0 times ULN
- Alkaline phosphatase ≤ 3.0 times ULN
- Hepatitis B serology negative (HBcAg-seronegative)
- No known hepatitis C or HIV serological positivity
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use one (male) or two (female) highly effective forms of
contraception 2 weeks before, during, and for 6 months after completion of study
therapy
- Not at high medical risk due to nonmalignant systemic disease including active
uncontrolled infection
- No known hypersensitivity to GM-CSF or excipients
- No history of autoimmune disease
- No concurrent congestive heart failure
- No prior history of NYHA class III-IV cardiac disease, cardiac ischemia, or cardiac
arrhythmia
- No other condition that might interfere with the patient's ability to generate an
immune response
- No other condition that, in the investigator's opinion, would make the patient not a
good candidate for the clinical trial
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- At least 7 days since prior dexamethasone (dose > 4 mg daily or equivalent)
- At least 4 weeks since prior major surgery for any condition (except surgical
resection as part of primary standard therapy in cohort 1)
- At least 30 days since prior and no concurrent participation in another clinical
trial or planning to participate in another interventional clinical trial (concurrent
participation on an observational study allowed)
- At least 30 days since prior and no other concurrent investigational drugs
- No prior treatment for glioblastoma including Gliadel Wafers
- Early components of standard therapy are allowed if already initiated (i.e.,
surgical resection [cohort 1] or surgical resection followed by conventional
external-beam radiotherapy and concomitant temozolomide [cohort 2])
- No other concurrent anticancer therapy
- No other concurrent vaccinations from 2 weeks before the first study vaccine to the
end of the sixth study vaccine (the induction phase)
Type of Study:
Interventional
Study Design:
Masking: Open Label, Primary Purpose: Treatment
Outcome Measure:
Causality of each adverse event (AE) to glioblastoma multiform multi-antigen vaccine IMA950 and GM-CSF and AE severity according to NCI CTCAE Version 4.0
Safety Issue:
Yes
Principal Investigator
Roy Rampling, MD, PhD
Investigator Role:
Principal Investigator
Investigator Affiliation:
University of Glasgow
Authority:
United Kingdom: Medicines and Healthcare Products Regulatory Agency
Study ID:
CDR0000686559
NCT ID:
NCT01222221
Start Date:
July 2010
Completion Date:
Related Keywords:
- Brain and Central Nervous System Tumors
- adult gliosarcoma
- adult giant cell glioblastoma
- adult glioblastoma
- Glioblastoma
- Nervous System Neoplasms
- Central Nervous System Neoplasms
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