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Randomized Single Institution Pilot Study of Vaccinia-CEA (6D)-Tricomand Fowlpox CEA(6D)-Tricom With GM-CSF in Combination With Docetaxel in Patients With CEA-Bearing Cancers


Phase 2
18 Years
N/A
Not Enrolling
Both
Colorectal Cancer, Lung Cancer

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Trial Information

Randomized Single Institution Pilot Study of Vaccinia-CEA (6D)-Tricomand Fowlpox CEA(6D)-Tricom With GM-CSF in Combination With Docetaxel in Patients With CEA-Bearing Cancers


OBJECTIVES:

- Determine the recommended dose and schedule of docetaxel when given in combination with
recombinant vaccinia-CEA-TRICOM vaccine, recombinant fowlpox-CEA-TRICOM vaccine, and
sargramostim (GM-CSF), defined by best immune response with acceptable toxicity, in
patients with carcinoembryonic antigen (CEA)-expressing metastatic lung or colorectal
cancer.

- Compare the effect of varying doses and schedules of docetaxel on CEA-specific T-cell
immune responses by ELISPOT assay in patients treated with these regimens.

- Compare objective antitumor response in patients treated with these regimens.

OUTLINE: This is a 2-part, randomized, pilot study. Patients are randomized to 1 of 6
treatment arms: arms I, II, and III in part I (lung cancer and colorectal cancer patients)
and arms IV, V, and VI in part II (lung cancer patients only). Patients are stratified
according to disease site and HLA-A2 positivity (positive vs negative). At least 6 of 10
patients must be HLA-A2 positive for each of the treatment arms.

- Vaccinia-CEA-TRICOM vaccine (parts I and II): In all treatment arms, patients receive
vaccinia-CEA-TRICOM vaccine intradermally on day 1 and sargramostim (GM-CSF)
subcutaneously (SC) into the vaccine site on days 1-4.

- Fowlpox-CEA-TRICOM vaccine and concurrent chemotherapy:

- Part I (lung cancer and colorectal cancer patients):

- Arm I: Three weeks after treatment with vaccinia-CEA-TRICOM vaccine, patients
receive fowlpox-CEA-TRICOM vaccine SC on day 1 and GM-CSF SC into each
vaccination site on days 1-4.

- Arm II: Patients receive fowlpox-CEA-TRICOM vaccine and GM-CSF as as in arm I
and lower-dose docetaxel IV over 30 minutes on days 1 and 8.

- Arm III: Patients receive fowlpox-CEA-TRICOM vaccine and GM-CSF as in arm I
and standard-dose docetaxel IV over 30 minutes on days 1 and 8.

- Part II (lung cancer patients only):

- Arm IV: Patients receive fowlpox-CEA-TRICOM vaccine and GM-CSF as in arm I
and full-dose docetaxel IV over 1 hour on day 1.

- Arm V: Patients receive full-dose docetaxel IV over 1 hour on day 1,
fowlpox-CEA-TRICOM vaccine SC on day 8, and GM-CSF SC into each vaccination
site on days 8-11.

- Arm VI: Patients receive full-dose docetaxel as in arm V, fowlpox-CEA-TRICOM
vaccine SC on day 15, and GM-CSF SC into each vaccination site on days 15-18.

Treatment in all arms repeats every 21 days for a total of 4 courses in the absence of
disease progression or unacceptable toxicity. Patients who do not have significant disease
progression or unacceptable toxicity after 4 courses of treatment may receive additional
fowlpox-CEA-TRICOM vaccine and docetaxel according to the treatment arm on which they were
enrolled at study entry.

Patients are followed every 6 months for 2 years and then annually for 13 years.

PROJECTED ACCRUAL: A total of 60 patients (10 per treatment arm) will be accrued for this
study within 10 months.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed lung OR colorectal cancer

- Incurable metastatic disease

- Currently available standard treatment not likely to offer a survival advantage
or result in superior palliation

- Evaluable disease by radiograph

- Tumor must currently express carcinoembryonic antigen (CEA) by immunohistochemistry
OR CEA ≥ 10 ng/mL at any point during disease course

- No clinically active brain metastases

- Part I only:

- Must have had first- and second-line treatment OR declined second-line treatment

- Patients with colon cancer must have had or have been offered treatment with
oxaliplatin

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-1

Life expectancy

- At least 4 months

Hematopoietic

- WBC ≥ 3,000/mm^3

- Absolute neutrophil count ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

Hepatic

- Bilirubin normal

- Meets 1 of the following criteria:

- SGOT and SGPT ≤ 2.5 times upper limit of normal (ULN) AND alkaline phosphatase
normal

- SGOT and SGPT ≤ normal AND alkaline phosphatase ≤ 4.0 times ULN

- Hepatitis B and C negative by clinical history and physical exam

Renal

- Creatinine ≤ 1.5 mg/dL OR

- Creatinine clearance ≥ 60 mL/min

- Proteinuria ≤ grade 1

Cardiovascular

- No known or suspected history of impaired cardiac function as evidenced by baseline
echocardiogram

Pulmonary

- Adequate pulmonary function

Immunologic

- No history or clinical evidence of immune deficiency or autoimmunity

- HIV negative

- No history of or concurrent diagnosis of any of the following:

- Altered immunodeficiency

- Eczema or other eczematoid skin disorders

- Acute, chronic, or exfoliative skin condition (e.g., atopic dermatitis, burns,
impetigo, varicella zoster, severe acne, or other open rashes or wounds)

- Addison's disease

- Hashimoto's thyroiditis

- Systemic lupus erythematosus

- Sjögren's syndrome

- Scleroderma

- Myasthenia gravis

- Goodpasture's syndrome

- Active Graves' disease

- No history of allergy or untoward reaction to prior vaccination with vaccinia virus

- No history of severe hypersensitivity reaction to docetaxel or other drugs formulated
with polysorbate 80

- No history of allergy to eggs or egg products

Gastrointestinal

- No frequent vomiting or severe anorexia

- No inflammatory bowel disease

- No Crohn's disease

- No ulcerative colitis

- No active diverticulitis

Neurologic

- Neuropathy ≤ grade 1 (sensory neuropathy)

- No uncontrolled seizure disorder

- No encephalitis

- No multiple sclerosis

Other

- Must be maintaining a reasonable state of nutrition (≤ 10 % weight loss in the past
month)

- Must be able to avoid close household contact (defined as sharing housing or having
close physical contact) for at least 3 weeks after recombinant vaccinia vaccination
with any of the following individuals:

- Individuals with active or a history of eczema or other eczematoid skin
disorders or those with unresolved acute, chronic, or exfoliative skin
conditions (e.g., atopic dermatitis, burns, impetigo, varicella zoster, severe
acne, or other open rashes or wounds)

- Pregnant or nursing women

- Children ≤ 5 years of age

- Immunodeficient or immunosuppressed individuals (by disease or therapy),
including HIV infection

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for at least 6 months
after study participation

- No other concurrent serious medical illness that would preclude study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No concurrent biologic therapy

- No other concurrent immunotherapy

Chemotherapy

- See Disease Characteristics

- At least 6 weeks since prior nitrosoureas or mitomycin

- Prior docetaxel allowed (part I only)

- No prior docetaxel (part II only)

- No other concurrent chemotherapy

Endocrine therapy

- No concurrent systemic steroids except for the following:

- Physiologic doses for systemic steroid replacement therapy

- Local (topical, nasal, or inhaled) steroid use

- No concurrent steroid eye drops

- Premedication prior to and after docetaxel

- No concurrent hormonal therapy

Radiotherapy

- No prior radiotherapy to > 50 % of all nodal groups

Surgery

- More than 21 days since prior major surgery

- No prior splenectomy

Other

- Recovered from prior therapy

- At least 3-4 weeks since prior cytotoxic therapy

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Primary Purpose: Treatment

Outcome Measure:

Change in immune response as assessed by T-cells monthly

Principal Investigator

John L. Marshall, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Lombardi Cancer Research Center

Authority:

United States: Food and Drug Administration

Study ID:

CDR0000377574

NCT ID:

NCT00088933

Start Date:

June 2004

Completion Date:

Related Keywords:

  • Colorectal Cancer
  • Lung Cancer
  • recurrent small cell lung cancer
  • stage IV non-small cell lung cancer
  • extensive stage small cell lung cancer
  • stage IV colon cancer
  • recurrent colon cancer
  • recurrent rectal cancer
  • stage IV rectal cancer
  • recurrent non-small cell lung cancer
  • Colorectal Neoplasms
  • Lung Neoplasms

Name

Location

Lombardi Comprehensive Cancer Center at Georgetown University Medical Center Washington, District of Columbia  20007