Ignite Creation Date:
2024-05-05 @ 11:45 AM
Last Modification Date:
2024-10-26 @ 9:12 AM
Study NCT ID:
NCT00122005
Status:
UNKNOWN
Last Update Posted:
2009-02-24
First Post:
2005-07-18
Brief Title:
GVAX in Advanced Prostate Cancer Patients Made Lymphopenic
Sponsor:
Providence Health Services
Organization:
Providence Health Services
Study Overview
Official Title:
Phase III Study of Human GM-CSF Gene-Transduced Irradiated Prostate Allogeneic Cancer Cell Vaccines GVAX in Advanced Prostate Cancer Patients Made Lymphopenic and Infused With Autologous Peripheral Blood Mononuclear Cells
Status:
UNKNOWN
Status Verified Date:
2009-02
Last Known Status:
ACTIVE_NOT_RECRUITING
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Androgen a male sex hormone deprivation is the standard therapy for metastatic prostate cancer and results in regression or control of disease in 80-85 of patients This hormone therapy results in a progression-free survival of 12-18 months and overall survival of 24-30 months However all patients ultimately develop hormone-refractory prostate cancer HRPC Management of HRPC patients is a significant challenge for both patient and physician Neither past nor current chemotherapy regimens have shown curative potential in patients with HRPC Thus new treatment strategies are a high priority
A major focus of new treatment strategies is to enlist the aid of the immune system particularly the development of prostate cancer vaccines There has been a number of studies using dendritic cell based vaccines and the treatment has been well tolerated Specific T-cell immune responses have been observed and occasional evidence for tumor regression A reduction in serum prostate-specific antigen PSA has been observed as well Lengthening the time-to-progression and delays in the onset of bone pain have been observed in subsets of patients with HRPC
The initial preclinical observations suggesting that a granulocyte-macrophage colony-stimulating factor GM-CSF gene transduced allogeneic GVAX prostate cancer vaccine may be efficacious in poorly immunogenic cancers were reported
The objective of this study is to evaluate the safety and immunologic effects of vaccinations with Allogeneic Prostate GVAX CG1940 CG8711 in patients made lymphopenic by treatment with chemotherapy and infused with autologous peripheral blood mononuclear cells PBMC Clinical observations and laboratory measurements will be monitored to evaluate safety toxicity and immune responses Additionally the effects of treatment on serum PSA levels and tumor response will be evaluated
A major focus of new treatment strategies is to enlist the aid of the immune system particularly the development of prostate cancer vaccines There has been a number of studies using dendritic cell based vaccines and the treatment has been well tolerated Specific T-cell immune responses have been observed and occasional evidence for tumor regression A reduction in serum prostate-specific antigen PSA has been observed as well Lengthening the time-to-progression and delays in the onset of bone pain have been observed in subsets of patients with HRPC
The initial preclinical observations suggesting that a granulocyte-macrophage colony-stimulating factor GM-CSF gene transduced allogeneic GVAX prostate cancer vaccine may be efficacious in poorly immunogenic cancers were reported
The objective of this study is to evaluate the safety and immunologic effects of vaccinations with Allogeneic Prostate GVAX CG1940 CG8711 in patients made lymphopenic by treatment with chemotherapy and infused with autologous peripheral blood mononuclear cells PBMC Clinical observations and laboratory measurements will be monitored to evaluate safety toxicity and immune responses Additionally the effects of treatment on serum PSA levels and tumor response will be evaluated
Detailed Description:
Other investigators have focused on tumor cell-based vaccine strategies using either allogeneic or autologous tumor cells Vaccines derived from allogeneic melanoma tumor cell lines are associated with no clinically significant toxicity when given alone
Most tumor cell line vaccines are lethally irradiated but not genetically modified However a newer generation of tumor vaccines that have been genetically modified to enhance tumor-associated antigen presentation to patient T cells have reached early clinical trials Based on extensive preclinical studies and clinical allogeneic prostate cancer vaccine data a strong impression exists that ex vivo GM-CSF gene transfer may make human prostate cancer cell lines more potent in inducing clinically relevant antitumor immune responses in men with micrometastatic prostate cancer
In the early clinical studies of irradiated GM-CSF-secreting autologous cancer cell vaccine treatment of advanced kidney cancer and advanced melanoma immune responses elicited by vaccination appeared dependent on both the vaccine cell dose administered and the level of GM-CSF secretion by the vaccine cells A significant fraction of the nearly 50000 men each year who suffer from life-threatening prostate cancer will not be candidates for autologous tumor vaccine treatments simply because an insufficient number of autologous prostatic carcinoma cells will be available after surgery These men may benefit from an allogeneic GM-CSF-gene-transduced prostate cancer vaccine
Theoretically autologous prostate cancer cells may be the best source of prostate cancer antigens for eliciting therapeutically useful immune responses However evidence has accumulated to suggest that allogeneic prostatic carcinoma cells might also serve as useful sources of prostate cancer antigens for prostate cancer vaccine construction One theoretical concern about the use of allogeneic prostate cancer cells to prime antigen specific T-cell immunity is whether cytolytic T lymphocytes CTLs restricted to the HLA molecules of the patients tumors can be primed by vaccine cells expressing different allogeneic HLA molecules Recent work has shown that the GM-CSF gene transduced tumor cells do not directly prime MHC class I restricted CTLs but are broken down by the recipients antigen-presenting cells which process and present these antigens on their HLA molecules to prime T cells In fact tumor cells that do not express any MHC class I molecules are nevertheless capable of generating systemic antitumor immunity that is comparable to their MHC class I positive counterparts
Phase I and II studies of the allogeneic prostate cancer vaccine have been performed in patients with metastatic prostate cancer One is a Phase I trial of CG1940 alone and one is a phase III trial of CG1940 and CG8711 using the AAV GM-CSF vaccine cells These trials are currently in progress to evaluate safety and time to progression by PSA and bone scan In these trials the vaccines are administered at dose levels of 5 x 107 1 x 108 2 x 108 or 3 x 108 cells every 2 or 4 weeks for 3 to 12 vaccinations and a 5 x 108 cell prime vaccination followed by a 3 x 108 cell boost vaccination every 2 weeks for a total of 13 vaccinations Preliminary analysis of the 12 patients enrolled in the phase I trial shows one patient with stable disease Eighty patients have been enrolled in the phase II trial Sixty-five of these patients in the phase II trial have been followed for a median of 4 months One of these patients had a partial PSA response and 10 maintained stable PSAs Follow-up bone scans were obtained in 33 patients One patient showed improvement in metastatic lesions on his bone scan and 12 patients maintained stable disease on bone scans ICTP was assayed at Treatment 1 Treatment 4 and at the First Follow-Up Visit in fifteen patients The ICTP level decreased in five patients 33 of whom two had undetectable levels after vaccine treatment This normalization of osteoclast activity suggests a novel mechanism of immunotherapy in metastatic prostate cancer
As of November 29 2004 188 patients have received the prostate GVAX vaccine In summary these phase I and II trials showed that CG1940 and CG8711 has an excellent safety profile As of January 24 2005 a phase III trial of prostate GVAX is open at more than 40 medical centers in the USA
Most tumor cell line vaccines are lethally irradiated but not genetically modified However a newer generation of tumor vaccines that have been genetically modified to enhance tumor-associated antigen presentation to patient T cells have reached early clinical trials Based on extensive preclinical studies and clinical allogeneic prostate cancer vaccine data a strong impression exists that ex vivo GM-CSF gene transfer may make human prostate cancer cell lines more potent in inducing clinically relevant antitumor immune responses in men with micrometastatic prostate cancer
In the early clinical studies of irradiated GM-CSF-secreting autologous cancer cell vaccine treatment of advanced kidney cancer and advanced melanoma immune responses elicited by vaccination appeared dependent on both the vaccine cell dose administered and the level of GM-CSF secretion by the vaccine cells A significant fraction of the nearly 50000 men each year who suffer from life-threatening prostate cancer will not be candidates for autologous tumor vaccine treatments simply because an insufficient number of autologous prostatic carcinoma cells will be available after surgery These men may benefit from an allogeneic GM-CSF-gene-transduced prostate cancer vaccine
Theoretically autologous prostate cancer cells may be the best source of prostate cancer antigens for eliciting therapeutically useful immune responses However evidence has accumulated to suggest that allogeneic prostatic carcinoma cells might also serve as useful sources of prostate cancer antigens for prostate cancer vaccine construction One theoretical concern about the use of allogeneic prostate cancer cells to prime antigen specific T-cell immunity is whether cytolytic T lymphocytes CTLs restricted to the HLA molecules of the patients tumors can be primed by vaccine cells expressing different allogeneic HLA molecules Recent work has shown that the GM-CSF gene transduced tumor cells do not directly prime MHC class I restricted CTLs but are broken down by the recipients antigen-presenting cells which process and present these antigens on their HLA molecules to prime T cells In fact tumor cells that do not express any MHC class I molecules are nevertheless capable of generating systemic antitumor immunity that is comparable to their MHC class I positive counterparts
Phase I and II studies of the allogeneic prostate cancer vaccine have been performed in patients with metastatic prostate cancer One is a Phase I trial of CG1940 alone and one is a phase III trial of CG1940 and CG8711 using the AAV GM-CSF vaccine cells These trials are currently in progress to evaluate safety and time to progression by PSA and bone scan In these trials the vaccines are administered at dose levels of 5 x 107 1 x 108 2 x 108 or 3 x 108 cells every 2 or 4 weeks for 3 to 12 vaccinations and a 5 x 108 cell prime vaccination followed by a 3 x 108 cell boost vaccination every 2 weeks for a total of 13 vaccinations Preliminary analysis of the 12 patients enrolled in the phase I trial shows one patient with stable disease Eighty patients have been enrolled in the phase II trial Sixty-five of these patients in the phase II trial have been followed for a median of 4 months One of these patients had a partial PSA response and 10 maintained stable PSAs Follow-up bone scans were obtained in 33 patients One patient showed improvement in metastatic lesions on his bone scan and 12 patients maintained stable disease on bone scans ICTP was assayed at Treatment 1 Treatment 4 and at the First Follow-Up Visit in fifteen patients The ICTP level decreased in five patients 33 of whom two had undetectable levels after vaccine treatment This normalization of osteoclast activity suggests a novel mechanism of immunotherapy in metastatic prostate cancer
As of November 29 2004 188 patients have received the prostate GVAX vaccine In summary these phase I and II trials showed that CG1940 and CG8711 has an excellent safety profile As of January 24 2005 a phase III trial of prostate GVAX is open at more than 40 medical centers in the USA
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| DOD Grant DAMD17-03-1-0097 | None | None | None |