Neoplasm Metastases
Conditions
Keywords
Cancerous solid tumors, Alpha-Gal Glycosphingolipids
Brief summary
This is a Phase I pilot study to evaluate the toxicity and feasibility of intratumoral injection (Glycosphingolipids) GSL alpha-GAL (beta-galactosidase) in patients with advanced, refractory solid tumors who have failed standard therapies or are not eligible for standard treatment.
Detailed description
Intratumoral injection of alpha gal glycolipid in experimental knockout mouse model systems incorporates into tumor cell membranes and presents these xeno-transplantation epitopes to antigen presenting cells with that particular tumor's tumor associated antigens (TAA). Thus this maneuver converts any individual tumor into an in situ tumor vaccine without the need to isolate, purify or supply TAA exogenously. The effects in these model systems demonstrate both the upregulation of cytotoxic T cells which react against the particular tumor's TAA, as well as resolution of injected primary tumor and eradication and prevention of metastatic disease at distant sites. This current study was undertaken to investigate the safety and feasibility of such an approach in humans. The major toxicity concerns are acute allergic or complement activation reactions or development of autoimmunity. The primary treatment is a single intratumoral injection of alpha gal glycolipid. The study design is a standard dose escalation design and the primary endpoint is Dose limiting toxicity at one month after injection (grade 3 or 4. Subjects are followed until death utilizing standard clinical imaging and evaluation to judge overall tumor response.
Interventions
BIOLOGICALAlpha-Gal Glycosphingolipid
Intra-tumoral injection of Alpha-Gal Glycosphingolipid to evaluate toxicity
Sponsors
University of Massachusetts, Worcester
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Patients with solid tumors who have failed standard therapies, or are not candidates for standard therapies. 2. Patients must have at least one measurable lesion that is accessible and suitable for injection of the GSL alpha-GAL. 3. Patients should not be undergoing any active treatment with chemotherapy, radiotherapy, or steroids (either because the patient or the treating physician have decided not to employ these therapies at this time, or because they had already been tried and failed). If they have been treated with these modalities, the treatments should have been completed at least two weeks prior to date of injection of GSL alpha-GAL. 4. Patients should be judged by the investigator to be able to undergo safely the procedure needed to inject the tumor with GSL alpha-GAL. 5. Age equal or over 18 years old. 6. ECOG (Eastern Cooperative Oncology Group ) performance of less than 2. (International Normalized Ratio) INR less than 1.5 and a (Partial Thromboplastin Time) PTT no greater than normal limits within 1 week prior to intra-tumoral injection (For patients who requires invasive procedure for intra-tumoral injection). 7. Laboratory Criteria (completed equal or less 2 weeks before enrollment) Hematologic: (White Blood Cell Count) WBC equal or above 3500/millimeter-cubed or (Absolute Neutrophil Count) ANC equal or above 1500/millimeter-cubed and platelet count equal or above 100,000/ millimeter-cubed. Hepatic: Total bilirubin equal or less 4.0 milligrams/deciliter. Renal: Creatinine equal or less 2.2 milligrams/deciliter. 8. Patients must be negative for HIV (circulating antibody), Hepatitis B (circulating antigen), and Hepatitis C (circulating antibody). 9. Patients should have an expected survival of more than 6 weeks and should not have other systemic anti-tumor treatments planned during this time frame.
Exclusion criteria
1. Patients who are pregnant (as determined by a positive serum HCG (Human Chorionic Gonadotropin) in patients of childbearing potential) or nursing. 2. Patients under the age of 18. 3. Patients with severe infections or septicemia. 4. Patients with a history of autoimmune disease. 5. Patients in, or about to be in, active treatment with chemotherapy or steroids. 6. Patients who refuse HIV/hepatitis testing and patients who do not sign an approved consent form. 7. Patient has received other investigational drugs within 14 days before enrollment or is expected to participate in an experimental drug study during this study treatment. 8. Serious medical or psychiatric illness likely to interfere with participation in this clinical study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Subjects With Greater Than Grade 3 or 4 Toxicity | 1 month | Grade 3/4 Toxicity occurring in a participant within a month of intratumoral injection |
Countries
United States
Participant flow
Recruitment details
Patients recruited from medical and surgical oncology clinics with currently untreatable tumors from march 2007 through June 2011
Pre-assignment details
No assignment to separate arms, Patients had to be off any active treatment for their advanced tumors for at least 2 weeks before entry onto study and a month after. Two subjects withdrew after screening and consent because of stroke (1) and insurance refusal(1). Two patients dropped out in the first month due to treatment needs.
Participants by arm
| Arm | Count |
|---|---|
| Alpha-Gal Glycosphingolipid Injection Intervention: Intratumoral injection of a single dose of Alpha-Gal Glycosphingolipid (0.1 mg,1mg, 10mg) | 11 |
| Total | 11 |
Baseline characteristics
| Characteristic | Alpha-Gal Glycosphingolipid Injection |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 4 Participants |
| Age, Categorical Between 18 and 65 years | 7 Participants |
| Age Continuous | 60 years STANDARD_DEVIATION 12.5 |
| Region of Enrollment United States | 11 participants |
| Sex: Female, Male Female | 3 Participants |
| Sex: Female, Male Male | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 11 |
| serious Total, serious adverse events | 1 / 11 |
Outcome results
Primary
Number of Subjects With Greater Than Grade 3 or 4 Toxicity
Grade 3/4 Toxicity occurring in a participant within a month of intratumoral injection
Time frame: 1 month
Population: Dose escalating Phase 1 scheme: three participants for each dose cohort. The second patient in the last (10 mg) dose cohort developed and adverse event (infection at injection site) and so three more participants were entered and analyzed at that dose
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Intratumoral Injection | Number of Subjects With Greater Than Grade 3 or 4 Toxicity | 1 participants |