Melanoma
Conditions
Keywords
Melanoma, Skin Cancer, Adjuvant Therapy, Oncogenesis, LAGE, Cancer Immunity, Neoplasms, Immunogenicity, Vaccine, Immunotherapy
Brief summary
The incidence of melanoma is increasing with an estimated incidence of 59,940 cases and an annual death rate of 8110 in 2007. Although patients diagnosed with early stage disease have an excellent clinical outcome, patients diagnosed with advanced or recurrent disease, continue to have a high mortality rate, even with initial optimal surgical resection. Effective adjuvant strategies are needed to increase the time to progression and to decrease the recurrence rate. Immunotherapy has long been recognized as a potential therapy for melanoma; the goal of adjuvant vaccine therapy is to train the endogenous immune system to recognize and target minimal residual disease.
Detailed description
This is a Phase I open label dose escalation study of the TLR3 agonist Poly-ICLC as an adjuvant for NY-ESO-1 protein vaccination in patients with high risk melanoma in clinical complete remission (cCr), followed by a randomized Phase II component in which patients will be randomized to subcutaneous vaccination of NY-ESO-1 protein with Poly-ICLC alone dose TBD (Arm A) or with NY-ESO-1 protein, Poly-ICLC dose TBD and Montanide® ISA-51 VG (Montanide) (Arm B). Patients with histological confirmed malignant melanoma, AJCC Stages: IIB, IIC, III or IV, who are in complete clinical remission (cCr) but at high risk of disease recurrence, will be eligible for enrollment, regardless of whether antigen expression in the autologous tumor can be demonstrated by either PCR or immunohistochemistry. Primary Objectives: * Phase I: To define the safety of subcutaneous vaccination with NY-ESO-1 protein, Montanide and escalating doses of Poly-ICLC. * Phase II: To evaluate the induction of humoral and T cell (CD4+ and CD8+) immunity to subcutaneous vaccination with NY-ESO-1 protein in combination with Poly-ICLC when given with or without Montanide. Exploratory analyses: * Evaluation of primary tumor expression of NY-ESO-1 by IHC or RT-PCR. * Histologic quantitation of original tumor TILs (tumor infiltrating lymphocytes), CD3+ cells, evaluation of mitotic index and correlation of this data with immunologic response. * Correlation of NY-ESO-1 specific T cell responses with HLA type * Investigation of polymorphisms for TLR3 through germline SNP analysis. * Clinical Outcome (Time to Progression) reported descriptively. * Skin section analysis of protein/adjuvant treated sites for immune cell infiltration and gene expression analysis
Interventions
BIOLOGICALNY-ESO-1 protein; Poly-ICLC; Montanide
Phase I represents the dose-escalation component with Poly-ICLC given in combination with NY-ESO-1 and Montanide in an open-label fashion. The dose of Poly-ICLC will be increased stepwise from 0.35mg to 1.4mg while the dose of NY-ESO-1 antigen (100µg) and Montanide (1.1mL) will be held constant. Phase II: The doses of NY-ESO-1 and Montanide will remain the same as in Phase I; the highest tolerated Phase I dose of Poly-ICLC will become the Phase II Poly-ICLC dose. In Phase II, patients will be randomized to a subcutaneous vaccination of NY-ESO-1 protein with Poly-ICLC alone dose TBD (Arm A) or with NY-ESO-1 protein, Poly-ICLC dose TBD and Montanide (Arm B).
Sponsors
Ludwig Institute for Cancer Research
Oncovir, Inc.
Cancer Research Institute, New York City
Nina Bhardwaj
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Histological diagnosis of malignant melanoma, stages IIB-IV in radiologically confirmed cCr without clinical evidence of disease. 2. At least 4 weeks since surgery prior to first dosing of study agent. 3. Laboratory values within the following limits: 1. Hemoglobin \> 10.0 g/dL 2. Neutrophil count \> 1.5 x l09/L 3. Lymphocyte count \> Lower limit of institutional normal 4. Platelet count \> 80 x l09/L 5. Serum creatinine \< 2.0 mg/dL 6. Serum bilirubin \< 2 x upper limit of institutional normal 7. AST/ALT \< 2 x upper limit of institutional normal 4. Patients must have an ECOG performance status of \<2 (ECOG criteria published in \[67\]. 5. Life expectancy \> 6 months. 6. Age \> 18 years. 7. Able and willing to give written informed consent for participation in the trial (see Section 12.2).
Exclusion criteria
1. Serious illnesses, e.g., serious infections requiring antibiotics. 2. Previous bone marrow or stem cell transplant. 3. History of immunodeficiency disease (such as HIV) or autoimmune disease except vitiligo. 4. Metastatic disease to the central nervous system. 5. Other malignancy within 3 years prior to entry into the study, except for treated early-stage melanoma or non-melanoma skin cancer, or cervical carcinoma in situ. 6. Prior chemotherapy or vaccine therapy. 7. Radiation therapy, biological therapy or surgery within 4 weeks prior to first dose of study agent. 8. Concomitant treatment with systemic corticosteroids greater than physiologic doses. Topical (but not at the proposed vaccination sites) or inhalational steroids are permitted. 9. Participation in any other clinical trial involving another investigational agent within 4 weeks prior to first dose of study agent. 10. Pregnancy or lactation. 11. Women of childbearing potential not using a medically acceptable means of contraception. 12. Psychiatric or addictive disorders that may compromise the ability to give informed consent. 13. Lack of availability of the patient for immunological and clinical follow-up assessment. 14. Children \<18 years of age who cannot undergo the leukapheresis procedure, do not meet the disease staging and/or the size criteria for frequent blood donations
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Phase I, Number of Participants With SAE and DLT | 52 weeks | Safety measured by number of Serious Adverse Events per the CTEP v4.0 of the NCI Common Terminology Criteria for Adverse Events (CTCAE) and Dose Limiting Toxicity (DLT). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CD4+ and CD8+ Response | Up to 52 weeks | Cellular response evaluated for the induction of cellular T cell (CD4+ and CD8+) immunity to subcutaneous vaccination with NY-ESO-1 protein in combination with Poly-ICLC when given with or without Montanide. Number of participants with increase CD4+ and CD8+ levels. |
| NY-ESO-1 Expression by IHC | up to 52 weeks | Analysis of immune cell infiltration at the injection site by IHC. IHC analysis of immune cell infiltration was performed for each arm using a scoring system. 0: No expression of the marker of interest, 1: single cells or small clusters (\<5 cells together) expressing marker of interest, 2: medium size clusters of cells expressing marker of interest, and 3: huge and homogeneously positive clusters of cells expressing marker of interest. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Poly-ICLC 0.35 mg Cohort 1 100µg NY-ESO-1 protein + 1.1 mL Montanide + 0.35mg Poly-ICLC. The cycle was repeated every 3 weeks for a total of 4 cycles. | 3 |
| Poly-ICLC 0.70 mg 100 µg NY-ESO-1 protein + 1.1 mL Montanide + 0.7mg Poly-ICLC.The cycle was repeated every 3 weeks for a total of 4 cycles. | 4 |
| Poly-ICLC 1.4mg 100 µg NY-ESO-1 protein + 1.1 mL Montanide + 1.4 mg Poly-ICLC. The cycle was repeated every 3 weeks for a total of 4 cycles. | 3 |
| NY-ESO-1 Protein and Poly-ICLC 100μg NY-ESO-1 protein, 1.4mg Poly-ICLC. | 12 |
| NY-ESO-1 Protein, Poly-ICLC and Montanide 100μg NY-ESO-1 protein, 1.4mg Poly-ICLC and 1.1mL Montanide. | 12 |
| Total | 34 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 |
|---|---|---|---|---|---|---|
| Cohort 2: Dose Level 2 (Weeks 13-24) | Disease Progression | 0 | 1 | 0 | 0 | 0 |
| Phase 2 (Weeks 37-48) | Withdrawal by Subject | 0 | 0 | 0 | 0 | 3 |
Baseline characteristics
| Characteristic | Poly-ICLC 0.35 mg | Poly-ICLC 0.70 mg | Poly-ICLC 1.4mg | NY-ESO-1 Protein and Poly-ICLC | NY-ESO-1 Protein, Poly-ICLC and Montanide | Total |
|---|---|---|---|---|---|---|
| Age, Continuous | 64 years | 65 years | 73 years | 50 years | 57 years | 55 years |
| Pathologic Staging IIA | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Pathologic Staging IIB | 0 Participants | 0 Participants | 1 Participants | 1 Participants | 0 Participants | 2 Participants |
| Pathologic Staging IIC | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 2 Participants |
| Pathologic Staging IIIA | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 2 Participants | 3 Participants |
| Pathologic Staging IIIB | 1 Participants | 1 Participants | 0 Participants | 4 Participants | 3 Participants | 9 Participants |
| Pathologic Staging IIIC | 0 Participants | 3 Participants | 2 Participants | 4 Participants | 4 Participants | 13 Participants |
| Pathologic Staging IV | 0 Participants | 0 Participants | 0 Participants | 2 Participants | 2 Participants | 4 Participants |
| Sex: Female, Male Female | 0 Participants | 2 Participants | 0 Participants | 5 Participants | 6 Participants | 13 Participants |
| Sex: Female, Male Male | 3 Participants | 2 Participants | 3 Participants | 7 Participants | 6 Participants | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 3 | 0 / 4 | 0 / 3 | 0 / 12 | 0 / 12 |
| other Total, other adverse events | 3 / 3 | 4 / 4 | 3 / 3 | 12 / 12 | 12 / 12 |
| serious Total, serious adverse events | 0 / 3 | 0 / 4 | 1 / 3 | 0 / 12 | 0 / 12 |
Outcome results
Primary
Phase I, Number of Participants With SAE and DLT
Safety measured by number of Serious Adverse Events per the CTEP v4.0 of the NCI Common Terminology Criteria for Adverse Events (CTCAE) and Dose Limiting Toxicity (DLT).
Time frame: 52 weeks
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Poly-ICLC 0.35 mg | Phase I, Number of Participants With SAE and DLT | Serious Adverse Events | 0 Participants |
| Poly-ICLC 0.35 mg | Phase I, Number of Participants With SAE and DLT | DLT | 0 Participants |
| Poly-ICLC 0.70 mg | Phase I, Number of Participants With SAE and DLT | Serious Adverse Events | 0 Participants |
| Poly-ICLC 0.70 mg | Phase I, Number of Participants With SAE and DLT | DLT | 0 Participants |
| Poly-ICLC 1.4mg | Phase I, Number of Participants With SAE and DLT | Serious Adverse Events | 1 Participants |
| Poly-ICLC 1.4mg | Phase I, Number of Participants With SAE and DLT | DLT | 0 Participants |
Secondary
CD4+ and CD8+ Response
Cellular response evaluated for the induction of cellular T cell (CD4+ and CD8+) immunity to subcutaneous vaccination with NY-ESO-1 protein in combination with Poly-ICLC when given with or without Montanide. Number of participants with increase CD4+ and CD8+ levels.
Time frame: Up to 52 weeks
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Poly-ICLC 0.35 mg | CD4+ and CD8+ Response | CD4 Responder | 10 Participants |
| Poly-ICLC 0.35 mg | CD4+ and CD8+ Response | CD8 Responder | 1 Participants |
| Poly-ICLC 0.70 mg | CD4+ and CD8+ Response | CD4 Responder | 9 Participants |
| Poly-ICLC 0.70 mg | CD4+ and CD8+ Response | CD8 Responder | 4 Participants |
Secondary
NY-ESO-1 Expression by IHC
Analysis of immune cell infiltration at the injection site by IHC. IHC analysis of immune cell infiltration was performed for each arm using a scoring system. 0: No expression of the marker of interest, 1: single cells or small clusters (\<5 cells together) expressing marker of interest, 2: medium size clusters of cells expressing marker of interest, and 3: huge and homogeneously positive clusters of cells expressing marker of interest.
Time frame: up to 52 weeks
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Poly-ICLC 0.35 mg | NY-ESO-1 Expression by IHC | CD4 lymphocytes | 1.318 units on a scale | Standard Deviation 0.643 |
| Poly-ICLC 0.35 mg | NY-ESO-1 Expression by IHC | CD8 lymphocytes | 1.091 units on a scale | Standard Deviation 0.437 |
| Poly-ICLC 0.35 mg | NY-ESO-1 Expression by IHC | CD20 B cells | 0.773 units on a scale | Standard Deviation 0.518 |
| Poly-ICLC 0.35 mg | NY-ESO-1 Expression by IHC | CD11c dendritic cells | 1.455 units on a scale | Standard Deviation 0.611 |
| Poly-ICLC 0.35 mg | NY-ESO-1 Expression by IHC | CD3 lymphocytes | 1.500 units on a scale | Standard Deviation 0.707 |
| Poly-ICLC 0.70 mg | NY-ESO-1 Expression by IHC | CD3 lymphocytes | 1.944 units on a scale | Standard Deviation 0.682 |
| Poly-ICLC 0.70 mg | NY-ESO-1 Expression by IHC | CD11c dendritic cells | 2.111 units on a scale | Standard Deviation 0.741 |
| Poly-ICLC 0.70 mg | NY-ESO-1 Expression by IHC | CD8 lymphocytes | 1.222 units on a scale | Standard Deviation 0.565 |
| Poly-ICLC 0.70 mg | NY-ESO-1 Expression by IHC | CD4 lymphocytes | 2.167 units on a scale | Standard Deviation 0.661 |
| Poly-ICLC 0.70 mg | NY-ESO-1 Expression by IHC | CD20 B cells | 1.500 units on a scale | Standard Deviation 0.5 |