Glioblastoma (GBM)
Conditions
Keywords
Glioblastoma, GBM
Brief summary
The objective of this study is to evaluate the safety, feasibility, and preliminary antitumor activity of this multi-component immunotherapy strategy in patients with advanced solid tumors. The study is designed to assess whether coordinated enhancement of antigen-specific T-cell priming and tumor microenvironment modulation can improve immune-mediated tumor control. In this study, BreakVax with adjuvants (Montanide and Poly-ICLC) is administered in combination with: 1. Low-dose subcutaneous ipilimumab at the injection site as a dendritic cell adjuvant to enhance local dendritic cell-mediated T-cell priming; 2. Pembrolizumab to mitigate PD-1-mediated T-cell exhaustion and sustain effector function; 3. Standard-of-care chemotherapy, which may promote immunogenic cell death, increase antigen release and modulate the tumor microenvironment; and 4. Losartan and aspirin, which have been associated in preclinical and translational studies with modulation of stromal architecture, vascular normalization, and reduction of tumor-associated immunosuppressive signaling. This is a Phase 1/2, multi-center, open-label single-arm clinical study in adult patients who have Glioblastoma (GBM). The study consists of two components: a Safety Lead-in Cohort and a combination therapy cohort. The Safety Lead-in Cohort is designed to evaluate safety and tolerability of the study combination and to characterize dose-limiting toxicities (DLTs). The combination therapy cohort portion intends to evaluate the superiority of the study combination treatment vs the SOC chemotherapy, measured by OS at 12 months
Interventions
DRUGBreakVax
An investigational, personalized peptide-based cancer immunotherapy designed to stimulate patient-specific antitumor T-cell responses. For each patient, tumor tissue undergoes integrated genomic, transcriptomic, and proteomic analysis to identify tumor-associated antigens (TAAs) and tumor-specific neoantigens (TSAs). A proprietary selection algorithm prioritizes peptides predicted to be presented by the patient's HLA molecules and selectively expressed or overexpressed in tumor tissue. The resulting individualized peptide pools are manufactured, formulated with adjuvants (Montanide ISA 51 and Poly-ICLC), and administered subcutaneously
Low-dose subcutaneous ipilimumab at the injection site as a dendritic cell adjuvant to enhance local dendritic cell-mediated T-cell priming
DRUGPembrolizumab
To mitigate PD-1-mediated T-cell exhaustion and sustain effector function
DRUGTemozolomide (TMZ)
May promote immunogenic cell death, increase antigen release and modulate the tumor microenvironment
Have been associated in preclinical and translational studies with modulation of stromal architecture, vascular normalization, and reduction of tumor-associated immunosuppressive signaling
Sponsors
BreakBio Corp
Miami Cancer Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 72 Years
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years and \< 72 2. Patients with histologically confirmed GBM who have sent 200 mg (approximately) of tumor tissue (fresh tissue immersed in AllProtect then frozen) to BreakBio for analysis. 3. KPS of 80 or greater on day of first dose 4. Patient has adequate organ function on day one of the trial as defined by: * Neutrophil to Lymphocyte Ratio (NLR)1 at a healthy adult's normal level: ≤ 3.5 * Absolute Neutrophil Count (ANC) at the normal level: ≤ 7,000/mm3 * Absolute Lymphocyte Count in normal level: ≥ 1,000/mm3 * Monocytes at normal level: \< 700/mm3 * Platelet count: ≥ 100 x 109/L (without transfusion support in the last two weeks) * Hemoglobin: \> 10.0 g/dL (without transfusion support in the last two weeks) * AST and ALT: ≤ 3 X institutional upper limit of normal (ULN) in the absence of liver mets; AST and/or ALT may be ≤ 5 x ULN in the setting of liver metastases * Total Bilirubin at the normal level: ≤ 1.2mg/dL * Serum creatinine: ≤ 1.5 x institution's ULN * Albumin at the normal level: ≥ 3.4 g/dL * Serum Magnesium at normal level: ≥ 1.7 mg/dL * Pulse oximetry ≥ 92% on room air. 5. Provision of consent for on-treatment biopsy (compulsory) and post-treatment biopsy (optional). 6. Both male and female patients enrolled in this trial must agree to use effective contraception during the course of the trial and for at least 3 months after discontinuing study treatment. Patients and/or partners who are surgically sterile or postmenopausal are exempt from this requirement. 7. Negative pregnancy test ≤ 7 days prior to day one of cycle 1, for women of childbearing potential only. 8. Life expectancy \> 6 months. 9. Willing and able to provide informed consent
Exclusion criteria
1. Prior exposure to anti PD- 1/PD-L1 agents. 2. Prior exposure to immunosuppressive therapy within the last 12 months prior to enrollment. 3. Receiving or previously receiving oral or IV steroids within 6 weeks of starting study treatment. Currently using or previously used topical steroids within 6 weeks of starting study treatment. Expected to require steroid-containing pre-meds before chemotherapy doses. 4. Patients with deficient mismatch repair (dMMR) or microsatellite instability (MSI-H) phenotype 5. Any liver metastasis greater than 2 cm or greater than 5 liver metastases. Patients who have liver metastasis removed by surgery, and therefore meet this criterion at first dose, may enroll. 6. Patients not recovered from all clinically significant toxic effects of previous therapies to ≤Grade 1 or baseline with the exception of peripheral neuropathy and alopecia. 7. Patients not recovered adequately from the toxicity and/or complications from any major surgery prior to starting study treatment. 8. Known or suspected hypersensitivity to any of the study drugs. 9. Received an investigational agent within 28 days prior to the first dose of study drug. 10. History of myocarditis or congestive heart failure (as defined by New York Heart Association Functional Classification III or IV), as well as unstable angina, serious uncontrolled cardiac arrhythmia, uncontrolled infection, or myocardial infarction within the past 6 months. Note: Prior to trial entry, any ECG abnormality at screening must be documented by the investigator as not medically relevant. 11. LVEF \<50%. 12. Active interstitial lung disease (ILD)/pneumonitis or a history of ILD/pneumonitis requiring treatment with systemic steroids. 13. Known history of Hepatitis B (defined as Hepatitis B surface antigen \[HBsAg\] reactive) or known active Hepatitis C virus (defined as HCV RNA \[qualitative\] is detected) infection. Note: no testing for Hepatitis B and Hepatitis C is required unless mandated by local health authority. Individuals who are hepatitis C antibody positive may be enrolled if negative viral load confirmed. 14. History of autoimmune disease including inflammatory bowel disease (including ulcerative colitis and Crohn's Disease), rheumatoid arthritis, systemic progressive sclerosis (scleroderma), systemic lupus erythematosus, autoimmune vasculitis (e.g. Wegener's granulomatosis); central nervous system or motor neuropathy considered of autoimmune origin (e.g. Guillain-Barré syndrome, myasthenia gravis, multiple sclerosis). Individuals with vitiligo, Sjogren's Syndrome, interstitial cystitis, Graves' or Hashimoto's Disease, celiac disease, DM1, hypothyroidism stable on hormone replacement, or any autoimmune disease without symptoms and not requiring active therapy for at least 2 years will be allowed with Study Medical Monitor's approval. 15. A serious local infection (e.g. cellulitis, abscess) or systemic infection (e.g. pneumonia, septicemia) which requires systemic antibiotic treatment within 4 weeks prior to the first dose of study medication. 16. Receiving coumarin-derived anticoagulants. 17. Unable or unwilling to withhold or discontinue any prohibited or restricted medications/procedures for the specified windows during the study. 18. Inability or refusal to comply with the protocol or with the clinical trial procedures. 19. If female, pregnant or breastfeeding. All female patients with reproductive potential must have a negative pregnancy test prior to starting treatment. 20. Chronic intake of drugs that lead to known interference with metabolism through strong Cytochrome P450 3A4 (CYP3A4) interaction: e.g. Rifampicin, Rifabutin, Clarithromycin, Telithromycin, Ketoconazole, Itraconazole, Fluconazole, Hypericum perforatum (St. John's Wort /Johanniskraut) or any strong CYP3A4 inducing or inhibiting drug (Note: participants in this study should avoid consuming grapefruit or grapefruit-containing products during the duration of the study, including the screening phase, treatment period, and follow-up period). 21. Uncontrolled hypertension defined as persistent systolic blood pressure ≥ 150 mmHg or diastolic blood pressure ≥ 100 mmHg despite current therapy. 22. Arterial thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks) within 6 months before the start of study medication. Active pulmonary emboli or deep vein thrombosis that are significant or not adequately controlled on anticoagulation regimen 23. Any hemorrhage or bleeding event ≥ National Cancer Institute - Common terminology criteria for adverse events (NCI-CTCAE) Grade 3 within 28 days prior to the start of study medication 24. History of other invasive cancer within 2 years prior to enrollment, except for treated non-melanoma skin cancer 25. Known DNA Polymerase Epsilon (POLE) mutations
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percentage of patients for whom BreakVax is successfully manufactured | up to 24 Months |
| Adverse events | up to 24 Months |
| Overall Survival (OS) | 12 Months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Pseudoprogression per iRANO | From start of study treatment through disease progression or end of treatment, up to 2 years. | Percentage of participants who experience apparent radiographic progression that is subsequently determined not to represent true disease progression according to iRANO criteria. |
| Stable Disease for at Least 12 Weeks per iRANO | From start of study treatment through disease progression or end of treatment, up to 2 years. | Percentage of participants whose best response is stable disease according to iRANO criteria for at least 12 weeks, using the protocol-specified assessment window of 12 weeks ±1 week. |
| Overall Survival (OS) | Up to 5 years. | Time from the start of study treatment to death from any cause. |
| T-cell infiltration | From pre-treatment biopsy to on-treatment biopsy (Cycle 2 after imaging) | Change in tumor-infiltrating T-cells between the pre-treatment biopsy and the on-treatment biopsy |
| Immune-related Objective Response Rate (irORR) per iRANO | From start of study treatment through disease progression or end of treatment, up to 2 years. | Percentage of participants with measurable enhancing disease at baseline who achieve an immune-related complete response or partial response according to iRANO criteria, as assessed by a central independent review committee (IRC). |
| Progression-Free Survival (PFS) per RANO | From start of study treatment through progression or death, up to 2 years. | Time from the start of study treatment to the first documentation of progressive disease according to RANO criteria or death from any cause, whichever occurs first, as assessed by a central independent review committee (IRC). Participants without documented progression or death will be censored according to the Statistical Analysis Plan. |
| Clinical Benefit Rate (CBR) per RANO | From start of study treatment through disease progression or end of treatment, up to 2 years. | Percentage of participants who achieve complete response (CR), partial response (PR), or stable disease (SD) lasting at least 12 weeks according to RANO criteria, as assessed by a central independent review committee (IRC). |
| Duration of Response (DoR) per RANO | From first documented CR or PR through progression or death, up to 2 years. | Among participants who achieve a complete response or partial response according to RANO criteria, duration of response is measured from the first date on which criteria for complete response or partial response are met until the first date on which recurrent or progressive disease is objectively documented or death occurs, as assessed by a central independent review committee (IRC). |
| Objective Response Rate (ORR) per RANO | From start of study treatment through disease progression or end of treatment, up to 2 years. | Percentage of participants with measurable enhancing disease at baseline who achieve a complete response (CR) or partial response (PR) according to RANO criteria, as assessed by a central independent review committee (IRC). |
| Immune-related Progression-Free Survival (irPFS) per iRANO | From start of study treatment through confirmed progression or death, up to 2 years. | Time from the start of study treatment to confirmed disease progression according to iRANO criteria or death from any cause, whichever occurs first. Unconfirmed progression does not constitute a progression event until confirmation according to iRANO criteria. |
Countries
United States
Outcome results
None listed