VXM01 phase I pilot study in patients with operable recurrence of a glioblastoma to examine safety, tolerability, immune and biomarker response to the investigational VEGFR-2 DNA vaccine VXM01

Inclusion Criteria:

1. Written informed consent, signed and dated
2. Histologically diagnosed intracranial supratentorial malignant glioma (contrast-enhancing anaplastic astrocytoma WHO Grade III or glioblastoma WHO Grade IV).
3. Male or female patients who must be post-menopausal for at least 2 years or surgically sterile.
4. Age ≥18 years
5. Evidence of tumor progression following at least one therapy regimen that must have contained radiation and chemotherapy with temozolamid, as measured by MRI
6. Candidates for a tumor reoperation
7. Neurosurgical intervention should be postponable for 30 days
8. Laboratory results (clinical chemistry, hematology, urine, liver enzymes, creatinine) without clinically relevant abnormalities
9. Patients must be able to undergo MRI
10. No concomitant medication with dexamethasone at the time of vaccination
11. No active infection at the time of vaccination
12. Karnofsky performance status >70
13. Appropriate hematologic parameters (for immunomonitoring): leukocytes ≥4.0 x 109 / L, lymphocytes ≥0.6 x 109 / L
14. Tumor samples available for pathology review, central detection of T-cell responses in the peripheral blood and in the tumor tissue
15. No medical or social conditions that may interfere with study outcome and follow-up

Exclusion Criteria:

1. Treatment in any other clinical trial within 30 days before screening

2. Known positive test results for Hepatitis B surface antigen , hepatitis C virus antibodies, human immunodeficiency virus antibodies -1/-2

3. Any other condition or treatment that, in the opinion of the investigator, might interfere with the study or current drug or substance abuse

4. Inability to understand the protocol requirements, instructions and study-related restrictions, the nature, scope, and possible consequences of the study

5. Unlikely to comply with the protocol requirements, instructions and study-related restrictions; e.g., uncooperative attitude, inability to return for follow-up visits, and improbability of completing the study

6. Pregnancy or breast feeding

7. Positive for anti-typhoid IgG/IgM antibodies according to the onsite test on Day 0

8. Cardiovascular disease defined as:

   Uncontrolled hypertension (systolic blood pressure >160 mmHg or diastolic blood pressure >100 mmHg)

   Arterial thromboembolic event within 6 months before randomization including:

   • Myocardial infarction
   • Unstable angina pectoris
   • Cerebrovascular accident
   • Transient ischemic attack

9. Congestive heart failure New York Heart Association grade III to IV

10. Serious ventricular arrhythmia requiring medication

11. Clinically significant peripheral artery disease > grade 2b according to Fontaine

12. Intracranial ischemic stroke within 6 months before randomization

13. History of intracranial hemorrhage

14. Hemoptysis within 6 months before randomization

15. Esophageal varices

16. Upper or lower gastrointestinal bleeding within 6 months before inclusion (Day 0)

17. Significant traumatic injury or surgery within 4 weeks before randomization

18. Non-healing wound, incomplete wound healing, bone fracture or any history of gastrointestinal ulcers within three years before inclusion, or positive gastroscopy within 3 months before inclusion

19. Gastrointestinal fistula

20. Thrombolysis therapy within 4 weeks before randomization

21. Presence of any acute or chronic systemic infection

22. Major surgical procedures, or open biopsy within 4 weeks before randomization

23. Chronic concurrent therapy within 2 weeks before and during the treatment period up to Day 35 with:

    • Corticosteroids (except steroids for adrenal failure or emesis prophylaxis up to 4 mg daily dose) or immunosuppressive agents
    • Antibiotics
    • Bevacizumab
    • Any cancer anti-angiogenic treatment

24. Chemotherapy from screening until reoperation (Day 35)

25. Known multi-drug resistant gram-negative germ

26. History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect the interpretation of the study results or render the patient at high risk for treatment complications

27. Women of childbearing potential

28. Any condition which results in an undue risk for the patient during the study participation according to the investigator