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| Name | Class |
|---|---|
| EMD Serono | INDUSTRY |
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Up to 20% of all cancers may be associated with a bacterial or viral infection. In some instances, the infection may be one of the reasons why the cancer developed in the first place. One such example is infection with the human papilloma virus (HPV) and the development of cervical or oral cavity cancer.
A viral infection that is chronic may not cause a person symptoms, and may be able to escape detection by a person's own immune system. One of the medications being studied in this clinical trial (Valproic acid) may be able to unmask a chronic viral infection from a person's own immune system, therefore making the virus susceptible to attack by the immune system. In this study Valproic acid is being combined with an immune therapy, Avelumab. Avelumab is an antibody that targets a person's own immune cells, or lymphocytes. Lymphocytes must be activated to fight infections or cancer, but after activation they are deactivated. Avelumab prevents the deactivation of a lymphocyte, in effect "turning off the off-switch." This leads to a re-energizing of a person's immune system, hopefully leading to an attack by the immune system on a person's cancer.
Avelumab is known to be an effective treatment for a variety of cancers, although it has not yet been tested in all cancers. By combining Valproic acid, a treatment which targets the virus that contributed to the development of this type of cancer with Avelumab the investigators hope to enhance the ability of Avelumab to restore the body's own immune defense against the cancer.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Avelumab with VPA | Experimental | Valproic Acid (VPA, 12.5 mg/kg) once per day and Avelumab (10 mg/kg IV) every 2 weeks for up to 2 years. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Valproic Acid | Drug | The target serum level for VPA will be between 75 and 100 mcg/mL checked every 2 weeks for the first 6 cycles. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Efficacy of Avelumab and VPA | • Assessment of the clinical response rate according to the immune-related RECIST criteria (iRECIST) | 1 year after enrolment of last patient |
| Proportion of subjects who complete 4 doses of Avelumab in combination with VPA | • Feasibility analysis, defined as the proportion of subjects who complete 4 doses of Avelumab in combination with VPA over the total duration of the study. | 1 year after enrolment of last patient |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | defined as the time from the date of enrollment to the date of death, whatever the cause. | 5 years from final study drug dose |
| Progression free survival | Progression free survival is defined as the time between the date of treatment initiation and the date of disease progression or death (whatever the cause), whichever occurs first. |
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Inclusion Criteria:
Patients must be 18 years of age or older.
Patients with the following histologically confirmed diagnoses will be eligible for enrolment: p16 positive SCCHN; squamous cell carcinoma of the cervix; p16 positive squamous cell carcinoma of the vagina or vulva; p16 positive squamous cell carcinoma of the penis; p16 positive squamous cell carcinoma of the anus or anal canal; EBER positive NPC; EBER positive Hodgkins and non-hodgkins lymphoma.
Note: patients with p16 positive SCC of unknown primary origin meeting the minimum life expectancy and performance status requirements will also be eligible for enrollment, as the majority of these patients may be assumed to represent HPV-associated disease.
Patients must be capable of providing consent to enrolment and treatment.
Patients with a performance status of ECOG 0-1(51) will be eligible for enrolment (see appendix 1).
Measurable disease must be present according to irRECIST criteria(50).
Women of child bearing potential (WOCBP) must have a negative serum (or urine) pregnancy test at the time of screening.
Patients of childbearing / reproductive potential should use highly effective birth control methods, as defined by the investigator, during the study treatment period and for a period of 60 days after the last dose of study drug. A highly effective method of birth control is defined as those that result in low failure rate (i.e. less than 1% per year) when used consistently and correctly.
Note: abstinence is acceptable if this is established and preferred contraception for the patient and is accepted as a local standard.
Female patients who are breast-feeding should discontinue nursing prior to the first dose of study treatment and until 120 days after the last dose of study drug.
Absence of any condition hampering compliance with the study protocol and follow- up schedule; those conditions should be discussed with the patient before registration in the trial.
The following adequate organ function laboratory values must be met:
Hematological:
Renal:
o Estimated creatinine clearance ≥ 30 mL/min according to the Cockcroft-Gault formula (or local institutional standard method)
Hepatic:
Coagulation:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| John Walker, MD PhD FRCPC | Alberta Health services | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cross Cancer Institute | Edmonton | Alberta | T6G 1Z2 | Canada |
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| Avelumab | Biological | 10 mg/kg IV |
|
| 5 years from final study drug dose |
| Number of participants with adverse events | • Incidence of adverse events (assessed as the incidence and severity of adverse events, including immune-related adverse events, and the number of discontinuations due to adverse events). | Through study completion, up to 2 years |
| Identify specific virus-associated cancers as candidates for subsequent study | Through study completion, up to 2 years |
| Measurement of Immuno-score | AffymetriX Micro-array (Immuno-score) | Through study completion, up to 2 years |
| Measurement of MHC expression | Through study completion, up to 2 years |
| Measurement of cell-free tumoral DNA in blood | Through study completion, up to 2 years |
| Phenotyping of Tumour Infiltrating Lymphocytes | Through study completion, up to 2 years |
| DNA viral load | DNA Quantitative PCR (viral load) | Through study completion, up to 2 years |
| Expression of lytic viral genes | Through study completion, up to 2 years |
| Cytotoxic T-Lymphocyte immunophenotyping | Through study completion, up to 2 years |
| T-cell receptor sequencing | Through study completion, up to 2 years |
| Hsp90 concentration in serum | Through study completion, up to 2 years |
| ID | Term |
|---|---|
| D014635 | Valproic Acid |
| C000609138 | avelumab |
| ID | Term |
|---|---|
| D010421 | Pentanoic Acids |
| D014631 | Valerates |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D009930 | Organic Chemicals |
| D005232 | Fatty Acids, Volatile |
| D005227 | Fatty Acids |
| D008055 | Lipids |
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