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| ID | Type | Description | Link |
|---|---|---|---|
| CA209-9MW | Other Identifier | Bristol-Myers Squibb |
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| Name | Class |
|---|---|
| Bristol-Myers Squibb | INDUSTRY |
| Prostate Cancer Foundation | OTHER |
| The Foundation for Barnes-Jewish Hospital | OTHER |
| Bavarian Nordic |
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This study study aims to elucidate the immune responses to a shared antigen vaccine (PROSTVAC) and tumor specific antigens generated DNA vaccine in combination with checkpoint blockade using nivolumab (anti-PD-1), and ipilimumab (anti-CTLA-4). Additionally, the investigators will study the impact of the combination immunotherapy on peripheral T cell activation, as well as immune response in the tumor microenvironment. Finally, the investigators will evaluate the safety and tolerability to this novel personalized immunotherapy in combination with checkpoint blockade.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PROSTVAC/Ipilimumab/Nivolumab/Neoantigen DNA vaccine | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PROSTVAC-V | Biological | -Replication-competent vaccinia virus which has been engineered to encode the sequences for a modified human prostate-specific antigen (PSA) and a triad of co-stimulatory molecules (TRICOM) |
| Measure | Description | Time Frame |
|---|---|---|
| Safety and tolerability of regimen as defined by incidence of adverse events | -Adverse events will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 | Through 100 days after completion of treatment (estimated to be 55 weeks) |
| Immune response as measured by tetramers | -MHC tetramers made against the identified neoantigens will be used to evaluate PBMC for neoantigen-reactive T cells | Through completion of treatment (estimated to be 41 weeks) |
| Immune response as measured by genomic studies | -Laser capture microdissection will be performed to perform genomic studies on specific areas of tissue | Through completion of treatment (estimated to be 41 weeks) |
| Immune response as measured by flow cytometry | -Multiparametric flow cytometry or CyTOF will be performed in parallel to evaluate for any shifts (in quality and quantity) in peripheral leukocyte subsets. | Through completion of treatment (estimated to be 41 weeks) |
| Safety and tolerability of regimen as defined by incidence of dose-limiting toxicities (DLTs) | -DLT is defined as any unexpected, treatment-related grade 4 or 5 adverse event that occurs with increased severity or incidence outside of known, expected toxicities, that occur in the first 6 patients enrolled (safety lead-in cohort) | Through 100 days after completion of treatment (estimated to be 55 weeks) |
| Measure | Description | Time Frame |
|---|---|---|
| Failure-free survival (FFS) | -Defined as time from day 0 of treatment to evidence of at least one of the following: biochemical failure; radiographic or clinical progression either locally, in lymph nodes, or in distant metastases; or death from prostate cancer) compared to historical controls (ADT + docetaxel). Biochemical failure is defined as three consecutive rises (at lease one week apart) in PSA levels with the date of failure being the midpoint between the PSA nadir and the first PSA rise. Radiographic progression is defined as either RECIST1.1 or PCWG3 criteria. |
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Inclusion Criteria:
Histologically confirmed adenocarcinoma of the prostate.
High risk/volume metastatic disease, as defined by 4 or more sites of disease or the presence of visceral metastases.
Must have completed an adequate course of chemo-hormonal, first line therapy for metastatic hormone-sensitive prostate cancer, as determined by the investigator. Patients must remain on stable dose of ADT with castrate levels of testosterone (defined as testosterone < 50 ng/dL)
At least 18 years of age.
PSA may be undetectable after initial chemo-ADT.
ECOG performance status ≤ 2
Normal bone marrow and organ function as defined below:
Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).
Must have a biopsy of a metastatic site of disease (may be archival) available and adequate for evaluation and determination of neoantigens by genomic analyses.
Must have all AEs resolved to baseline prior to chemo-ADT, or if treatment related, resolved to grade 1 prior to enrollment.
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Russell Pachynski, M.D. | Washington University School of Medicine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Washington University School of Medicine | St Louis | Missouri | 63110 | United States |
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| Label | URL |
|---|---|
| Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine | View source |
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| INDUSTRY |
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| PROSTVAC-F | Biological | -Fowlpox virus which does not replicate in human cells and has been engineered to encode the same sequences present in PROSTVAC-V. |
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| Nivolumab | Drug | -Nivolumab is a human monoclonal antibody (mAb) |
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| Ipilimumab | Drug | -Ipilimumab is a mAb blocking the inhibitory signal mediated by cytotoxic T Lymphocyte-associated antigen 4 (CTLA-4), a protein receptor that downregulates the immune system. |
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| Neoantigen DNA vaccine | Biological | Each DNA vaccination will be 1 mL vaccine administered intramuscularly. At each vaccination time point, patients will receive two injections at separate sites. |
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| TriGrid Delivery System | Device | -Electroporation device |
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| Tumor biopsy | Procedure | -Pre-treatment, post-treatment A (optional), and end of treatment |
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| Peripheral blood | Procedure | -At the time of pre-treatment biopsy, mid-treatment of chemo-ADT, at time of enrollment (prior to POSTVAC administration), mid-treatment A, mid-treatment B (multiple) |
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| Fecal samples | Procedure | -Post chemo/pre-treatment A, post-treatment A, pre-treatment B, post-treatment B |
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| Leukapheresis | Procedure |
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| Through completion of follow-up (estimated to be 65 weeks) |
| Milestone survival | -Defined as the Kaplan-Meier survival probability | Through completion of follow-up (estimated to be 65 weeks) |
| Number of participants who have PSA responses at 30% reduction level |
| Through completion of treatment (estimated to be 41 weeks) |
| Number of participants who have PSA responses at 50% reduction level |
| Through completion of treatment (estimated to be 41 weeks) |
| Radiographic progression as determined by RECIST 1.1 | At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions). | Through completion of treatment (estimated to be 41 weeks) |
| Radiographic progression as determined by Prostate Cancer Working Group 3 (PCWG3) |
| Through completion of treatment (estimated to be 41 weeks) |
| Radiographic progression free survival (rPFS) | -Radiographic progression-free survival (rPFS) is the time interval from baseline to the date when the first site of disease is found to progress (using a manifestation-specific definition of progression), or death, whichever occurs first. To better understand the effect of therapy on an individual site of disease, PCWG3 advises the date of progression in all specific sites be reported independently whether it is bone, nodes (pelvic or extrapelvic), visceral (lung, liver, adrenal, or CNS), or other. | Through completion of treatment (estimated to be 41 weeks) |
| Comparison of the immune correlates on matched tumor tissue and peripheral blood | Laser capture microdissection will be performed to perform genomic studies on specific areas of tissue (eg tumor core, high TIL areas, tumor-stromal interface, etc). These will be correlated with multiplexed immunofluorescence studies, as well as assays on peripheral blood. | Pre- and post-treatment (estimated to be 41 weeks) |
| ID | Term |
|---|---|
| C588274 | PROSTVAC |
| D000077594 | Nivolumab |
| D000074324 | Ipilimumab |
| D007937 | Leukapheresis |
| ID | Term |
|---|---|
| D061067 | Antibodies, Monoclonal, Humanized |
| D000911 | Antibodies, Monoclonal |
| D000906 | Antibodies |
| D007136 | Immunoglobulins |
| D007162 | Immunoproteins |
| D001798 | Blood Proteins |
| D011506 | Proteins |
| D000602 | Amino Acids, Peptides, and Proteins |
| D012712 | Serum Globulins |
| D005916 | Globulins |
| D016238 | Cytapheresis |
| D001691 | Biological Therapy |
| D013812 | Therapeutics |
| D001781 | Blood Component Removal |
| D047589 | Leukocyte Reduction Procedures |
| D002469 | Cell Separation |
| D003584 | Cytological Techniques |
| D019411 | Clinical Laboratory Techniques |
| D008919 | Investigative Techniques |
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