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The purpose of this study is to determine the safety and feasibility of administering the Tetanus Diptheria Vaccine (Td) or Polio Boost Immunization (IPOL) to patients with metastatic melanoma who are receiving immune checkpoint inhibitor (IO) therapy per standard of care. Subjects will have the vaccine at cycle 4 of IO therapy and will have research blood and tissue samples collected prior to starting IO therapy, at cycle 4 prior to vaccine administration, and at 12-17 days post vaccine.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Td Vaccine | Experimental | The first 15 subjects enrolled will receive the Td (tetanus diphtheria) vaccine at cycle 4 of IO therapy. The Td vaccine is administered as 0.5 mL intramuscular injection in the extremity (thigh or upper arm) in closest proximity to the largest tumor. |
|
| IPOL Vaccine | Experimental | Subjects 16 through 25 will receive the IPOL (polio booster) vaccine at cycle 4 of IO therapy. The IPOL vaccine is administered as 0.5 mL intramuscular or subcutaneous injection in the extremity (thigh or upper arm) in closest proximity to the largest tumor |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tetanus Diptheria Vaccine | Biological | tetanus and diphtheria toxoids |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of subjects out of the proposed 25 that successfully receive the vaccine after 4 cycles of IO therapy | Evaluable patients are defined as those who receive four cycles of IO therapy and then receive a Td or IPOL vaccine | informed consent through date of vaccine (est apx 4-5 months) |
| Safety, as measured by the change in the number and severity of adverse events deemed related to the vaccine or study procedures (blood draw and biopsies) | Adverse events will only include those that are determined to be related to the study vaccine or study procedures (blood draw and biopsies) | Baseline, cycle 4 of IO therapy (apx 12-16 weeks), 12-17 days post vaccine, SOC scan following vaccine (apx 8-12 weeks post vaccine) |
| Measure | Description | Time Frame |
|---|---|---|
| Preliminary efficacy, as measured by objective response rate | Number of patients that experience tumor response vs. stable disease vs. progression as determined by PI assessment of standard of care scans | up to 36 months |
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Inclusion Criteria:
Histologically confirmed advanced metastatic melanoma
Male or female participants who are at least 18 years of age on the day of signing informed consent
Participants must be planned or scheduled by their treating physician to receive PD-1 therapy or PD-1 plus anti CTLA-4 therapy as standard of care
Participant (or legally acceptable representative if applicable) provides written informed consent for the trial
Participant must have at least 1 lesion that is at least 8 mm in size and is cutaneous, subcutaneous, palpable, or amenable to ultrasound guided core biopsy. The lesion chosen for biopsy can also be a target lesion but does not have to be a target lesion
Adequate organ function as defined below. Standard of care labs drawn within 45 days prior to consent may be used for the purposes of determining eligibility
Exclusion Criteria:
Uveal or mucosal melanoma
Any women known to be pregnant or breastfeeding
Any prior systemic therapy for metastatic melanoma (prior surgery is allowed)
Known diagnosis of immunodeficiency or receiving chronic systemic steroid therapy (in doses exceeding 10 mg daily of prednisone or equivalent), or any other form of immunosuppressive therapy within 7 days prior to first research biopsy
Patients with symptomatic CNS metastases and/or carcinomatous meningitis
a) Patients with asymptomatic, stable CNS metastases are allowed provided that they are not on >10mg prednisone daily
History of or active (non-infectious) pneumonitis that required steroids
Active infection requiring systemic therapy
Known history of Human Immunodeficiency Virus (HIV) infection
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 or Hepatitis C is required
Known history of active TB (Bacillus Tuberculosis)
History or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with subject's participation for the full duration of the study, or make it not in the best interest of the subject to participate, in the opinion of the treating physician
Known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial
History of allogenic tissue or solid organ transplant
History of allergic reaction to IPOL or Td vaccine
Receipt of Td vaccine within 30 days prior to starting IO therapy
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Carol Ann Wiggs, BSN | Contact | 919-684-0281 | carolann.wiggs@duke.edu |
| Name | Affiliation | Role |
|---|---|---|
| Georgia Beasley, MD | Duke University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Duke University Medical Center | Recruiting | Durham | North Carolina | 27710 | United States |
IPD will only be used internally by the study team
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| ID | Term |
|---|---|
| D008545 | Melanoma |
| ID | Term |
|---|---|
| D018358 | Neuroendocrine Tumors |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
| D009370 | Neoplasms by Histologic Type |
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| ID | Term |
|---|---|
| D022422 | Diphtheria-Tetanus Vaccine |
| ID | Term |
|---|---|
| D001428 | Bacterial Vaccines |
| D014612 | Vaccines |
| D001688 | Biological Products |
| D045424 | Complex Mixtures |
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| Polio Boost Immunization | Biological | trivalent inactivated polio vaccine |
|
|
| D009369 | Neoplasms |
| D009380 | Neoplasms, Nerve Tissue |
| D018326 | Nevi and Melanomas |
| D012878 | Skin Neoplasms |
| D009371 | Neoplasms by Site |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D004168 |
| Diphtheria Toxoid |
| D014121 | Toxoids |
| D013745 | Tetanus Toxoid |
| D017778 | Vaccines, Combined |