Phase 1 Trial of Ipilimumab and GVAX in Patients With Metastatic Castration-resistant Prostate Cancer
Study Details
Study Description
Brief Summary
Ipilimumab, an antibody that blocks cytotoxic T-lymphocyte antigen 4, and GVAX have demonstrated anti-tumor activity in prostate cancer. Pre-clinical studies with this combination have demonstrated potent synergy. The purpose of this study is to investigate, using a phase-I 3+3 dose escalation design followed by an expansion cohort, the safety and efficacy of combined treatment with GVAX and ipilimumab in castration-resistant metastatic prostate cancer (CRPC) patients.
Condition or Disease | Intervention/Treatment | Phase |
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Phase 1 |
Detailed Description
A promising immunotherapeutic approach in prostate cancer is whole-cell vaccination. Irradiated allogeneic tumor cells expressing GM-CSF generate a long-lasting and specific anti-tumor immunity in preclinical models. Results from several phase I and II trials showed Prostate GVAX (GVAX) to be well tolerated and suggested improved survival. Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) is a crucial immune checkpoint molecule that down-regulates T-cell activation and proliferation. Ipilimumab, a fully human monoclonal antibody (IgG1) that blocks CTLA-4, promotes antitumor immunity, and has been demonstrated in two phase III trials to improve overall survival in metastatic melanoma patients. Pre-clinical studies of the anti-CTLA-4 antibody in combination with GM-CSF secreting tumor cell vaccines demonstrated a potent synergy. In this phase I study the investigators examine in CRPC patients whether ipilimumab can be safely combined with GVAX. In addition, the investigators will treat an additional 16 patients at a dose level of 3•0 mg/kg to determine the safety profile and antitumor effects of GVAX and ipilimumab in patients with CRPC.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Ipilimumab and GVAX
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Drug: GVAX and ipilimumab
All patients receive a 500 million cell priming dose of granulocyte-macrophage colony-stimulating factor-transduced allogeneic prostate cancer cells (GVAX) intradermally on day 1 followed by bi-weekly intradermal injections of 300 million cells for a 24 week period. The vaccinations are combined with monthly intravenous administrations of ipilimumab. The dose-escalation part of this study will be performed using the standard 3+3 phase-I trial design. Patients will be enrolled in cohorts of three; each cohort will receive an escalating dose of ipilimumab at 0•3, 1•0, 3•0 or 5•0 mg/kg. Sixteen patients will be treated in an expansion cohort with GVAX and 3•0 mg/kg ipilimumab.
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Outcome Measures
Primary Outcome Measures
- Number of patients with adverse events [7 months]
Secondary Outcome Measures
- number of patients that have a tumor/PSA response [7 months]
- number of patients that will develop a tumor-specific (e.g. PSMA, NY-ESO) antibody response as measured by ELISA [7 months]
- the number of patients that have activated T cells and dendritic cells as measured by FACS [7 months]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Males age 18-80 years
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Histologic diagnosis of adenocarcinoma of the prostate
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Metastatic prostate cancer deemed to be unresponsive or refractory to hormone therapy
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Detectable metastases by bone scan, CT scan or MRI
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Two consecutive rising PSA values obtained at least two weeks apart and both obtained at least 4-6 weeks after discontinuation of hormone therapy. Second PSA value must be
5.0 ng/mL. LHRH agonist should not be discontinued.
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Testosterone < 50 ng/dL. Must have had orchiectomy or is currently receiving an LHRH agonist.
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WBC > 3.0 x 109/L, ANC > 1.5 x 109/L, hemoglobin > 6.2 mmol/L, and platelets > 100 x 109/L
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Serum creatinine < 177 umol/L Bilirubin < 1.5 times the upper limit of normal AST < 3 times the upper limit of normal
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ECOG performance status 0-2
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Life expectancy of at least 6 months
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If sexually active, willing to use barrier contraception during the treatment phase of the protocol
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The ability to understand and willingness to sign a written informed consent
Exclusion Criteria:
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Transitional cell, small cell, neuroendocrine, or squamous cell prostate cancer
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Bone pain severe enough to require routine narcotic analgesia use
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Clinical evidence of brain metastases or history of brain metastases
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Seropositive for HIV, Hepatitis B antigen positive and/or Hepatitis C viremic
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Prior chemotherapy or immunotherapy for prostate cancer
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Radiation therapy within 4 weeks of the first treatment
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Surgery within 4 weeks of the first treatment. Must have recovered from all side effects.
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Flutamide within 4 weeks of the first treatment Megesterol acetate (Megace), finasteride (Proscar), bicalutamide (Casodex),nilutamide, aminoglutethimide, ketoconazole or diethylstilbestrol within 6 weeks of the first treatment.
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Systemic corticosteroid use within 4 weeks of the first treatment
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History of autoimmune disease
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History of another malignancy, except for the following: adequately treated basal cell or squamous cell skin cancer, superficial bladder cancer, adequately treated Stage I or II cancer currently in complete remission or any other cancer that has been in complete remission for at least 5 years
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | VU university medical center | Amsterdam | Netherlands | 1081 HV |
Sponsors and Collaborators
- Amsterdam UMC, location VUmc
- Cell Genesys
- Medarex
Investigators
- Principal Investigator: Winald Gerritsen, Prof. MD PhD, Amsterdam UMC, location VUmc
- Principal Investigator: Fons van den Eertwegh, MD PhD, Amsterdam UMC, location VUmc
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- G-0016