Neoantigen Derived DCs as Cancer Treatment
Study Details
Study Description
Brief Summary
Tumor lysate or carcinoembryonic antigen (CEA) derived DCs-based therapy is safe and can elicites remarkable T-cell responses but mostly did not really transfer into significant clinical benefit. One possible reason is the lack of effective antigen and the immunosuppressive microenvironment. Now we are exploring another new strategy, prediction of neoantigen for priming DCs as cell-based therapy with or without booster of anti-VEGF/anti-PD-1.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 1 |
Detailed Description
The human immune system can recognize and destroy cancer cells but cancer cells are capable of escaping from immune system by different ways, including the PD-1/PDL-1 axis and the VEGF signaling pathway. The PD-1/PD-L1 axis represents an adaptive immune resistance mechanism exerted by tumor cells. Previous study also revealed VEGF-A could induce tumor-associated macrophages, Treg cells, and myeloid-derived suppressor cells, creating an immunosuppressive microenvironment that prevent the maturation of dendritic cells (DCs) and inhibit the activation of NK cells and T cells. Our research group already completed some early phase clinical trials of DCs-based therapy, which illustrated tumor lysate or carcinoembryonic antigen (CEA) derived DCs-based therapy is feasible and safe in patients with advanced colorectal cancer and lung cancer, respectively. However, although DCs-based therapy elicited remarkable T-cell responses but mostly did not really transfer into significant clinical benefit in previous study. One possible reason is the lack of effective antigen and the immunosuppressive microenvironment. Now we are exploring another new strategy, prediction of neoantigen for priming DCs as cell-based therapy with or without booster of anti-VEGF/anti-PD-1.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Arm 1: DCs monotherapy DCs injection on day 1, 8, 15, 29, 85, 141, 197, 253 and 309. |
Biological: Dendritic Cell Vaccine
Approximately 1.5 x 10^6±20% cells will be subcutaneously injected to the patient's inguinal area (either left side or right side can be injected, only one area will be injected each time) on day 1, 8, 15, 29, 85, 141, 197, 253 and 309.
Other Names:
|
| Experimental: Arm 2: DCs with booster of anti-VEGF/anti-PD-1. DCs injection on day 1, 8, 15, 29, 85, 141, 197, 253 and 309 plus lenvatinib 10mg QD on day 43-77 and nivolumab 3mg/kg on day 43, 57 and 71. |
Biological: Dendritic Cell Vaccine
Approximately 1.5 x 10^6±20% cells will be subcutaneously injected to the patient's inguinal area (either left side or right side can be injected, only one area will be injected each time) on day 1, 8, 15, 29, 85, 141, 197, 253 and 309.
Other Names:
Drug: Lenvatinib
Lenvatinib 10mg/day on day 43-77
Other Names:
Drug: Nivolumab
Nivolumab 3mg/kg on day 43, 57 and 71.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Number of subjects experienced limiting toxicities in the first 6 weeks. [6 weeks]
The following toxicities that happened during first 6 weeks are considered LTs. Toxicities are graded using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0: >=Grade 3 non-hematological toxicity >=Grade 4 hematological toxicity Any death not clearly due to the underlying disease or extraneous causes. Any case meeting Hy's law Recurrent grade 2 pneumonitis
Secondary Outcome Measures
- Percentage of patients who had a clinical response [1 year]
Response was assessed by the iRECIST.
- Number of participants who did not progressed or survived at 1 year [1 year]
1 year progression-free survival and overall survival rate
- Number of subjects experienced any ≥ grade 3 toxicities. [1 year]
any ≥ grade 3 toxicities rate
Other Outcome Measures
- Number of subjects experienced immune response [1 year]
The production of IFN-γ that occurs subsequent to the dendritic cells-based therapy as determined by ELISPOT Assay or Flow Cytometry Analysis. Other immune response biomarker study including but not limited to whole exome sequencing, bulk RNA sequencing and single cell RNA sequencing.
Eligibility Criteria
Criteria
Inclusion Criteria:
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≥20 years of age
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Provide written informed consent
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Histologically confirmed stage IV pancreatic cancer, liver cancer, biliary tract cancer and colorectal cancer (excluding sarcoma and neuroendocrine tumor) that refractory or intolerance to standard therapies for their condition (there is no effective treatment by investigator judgement)
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Completed tumor and germline DNA and RNA sequencing and the neoantigen prediction
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Patients with chronic hepatitis B is eligible if receiving anti-hepatitis B agents and the HBV DNA level < 2000 IU/ml prior to the preparation phase. Patients with chronic hepatitis C are eligible if HCV RNA is undetectable (<15 IU/ml) prior to the preparation phase
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Adequate organ function
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Absolute neutrophil count >1000/mcL
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Hemoglobin > 8.0 g/dl
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Platelet > 50000/mcL
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PT/aPTT < 1.5 x upper limit of normal (ULN)
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AST/ALT < 3 x ULN
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Bil(T) < 1.5 x ULN
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BUN/Cr < 1.5 x ULN
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Adequate immune system as defined by
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IgG > 614 mg/dl
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IgM > 53mg/dl
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Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2
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Life expectancy at least>12weeks
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At least one measurable target lesion as defined by RECIST 1.1
Exclusion Criteria:
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Sarcoma、neuroendocrine tumor
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Last anticancer therapy administered within 2 weeks and any AEs should be ≤ grade 2 prior to leukapheresis
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Patients who cannot tolerate leukapheresis and follow-up blood sampling of 50ml at day 43, day 85 and end-of- treatment.
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Any known active infection as judged by the investigator
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Any known chronic active infection of HIV, HTLV-1 or HTLV-2
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Requirement of systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days prior to the screen phase. Inhaled or topical steroids and adrenal replacement doses > 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
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Other immunocompromising condition that in the opinion of the treating physician renders the patient a poor candidate for this trial
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Pregnant women, nursing women, men or women of childbearing potential who are unwilling to employ adequate contraception (condoms, diaphragm, birth control pills, injections, intrauterine device (IUD), abstinence, etc.)
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Patients with history of penicillin allergy
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Other medical problems or conditions that, in the opinion of the investigator, would make participation in the study hazardous for the patient
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Kaohsiung Medical University Hospital | Kaohsiung | Taiwan | ||
| 2 | National Cheng-Kung University Hospital | Tainan | Taiwan | ||
| 3 | National Institute of Cancer Research | Tainan | Taiwan |
Sponsors and Collaborators
- National Health Research Institutes, Taiwan
- National Cheng-Kung University Hospital
Investigators
- Principal Investigator: Li-Tzong Chen, MD, PhD, Kaohsiung Medical University Hospital, and Center for Cancer Research, Kaohsiung Medical University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- A-BR-108-087