Ovarian Cancer Vaccine for Patients in Remission
A Randomized, Open-label Phase IIb Trial of Maintenance Therapy With a MUC1 Dendritic Cell Vaccine (Cvac™) for Epithelial Ovarian Cancer Patients in First or Second Remission
The purpose of this study is to determine the safety and efficacy of an investigational therapeutic agent (Cvac) in ovarian cancer patients in first or second remission and to determine its ability to prevent cancer from returning.
Study objectives
Primary objectives:
- To confirm the safety of administering Cvac in this population.
- To determine the effects of Cvac on progression-free survival (PFS).
Secondary objectives:
- To determine overall survival (OS) for ovarian cancer patients who receive Cvac after achieving remission in the first or second-line setting.
- Evaluation of host immunologic response to Cvac administration.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Locations
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Queensland
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Greenslopes, Queensland, Australia, 4120
- Greenslopes Private Hospital
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Southport, Queensland, Australia, 4215
- Gold Coast Hospital
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South Australia
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Adelaide, South Australia, Australia, 5000
- Royal Adelaide Hospital
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Victoria
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East Melbourne, Victoria, Australia, 3002
- Peter MacCallum Cancer Cetnre
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Heidelberg, Victoria, Australia, 3084
- Austin Health Cancer Centre
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California
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Greenbrae, California, United States, 94904
- Marin Cancer Care, Inc.
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La Jolla, California, United States, 92037
- Scripps Cancer Center
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Palo Alto, California, United States, 94305
- Stanford University School of Medicine
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San Francisco, California, United States, 94115
- University of California, San Francisco
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Florida
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Boca Raton, Florida, United States, 33487
- Collaborative Research Group
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Georgia
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Atlanta, Georgia, United States, 30342
- Northside Hospital
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Indiana
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Indianapolis, Indiana, United States, 46202
- Indiana University Simon Cancer Center
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New Jersey
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Morristown, New Jersey, United States, 07962
- Morristown Medical Center
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New York
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New York, New York, United States, 10038
- New York Downtown Hospital
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North Carolina
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Durham, North Carolina, United States, 27710
- Duke University Medical Center
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Ohio
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Cleveland, Ohio, United States, 44195
- Cleveland Clinic Foundation
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South Carolina
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Charleston, South Carolina, United States, 29425
- Medical University of South Carolina
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Washington
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Seattle, Washington, United States, 98109
- University of Washington Medical Center
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Female subjects ≥ 18 years old with histologically confirmed Stage III or IV epithelial ovarian, primary peritoneal or fallopian tube cancer who have previously undergone surgical cytoreduction and received first or second line conventional chemotherapy and are currently in complete remission (based on clinical and radiologic studies).
- Cancer antigen (CA)-125 ≤ upper limit of normal with a prior history of an elevated CA-125.
- Able and willing to undergo mononuclear cell collection.
- Not more than 12 weeks between enrollment and the last dose of chemotherapy that resulted in complete remission.
- No prior surgery to the peritoneum or pleural space within 28 days of enrollment, excluding removal of catheters used for chemotherapy administration.
- No prior treatment with an investigational product within 30 days of enrollment.
- Baseline electrocardiogram within normal limits or any abnormalities deemed not indicative of cardiac disease for which intervention is required.
- Serum creatinine ≤ 2 mg/dL.
- Serum aspartate aminotransferase or serum alanine aminotransferase ≤ 2.5x the upper limit of normal or serum total bilirubin ≤ 1.5x the upper limit of normal.
- White blood cell count ≥ 3.0 K/µL; absolute neutrophil count ≥ 1.5K/µL; hemoglobin ≥ 9.0 g/dL, and platelets ≥ 100,000/mm^3. (These complete blood count results are required for enrollment. It should be noted that complete blood count results, including monocyte count ≥ 0.2 × 10^9/L, will be needed prior to leukapheresis to determine if sufficient dendritic cells can be obtained for Cvac™ manufacture.)
- Life expectancy of at least 12 months.
- Eastern Cooperative Oncology Group Performance Status of 0-1.
- All toxicities from prior therapies, excluding alopecia, must have resolved to Common Terminology Criteria for Adverse Events Grade ≤ 1.
- Must be non-pregnant and, if of childbearing potential, must use adequate birth control (hormonal or barrier method of birth control or abstinence) for the duration of the study and for 3 months after study completion.
- Able to provide written informed consent.
Exclusion Criteria:
- Coexisting or other malignancies unless in complete remission for not less than 3 years. Does not include in situ carcinoma of the cervix or basal cell or squamous cell carcinoma of the skin for which no restrictions apply, assuming they have been adequately treated.
- Ovarian germ cell, sarcoma, or mixed Mullerian tumors.
- Prior cancer vaccine or cellular therapy.
- Active uncontrolled infections or any organ system toxicity ≥ Grade 2 by Common Terminology Criteria for Adverse Events criteria.
- Inability to provide informed consent or to comply with study-related procedures.
- Concurrent systemic treatment with steroids or other immunosuppressive agents.
- Diagnosed immunodeficiency and/or autoimmune disorders.
- Myocardial infarction in the past 6 months and/or clinically significant heart disease.
- Infection with human immunodeficient virus (HIV), hepatitis B or C virus.
- Pregnant or breastfeeding.
- Evidence or history of central nervous system metastases.
- Full dose anticoagulation therapy administered within 7 days of leukapheresis procedure.
- Hematopoietic growth factors administered within 14 days of enrollment.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: Non-randomized Cvac
Participants received 6-8 intradermal injections of Cvac at 4 sites along both upper arms and both thighs.
The 6-8 injections contained ~ 60 × 10^6 dendritic cells.
Following evaluation after the first dose, participants received additional injections as described for the randomized Cvac group below.
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Cvac consists of autologous dendritic cells (DCs) incubated with the antigen, mannosylated fusion protein (M-FP), to target the DCs to the specific mucin 1 antigen.
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Experimental: Randomized Cvac
Participants received 6-8 intradermal injections of Cvac at 4 sites along both upper arms and both thighs every 4 weeks for 24 weeks (7 doses at Weeks 8, 12, 16, 20, 24, 28, and 32), and then every 8 weeks for 24 weeks (3 doses at Weeks 40, 48, and 56).
The 6-8 injections contained ~ 60 × 10^6 dendritic cells.
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Cvac consists of autologous dendritic cells (DCs) incubated with the antigen, mannosylated fusion protein (M-FP), to target the DCs to the specific mucin 1 antigen.
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No Intervention: Observational standard of care
Participants in this group did not receive any treatment during the study.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Progression-free Survival
Time Frame: Baseline to 48 weeks after the last visit or dose of Cvac (up to 104 weeks)
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Progression-free survival was defined as the time from randomization to the date of documented disease progression or death from any cause, whichever occurred earlier.
Disease progression occurred when a patient met either the Gynecologic Cancer Intergroup (GCIG) cancer-antigen (CA)-125 definition or the Response Evaluation Criteria in Solid Tumors (RECIST) radiological definition of progressive disease.
The GCIG CA-125 definition of disease progression was defined as a CA-125 level ≥ 2 × the upper limit of normal documented on 2 occasions at least 1 week apart.
The radiological RECIST criteria of disease progression was defined as the appearance of new lesions or an overall increase ≥ 20% or at least 5 mm in existing tumors.
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Baseline to 48 weeks after the last visit or dose of Cvac (up to 104 weeks)
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Overall Survival
Time Frame: Baseline to the end of the study (up to 4 years 10 months)
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Overall survival was defined as the time from randomization until death from any cause.
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Baseline to the end of the study (up to 4 years 10 months)
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Change From Baseline in Mucin 1 Antibody Levels at Weeks 20, 56, and 104
Time Frame: Baseline to Week 104
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Mucin 1 antibodies were assessed in serum samples using a quantitative enzyme-linked immunosorbent assay (ELISA).
Detection was achieved with electrochemiluminescence.
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Baseline to Week 104
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Change From Baseline in ICS of IL2, IL4, IL17, TNF, and IFNg in CD4+ and CD8+ Cells at Weeks 20, 56, and 104
Time Frame: Baseline to Week 104
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Intracellular cytokine staining (ICS) for IL2, IL4, IL17, tumor necrosis factor (TNF), and interferon gamma (IFNg) was done in both CD4+ and CD8+ cells from serum samples collected at Weeks, 20, 56, and 104.
Intracellular cytokine staining data were acquired with 8-color flow cytometry on a BD LSR II flow cytometer and a high-throughput screening microplate reader.
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Baseline to Week 104
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Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Heidi Gray, MD, University of Washington
- Principal Investigator: Mark Moradi, MD, New York Presbyterian Hospital
- Principal Investigator: Jonathan Berek, MD, MMS, Stanford University
- Principal Investigator: Nana Tchabo, MD, Morristown Medical Center
- Principal Investigator: Jennifer Young, MD, Medical University of South Carolina
- Principal Investigator: Benedict Benigno, MD, Northside Hospital
- Principal Investigator: John Chan, MD, University of California, San Francisco
- Principal Investigator: Paul Mitchell, MB ChB, Austin Health Cancer Care
- Principal Investigator: Linda Mileshkin, MBBS, Peter MacCallum Cancer Centre, Australia
- Principal Investigator: Margaret Davy, MBBS, CGO, Royal Adelaide Hospital
- Principal Investigator: Jeffrey Goh, MBBS, FRACP, Greenslopes Private Hospital
- Principal Investigator: Marco Matos, FRACP, Gold Coast Hospital
Publications and helpful links
General Publications
- Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ. Cancer statistics, 2008. CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96. doi: 10.3322/CA.2007.0010. Epub 2008 Feb 20.
- Grossi M, Quinn MA, Thursfield VJ, Francis PA, Rome RM, Planner RS, Giles GG. Ovarian cancer: patterns of care in Victoria during 1993-1995. Med J Aust. 2002 Jul 1;177(1):11-6. doi: 10.5694/j.1326-5377.2002.tb04616.x.
- Ozols RF, Rubin SC, Thomas G, et al. Epithelial ovarian cancer. In: Hoskins WJ, Perez CA, Young RC, eds. Principles and Practice of Gynecologic Oncology, 4th ed. Philadelphia: Lippincott Williams & Wilkins. 2005:919-922.
- Markman M, Liu PY, Wilczynski S, Monk B, Copeland LJ, Alvarez RD, Jiang C, Alberts D; Southwest Oncology Group; Gynecologic Oncology Group. Phase III randomized trial of 12 versus 3 months of maintenance paclitaxel in patients with advanced ovarian cancer after complete response to platinum and paclitaxel-based chemotherapy: a Southwest Oncology Group and Gynecologic Oncology Group trial. J Clin Oncol. 2003 Jul 1;21(13):2460-5. doi: 10.1200/JCO.2003.07.013.
- Apostolopoulos V, McKenzie IF. Cellular mucins: targets for immunotherapy. Crit Rev Immunol. 1994;14(3-4):293-309. doi: 10.1615/critrevimmunol.v14.i3-4.40.
- Desai J, Mitchell P, Loveland B, et al. A phase I trial of dendritic cells pulsed with MUC1 peptide in patients with solid tumours. Proc ASCO 2002; 21:15b (A1868).
- Rustin GJ, Nelstrop AE, Bentzen SM, Bond SJ, McClean P. Selection of active drugs for ovarian cancer based on CA-125 and standard response rates in phase II trials. J Clin Oncol. 2000 Apr;18(8):1733-9. doi: 10.1200/JCO.2000.18.8.1733.
- Apostolopoulos V, McKenzie IF, Pietersz GA. Breast cancer immunotherapy: current status and future prospects. Immunol Cell Biol. 1996 Oct;74(5):457-64. doi: 10.1038/icb.1996.76.
- Apostolopoulos V, Karanikas V, Haurum JS, McKenzie IF. Induction of HLA-A2-restricted CTLs to the mucin 1 human breast cancer antigen. J Immunol. 1997 Dec 1;159(11):5211-8.
- Meyer T, Rustin GJ. Role of tumour markers in monitoring epithelial ovarian cancer. Br J Cancer. 2000 May;82(9):1535-8. doi: 10.1054/bjoc.2000.1174.
- Liu PY, Alberts DS, Monk BJ, Brady M, Moon J, Markman M. An early signal of CA-125 progression for ovarian cancer patients receiving maintenance treatment after complete clinical response to primary therapy. J Clin Oncol. 2007 Aug 20;25(24):3615-20. doi: 10.1200/JCO.2006.09.4540.
- Clinical Study Report: A Phase II Trial of Cellular Immunotherapy with M-FP Cancer Vaccine in Subjects with Epithelial Ovarian Cancer, 2007 (with permission from Martin Rogers of Prima Biomed).
- Immunotherapy for Prostate AdenoCarcinoma Treatment (IMPACT) Phase 3 study summary of sipuleucel-T in castrate-resistant prostate cancer: http://www.bio-medicine.org/medicine-technology-1/
- Austin Research Institute. SOP #811609. Leukapheresis for ex vivo Culture or Human Dendritic Cells for Immunotherapy. V004, 9 January 2004.
- Austin Research Institute. SOP #8116 Stages 3-4. Procedures for the ex vivo Generation of MF-P Vaccine Pulsed SC, Phase I Clinical Trial. V006, 10 June 2003.
- Gray HJ, Benigno B, Berek J, Chang J, Mason J, Mileshkin L, Mitchell P, Moradi M, Recio FO, Michener CM, Secord AA, Tchabo NE, Chan JK, Young J, Kohrt H, Gargosky SE, Goh JC. Progression-free and overall survival in ovarian cancer patients treated with CVac, a mucin 1 dendritic cell therapy in a randomized phase 2 trial. J Immunother Cancer. 2016 Jun 21;4:34. doi: 10.1186/s40425-016-0137-x. eCollection 2016.
Study record dates
Study Major Dates
Study Start
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimate)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Urogenital Neoplasms
- Neoplasms by Site
- Carcinoma
- Neoplasms, Glandular and Epithelial
- Genital Neoplasms, Female
- Endocrine System Diseases
- Ovarian Diseases
- Adnexal Diseases
- Gonadal Disorders
- Endocrine Gland Neoplasms
- Ovarian Neoplasms
- Carcinoma, Ovarian Epithelial
Other Study ID Numbers
Other Study ID Numbers
- CAN-003
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