Vaccine Therapy Combined With Adjuvant Chemoradiotherapy in Treating Patients With Resected Stage I or Stage II Adenocarcinoma (Cancer) of the Pancreas

A Safety and Efficacy Trial of Lethally Irradiated Allogeneic Pancreatic Tumor Cells Transfected With the GM-CSF Gene in Combination With Adjuvant Chemoradiotherapy for the Treatment of Adenocarcinoma of the Pancreas

RATIONALE: Vaccines made from gene-modified pancreatic cancer cells may make the body build an immune response to kill tumor cells. Drugs used in chemotherapy, such as fluorouracil, work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Giving vaccine therapy together with chemotherapy and radiation therapy after surgery may kill any remaining tumor cells.

PURPOSE: This phase II trial is studying how well giving vaccine therapy together with adjuvant chemoradiotherapy works in treating patients with resected stage I or stage II adenocarcinoma (cancer) of the pancreas.

Study Overview

• Status: Completed
• Conditions: Pancreatic Cancer
• Intervention / Treatment: Biological: GVAX pancreatic cancer vaccine

Detailed Description

OBJECTIVES:

Primary

• Determine overall and disease-free survival of patients with resected stage I or II adenocarcinoma of the pancreas treated with adjuvant chemoradiotherapy in combination with GVAX pancreatic cancer vaccine.

Secondary

• Correlate specific in vivo parameters of immune response (post-vaccination delayed-type hypersensitivity reactions to autologous tumor, mesothelin-specific T-cell response, and the degree of local eosinophil, macrophage, and T-cell infiltration at the vaccine site) with clinical responses in patients treated with this regimen.
• Determine the toxic effects associated with intradermal injections of this vaccine in these patients.

OUTLINE: This is an open-label study.

• Post surgery vaccination: Within 8-10 weeks after pancreaticoduodenectomy, patients receive GVAX pancreatic cancer vaccine intradermally (ID) on day 0.
• Adjuvant chemoradiotherapy: Within 16-28 days after the first vaccination, patients receive fluorouracil (5-FU) IV continuously for 3 weeks. Approximately 1-2 weeks after completion of 5-FU, patients receive chemoradiotherapy comprising radiotherapy daily and 5-FU IV continuously for 26-28 weeks. Approximately 3-5 weeks after completion of chemoradiotherapy, patients receive 5-FU IV continuously for 4 weeks. 5-FU repeats every 6 weeks for 2 courses.
• Post chemoradiotherapy vaccination: Within 4-8 weeks after the completion of chemoradiotherapy, patients receive GVAX pancreatic cancer vaccine ID on days 0, 28, 56, and 196.

Treatment continues in the absence of unacceptable toxicity.

Patients are followed every 3 months for 1 year and then every 6 months thereafter.

PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21231
      • Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Histologically confirmed invasive ductal adenocarcinoma of the head, neck, and uncinate process of the pancreas

  • Mixed adenocarcinoma tumors allowed if the predominant invasive component of the tumor is adenocarcinoma
  • Stage I or II (clinical stage T1-3, N0-1, M0) disease

• Has undergone pancreaticoduodenectomy at the Johns Hopkins Hospital within the past 8-10 weeks

  • Completely resected (R0) or microscopic residual (R1) disease

• No diagnosis other than ductal adenocarcinoma, including any of the following:

  • Adenosquamous
  • Squamous cell
  • Colloid
  • Islet cell
  • Non-invasive intraductal papillary mucinous neoplasms
  • Serous or mucinous cystadenoma or cystadenocarcinoma
  • Carcinoid
  • Small or large cell carcinoma
  • Intraductal oncocytic papillary neoplasms
  • Osteoclast-like giant cell tumors
  • Acinar cell carcinoma
  • Pancreatoblastoma
  • Solid pseudopapillary tumors
  • Undifferentiated small cell carcinoma
  • Non-epithelial tumors (sarcoma, gastrointestinal stromal tumor, or lymphoma)
  • Adenocarcinoma of the ampulla
  • Adenocarcinoma of the distal bile duct
  • Adenocarcinoma of the duodenum
• No recurrent disease
• No metastatic disease, including peritoneal implants or liver and/or lung involvement

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-1

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count >/= 1,500/mm^3
• Platelet count >/= 100,000/mm^3
• Hemoglobin >/= 10 g/dL

Hepatic

• Bilirubin </= 2 mg/dL
• AST/ALT </= 2 times upper limit of normal (ULN)
• Alkaline phosphatase </= 5 times ULN

Renal

• Creatinine </= 2 mg/dL

Pulmonary

• No asthma or chronic obstructive pulmonary disease requiring systemic corticosteroids

Immunologic

• HIV negative
• No active infection

• No prior or concurrent autoimmune disease requiring treatment with systemic immunosuppressants, including any of the following:

  • Inflammatory bowel disease
  • Systemic vasculitis
  • Scleroderma
  • Psoriasis
  • Multiple sclerosis
  • Hemolytic anemia or immune thrombocytopenia
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Sjogren's syndrome
  • Sarcoidosis
• Negative results to viral delayed-type hypersensitivity serology testing if autologous tumor cells are available

Other

• No postoperative complications (e.g., inability to take oral nutrition >/= 1,500 calories/day, ongoing requirement for long-term biliary stenting, or persistence of wound infection)
• No other malignancy within the past 5 years except nonmelanoma skin cancer
• No uncontrolled medical conditions that would preclude study participation
• No other major active medical or psychosocial problem that could be exacerbated by study treatment
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for at least 4 weeks after study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy

• More than 1 month since prior biologic therapy
• No other concurrent biologic therapy, immunotherapy, or gene therapy for pancreatic cancer

Chemotherapy

• More than 1 month since prior chemotherapy
• No other concurrent chemotherapy for pancreatic cancer

Endocrine therapy

• More than 28 days since prior systemic steroids
• No concurrent systemic corticosteroids

Radiotherapy

• More than 1 month since prior radiotherapy
• No other concurrent radiotherapy for pancreatic cancer

Surgery

• See Disease Characteristics
• Recovered from prior surgery

Other

• More than 1 month since prior participation in an investigational new drug trial
• No other concurrent investigational therapy for pancreatic cancer

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: GVAX pancreatic cancer vaccine; 5E8 vaccine cells. The first vaccination is administered 6-8 weeks after surgery. Four to eight weeks following the completion of the last cycle of adjuvant radiation and chemotherapy (chemo-radiation therapy is standard of care and not part of the protocol) eligible patients will receive three additional vaccinations at one month intervals. Patients who continue to remain disease-free will receive a fifth "booster" vaccination, six months following the fourth vaccination

Biological: GVAX pancreatic cancer vaccine; Patients will receive vaccinations consisting of 5E8 vaccine cells. The first vaccination is administered 6-8 weeks after surgery. Four to eight weeks following the completion of the last cycle of adjuvant radiation and chemotherapy (chemo-radiation therapy is standard of care and not part of the protocol) eligible patients will receive three additional vaccinations at one month intervals. Patients who continue to remain disease-free will receive a fifth "booster" vaccination, six months following the fourth vaccination.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Survival	Overall survival in patients treated with adjuvant chemoradiotherapy in sequence with the irradiated allogeneic GM-CSF transfected pancreatic tumor cell lines. Overall survival is defined as time from surgery until death, regardless of cause.	Participants were followed for the duration of the study, an average of 2 years
Disease-free Survival	Disease-free Survival in Patients Treated With Adjuvant Chemoradiotherapy in Sequence With the Irradiated Allogeneic GM-CSF Transfected Pancreatic Tumor Cell Lines. DFS is defined as time from surgery until clinical evidence of disease (eg, CT scan) or death due to any cause.	Participants were followed for the duration of the study, an average of 2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
To Further Identify and Characterize Toxicities Associated With Intradermal Injections of the Vaccine That Were Initially Reported in the Phase 1 Trial.		4 years
Estimate the Association of Specific in Vivo Parameters of Immune Response With Clinical Responses in Patients Treated With Combination Chemoradiotherapy Together With the Irradiated Allogeneic GM-CSF Transfected Pancreatic Tumor Cell Lines.	The specific immune parameters include: post-vaccination delayed type hypersensitivity reactions to autologous tumor and the degree of local eosinophil, macrophage, and T cell infiltration at the vaccine site, and mesothelin-specific T cell responses.	Continuous

Collaborators and Investigators

• Sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
• Collaborators: National Cancer Institute (NCI)

Publications and helpful links

General Publications

• Lutz E, Yeo CJ, Lillemoe KD, Biedrzycki B, Kobrin B, Herman J, Sugar E, Piantadosi S, Cameron JL, Solt S, Onners B, Tartakovsky I, Choi M, Sharma R, Illei PB, Hruban RH, Abrams RA, Le D, Jaffee E, Laheru D. A lethally irradiated allogeneic granulocyte-macrophage colony stimulating factor-secreting tumor vaccine for pancreatic adenocarcinoma. A Phase II trial of safety, efficacy, and immune activation. Ann Surg. 2011 Feb;253(2):328-35. doi: 10.1097/SLA.0b013e3181fd271c.

Study record dates

Study Major Dates

• Study Start: January 1, 2002
• Primary Completion (ACTUAL): December 1, 2005
• Study Completion (ACTUAL): July 1, 2006

Study Registration Dates

• First Submitted: June 10, 2004
• First Submitted That Met QC Criteria: June 10, 2004
• First Posted (ESTIMATE): June 11, 2004

Study Record Updates

• Last Update Posted (ESTIMATE): July 22, 2013
• Last Update Submitted That Met QC Criteria: July 17, 2013
• Last Verified: July 1, 2013

More Information

Terms related to this study

• Keywords: duct cell adenocarcinoma of the pancreas; stage I pancreatic cancer; stage II pancreatic cancer
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Endocrine System Diseases; Digestive System Neoplasms; Endocrine Gland Neoplasms; Pancreatic Diseases; Adenocarcinoma; Pancreatic Neoplasms
• Other Study ID Numbers: J9988; P30CA006973 (U.S. NIH Grant/Contract); R01CA088058 (NIH); JHOC-J9988