A Pilot Study of Tumor Cell Vaccine for High-risk Solid Tumor Patients Following Stem Cell Transplantation

November 2, 2017 updated by: James Geiger, MD, University of Michigan Rogel Cancer Center

A Pilot Study of Tumor Lysate-pulsed Dendritic Cell Vaccine for Immune Augmentation for High-risk Solid Tumor Patients Following Autologous Stem Cell Transplantation

Localized solid tumors such as, sarcoma, neuroblastoma, and Wilms' tumor, can generally be effectively treated with a combination of surgery, radiation and chemotherapy. However, patients with metastatic or relapsed disease have a very poor prognosis.

New approaches to the management of these difficult groups of patients are needed. There is evidence to suggest that solid tumors may be good candidates for immunotherapy approaches. In fact, recent experimental evidence indicates that the period of lymphopenia that occurs after stem cell transplant may be an opportune time to use an immunotherapy treatment approach. In light of the very poor prognosis of young patients with advanced solid tumors, this treatment approach warrants further investigation.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Localized solid tumors such as, sarcoma, neuroblastoma, and Wilms' tumor, can generally be effectively treated with a combination of surgery, radiation and chemotherapy. However, patients with metastatic or relapsed disease have a very poor prognosis.

For the past decade, efforts to increase overall survival and progression-free survival for patients with high-risk pediatric and young adult tumors, have evaluated the use of high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT). The proportion of patients who enter a complete remission with HSCT is high, ranging from 81 to 90%. While autologous HSCT renders a large proportion of patients temporarily disease-free, relapse develops in the majority of patients.

Survival appears to have been most improved with this strategy for neuroblastoma, but relapses occur in the majority of patients. Similar strategies have also been tried for patients with advanced stage sarcoma and Wilms' tumor, but relapses are even more problematic.

New approaches to the management of these difficult groups of patients are needed. There is evidence to suggest that solid tumors may be good candidates for immunotherapy approaches. In fact, recent experimental evidence indicates that the period of lymphopenia that occurs after HSCT may be an opportune time to use this treatment approach. In light of the very poor prognosis of young patients with advanced solid tumors, this treatment approach warrants further investigation.

Study Type

Interventional

Enrollment (Actual)

16

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Michigan
      • Ann Arbor, Michigan, United States, 48170
        • University of Michigan, Department of Surgery, Pediatric Section

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

No older than 30 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Eligibility

Inclusion Criteria:

To participate in this study, it is necessary to collect sufficient tumor and peripheral blood stem cells to both develop the vaccine and perform the autologous stem cell transplant. Patients who also have previously had tumor or stem cells collected, which are available and sufficient for this study, are eligible to participate as study subjects.

  1. Patients must have a histologically verified diagnosis of neuroblastoma, Wilm's tumor, or sarcoma, including rhabdomyosarcoma, a Ewing's sarcoma family tumor (ES, PNET), synovial sarcoma, fibrosarcoma, or desmoplastic round cell tumor.

    and must meet one of the following criteria:

    1. have metastatic disease at diagnosis
    2. have never achieved complete remission following frontline standard therapy
    3. have relapsed after receiving standard therapy
  2. Patients must have been < 30 years of age at the time of original diagnosis.
  3. Patients must have a source of tumor tissue from which approximately 1 gram of viable tumor can be obtained for vaccine development.
  4. Patients must have a good performance status (>70% by Lansky or Karnofsky scales).
  5. Patients must have a life expectancy of at least 16 weeks.

  6. Females of child-bearing age (>= 12 years old) must have a negative pregnancy test.

    Patients may enroll on this study at various points in their treatment including diagnosis, recurrence, or just prior to initiation of study mandated transplant therapy. Because patients may enter this study prior to completion of retransplant treatments, the below criteria must be met only to proceed to the high dose chemotherapy and autologous stem cell transplant part of this study. These criteria are not a requirement to enter this study in order to collect tumor or peripheral blood stem cells.

  7. Patients must have achieved complete response or very good partial response(>= 90% decrease in tumor volume) before proceeding to transplant. For patients enrolling on this study just prior to transplant a VGPR or CR must be achieved to be eligible.
  8. Patients may have undergone prior autologous peripheral blood stem cell transplantation, provided at least 12 months have elapsed prior to entry on this study.
  9. Patients must have had a successful peripheral blood stem cell collection, with cryopreservation of PBSCs for both engraftment and for generation of dendritic cells.

  10. Adequate baseline organ function must be present:

    hematologic parameters (not applicable if bone marrow is involved with tumor):

    1. ANC > 500/mm3
    2. platelet count > 50,000/mm3
    3. serum creatinine < 1.5x upper limit of normal for age
    4. serum hepatic transaminases (AST, ALT) < 3x upper limit of normal
    5. serum bilirubin < 1.5x upper limit of normal
    6. cardiac echocardiogram with either SF > 27% or EF > 50%. A comparable EF on a MUGA scan will also meet eligibility criteria.
  11. Give or obtain informed consent

Exclusion Criteria:

  1. Patients who have received prior antitumor vaccines are ineligible
  2. Patients who meet the response criteria but progress prior to study enrollment are ineligible
  3. Patients with known autoimmune diseases or conditions are ineligible
  4. Patients with HIV infection, AIDS, hepatitis B surface antigen positivity, ongoing bleeding, or any significant uncontrolled medical or psychiatric illness are ineligible.
  5. Patients under treatment for infection must cleared by BMT physician prior to enrollment.
  6. Patients who are pregnant or nursing are ineligible
  7. Prior allogenic transplant

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: DC vaccine therapy
Tumor lysate-pulsed dendritic cell (DC) vaccine following HSCT
Biological: Tumor lysate-pulsed dendritic cell (DC) vaccine
Tumor lysate-pulsed dendritic cell vaccine
Other: Hematopoietic stem cell transplantation (HSCT)
Hematopoietic stem cell transplantation (HSCT)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
To estimate the rate of immune response of this immunotherapy treatment
Time Frame: 70 days
70 days

Secondary Outcome Measures

Outcome Measure
Time Frame
To correlate and characterize the immune response to the clinical response.
Time Frame: three years
three years
To define immunologic endpoints that can serve as surrogates of clinical response.
Time Frame: three years
three years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Michigan Rogel Cancer Center

Investigators

  • Principal Investigator: James D Geiger, M.D., University of Michigan, Department of Surgery, Pediatric Section

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

June 1, 2006

Primary Completion (Actual)

June 1, 2009

Study Completion (Actual)

June 1, 2010

Study Registration Dates

First Submitted

November 29, 2006

First Submitted That Met QC Criteria

November 29, 2006

First Posted (Estimate)

November 30, 2006

Study Record Updates

Last Update Posted (Actual)

November 6, 2017

Last Update Submitted That Met QC Criteria

November 2, 2017

Last Verified

November 1, 2017

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • UMCC 2005.050
  • GCRC ID # 2191
  • HUM00002650 (Other Identifier: University of Michigan Medical School)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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