Immunotherapy for Recurrent Ependymomas in Children Using Tumor Antigen Peptides With Imiquimod

Immunotherapy for Recurrent Ependymomas in Children Using Human Leukocyte Antigen (HLA)-A2 Restricted Tumor Antigen Peptides in Combination With Imiquimod

The purpose of this study is to see if vaccination with HLA-A2 restricted peptides, combined with the immunoadjuvant imiquimod is safe and can induce immune responses in children with recurrent ependymomas. Eligible patients are stratified by primary tumor location.

Study Overview

• Status: Terminated
• Conditions: Ependymoma
• Intervention / Treatment: Other: laboratory biomarker analysis; Other: immunohistochemistry staining method; Other: flow cytometry; Drug: Imiquimod; Other: enzyme-linked immunosorbent assay; Biological: HLA-A2 restricted synthetic tumor antigen

• Study Type: Interventional
• Enrollment (Actual): 23
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15224
      • Children's Hospital of Pittsburgh of UPMC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 year to 21 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria: All grades of ependymoma are eligible.

• Patients must have recurrent/progressive ependymoma that has progressed or recurred after initial adjuvant therapy.
• HLA-A2 positive based on flow cytometry performed at the University of Pittsburgh.
• Patients must have previously received standard initial therapy including attempted gross total resection, where safely feasible, and in appropriate circumstances (e.g., those older than one year at initial diagnosis, with non-metastatic tumors and at least microscopic residual disease), involved field fractionated radiation therapy (RT). Patients may have received re-irradiation but not to the index lesion within 4 weeks.
• Patients must be clinically stable and off or on low-dose (no more than 0.1 mg/kg/day, max 4 mg/day Dexamethasone) corticosteroid for at least one week prior to study registration.
• Patients must be ≥ 12 months and <22 years of age at the time of study registration.
• Patients must have a performance status of ≥ 70; (Karnofsky if > 16 years and Lansky if ≤ 16 years of age).
• Patients may have non-bulky, asymptomatic metastatic disease.
• Males and females must agree to use effective birth control methods during the course of vaccination (from the first vaccine to two weeks after the last vaccine).
• Patients must be free of systemic infection requiring IV antibiotics at the time of registration and off IV antibiotics for at least 7 days prior to registration.

• Patients must have adequate organ function as measured by:

  • Bone marrow: Absolute neutrophil count (ANC) > 1,000/µl; Platelets > 100,000/µl (transfusion independent); Absolute lymphocyte count (ALC) ≥ 500/µl; Hemoglobin >8 g/dl (may be transfused).
  • Hepatic: bilirubin ≤ 1.5x institutional normal for age; serum glutamate pyruvate transaminase (SGPT) < 3x institutional normal
  • Renal: Serum creatinine based on age or creatinine clearance or radioisotope glomerular filtration rate (GFR) > 70 ml/min/1.73 m²
• Patients must have recovered from the toxic effects of prior therapy and be at least 3 weeks from the last dose of standard cytotoxic chemotherapy or myelosuppressive biological therapy, at least one week from the last dose of non-myelosuppressive biological therapy and at least 4 weeks from the completion of radiation therapy.
• Patients must have no overt cardiac, gastrointestinal, pulmonary, or psychiatric disease.

Patients must be willing to travel to Pittsburgh to receive the vaccine. Visits: Every 3 weeks x 9, then every 6 weeks x 12 depending on response/side effects

Exclusion Criteria:

• Patients living outside of North America are not eligible.
• Patients must be off concurrent treatment or medications for at least 1 week including: Interferon (e.g. Intron-A®), allergy desensitization injections, growth factors (e.g. Procrit®, Aranesp®, Neulasta®), interleukins (e.g. Proleukin®), and any investigational therapeutic medication.
• Patients must not have a history of any immune system disorder or laboratory abnormality or any condition that could potentially alter immune function.
• Use of immunosuppressives within four weeks prior to study entry or anticipated use of immunosuppressive agents. Patients must be on no more than 0.1 mg/kg/day, max 4 mg/day dexamethasone for at least one week before study registration. Topical corticosteroids are acceptable.
• Patients with a known immune deficiency.
• Pregnancy or breastfeeding. Female patients who are post-menarchal must have a documented negative pregnancy test.
• Tetanus vaccine during therapy or within 1 week prior to enrollment.
• Patients who have received prior immunotherapy.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: HLA-A2 restricted tumor antigen vaccine; This is a single-arm study of a HLA-A2 restricted tumor antigen peptide vaccine, administered in conjunction with imiquimod	Other: laboratory biomarker analysis; Other: immunohistochemistry staining method; Other: flow cytometry; Drug: Imiquimod; Other: enzyme-linked immunosorbent assay; Biological: HLA-A2 restricted synthetic tumor antigen

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants with unacceptable toxicity	Grade 3 or 4 non-hematological toxicities.	2 years

Secondary Outcome Measures

Outcome Measure	Time Frame
Tumor-associated antigen-specific T-cell	2 years

Collaborators and Investigators

• Sponsor: James Felker
• Collaborators: National Cancer Institute (NCI); Solving Kids' Cancer
• Investigators: Principal Investigator: James Felker, MD, University of Pittsburgh

Study record dates

Study Major Dates

• Study Start: August 1, 2012
• Primary Completion (Actual): December 3, 2025
• Study Completion (Actual): December 3, 2025

Study Registration Dates

• First Submitted: February 12, 2013
• First Submitted That Met QC Criteria: February 18, 2013
• First Posted (Estimated): February 20, 2013

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: February 3, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms; Neoplasms by Histologic Type; Neoplasms, Glandular and Epithelial; Glioma; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Ependymoma; Heterocyclic Compounds; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Investigative Techniques; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Cytological Techniques; Chemistry Techniques, Analytical; Cell Separation; Quinolines; Histocytochemistry; Histological Techniques; Immunologic Techniques; Aminoquinolines; Photometry; Fluorometry; Luminescent Measurements; Cytophotometry; Molecular Probe Techniques; Immunoenzyme Techniques; Immunoassay; Immunosorbent Techniques; Imiquimod; Immunohistochemistry; Flow Cytometry; Enzyme-Linked Immunosorbent Assay
• Other Study ID Numbers: STUDY19100001; R01CA174858 (U.S. NIH Grant/Contract); PRO12050422 (Other Identifier: Former IRB protocol ID)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No