Vaccine Therapy for the Treatment of Newly Diagnosed Glioblastoma Multiforme (ATTAC-II)

ATTAC-II: A Phase II Randomized, Blinded, and Placebo-controlled Trial of CMV RNA-Pulsed Dendritic Cells With Tetanus-Diphtheria Toxoid Vaccine in Patients With Newly-Diagnosed Glioblastoma

The purpose of this research study is to determine if an investigational dendritic cell vaccine, called pp65 DC, is effective for the treatment of a specific type of brain tumor called glioblastoma (GBM) when given with stronger doses of routine chemotherapy.

Study Overview

• Status: Completed
• Conditions: Glioblastoma; Glioblastoma Multiforme; Malignant Glioma; GBM; Astrocytoma, Grade IV
• Intervention / Treatment: Drug: Saline; Biological: pp65-shLAMP DC with GM-CSF; Drug: Td; Biological: pp65-flLAMP DC with GM-CSF; Biological: unpulsed PBMC and saline

Detailed Description

Dendritic cells (DC) are involved in activating, or turning-on, your body's immune system. Your immune system helps guard your body from germs, viruses, and other threats. Although dendritic cells are very strong, the number of them in the body is not high enough to cause a powerful immune response; therefore, more DC are made in a laboratory with cells collected from an individual's blood.

In this study, we will make a vaccine that we hope will educate immune cells to target the pp65 antigen, a type of immune marker in GBM, thus resulting in what we call the pp65 DC vaccine. Use of a vaccine that activates your immune system is a type of immunotherapy. It is hoped that by giving the pp65 DC vaccine as a shot under the skin, the immune system will be activated to attack tumor cells in the brain while leaving normal cells alone.

To see if the pp65 DC vaccine is effective for the treatment of GBM, subjects will be assigned to different treatment groups. Two groups of subjects will receive the pp65 DC vaccine and one group will receive a placebo.

• Study Type: Interventional
• Enrollment (Actual): 175
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Florida
    • Gainesville, Florida, United States, 32610
      • University of Florida
    • Orlando, Florida, United States, 32806
      • Orlando Health
  • North Carolina
    • Durham, North Carolina, United States, 27710
      • Duke University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Abbreviated Inclusion Criteria:

To be assessed at study enrollment prior to standard of care chemo-radiation therapy:

• Age ≥ 18 years.
• Histopathologically proven newly-diagnosed de novo GBM (WHO Grade IV glioma)
• The tumor must have a supratentorial component.
• Must have undergone definitive surgical resection of tumor with less than approximately 3cm x 3cm residual enhancing tumor as product of longest perpendicular planes by MRI.
• Recovery from the effects of surgery, postoperative infection, and other complications.
• Diagnostic contrast-enhanced MRI or CT scan of the brain preoperatively and postoperatively.
• Karnofsky Performance Status of ≥ 70.
• Signed informed consent.
• For females of childbearing potential, negative serum pregnancy test.
• Women of childbearing potential and male participants must be willing to practice adequate contraception throughout the study and for at least 24 weeks after the last dose of study drug.

To be assessed prior to initiation of adjuvant TMZ:

• Must have completed RT (targeted total dose of 59.4-60.0 Gy over ≤ 7 weeks) and concomitant TMZ (targeted dose of 75mg/m2/d for ≤ 49 days) therapy without significant toxicity that persisted over 4 weeks.
• History & physical with neurologic examination prior to initiation of adjuvant TMZ.
• For patients receiving steroids, daily dose must be ≤ 4 mg.
• CBC with differential with adequate bone marrow function.
• Adequate renal function.
• Adequate hepatic function.

Abbreviated Exclusion Criteria:

To be verified in order to randomize subject:

• Prior invasive malignancy unless disease free for ≥ 3 years.
• Metastases detected below the tentorium or beyond the cranial vault and leptomeningeal involvement.
• Recurrent or multifocal malignant gliomas.
• HIV, Hepatitis B, or Hepatitis C seropositive.
• Known active infection or immunosuppressive disease.
• Prior chemotherapy or radiosensitizers (including Gliadel wafers) for cancers of the head and neck region.
• Prior radiotherapy to the head or neck, resulting in overlap of radiation fields.
• Severe, active co-morbidity.
• Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception for the entire study period.
• Pregnant or lactating women.
• Prior allergic reaction to temozolomide, GM-CSF or Td.
• Prior history of brachial neuritis or Guillain-Barré syndrome.
• Patients treated on any other therapeutic clinical protocols within 30 days prior to study entry.

To be assessed prior to initiation of adjuvant TMZ:

• Did not start radiation therapy and temozolomide within 7 weeks of surgery.
• Progression of disease as defined by modified RANO criteria.
• More than 45 days after completion of radiation therapy and temozolomide

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Arm 1: pp65-shLAMP DC with GM-CSF and Td; Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.	Biological: pp65-shLAMP DC with GM-CSF; Other Names: pp65-shLAMP mRNA DCs with GM-CSF; Drug: Td; All subjects will receive a Td booster before study drug dose #1. Subjects in the experimental arms will receive Td skin prep before study drug doses #3, #6, and #9.; Other Names: Tetanus and Diphtheria Toxoid
Experimental: Arm 2: pp65-flLAMP DC with GM-CSF and Td; Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.	Drug: Td; All subjects will receive a Td booster before study drug dose #1. Subjects in the experimental arms will receive Td skin prep before study drug doses #3, #6, and #9.; Other Names: Tetanus and Diphtheria Toxoid; Biological: pp65-flLAMP DC with GM-CSF; Other Names: pp65-flLAMP mRNA DCs with GM-CSF
Placebo Comparator: Arm 3: unpulsed PBMC and Saline; Given under the skin at day 22-24 after the first temozolomide cycle then at 2 week intervals. Doses 4-10 will be given on day 22-24 of each temozolomide cycle. Doses will continue until a total of 10 or until progression or unacceptable toxicity.	Drug: Saline; Other Names: Normal Saline; Biological: unpulsed PBMC and saline; Other Names: Peripheral Blood Mononuclear Cells

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparison of Overall Survival (OS) Between the Active Treatment Group (Arms 1 and 2) and the Control Group (Arm 3)	Kaplan-Meier survival curves and the log rank test will be used to characterize and compare OS in patients who received pp65-LAMP mRNA DC vaccine (Arms 1 and 2) and in control patients (Arm 3). OS will be defined as the time between first vaccination and death and will be censored at the last follow-up if death has not occurred.	From date of first vaccine until the date of death, up to 48 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Comparison of Progression-free Survival Between the Active Treatment Group (Arms 1 and 2 Combined) and the Control Group (Arm 3)	Calculated as dated of first vaccine to date first progression/recurrence or death. Kaplan-Meier survival curves and the log rank test will be used to characterize and compare PFS in patients who received pp65-LAMP mRNA DC vaccine (Arms 1 and 2) and in control patients (Arm 3). PFS is defined as the time between first vaccination and first documentation of either disease progression/recurrence, or death without prior progression/recurrence.	From date of first vaccine until time disease progression or death without prior progression/recurrence, up to 48 months
ELISPOT Assay (pp65)	Within patient changes from baseline to vaccine 3.	baseline, post-vaccine #3
Flow Cytometric Analysis (T Cell)	Percentage of circulating cellular subsets of T cells within PBMCs.	baseline, post-vaccine #3
Cytokine Array Analysis (IFN-g)	Change in concentration (pg/mL) of IFN-g as measured by multiplex array from Baseline (V1) to post-Vaccine #3.	baseline, post-vaccine #3
ELISPOT Assay (Actin)	Within patient changes from baseline to vaccine 3.	baseline, post-vaccine #3
Flow Cytometric Analysis (NK Cell)	Percentage of circulating cellular subsets of NK cells within PBMCs.	baseline, post-vaccine #3
Flow Cytometric Analysis (CD4.CD25 T Reg)	Percentage of circulating cellular subsets of CD4.CD25 T Reg within PBMCs.	baseline, post-vaccine #3

Collaborators and Investigators

• Sponsor: University of Florida
• Collaborators: National Cancer Institute (NCI)
• Investigators: Study Chair: Duane Mitchell, MD, PhD, University of Florida; Principal Investigator: Maryam Rahman, MD, University of Florida

Study record dates

Study Major Dates

• Study Start (Actual): August 9, 2016
• Primary Completion (Actual): November 30, 2023
• Study Completion (Actual): November 30, 2023

Study Registration Dates

• First Submitted: May 27, 2015
• First Submitted That Met QC Criteria: June 3, 2015
• First Posted (Estimated): June 8, 2015

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: December 19, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms; Neoplasms by Histologic Type; Neoplasms, Glandular and Epithelial; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Glioblastoma; Glioma; Astrocytoma; Antineoplastic Agents; Immunologic Factors; Physiological Effects of Drugs; Sargramostim; Molgramostim
• Other Study ID Numbers: IRB201400697-N; R01CA175517 (U.S. NIH Grant/Contract); OCR14127 (Other Identifier: Universiy of Florida)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No