- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT07417488
GUCY2C Prime-Boost Vaccination for Advanced Colorectal and Small Bowel Adenocarcinomas
A Phase I, Single-Center, Dose Escalation Trial of Heterologous Prime-Boost Vaccination With Ad5.F35-hGUCY2C-PADRE and Lm-GUCY2C Vaccines in Adults With Advanced Colorectal and Small Bowel Adenocarcinomas
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This phase 1 study is an open-label study of heterologous prime-boost vaccination with Ad5.F35-hGUCY2C-PADRE and recombinant listeria monocytogenes (Lm-GUCY2C) vaccines in patients with advanced solid tumors including colorectal cancer and small bowel adenocarcinomas who have progressed on available standard therapies.. Subjects will receive Ad5.F35-hGUCY2C-PADRE intramuscularly (IM) followed by two administrations of the Lm-GUCY2C vaccine intravenously (IV) as described and will be followed primarily to evaluate safety endpoints for the duration of the study (through eight weeks after the first administration of Lm-GUCY2C). The main objective of this Phase I trial is to determine the MTD and the RPTD of this prime-boost vaccination regimen.
Subjects will be enrolled by Bayesian optimal interval (BOIN) design in dose-escalation cohorts of three. The first cohort will receive Lm-GUCY2C at a dose of 3 x 10⁸ CFU, and this dose will be escalated to subsequent levels (1 x 10⁹, 3 x 10⁹ CFU) with each cohort according to the BOIN model until the maximum dose, barring excessive rates of dose-limiting toxicities. One dose level will be reserved for de-escalation if necessary (1 x 10⁸ CFU).
Subjects will receive treatment over a 12-week period including the Ad5.F35-hGUCY2C-PADRE vaccine, with evaluation of DLTs over 4 weeks following the first Lm-GUCY2C vaccine and clinical and laboratory monitoring after the second Lm-GUCY2C vaccine. Only the necessary safety evaluations will be conducted after Ad5.F35-hGUCY2C-PADRE vaccination.
Subjects will be actively followed (clinical and laboratory evaluations) for 12 weeks following first vaccination with Ad5.F35-hGUCY2C-PADRE. Then, they will be followed every 3 months for Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. evaluation until all subjects have had disease progression or have started new anti-cancer therapies or death.
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Babar Bashir, M.D., M.S.
- Phone Number: 215-503-5097
- Email: Babar.Bashir@jefferson.edu
Study Locations
-
-
Pennsylvania
-
Philadelphia, Pennsylvania, United States, 19107
- Recruiting
- Sidney Kimmel Cancer Center at Thomas Jefferson University
-
Contact:
- Babar Bashir, MD
- Phone Number: 2159558874
- Email: babar.bashir@jefferson.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Individuals must meet all of the following inclusion criteria in order to be eligible to participate in the study:
- Males or females aged ≥ 18 years
- Have Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Histologically or cytologically diagnosed, locally advanced or metastatic adenocarcinomas of colorectum or small bowel that have progressed after standard of care therapy or for which no standard therapy exists. Patients for whom standard therapies are intolerable or considered clinically inappropriate by the Investigator are eligible. If a patient refused available standard therapy or Investigator determined standard therapy was inappropriate, the reason for refusal or Investigator determination should be documented.
- Patients with MSS CRC or small bowel adenocarcinoma must have received at least 1) a fluoropyrimidine, 2) oxaliplatin or irinotecan, and 3) a VEGF/VEGF receptor inhibitor unless deemed clinically inappropriate, refused by the patient, or not considered standard practice per institutional standards.
- Patients with MSI-H and/or dMMR CRC or small bowel adenocarcinoma must have received a programmed death-1 or programmed death-ligand 1 (PD-L1) inhibitor unless deemed clinically inappropriate, refused by the patient, or not considered standard practice.
- Have an anticipated life expectancy of greater than 12 weeks
- Have at least 1 extracranial measurable tumor lesion according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. Exceptions may be made to this inclusion if a patient has biochemical evidence (ctDNA) of disease upon discussion with principal investigator provided other eligilbity criteria are fulfilled.
- Adequate venous access by peripheral vein evaluation
Have adequate hematologic function at screening, as evidenced by:
- ANC ≥ 1500 cells/mL; no growth factor support within 14 days prior to Screening assessment
- Platelets ≥ 75,000 /mL; no transfusion within 14 days prior to Screening assessment
- Hemoglobin ≥ 9.0 g/dL; no transfusion or erythyropoietin support within 14 days prior to Screening assessment.
Patients must have adequate hepatic function, as evidenced by:
- Albumin ≥ 3.0 mg/dL; no albumin support within 14 days prior to Screening assessment,
- Total bilirubin ≤ 2.0 x upper limit of normal (ULN), except in patients with congenital bilirubinemia, such as Gilbert syndrome (in which case direct bilirubin ≤ 1.5 x ULN is required)
- Aspartate aminotransferase (AST) AND alanine aminotransferase ≤ 2.5 x ULN or ≤ 5 x ULN in the presence of liver metastases.
- Serum creatinine < 2.0 mg/dL
- For other blood and urine tests including blood chemistry, hepatic and renal functions, test results should not be worse than grade 1 levels of abnormalities defined by CTCAE, NCI version 5 (CTCAEv5) issued by the US Department of Health and Human Services.
- For women and men of childbearing potential, a medically acceptable method of highly effective contraception (oral hormonal contraceptive, condom plus spermicide, or hormonal implants) or abstinence must be used throughout the study period and for 28 days after their final vaccine administration. (A barrier method of contraception must be employed by all subjects [male and female], regardless of other methods unless abstinent.) A negative serum or urine pregnancy test is required as part of screening. Subjects capable of becoming pregnant include any female who has experienced menarche and has not undergone surgical sterilization (hysterectomy or bilateral oophorectomy) and who are not postmenopausal. Also, subjects assigned female sex at birth who are physiologically still able to become pregnant by similar definitions detailed here. Menopause is defined clinically as 12 months of amenorrhea in a woman over 45 in the absence of other biological or physiological causes. In addition, women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level less than 40 mIU/ml.
- Be willing to comply with all the study procedures. All subjects must be able to comprehend and sign a written informed consent document
Exclusion Criteria:
An individual who meets any of the following criteria will be excluded from participation in this study:
- History of splenectomy
- History of infection with listeriosis or has prior serious reaction to adenovirus
- Infection requiring systemic antibiotics within 1 week prior to administration of study intervention
Concurrent use of systemic steroids or immunosuppressive drugs (including TNF pathway inhibitors) with exceptions including:
- Topical, ocular, intra-articular, intranasal, and inhalation corticosteroids (with minimal systemic absorption)
- Adrenal replacement steroid dose < 10 mg daily prednisone
- A brief (fewer than three days) course of corticosteroids for prophylaxis (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type hypersensitivity reaction cause by a contrast allergen)
- Subjects who have implanted medical devices that pose high risks for colonization and cannot be easily removed (e.g., artificial heart valves, pacemakers, prosthetic joints, orthopedic screw(s), metal plate(s)). Chest wall infus-a-port catheter may be used for treatment administration and will not be subject to this exclusion.
- Has any immunodeficiency disease or immunocompromised state (e.g., use of immunosuppressive agents including TNF pathway inhibitors, chemotherapy, PI3 kinase inhibitors or radiation therapy within four weeks of study treatment)
- Has active or history of autoimmune disease (including inflammatory bowel disease), or is a transplant recipient requiring immunosuppressive treatment
- Has received a diagnosis of HIV, hepatitis B, or hepatitis C (subjects who are hepatitis C positive may be enrolled if they are confirmed with negative viral load at screening)
- Other malignancy within last 2 years except curatively treated non-melanomatous skin cancer and curatively treated carcinoma in situ (eg, cervix, bladder, breast), or prostate cancer in remission
Known active central nervous system metastases and/or carcinomatous meningitis. Patients with previously treated brain metastases may participate provided they are:
- Radiologically stable, ie, without evidence of progression for at least 12 weeks by repeat imaging
- Clinically stable per investigator assessment
- Without requirement of steroid treatment for at least 14 days prior to first dose of study vaccine
- Has an intercurrent illness that is either life-threatening or of clinical importance such that it might limit study compliance (such illnesses include, but are not limited to, ongoing or active infection, metabolic or neurologic disease, peripheral vascular disease, or psychiatric illness)
- Has insufficient peripheral venous access to permit completion of the study phlebotomy regimen or infusion of study vaccine
- Concurrent use of illicit drugs (e.g., opioids, cocaine, amphetamines, hallucinogens, etc.) that could potentially interfere with adherence to study procedures or requirements.
- Be pregnant or breastfeeding
- Toxicities from previous anti-cancer therapies that have not resolved to baseline levels or to grade 1 or less or baseline except for the following Grade 2 AEs that are considered chronic or irreversible: alopecia, peripheral neuropathy, endocrinopathies stable on therapy, and thromboembolic events stable on anticoagulation with no recurrence for > 6 months. Other Grade 2 AEs may be permitted upon discussion with the PI if not otherwise specified in the protocol.
- Are currently enrolled in an ongoing clinical trial or trial that could interfere with the protocol-specified requirements
- There are no restrictions on concurrent or prior use of preventative vaccines for infectious diseases including influenza or COVID-19, however it is required to include at least one week interval between vaccines and study agent administration.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Arm 1 Dose Level -1: Lm-GUCY2C 1 x 10⁸
Participants receive Ad5.F35-hGUCY2C-PADRE vaccine, administered as a single intramuscular (IM) injection (5 × 10¹² viral particles), followed by Lm-GUCY2C vaccine, administered intravenously at a dose of 1 × 10⁸ colony-forming units (CFU) on two occasions approximately four weeks apart.
|
Ad5.F35-hGUCY2C-PADRE vaccine administered as a single intramuscular injection at a dose of 5 × 10¹² viral particles as the priming vaccination in a heterologous prime-boost vaccination regimen.
Other Names:
Lm-GUCY2C vaccine administered as an intravenous infusion at dose levels 1 x 10⁸, 3 x 10⁸, 1 x 10⁹, and 3 x 10⁹ colony-forming units (CFU) as booster vaccinations given twice approximately four weeks apart following Ad5.F35-hGUCY2C-PADRE priming.
Other Names:
Spiral CT of thorax, abdomen, and pelvis (and other imaging studies as clinically indicated) for disease assessment at Screening and EOT.
If a subject cannot have a CT scan (e.g., allergy to contrast dye), MRI results are acceptable.
Other Names:
|
|
Experimental: Arm 2 Dose Level 1: Lm-GUCY2C 3 x 10⁸
Participants receive Ad5.F35-hGUCY2C-PADRE vaccine, administered as a single intramuscular (IM) injection (5 × 10¹² viral particles), followed by Lm-GUCY2C vaccine, administered intravenously at a dose of 3 × 10⁸ colony-forming units (CFU) on two occasions approximately four weeks apart.
|
Ad5.F35-hGUCY2C-PADRE vaccine administered as a single intramuscular injection at a dose of 5 × 10¹² viral particles as the priming vaccination in a heterologous prime-boost vaccination regimen.
Other Names:
Lm-GUCY2C vaccine administered as an intravenous infusion at dose levels 1 x 10⁸, 3 x 10⁸, 1 x 10⁹, and 3 x 10⁹ colony-forming units (CFU) as booster vaccinations given twice approximately four weeks apart following Ad5.F35-hGUCY2C-PADRE priming.
Other Names:
Spiral CT of thorax, abdomen, and pelvis (and other imaging studies as clinically indicated) for disease assessment at Screening and EOT.
If a subject cannot have a CT scan (e.g., allergy to contrast dye), MRI results are acceptable.
Other Names:
|
|
Experimental: Arm 3 Dose Level 2: Lm-GUCY2C 1 x 10⁹
Participants receive Ad5.F35-hGUCY2C-PADRE vaccine, administered as a single intramuscular (IM) injection (5 × 10¹² viral particles), followed by Lm-GUCY2C vaccine, administered intravenously at a dose of 1 × 10⁹ colony-forming units (CFU) on two occasions approximately four weeks apart.
|
Ad5.F35-hGUCY2C-PADRE vaccine administered as a single intramuscular injection at a dose of 5 × 10¹² viral particles as the priming vaccination in a heterologous prime-boost vaccination regimen.
Other Names:
Lm-GUCY2C vaccine administered as an intravenous infusion at dose levels 1 x 10⁸, 3 x 10⁸, 1 x 10⁹, and 3 x 10⁹ colony-forming units (CFU) as booster vaccinations given twice approximately four weeks apart following Ad5.F35-hGUCY2C-PADRE priming.
Other Names:
Spiral CT of thorax, abdomen, and pelvis (and other imaging studies as clinically indicated) for disease assessment at Screening and EOT.
If a subject cannot have a CT scan (e.g., allergy to contrast dye), MRI results are acceptable.
Other Names:
|
|
Experimental: Arm 4 Dose Level 3: Lm-GUCY2C 3 x 10⁹
Participants receive Ad5.F35-hGUCY2C-PADRE vaccine, administered as a single intramuscular (IM) injection (5 × 10¹² viral particles), followed by Lm-GUCY2C vaccine, administered intravenously at a dose of 3 × 10⁹ colony-forming units (CFU) on two occasions approximately four weeks apart.
|
Ad5.F35-hGUCY2C-PADRE vaccine administered as a single intramuscular injection at a dose of 5 × 10¹² viral particles as the priming vaccination in a heterologous prime-boost vaccination regimen.
Other Names:
Lm-GUCY2C vaccine administered as an intravenous infusion at dose levels 1 x 10⁸, 3 x 10⁸, 1 x 10⁹, and 3 x 10⁹ colony-forming units (CFU) as booster vaccinations given twice approximately four weeks apart following Ad5.F35-hGUCY2C-PADRE priming.
Other Names:
Spiral CT of thorax, abdomen, and pelvis (and other imaging studies as clinically indicated) for disease assessment at Screening and EOT.
If a subject cannot have a CT scan (e.g., allergy to contrast dye), MRI results are acceptable.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of Dose Limiting Toxicities (DLT) to determine recommended Phase 2 dose (RPTD) of Lm-GUCY2C vaccine boosts following Ad5.F35-hGUCY2C-PADRE vaccine
Time Frame: 28 days after first Lm-GUCY2C vaccination
|
Number of Participants who experience a dose-limiting toxicity
|
28 days after first Lm-GUCY2C vaccination
|
|
Number of patients with dose limiting toxicities (DLTs) in the maximum tolerated dose (MTD) evaluation period
Time Frame: 28 days after first Lm-GUCY2C vaccination
|
Number of participants who experience at least once dose-limiting toxicity during the maximum tolerated dose (MTD) evaluation period.
|
28 days after first Lm-GUCY2C vaccination
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Number of Treatment Emergent Adverse Events (TEAEs) as defined by the Common Terminology Criteria for Adverse Events version 5 (CTCAE v5)
Time Frame: Up to 1 year after first vaccination
|
Number of participants experiencing treatment-emergent adverse events following administration of study vaccines.
|
Up to 1 year after first vaccination
|
|
Change in ctDNA Levels
Time Frame: Baseline through Week 12 after first vaccination with optional collections and analyses until end of follow-up (when all subjects reach 24 months of follow-up)
|
Baseline measurement of circulating tumor DNA (ctDNA) will occur prior to beginning therapy with any administration of a vaccine.
This will be used as a baseline for comparison at other time points throughout the study (increasing or decreasing if positive or negative).
ctDNA will be measured at Days 29 and 57, and measurements will be categorized into one of five possible results at each time points: 1) decrease from baseline, 2) increase from baseline, 3) conversion from positive to negative, 2) conversion from negative to positive, and 5) maintenance of negative result.
The time of conversion will be notated, where applicable.
|
Baseline through Week 12 after first vaccination with optional collections and analyses until end of follow-up (when all subjects reach 24 months of follow-up)
|
|
Characterize the shedding assessment for the Ad5.F35-hGUCY2C-PADRE vaccine vector
Time Frame: Screening through 4 weeks after final Lm-GUCY2C administration
|
Vector (Ad5.F35-GUCY2C-PADRE and Lm-GUCY2C) DNA will be quantified by qPCR in saliva, urine, and feces to determine shedding from the subject.
|
Screening through 4 weeks after final Lm-GUCY2C administration
|
|
Characterize the pharmacokinetics (PK) of Lm-GUCY2C vaccine vector
Time Frame: Screening through 4 weeks after final Lm-GUCY2C administration
|
Vector (Ad5.F35-GUCY2C-PADRE and Lm-GUCY2C) DNA will be quantified by qPCR in blood to determine pharmacokinetics in blood)
|
Screening through 4 weeks after final Lm-GUCY2C administration
|
|
Characterize the shedding assessment for the Lm-GUCY2C vaccine vector
Time Frame: Screening through 4 weeks after final Lm-GUCY2C administration
|
Vector (Ad5.F35-GUCY2C-PADRE and Lm-GUCY2C) DNA will be quantified by qPCR in saliva, urine, and feces to determine shedding from the subject.
|
Screening through 4 weeks after final Lm-GUCY2C administration
|
|
T-cell Responses to GUCY2C measured by enzyme-linked immunosorbent spot (ELISpot) assay
Time Frame: Baseline through Week 12 after first vaccination with optional collections and analyses until end of follow-up (when all subjects reach 24 months of follow-up)
|
Antibody and T-cell data will be summarized by positive response rates (each subject recorded as yes/no) and exact 2-sided 95% confidence intervals.
For this study, a small GUCY2C-specific T-cell response can be expected after Ad5.F35-hGUCY2C-PADRE, but a significant T-cell response is expected at Days 29 and 57 (four weeks after each Lm-GUCY2C dose).
Significance of the change from baseline will be assessed using the modified distribution-free resampling (DFR) method.
A subject with a response at either Day 29 or Day 57 will be considered a responder.
Supporting analysis will model the trajectory of GUCY2C-specific T-cell responses over time using mixed effects linear regression.
|
Baseline through Week 12 after first vaccination with optional collections and analyses until end of follow-up (when all subjects reach 24 months of follow-up)
|
|
Humoral Responsess to GUCY2C
Time Frame: Baseline through Week 12 after first vaccination with optional collections and analyses until end of follow-up (when all subjects reach 24 months of follow-up)
|
(pan-Ig) ELISA will be used to detect responses, which will be graded on a scale of mean absorbance at 405 nm.
Some GUCY2C-specific humoral response may be detectable at Day 29, but a stronger response is expected at measurement on Day 57.
Subjects that fail to produce an end-point titer (no dilution is greater than pre-treatment) by Day 57 will be considered non-responders.
Otherwise, responses will be measured on a continuous basis and compared both within and among cohorts at the end of the study.
Supporting analysis will model the trajectory of GUCY2C-specific pan-Ig responses over time using mixed effects linear regression.
|
Baseline through Week 12 after first vaccination with optional collections and analyses until end of follow-up (when all subjects reach 24 months of follow-up)
|
|
Overall Response Rate (ORR)
Time Frame: Up to 12 months after first vaccination
|
The duration of overall response is measured from the time the criteria are first met for a Complete Response (CR) or Partial Response (PR)-whichever occurs first-until the first date that recurrent or Progressive Disease (PD) is objectively documented, using the smallest measurements recorded during the study as the reference for determining PD.
The proportion of participants with a best overall response is assessed by the investigator according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Under RECIST version 1.0, target lesions evaluated by magnetic resonance imaging (MRI) are categorized as follows: a Complete Response (CR) is defined as the disappearance of all target lesions; a Partial Response (PR) is defined as at least a 30% decrease in the sum of the longest diameters of target lesions; and the Overall Response (OR) represents the combined total of CR and PR.
|
Up to 12 months after first vaccination
|
|
Disease Control Rate (DCR)
Time Frame: At 12 weeks
|
Defined as the time from the first occurrence of the best overall response-Complete Response (CR), Partial Response (PR), or Stable Disease (SD)-to either disease progression or death from any cause during the treatment period.
|
At 12 weeks
|
|
Characterize the pharmacokinetics (PK) of Ad5.F35-hGUCY2C-PADRE vaccine vector
Time Frame: Screening through 4 weeks after final Lm-GUCY2C administration
|
Vector (Adenovirus Serotype 5/35 [Ad5.F35]-Guanylyl Cyclase C [GUCY2C]-PADRE) and Listeria monocytogenes-GUCY2C (Lm-GUCY2C) DNA will be quantified in blood using quantitative polymerase chain reaction (qPCR) to assess pharmacokinetics in the bloodstream.
|
Screening through 4 weeks after final Lm-GUCY2C administration
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Babar Bashir, M.D., M.S., Sidney Kimmel Comprehensive Cancer Center at Thomas Jefferson University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms by Site
- Neoplasms
- Intestinal Diseases
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Digestive System Diseases
- Gastrointestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Colonic Diseases
- Colorectal Neoplasms
- Diagnostic Techniques and Procedures
- Diagnosis
- Tomography
- Diagnostic Imaging
- Radiography
- Image Interpretation, Computer-Assisted
- Radiographic Image Enhancement
- Image Enhancement
- Photography
- Tomography, X-Ray
- Tomography, X-Ray Computed
Other Study ID Numbers
- iRISID-2025-1138
- JT 44551 (Other Identifier: JeffTrial Number)
- CA210829 (Other Grant/Funding Number: DOD)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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