用于前列腺癌的新辅助 Hiltonol® (PolyICLC)
在根治性前列腺切除术之前使用瘤内和全身 Hiltonol® (Poly-ICLC) 原位自体疫苗接种抗前列腺癌的 I 期研究
研究概览
地位
条件
详细说明
这是一项针对高危临床局限性前列腺癌患者的 IT/IM Poly-ICLC 剂量递增试验性研究。 IT 注射的剂量和频率将在连续的队列中增加,以确定安全剂量和进一步测试的时间表。
临床局限性前列腺癌患者的肿瘤内 + 肌肉内多聚 ICLC。 在目前的试点临床试验中,poly-ICLC 将在临床局限性前列腺癌患者的前列腺切除术之前通过肿瘤内(Artemis 指导)和肌肉内(例如三角肌)给药。 基于探索上述 PAMPs 瘤内给药的可用临床前数据,我们预计这种方法将导致三个免疫调节步骤 26:
免疫调节步骤 1:肿瘤内多聚 ICLC 诱导的先天性免疫局部肿瘤杀伤——最初的肿瘤内注射预计会诱导 IL-12、TNF-α 和其他细胞因子和 NK 细胞的激活/募集,从而导致早期肿瘤杀伤和抗原发布.9-11 Poly-ICLC 还可能对由干扰素诱导的核酶系统介导的肿瘤细胞具有直接的抗增殖作用。
免疫调节第 2 步:Th1 和细胞毒性 T 淋巴细胞启动,这是由于重复的原位多聚 ICLC“危险信号”与步骤 1 中释放的肿瘤抗原相结合,并由多聚 ICLC 激活的髓样树突进一步处理和交叉呈递细胞.7,8 Poly-ICLC 有望将髓样树突状细胞和巨噬细胞募集到肿瘤部位,在那里它们可以装载通过先天机制释放的抗原,将它们呈递给 Th1 细胞,并将它们交叉呈递给肿瘤或区域中的 CD8 T 细胞淋巴结,从而产生抗原特异性细胞毒性 T 淋巴细胞。
免疫调节第 3 步(或“增强”阶段):通过反复肌内诱导趋化因子、其他共刺激因子和炎性体激活,维持全身抗肿瘤免疫反应和细胞毒性 T 淋巴细胞向远处转移的迁移。 23- 25 进行肌内维持随访的基本原理是,作为综合反应的一部分,dsRNA(例如 poly-ICLC)会诱导各种有助于靶向肿瘤反应的趋化因子和共刺激因子。 例如,这些共刺激因子之一是 OX40,它属于细胞因子的肿瘤坏死因子家族,有助于维持细胞毒性淋巴细胞的寿命以及在肿瘤和转移部位的作用。
研究类型
注册 (实际的)
阶段
- 阶段1
联系人和位置
学习地点
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New York
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New York、New York、美国、10029
- Icahn School of Medicine at Mount Sinai
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
纳入标准:
- 用于发布个人健康信息的书面知情同意书和 HIPAA 授权。
- 同意时年龄 > 18 岁。
- 在注册协议治疗(研究程序手册)之前的 14 天内,ECOG 表现状态为 0-1。
- 经组织学证实的前列腺腺癌(先前的诊断组织可用于肿瘤标记物分析)。
- Gleason 7 - 10,cT2a - cT3b 前列腺腺癌,计划进行根治性前列腺切除术
- PSA ≥ 4 纳克/毫升
- 多参数 MRI 上可见肿瘤
- 耐受先前在局部麻醉下经直肠超声引导的活检程序
- 既往无复杂的 TRUS 活检程序(即,既往未因 TRUS 前列腺活检后败血症、前列腺脓肿或严重出血而住院)
- 愿意按照协议将 Poly-ICLC 肿瘤内 (IT) 注射到前列腺肿瘤中
- 除了口服 5-α-还原酶抑制剂(非那雄胺、度他雄胺等)外,之前没有接受过激素治疗。 之前接受过口服抗雄激素治疗(比卡鲁胺、氟他胺、尼鲁米特等)的患者必须在入组前停止治疗至少 6 周。 先前接受过 LHRH 激动剂或拮抗剂治疗(亮丙瑞林、醋酸戈舍瑞林等)的患者符合条件,前提是血清睾酮 > 50 mg/dl。
- 之前没有对骨盆或前列腺进行放射治疗(外照射或近距离放射治疗)。
- 治疗研究者判断没有临床意义的感染。
没有特征表明前列腺内注射有潜在的更高感染风险:
- 入组前 3 个月内复发性尿路感染或前列腺炎病史。
- 尿液分析显示亚硝酸盐和白细胞酯酶呈阳性。 在治疗和解决感染后,可以考虑将此类患者用于研究。
- 活动性直肠炎
- 前列腺脓肿史
- 服用免疫抑制药物,包括全身性皮质类固醇
- 活动性血液系统恶性肿瘤
- 6 个月内无不受控制的心绞痛、充血性心力衰竭或心梗。
- 有 HIV 病史(如果 CD4+ T 细胞计数≥350 个细胞/µL 接受 ART 治疗)、乙型肝炎(病毒载量低于定量限)或丙型肝炎(已完成治愈性治疗且病毒载量低于定量限)的患者量化的限制)有资格参加这项研究。
在注册协议治疗之前的 28 天内,未使用任何研究药物治疗任何医疗状况。
由以下实验室值确定的适当终末器官功能:
- 白细胞计数 (WBC) > 2.5 k/mm3
- 中性粒细胞绝对计数 (ANC) > 1.5 k/mm3
- 血红蛋白 (Hgb) > 8.0 克/分升
- 血小板 > 100 k/mm3
- 使用 Cockcroft-Gault 公式计算的肌酐清除率 > 60 cc/min:
男性:(140 - 岁)× 实际体重 kg 72 × 血清肌酐(mg/dL)
- 胆红素 < 2.0 x ULN
- 天冬氨酸转氨酶 (AST) < 2.5 x ULN
- 丙氨酸氨基转移酶 (ALT) < 2.5 x ULN 18) 能够说、读和写英语。
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:非随机
- 介入模型:顺序的
- 屏蔽:没有任何
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:队列 1
瘤内 (IT) Poly ICLC 0.5 mg IT 每周一次(第 1 周) 肌内 (IM) Poly ICLC 1 mg IM 每周两次(第 3-6 周) 随后在第 10 周进行根治性前列腺切除术
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0.5 mg IT 一次/周(第 1 周)
每周两次 1 mg 肌注(第 3-6 周)
其他名称:
按照标准护理
|
实验性的:队列 2
瘤内 (IT) Poly ICLC 0.5 mg IT 每周一次(第 1+2 周) 肌内 (IM) Poly ICLC 1 mg IM 每周两次(第 3-6 周) 随后在第 10 周进行根治性前列腺切除术
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0.5 mg IT 一次/周(第 1 周)
每周两次 1 mg 肌注(第 3-6 周)
其他名称:
按照标准护理
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实验性的:队列 3
瘤内 (IT) Poly ICLC 1.0 mg IT 每周一次(第 1 周) 肌肉内 (IM) Poly ICLC 1 mg IM 每周两次(第 3-6 周) 随后在第 10 周进行根治性前列腺切除术
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每周两次 1 mg 肌注(第 3-6 周)
其他名称:
按照标准护理
1.0 mg IT 一次/周(第 1 周)
其他名称:
|
实验性的:队列 4
瘤内 (IT) Poly ICLC 1.0 mg IT 每周一次(第 1+2 周) 肌内 (IM) Poly ICLC 1 mg IM 每周两次(第 3-6 周) 随后在第 10 周进行根治性前列腺切除术
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每周两次 1 mg 肌注(第 3-6 周)
其他名称:
按照标准护理
1.0 mg IT 一次/周(第 1 周)
其他名称:
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
剂量限制毒性水平
大体时间:第 6 周
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3+3 剂量递增规则,用于确定根治性前列腺切除术前使用聚赖氨酸和羧甲基纤维素稳定的术前瘤内 (IT) 加肌注 (IM) 聚肌胞苷酸(poly-ICLC、Hiltonol®)的安全剂量
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第 6 周
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
不良事件数
大体时间:第 6 周
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安全性根据不良事件通用术语 (CTCAE) 4.0 版的不良事件频率确定。
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第 6 周
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PSA进展时间
大体时间:至第 12 周
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前列腺特异性抗原 (PSA) 进展的时间将定义为 PSA > 0.2 ng/mL 的时间
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至第 12 周
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合作者和调查者
合作者
调查人员
- 研究主任:Sujit S Nair, Ph.D.、Icahn School of Medicine at Mount Sinai
- 首席研究员:Ashutosh K. Tewari, MD、Icahn School of Medicine at Mount Sinai
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