Immune Modulatory DC Vaccine Against Brain Tumor

Official title

Immune Modulatory DC Vaccine Against Diffuse Intrinsic Pontine Glioma (DIPG) and Glioblastoma (GBM)

Overview

This study is designed to treat patients who have been diagnosed with brain cancer, including glioblastoma (GBM) and diffuse intrinsic pontine glioma (DIPG). The treatment uses immunomodulatory vaccine generated by autologous dendritic cells (DCs) pulsed with genetically modified tumor cells or tumor-related antigens including neoantigens to inject into patients. Vaccine-induced T cell responses have been associated with improved survival. The study will evaluate the safety and potential benefit of the novel immunomodulatory DC vaccines.

Detailed description

Diffuse intrinsic pontine glioma (DIPG) or glioblastoma (GBM) is an aggressive malignancy. DIPG mainly occurs in the ventral pontine of childhood. The overall median survival time is 9 to 11 months. The 2-year survival rate is less than 10%. Thus DIPG has become one of the most fatal diseases in children. These tumors invade and infiltrate the surrounding brain, making complete surgical excision impossible. Several studies focused on the identification of GBM or DIPG-specific antigens and evaluated their potential for vaccine application. Immunomodulatory DC vaccines based on ex vivo genetic modifications in combination with known tumor-specific antigens may substantially enhance the activation potential of tumor-specific T cells with improved benefit to patients.

Although certain antigens are highly specific in DIPG or GBM, existing immune tolerance suppresses anti-tumor immunity in cancer patients. To induce anti-cancer immune response in patients, ex vivo modification of immune modulatory antigens or immune cells will be necessary. Advanced whole exome sequencing has been developed to identify specific mutations in tumors and predict best-fit MHC-specific neoepitopes for T cell activation. In this study we will investigate novel DC vaccines based on autologous DCs pulsed with genetically modified tumor cells or related antigens such as neoantigens to induce a strong anti-tumor immunity. Early studies of DC-based vaccines targeting gliomas have shown acceptable safety and low toxicity profile. This is a multi-center randomized Phase I study to evaluate safety of novel DC vaccines.

Interventions

• Biological Immunomodulatory DC vaccine to target DIPG and GBM
  This study will inject DC vaccine cells near lymphoid tissue close to the tumor. The patient will receive intravenous cyclophosphamide (200 mg/m2) or oral (cytoxan) before the vaccine, followed by DC vaccine and intravenous bevacizumab (15 mg/kg) the next day. The cells will be repeatedly infused every month for six consecutive months depending on the response and the condition of the patient. The amount of DC vaccine cells per injection is based on prior report at 5-10x106. An initial dose esca

Primary outcome measures

• Safety of infusion of autologous immunomodulatory DC Vaccine is assessed by the NCI CTCAE V4.0 criteria. [Time frame: 2 years]
• Overall survival (OS) at 12 months (OS12). [Time frame: 12 months]

Secondary outcome measures (5)

• Treatment response rate of DIPG or GBM [Time frame: 6 months]]
• Overall survival Rate [Time frame: 1 year follow up]
• Progression-free survival rate [Time frame: 1 years]
• ELISPOT or antigen specific functional assays for evaluation of antigen specific immune response in patients [Time frame: 1 year]
• Magnetic resonance imaging for evaluation of disease progression and prognosis [Time frame: 1 years]

Eligibility criteria

Inclusion criteria

• Abilities to understand and the willingness to provide written informed consent. Assent will be obtained when appropriate based on the subjects age;
• Patients are ≥ 6 months and ≤ 80 years old;
• DIPG or GBM patients with existing or measurable tumors in the brain. Patients have received standard care of medication, such as gross total resection with concurrent radio chemotherapy (\~54 - 60 Gy, TMZ);
• Patients with adequate neurological function and epileptic symptoms that are well controlled;
• Observing the condition after surgery or without surgery;
• Karnofsky performance score (KPS) ≥ 60;Life expectancy >3 months;
• Important organ function is satisfied: Cardiac ultrasound indicates a cardiac ejection fraction ≥50%; and there is no obvious abnormality in the electrocardiogram; blood oxygen saturation ≥90%; creatinine <2.5 times normal range; alanine aminotransferase (ALT) or aspartate aminotransferase (AST) < 3 times normal range; Total bilirubin ≤ 2.0 mg / dl; Hgb (hemoglobin) ≥ 80g / L;
• Peripheral blood absolute lymphocyte count must be above 0.8×10\^9/L;
• Adequate Neurologic Function Defined as: Patients with seizure disorder may be enrolled if seizure disorder is well controlled;
• Patients must be willing to follow the orders of doctors.

Exclusion criteria

• A prior history of gliadel implantation 4 weeks before this study start or antibody based therapies;
• The patient was still using dexamethasone at a dose greater than 4 mg/day during mononuclear cell collection;
• Patients have a history of autoimmune diseases or other diseases requiring long-term use of hormones or immunosuppressive drugs;
• Patients with a history of allergies or allergies to immune cells and adjuvants of cellular products;
• Active infection with fever;
• Patients with neutropenia (> 10 days) that are difficult to correct after treatment;
• Infection with bacteria, fungi or viruses, uncontrolled;
• Patients with HIV and those living with active HBV and HCV;
• Pregnant, pregnant and lactating women;
• Important organ failure (heart, liver, kidney, lung);
• Patients who had previously been treated with cell therapy but were ineffective after physical examination were discussed and confirmed by team experts and were not suitable for re-treatment;
• Anything that researchers believe may increase the risk of subjects or interfere with test results.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

China · 1 center

• Shenzhen Geno-immune Medical Institute — Shenzhen

Identifiers

NCT: NCT03914768 · GIMI-IRB-19001

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗