Clinical Trials Logo

Clinical Trial Details — Status: Not yet recruiting

Administrative data

NCT number NCT05609994
Other study ID # Pro00108636
Secondary ID
Status Not yet recruiting
Phase Phase 1
First received
Last updated
Start date June 2024
Est. completion date August 2027

Study information

Verified date March 2024
Source Duke University
Contact Katherine Peters, MD, PhD
Phone 919-684-5301
Email dukebrain1@duke.edu
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The purpose of this study is to determine the safety and efficacy of a PEPIDH1M vaccine in combination with vorasidenib, a dual inhibitor of mutant IDH1 and IDH2 enzymes, in adult patients diagnosed with recurrent IDH1 mutant lower grade gliomas.


Description:

This study is designed to assess the safety and efficacy of the PEPIDH1M vaccine in combination with vorasidenib in adult patients recurrent IDH1 mutant lower grade gliomas. Patients will receive vaccination with 0.5 mL of Td (tetanus and diphtheria toxoids adsorbed) intramuscularly (I.M.) into the deltoid muscle to ensure adequate immunity to the tetanus antigen. Patients will then receive vorasidenib 40 mg orally once a day for 28 days. After two cycles of 28-day vorasidenib and at the start of the 3rd cycle of vorasidenib, patients will receive the PEPIDH1M vaccine intradermally (i.d.) to alternating groin regions on the following schedule: vaccine #1, day 1; vaccine #2, day 15. The day before vaccine #1, patients will receive a vaccine site pre-conditioning injection of a single dose of Td toxoid (1 flocculation unit [Lf] in a total volume of 0.4 mL saline). This will be administered twelve hours to one day prior to receiving PEPIDH1M vaccine i.d. to the RIGHT groin area. Vaccines #3 and #4 will be given on day 1 and day 15 of cycle 4. Starting on 6th cycle of 28-day vorasidenib, subjects will receive PEPIDH1M vaccine (i.d. to alternating groin regions) every 28 days on day 1 for vaccine #5-#12. Patients will receive up to a total of 14 cycles of vorasidenib. Notably, a safety lead-in will be performed before commencing on the full study to assess the safety of the combination and evaluation for any dose-limiting toxicity (DLT). The most common side effects of peptide vaccines are redness or swelling at the injection site, local changes to the texture of skin (hardening) at the injection site, itching, allergic reactions, and a potentially serious side effect called cytokine release syndrome. The most common side effects of vorasidenib are abnormal liver function tests, QT prolongation, stomach and/or intestinal ulcers, neurologic disturbances, skin peeling, and isocitrate dehydrogenase (IDH) differentiation syndrome. All patients who receive any protocol treatment will be included in either primary or secondary efficacy analyses. Statistical analyses for the primary objective of adverse experience will exclude patients who terminate protocol treatment prematurely (i.e., less than 4 vaccinations) without an unacceptable toxicity.


Recruitment information / eligibility

Status Not yet recruiting
Enrollment 48
Est. completion date August 2027
Est. primary completion date August 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: 1. Age = 18 years 2. IDH1R132H expression in primary tumor 3. Clinical and/or radiographic, progressive Grade 2-3 glioma with greater than 2 cm of non-enhancing disease in one plane. 4. 1st recurrence only 5. Signed informed consent 6. For females of child-bearing potential, negative serum pregnancy test at screening 7. Women of childbearing potential and male participants must agree to practice contraception 8. Karnofsky Performance Status (KPS) of = 70 9. Expected survival of = 12 months 10. Recovered from any clinically relevant toxicities associated with any prior surgery for the treatment of glioma unless stabilized under medical management 11. Complete Blood Count (CBC)/differential with adequate bone marrow function as defined below within 2 weeks of enrollment: 1. Absolute neutrophil count (ANC) = 1000 cells/mm3 2. Platelet count = 100,000 cells/mm3 3. Hemoglobin (Hgb) = 10 g/dl (Note: The use of transfusion or other intervention to achieve Hgb = 10 g/dl is acceptable.) 12. Adequate renal function as defined below within 2 weeks of enrollment: 1. Blood urea nitrogen (BUN) = 25 mg/dl 2. Creatinine = 1.7 mg/dl 13. Adequate hepatic function as defined below within 2 weeks of enrollment: 1. Bilirubin = 2.0 mg/dl 2. Alanine transaminase (ALT) = 3 x normal range 3. Aspartate aminotransferase (AST) = 3 x normal range Exclusion Criteria: 1. Prior invasive malignancy (except for non-melanomatous skin cancer) unless disease free for = 3 years (e.g., carcinoma in situ of the breast, oral cavity, and cervix are all permissible) 2. Metastases detected below the tentorium or beyond the cranial vault 3. More than 1 cm X 1 cm of enhancing disease on gadolinium contrasted MRI imaging 4. Severe, active co-morbidity, defined as follows: 1. Unstable angina and/or congestive heart failure requiring hospitalization 2. Myocardial infarction within the last 6 months. 3. Known Acquired Immune Deficiency Syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition (Note: human immunodeficiency virus [HIV] testing is not required for entry into this protocol. The need to exclude patients with Acquired Immunodeficiency Syndrome (AIDS) from this protocol is necessary because treatments involved in this protocol may be significantly immunosuppressive.) 4. Major medical illnesses or psychiatric impairments that in the investigator's opinion will prevent administration or completion of protocol therapy. 5. Pregnant or lactating women, due to possible adverse effects on the developing fetus or infant due to study drug 6. Patients with a heart-rate corrected QT interval using Fridericia's formula (QTcF) = 450 msec or other factors that increase the risk of QT prolongation or arrhythmic events (e.g., heart failure, hypokalemia, family history of long QT interval syndrome) 7. Patients with known active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Subjects with a sustained viral response to HCV treatment or immunity to prior HBV infection will be permitted (Note: Patients with chronic HBV that is adequately suppressed by institutional practice will be permitted.) 8. Patients with active gastrointestinal disease, chronic diarrhea, previous gastric resection or lap band dysphagia, short-gut syndrome, gastroparesis, or other condition that limits the ingestion or gastrointestinal absorption of drugs administered orally (Note: Gastroesophageal reflux disease under medical treatment is allowed.) 9. Patient taking any medications that are CYP3A or CYP2C9 substrates with a narrow therapeutic index (Note: Patients should be transferred to other medications before receiving the first dose of study drug.) 10. Patients treated on any other therapeutic clinical protocols within 30 days prior to study entry or during participation in the study 11. Patients with known hypersensitivity to GM-CSF, yeast-derived products, or any component of Leukine® 12. Allergy or hypersensitivity to tetanus vaccine or any component of the tetanus vaccine. 13. Known hypersensitivity to any component of vorasidenib 14. Prior therapy with mIDH1 targeted therapeutics 15. Unable to undergo MRI imaging

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
PEPIDH1M vaccine + vorasidenib
Patients will receive vaccination with 0.5 mL of Td (tetanus and diphtheria toxoids) intramuscularly into the deltoid muscle. Patients will then receive vorasidenib 40mg orally once a day for 28 days. After two cycles of 28-day vorasidenib and at the start of the 3rd cycle of vorasidenib, patients will receive the PEPIDH1M vaccine intradermally (i.d.) to alternating groin regions on the following schedule: vaccine #1, day 1; vaccine #2, day 15. The day before vaccine #1, patients will receive a vaccine site pre-conditioning injection of a single dose of Td toxoid. This will be administered twelve hours to one day prior to receiving PEPIDH1M vaccine i.d. to the RIGHT groin area. Vaccines #3 and #4 will be given on day 1 and day 15 of cycle 4. Starting on 6th cycle of 28-day vorasidenib, subjects will receive PEPIDH1M vaccine (i.d. to alternating groin regions) every 28 days on day 1 for vaccine #5-#12. Patients will receive up to a total of 14 cycles of vorasidenib.

Locations

Country Name City State
United States Duke University Medical Center Durham North Carolina

Sponsors (2)

Lead Sponsor Collaborator
Katy Peters, MD, PhD Servier

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary To assess the safety of the PEPIDH1M vaccine in combination vorasidenib in adult patients with progressive IDH1 mutant World Health Organization (WHO) Grade 2-3 gliomas The proportion of patients with an unacceptable toxicity 3.5 years
Primary Describe the efficacy, as measured by progression-free survival (PFS), of the combination of PEPIDH1M vaccine and vorasidenib in adult patients with recurrent IDH1 lower grade glioma The time between initiation of cycle 1 vorasidenib and first documentation of disease progression or death 10 years
See also
  Status Clinical Trial Phase
Recruiting NCT04859725 - HyperSpectral Imaging in Low Grade Glioma N/A
Suspended NCT03717142 - Feasibility of the LUM Imaging System for Detection of Cancer to the Brain N/A
Enrolling by invitation NCT04063514 - The Use of Focused Ultrasound and DCE K-trans Imaging to Evaluate Permeability of the Blood-Brain Barrier N/A
Active, not recruiting NCT03154801 - Early Detection and Paramedical Care of Sexual Difficulties in Nervous System Diseases: Example of Multiple Sclerosis and Brain Tumors (NEUROSEX) N/A
Recruiting NCT02509442 - Measure of the Potential Evoked by Electric Stimulation N/A
Not yet recruiting NCT05555550 - Evaluation of 18F-Fluciclovine Positron Emission Tomography - Magnetic Resonance Imaging (PET-MRI) in LGG Early Phase 1
Completed NCT02303938 - Effects of Exercise on Cognitive Function in Glioma Patients N/A