Recurrent Glioblastoma Clinical Trial
Official title:
A Phase II Clinical Trial Evaluating Combination Therapy Using DCVax-L (Autologous Dendritic Cells Pulsed With Tumor Lysate Antigen) and Nivolumab (an Anti-PD-1 Antibody) for Subjects With Recurrent Glioblastoma Multiforme
This phase II trial studies the side effects of autologous dendritic cells pulsed with tumor lysate antigen vaccine and nivolumab and to see how well they work in treating patients with glioblastoma that has come back. Vaccines made from a person's tumor cells may help the body build an effective immune response to kill tumor cells. Monoclonal antibodies, such as nivolumab, may interfere with the ability of tumor cells to grow and spread. Giving dendritic cell-autologous lung tumor vaccine and nivolumab may work better in treating patients with glioblastoma.
PRIMARY OBJECTIVES:
I. To evaluate the safety and tolerability of the combination treatment of autologous
dendritic cells pulsed with tumor lysate antigen vaccine (DCVax-L) and nivolumab.
II. To compare overall survival (OS) from the date of surgery in a pooled evaluation of group
1 subjects receiving DCVax-L and group 2 subjects receiving DCVax-L and nivolumab to recent
historical standards.
III. To compare OS between the two groups.
SECONDARY OBJECTIVES:
I. Safety. II. Feasibility. III. Tumor response. IV. Immune response. V. Quality of Life
(QoL). VI. Overall survival (OS). VII. Overall survival rate at 9, 12, and 18 months. VIII.
Progression-free survival (PFS). IX. Evaluation of the safety of the DCVax-L + nivolumab
combination regimen.
TERTIARY OBJECTIVES:
I. Estimate correlation of quantitative assessments of tumor-infiltrating lymphocyte (TIL)
proliferation (CD8+/Ki-67+ staining).
II. Estimate difference in PD-1 and PD-L1 immunohistochemistry expression between density or
clonality with clinical responses to combination therapy in recurrent glioblastoma subjects.
III. Estimate differences between outcome groups in monocytic PD-L1 expression at baseline
and over time.
IV. Estimate differences between outcome groups in circulating tumor DNA, circulating tumor
cells, and CD4+ T cells at baseline and over time.
V. Estimate difference in PD-1 and PD-L1 immunohistochemical (IHC) expression between
archived and study samples.
VI. Explore patterns of tumor proteomic profiling. VII. Estimate efficacy of combination
therapy by progression-free survival (PFS), rates of contrasted tumor change over time, and
overall survival (OS).
VIII. Explore effect of nivolumab on TIL proliferation (CD8+/Ki-67+ staining). IX. Explore
whether oligoclonal T cell populations within tumor tissue are similarly expanded in
peripheral blood after nivolumab, the magnitude of which correlates with clinical responses.
X. Explore if changes in specific MRI parameters correlate with tumor and peripheral blood
immune responses.
XI. Explore if a mesenchymal gene expression signature present in the initial archived tumor
sample correlates with T lymphocytic response in tumor after nivolumab.
XII. Correlate changes of positron emission tomography (PET) in tumor with the following: TIL
density or clonality, clinical outcome, T cell measures in peripheral blood, clinical
toxicity.
XIII. Correlate changes in PET in lymph nodes with the following: TIL density or clonality,
clinical outcome, T cell measures in peripheral blood, clinical toxicity.
XIV. Correlate changes in PET in organ tissue with TIL density or clonality.
OUTLINE: Patients are randomized to 1 of 2 groups.
GROUP I: Patients receive dendritic cell-autologous lung tumor vaccine intradermally (ID) on
days 0, 7, 14, and weeks 4, 6, 8, 11, 14, 17 and 20.
GROUP II: Patients receive dendritic cell-autologous lung tumor vaccine as in Group I, and
nivolumab intravenously (IV) over 30 minutes on days 0, 14, and weeks 4, 6, 8, 11, 14, 17,
and 20.
After completion of study treatment, patients are followed up for up to 12 months.
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