Sirolimus and Vaccine Therapy in Treating Patients With Stage II-IV Ovarian Epithelial, Fallopian Tube, or Primary Peritoneal Cavity Cancer

NCT01536054CompletedPHASE1INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Roswell Park Cancer Institute

Enrollment

7

Start Date

2012-08-20

Completion Date

2015-04-21

Study Type

INTERVENTIONAL

Official Title

A Phase I Clinical Trial of mTOR Inhibition With Sirolimus for Enhancing ALVAC(2)-NY-ESO-1(M)/TRICOM Vaccine Induced Anti-Tumor Immunity in Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

Interventions

ALVAC(2)-NY-ESO-1 (M)/TRICOM vaccinesirolimuslaboratory biomarker analysissargramostim

Conditions

Recurrent Fallopian Tube CancerRecurrent Ovarian Epithelial CancerRecurrent Primary Peritoneal Cavity CancerStage IIA Fallopian Tube CancerStage IIA Ovarian Epithelial CancerStage IIA Primary Peritoneal Cavity CancerStage IIB Fallopian Tube CancerStage IIB Ovarian Epithelial CancerStage IIB Primary Peritoneal Cavity CancerStage IIC Fallopian Tube CancerStage IIC Ovarian Epithelial CancerStage IIC Primary Peritoneal Cavity CancerStage IIIA Fallopian Tube CancerStage IIIA Ovarian Epithelial CancerStage IIIA Primary Peritoneal Cavity CancerStage IIIB Fallopian Tube CancerStage IIIB Ovarian Epithelial CancerStage IIIB Primary Peritoneal Cavity CancerStage IIIC Fallopian Tube CancerStage IIIC Ovarian Epithelial CancerStage IIIC Primary Peritoneal Cavity CancerStage IV Fallopian Tube CancerStage IV Ovarian Epithelial CancerStage IV Primary Peritoneal Cavity Cancer

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria:

* Eligible patients will be women with stages II-IV epithelial ovarian, fallopian tube, or primary peritoneal carcinoma who have completed standard therapy for primary or recurrent disease (i.e., patients who would normally be observed); eligible patients may have asymptomatic residual measurable disease on physical examination and/or computed tomography (CT) scan, and/or may have an elevated cancer antigen 125 (CA-125); or may be in complete clinical remission after treatment for primary or recurrent disease; these patients would normally enter a period of observation after standard management
* Any human leukocyte antigen (HLA) type; (historic HLA typing is permitted)
* Tumor expression of NY-ESO-1 or cancer/testis antigen 2 (LAGE-1) by immunohistochemistry (IHC) and/or real-time polymerase chain reaction (RT-PCR)
* No allergy to eggs
* Life expectancy \> 6 months
* Hematology and biochemistry laboratory results within the limits normally expected for the patient population, without evidence of major organ failure
* Absolute neutrophil count (ANC) \>= 1,000/uL
* Platelet \>= 75,000/uL
* Hemoglobin (Hgb) \>= 8 g/dL
* Total bilirubin =\< 1.5 x upper limit of normal (ULN)
* Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) or serum glutamic pyruvic transaminase (SGPT)/alanine aminotransferase (ALT) =\< 3 x ULN
* Serum creatinine =\< 2 x ULN
* Prothrombin time (PT)/international normalized ratio (INR) =\< 1.5
* Electrocardiogram, showing no evidence of congestive heart failure, myocardial infarction, and cardiomyopathy
* Have been informed of other treatment options
* Patient or legal representative must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure
* Have an Eastern Cooperative Oncology Group (ECOG) Performance Status of =\< 2
* Demonstrate the ability to swallow and retain oral medication
* Patients of child-bearing potential must agree to use acceptable contraceptive methods (e.g., double barrier) during treatment
* Patients may have received previous NY-ESO-1 vaccine therapy

Exclusion Criteria:

* Metastatic disease to the central nervous system for which other therapeutic options, including radiotherapy, may be available
* Other serious illnesses (e.g. serious infections requiring antibiotics, bleeding disorders)
* History of severe autoimmune disorders requiring use of steroids or other immunosuppressives
* Concomitant systemic treatment with corticosteroids, anti-histamine or nonsteroidal anti-inflammatory drugs and other platelet inhibitory agents, strong inhibitors/inducers of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP450-3A4)
* Chemotherapy, radiation therapy, or immunotherapy within 4 weeks prior to first dosing of study drug (6 weeks for nitrosoureas); concomitant hormonal therapies for breast cancers are allowed
* Known allergy or history of life threatening reaction to GM-CSF
* Clinically significant heart disease (N-YHA Class III or IV)
* Participation in any other clinical trial involving another investigational agent within 4 weeks prior to first dosing of study drug
* Known hepatitis B, hepatitis C, or HIV
* Mental impairment that may compromise the ability to give informed consent and comply with the requirements of the study
* Lack of availability of a patient for immunological and clinical follow-up assessment
* Known pulmonary hypertension
* Known hypersensitivity to sirolimus
* Evidence of current drug or alcohol abuse or psychiatric impairment, which in the investigator's opinion will prevent completion of the protocol therapy or follow-up
* Pregnant or nursing female patients
* Unwilling or unable to follow protocol requirements
* Any condition which in the investigator's opinion deems the patient an unsuitable candidate to receive study drug; (i.e., any significant medical illness or abnormal laboratory finding that would, in the investigator's judgment, increase the subject's risk by participating in this study)

Outcome Measures

Primary Outcomes

Safety of ALVAC(2)-NY-ESO-1 (M)/TRICOM vaccine in combination with varying dose levels and schedules of sirolimus, assessed using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4

The toxicity rate will be estimated using a one-sided, 95%, exact binomial confidence interval (Clopper-Pearson). The lower one sided limit will be used.

Time frame: Up to 30 days after completion of study treatment

Secondary Outcomes

Effectiveness of sirolimus on enhancing vaccine efficacy, assessed by NY-ESO-1 specific cellular and humoral immunity

The following parameters will be determined: (I) generation of memory T-cells with (2) high avidity that are also (3) resistant to regulatory T cells (Tregs): (4) secondary recall responses. Analyzed via an analysis-of-covariance (ANCOVA) model with post-treatment levels modeled as a function pretreatment levels and main effects corresponding to the 3 x 3 design. The biological signal across all cohorts will be tested on whether or not the slope parameter is 0 or not.

Time frame: Up to 1 year

Antibody titers

Will be analyzed via an ANCOVA model with post-treatment levels modeled as a function pretreatment levels and main effects corresponding to the 3 x 3 design.

Time frame: At baseline, days 29, 57, 85, 141, and at 6 weeks-post treatment

NY-ESO-1 specific CD8+ and CD4+ frequency and function

The analysis of continuous immunological response endpoints will be analyzed via an ANCOVA model with post-treatment levels modeled as a function pretreatment levels and main effects corresponding to the 3 x 3 design.

Time frame: At baseline, days 1, 29, 57, 85, 113, 141, and at 6 weeks-post treatment

Frequency of memory T-cell populations

The analysis of continuous immunological response endpoints will be analyzed via an ANCOVA model with post-treatment levels modeled as a function pretreatment levels and main effects corresponding to the 3 x 3 design.

Time frame: At baseline, days 1, 29, 57, 85, 113, 141, and at 6 weeks-post treatment

TCR avidity

The analysis of continuous immunological response endpoints will be analyzed via an ANCOVA model with post-treatment levels modeled as a function pretreatment levels and main effects corresponding to the 3 x 3 design.

Time frame: At baseline, days 1, 29, 57, 85, 113, 141, and at 6 weeks-post treatment

Secondary recall response

The analysis of continuous immunological response endpoints will be analyzed via an ANCOVA model with post-treatment levels modeled as a function pretreatment levels and main effects corresponding to the 3 x 3 design.

Time frame: Up to 1 year

Time to disease progression

Time frame: Up to 1 year

Locations

Roswell Park Cancer Institute, Buffalo, United States

Linked Papers

2025-03-25

mTOR inhibition modulates vaccine-induced immune responses to generate memory T cells in patients with solid tumors

Background Perturbation of the mechanistic target of rapamycin (mTOR) pathway can instruct effector versus memory cell fate of tumor antigen-specific T cells in preclinical models. In this study, we sought to understand the impact of rapamycin (sirolimus), an mTOR inhibitor, on reprogramming vaccine-induced T cells to enhance memory responses in patients with solid tumors following completion of their standard therapy. Methods We conducted three phase I clinical trials employing New York esophageal squamous cell carcinoma-1 (NY-ESO-1) vaccination approaches, with or without schedule-varied rapamycin. T cell phenotypes, functions, and Vβ usage in peripheral blood were analyzed to ask whether rapamycin influenced the generation of vaccine-induced T cells with memory attributes. Results The addition of rapamycin to all vaccination approaches was safe and well tolerated. Immediate (days 1–14 postvaccination) or delayed (days 15–28 postvaccination) administration of rapamycin led to a significant increase in the generation of vaccine-induced NY-ESO-1-specific T cells exhibiting central memory phenotypes (CD45RO+CD45RA− CCR7+). Moreover, delayed administration resulted in a greater than threefold (p=0.025) and eightfold (p=0.005) increase in the frequency of NY-ESO-1-specific CD4+ T and CD8+ T cells respectively at the time of long-term follow-up, compared with its immediate usage. Conclusion Our novel finding is that delayed administration of rapamycin to patients during the contraction phase of vaccine-induced antitumor immune responses was particularly effective in increasing the frequency of memory T cells up to 1 year postvaccination in patients with solid tumors. Further studies are warranted to identify the impact of this approach on the durability of clinical remission. Trial registration number NCT00803569, NCT01536054, NCT01522820.