A Trial of Vigil for Participants With Ovarian Cancer

NCT02346747Active, Not RecruitingPHASE2INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Gradalis, Inc.

Enrollment

92

Start Date

2015-02-01

Completion Date

2028-12-01

Study Type

INTERVENTIONAL

Official Title

A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial of Vigil Engineered Autologous Tumor Cell Immunotherapy in Subjects With Stage IIIb-IV Ovarian Cancer in Clinical Complete Response Following Surgery and Primary Chemotherapy

Interventions

VigilPlacebo

Conditions

Ovarian CancerOvarian Neoplasms

Eligibility

Age Range

18 Years+

Sex

FEMALE

Inclusion Criteria

Subjects will be eligible for tissue procurement for the Vigil manufacturing process if they meet all of the following criteria:

1. Presumptive Stage IIIb, IIIc or IV high-grade papillary serous/clear cell/endometrioid ovarian, fallopian tube or primary peritoneal cancer.
2. No chemotherapy prior or investigational agents prior to tissue acquisition for Vigil manufacture.
3. No other malignancy (excluding surgically cured nonmelanoma carcinomas of the skin and carcinoma in situ cervix) unless in remission for ≥ 2 years.
4. Anticipated availability of a cumulative mass of \~30 grams tissue ("golf-ball" size or approximately 3cm disease on CT scan) at time of diagnostic laparoscopy or primary surgical debulking. Infiltrating lumen (bowel, fallopian tube, urethra) tissue should not be used as Vigil immunotherapy material to minimize risk of bacterial contamination.
5. ECOG performance status (PS) 0-2 prior to diagnostic laparoscopy or debulking laparotomy.
6. No prior history of hypersensitivity reactions (HSR) with taxanes or platinums.
7. No prior history of allergies or sensitivities to gentamicin.
8. Female, 18 years of age or older.
9. Ability to understand and the willingness to sign a written informed consent document for tissue harvest.

Subjects will be registered in this study if they meet all of the following inclusion criteria:

1. Histologically confirmed Stage IIIb, IIIc or IV high-grade papillary serous/clear cell/endometrioid ovarian, fallopian tube or primary peritoneal.
2. Completion of primary surgical debulking including hysterectomy and bilateral salpingo oophorectomy, and at least 5 but no more than 8 cycles of platinum / taxane adjuvant chemotherapy or chemotherapy as per Category 1 recommendations of the NCCN guidelines, including 5-8 cycles adjuvant intraperitoneal + intravenous (IP/IV) chemotherapy, or 5-8 cycles of intravenous chemotherapy divided and administered as neoadjuvant and adjuvant therapy flanking primary debulking surgery.
3. Clinically defined complete response (cCR) following completion of primary surgical debulking and eligible chemotherapy. cCR defined as no evidence of malignancy on chest x-ray (CT scan is acceptable) and CT scan or MRI of the abdomen and pelvis, normal physical examination, CA-125 antigen level ≤ 35 U/ml (assessed ≥ 2 weeks following removal of catheter in subjects receiving intraperitoneal/intravenous chemotherapy) and no findings on physical examination or symptoms suggestive of active cancer.
4. Subjects must have initiated adjuvant chemotherapy no more than 8 weeks following primary debulking surgery.
5. Successful manufacturing of at least 4 doses (vials) of Vigil and placebo.
6. Recovered from all clinically relevant toxicities related to prior therapy (including neuropathy ≤Grade 2).
7. ECOG performance status (PS) 0-1.
8. Normal organ and marrow function as defined below: Absolute granulocyte count ≥ 1,500/mm\^3, Absolute lymphocyte count ≥ 500/mm\^3, Platelets ≥ 75,000/mm\^3, Total bilirubin ≤ 2 mg/dL, AST(SGOT)/ALT(SGPT)≤ 2x institutional upper limit of normal, Creatinine \< 1.5 mg/dL
9. Ability to understand and the willingness to sign a written informed protocol specific consent.

Exclusion Criteria:

Subjects will be excluded from this study if they meet any of the following criteria (at the time of tissue procurement or at randomization):

1. Surgery involving general anesthesia, radiotherapy, immunotherapy, or investigational agents within 4 weeks prior to randomization.
2. Histologically confirmed papillary serous adenocarcinoma of the uterus or disease involving myometrium/endometrium.
3. Systemic immunosuppressive therapy within 14 days of randomization.
4. Subjects requiring chronic steroid or immunosuppressive regimens are excluded except inhaled / intranasal steroids and short term systemic steroids \<30 days duration and ≤0.25 mg/kg prednisone-equivalent per day are allowed.
5. Congestive heart failure (NYHA Class II, III, or IV), unstable angina, ventricular or hemodynamically significant atrial arrhythmia, or cardiovascular disease such as stroke or myocardial infarction (current or within the past 6 months).
6. Psychiatric illness/social situations that would limit compliance with study requirements.
7. Subjects with history of brain metastases.
8. Subjects with known HIV or chronic Hepatitis B or C infection.
9. Prior solid organ or bone marrow transplant.
10. History of or active autoimmune disease (e.g., autoimmune neutropenia, thrombocytopenia, or hemolytic anemia, systemic lupus erythematosus, Sjogren's syndrome, scleroderma, myasthenia gravis, Goodpasture's syndrome, Addison's disease, Hashimoto's thyroiditis, or Graves disease). Persons with vitiligo are not excluded. Diabetics are not excluded if the condition is well controlled.

Outcome Measures

Primary Outcomes

Recurrence Free Survival (RFS)

Disease recurrence will be evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 by local and central radiology. RFS is defined as the time from randomization or from surgery/procurement to the event of disease recurrence/progression or death due to any cause.

Time frame: Time from randomization date to either the date of first recurrence or the date of death if the participant dies prior to recurrence, assessed up to 10 years.

Secondary Outcomes

Overall survival (OS)

OS is defined as the time from randomization to date of death due to any cause.

Time frame: OS will be evaluated from time of randomization until date of death can be obtained, assessed up to 10 years.

Locations

University of South Alabama Mitchell Cancer Institute, Mobile, United States

Southern California Permanente Medical Group, Irvine, United States

Palo Alto Foundation Medical Group, San Francisco, United States

University Of Miami Sylvester Comprehensive Cancer Center, Miami, United States

Moffitt Cancer Center, Tampa, United States

Florida Cancer Specialists, West Palm Beach, United States

Georgia Cancer Center at Augusta University, Augusta, United States

University Of Kentucky Markey Cancer Center, Lexington, United States

Maine Medical Center: MMP Women's Health, Scarborough, United States

Dana Farber Cancer Institute: Gynecologic Oncology, Boston, United States

Henry Ford Health System, Detroit, United States

Billings Clinic, Billings, United States

Nebraska Methodist Hospital, Omaha, United States

Dartmouth-Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, United States

University of New Mexico Cancer Center, Albuquerque, United States

Duke University Medical Center, Department of Medicine - Oncology, Durham, United States

Barrett Cancer Center University of Cincinnati Medical Center, Cincinnati, United States

Stephenson Cancer Center at University of Oklahoma, Oklahoma City, United States

AMD Asplundh Cancer Pavilion, Abington, United States

St. Luke's Health Network, Bethlehem, United States

Fox Chase Cancer Center, Philadelphia, United States

Prisma Health Cancer Institute, Greenville, United States

Mary Crowley Cancer Research Centers, Dallas, United States

University of Texas Southwestern Medical Center, Dallas, United States

Cancer Care Northwest, Spokane, United States

Franciscan Research Center, Tacoma, United States

Linked Papers

Gemogenovatucel-T (Vigil) immunotherapy as maintenance in frontline stage III/IV ovarian cancer (VITAL): a randomised, double-blind, placebo-controlled, phase 2b trial

Gemogenovatucel-T is an autologous tumour cell vaccine manufactured from harvested tumour tissue, which specifically reduces expression of furin and downstream TGF-β1 and TGF-β2. The aim of this study was to determine the safety and efficacy of gemogenovatucel-T in front-line ovarian cancer maintenance. This randomised, double-blind, placebo-controlled, phase 2b trial involved 25 hospitals in the USA. Women aged 18 years and older with stage III/IV high-grade serous, endometrioid, or clear cell ovarian cancer in clinical complete response after a combination of surgery and five to eight cycles of chemotherapy involving carboplatin and paclitaxel, and an Eastern Cooperative Oncology Group status of 0 or 1 were eligible for inclusion in the study. Patients were randomly assigned (1:1) to gemogenovatucel-T or placebo by an independent third party interactive response system after successful screening using randomly permuted block sizes of two and four and stratified by extent of surgical cytoreduction and neoadjuvant versus adjuvant chemotherapy. Gemogenovatucel-T (1 × 10 Between Feb 11, 2015, and March 2, 2017, 310 patients consented to the study at 22 sites. 217 were excluded. 91 patients received gemogenovatucel-T (n=47) or placebo (n=44) and were analysed for safety and efficacy. The median follow-up from first dose of gemogenovatucel-T was 40·0 months (IQR 35·0-44·8) and from first dose of placebo was 39·8 months (35·5-44·6). Recurrence-free survival was 11·5 months (95% CI 7·5-not reached) for patients assigned to gemogenovatucel-T versus 8·4 months (7·9-15·5) for patients assigned to placebo (HR 0·69, 90% CI 0·44-1·07; one-sided p=0·078). Gemogenovatucel-T resulted in no grade 3 or 4 toxic effects. Two patients in the placebo group had five grade 3 toxic events, including arthralgia, bone pain, generalised muscle weakness, syncope, and dyspnea. Seven patients (four in the placebo group and three in the gemogenovatucel-T group) had 11 serious adverse events. No treatment-related deaths were reported in either of the groups. Front-line use of gemogenovatucel-T immunotherapy as maintenance was well tolerated but the primary endpoint was not met. Further investigation of gemogenovatucel-T in patients stratified by BRCA mutation status is warranted. Gradalis.

A Trial of Vigil for Participants With Ovarian Cancer