A Phase 1 Open Label, Dose Escalation Study to Evaluate the Effect of Four Doses of MAGE-A3/HPV 16 Trojan Peptides 0001 and 0002 Administered Subcutaneously in Combination With Montanide and GM-CSF on Immunological Response, Safety, Tolerability, and Preliminary Efficacy in Patients With Squamous Cell Carcinoma of the Head and Neck
Squamous Cell Carcinoma of the Head and Neck affects 43,000 individuals in the United States
annually with an estimated overall survival rate of 50%. In order to improve both the
survival rate and quality of life for patients who develop unresectable disease recurrence,
new therapeutic alternatives are mandated. One potential treatment alternative for this
patient population is the use of peptide-based immunotherapy. Despite the success fo
preclinical studies using peptide vaccines, therapeutic responses in patients have been
sporadic. The reasons for failure are multifactorial and include problems with patient
selection, a limited number of antigenic targets, and an inability to correlate immunologic
response with therapeutic efficacy. Specifically, patients with disseminated SCCHN have
defects in antigen processing, presentation and effector mechanisms that limit their ability
to respond to T cell based immunotherapy. Additionally, a paucity of antigenic peptide
epitopes are defined for SCCHN, and immunologic monitoring does not correlate well with
clinical response.
Recently several investigators, including our research team, have identified a high
prevalence of MAGE-A3 and HPV 16 on SCCHN, and characterized several putative cytolytic and
helper epitopes. Additionally, we have defined a novel method to enhance the immune response
to therapeutic peptide vaccines using Trojan complexes composed of CD4 and CD8 T-cell
epitopes, connected by furin cleavable linkers.
In order to define the feasibility and safety of these agents in combination with GM-CSF and
montanide ISA 51 for the immunotherapy of SCCHN, in this proposed trial, we will screen
patients for immunologic competence based on specific eligibility criteria including both
antigen and HLA-A2 expression on tumors. In registered patients, we will test the ability of
two novel Trojan peptide complexes, composed of MAGE-A3 and human papilloma virus 16 (HPV
16) epitopes, to stimulate antigen-specific CD 4 and CD 8 T-cell responses. Finally, we will
correlate immunologic response with cell dose and the generation of both HPV 16 and MAGE-A3
antigen loss and HLA-A2 loss variants on tumors by evaluating patients for: 1) Changes in
tumor size by both physical measurement and CT plus PET measurement; 2) Determining what
proportions of individuals who achieve a complete response (CR), partial response (PR), or
have stable disease (SD); 3) Progression-free survival; 4) Survival. Successful completion
of this clinical trial will result in the development of a strong foundation for a Phase
II/III clinical trial using HPV 16 and MAGE-A3 Trojan peptides for the immunotherapy of
SCCHN.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Toxicity: Maximum grade of each toxicity and percentage of patients experiencing toxicity.
1 year
No
Martin J. Edelman, MD
Principal Investigator
University of Maryland, Greenebaum Cancer Ctr
United States: Food and Drug Administration
HP-00041372
NCT00257738
November 2005
December 2011
Name | Location |
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University of Maryland School of Medicine | Baltimore, Maryland 21201-1619 |