A Phase I Trial of Dendritic Cell Vaccination With and Without Inhibition of Myeloid Derived Suppressor Cells by Gemcitabine Pre-Treatment For Children And Adults With Sarcoma
This is a dose finding / dose escalation study of dendritic cell (DC) vaccination
administered through imiquimod (Aldara®) treated skin for refractory sarcoma patients, which
includes a subsequent cohort of subjects who will receive DC and gemcitabine (Gemzar®)
therapy. There are three intended dose levels for cell number of DC per treatment - 3, 6 and
12 million cells per treatment. There will be 5 subjects accrued per dose level. If one
subject in the first 5 patients per dose level experiences a dose limiting toxicity (DLT),
then the dose level will be expanded to 8 subjects. If 2 or more of the subjects at a given
dose level experience a DLT, then the maximum tolerated dose (MTD) will be considered to
have been exceeded. The MTD will be the cell dose level at which less than 1 in 5 or less
than 2 in 8 subjects experience a DLT. Provision will be made to de-escalate to dose level
0, or 1.5 million cells per treatment, should dose level 1 be too toxic. This is a 5+3
design modified from the conventional 3+3 dose escalation schema used for testing cytotoxic
agents in Phase I trials. A lower rate of DLTs is therefore potentially to be accepted on
this study than on such a conventional dose escalation trial of a cytotoxic agent. If no MTD
is reached, we will consider the third dose level to be the recommended phase 2 dose (RP2D)
going forward and expand this dose level to 8 subjects in total.
After the MTD/RP2D is reached, we will commence with the addition of gemcitabine
pre-treatment to the study therapy with the cell dose held at the dose determined for the DC
alone. This will include weekly gemcitabine infusion for three weeks out of four before the
initiation of vaccination. Gemcitabine treatment will commence as soon as the subject has
safely recovered from pheresis, but within 2 weeks of completion of pheresis. DC vaccination
will begin two weeks after the third administration of gemcitabine. Gemcitabine dosing will
be constant, but should the combination of gemcitabine with the MTD/RP2D of DC alone prove
too toxic, we will de-escalate the dose of DC on the gemcitabine containing levels. This
de-escalation will mirror the dose escalation for DC alone, and the MTD for the DC plus
gemcitabine will be defined as the dose level at which less than 1 in 5 or less than 2 in 8
subjects experience a DLT.
At least two children, defined as subjects who were initially diagnosed with sarcoma before
the age of 21 years, must be included on each dose level to insure that the experience is
representative of the distribution of age levels found in sarcoma patients.
Subjects will undergo resection of tumor followed by pheresis to acquire monocytes which
will be separated and used to grow out DC. Subjects not undergoing gemcitabine therapy will
begin vaccination approximately two weeks after pheresis, depending on the manufacture time
of their DC. All subjects will undergo lysate boost administration.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Number of Participants with Adverse Events as a Measure of Safety and Tolerability
To demonstrate that DC vaccination loaded with tumor lysate is feasible and that therapy with the vaccine with topical imiquimod (as final step in vaccine maturation), with or without the inhibition of MDSC by gemcitabine pre-treatment, is safe in pediatric and adult subjects with metastatic and refractory sarcoma.
3 years
Yes
John Goldberg, MD
Principal Investigator
University of Miami Sylvester Comprehensive Cancer Center
United States: Institutional Review Board
EPROST-20110462
NCT01803152
July 2012
July 2015
Name | Location |
---|---|
University of Miami Sylvester Comprehensive Cancer Center | Miami, Florida 33136 |