Ipilimumab and Sargramostim in Treating Patients With Metastatic Prostate Cancer

NCT ID: NCT00064129

Last Updated: 2020-07-30

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 42 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2003-05-13
• Study Completion Date: 2012-10-01

Brief Summary

This phase I trial is studying the side effects and best dose of ipilimumab when given with sargramostim in treating patients with metastatic prostate cancer. Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Colony-stimulating factors, such as sargramostim, may increase the number of immune cells found in bone marrow or peripheral blood and may help a person's immune system kill more tumor cells.

Detailed Description

PRIMARY OBJECTIVES:

I. Determine the maximum tolerated dose of anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) (ipilimumab) administered with sargramostim (GM-CSF) in patients with metastatic androgen-independent prostate cancer. (Phase I) II. Determine the safety of this regimen in these patients. (Phase I) III. Evaluate the efficacy as measured by reduction in PSA associated with combining GM-CSF with CTLA-4 blockade with ipilimumab at a dosage of 3 mg/kg given monthly x 6 doses (d1 of courses 1-6). (Cohort Expansion)

SECONDARY OBJECTIVES:

I. Determine the T-cell immunity and T-cell response in patients treated with this regimen. (Phase I) II. Determine the pharmacokinetics of MDX-010 in these patients. (Phase I) III. Determine the prostate-specific antigen and/or objective responses in patients treated with this regimen. (Phase I) IV. Determine the percentages of activated, naive, and memory T-cells. (Cohort Expansion) V. Determine the measurement of T-cell response to describe epitopes from prostate antigens including PSA, PSMA, and PAP. (Cohort Expansion) VI. Quantitate T-cell response to antigens in patients with relevant HLA allele using HLA*0201 tetramers. (Cohort Expansion) VII. Evaluate the toxicity of this regimen in these patients. (Cohort Expansion) VIII. Determine the initial efficacy as measured by reduction in PSA associated with combining GM-CSF with CTLA-4 blockade with ipilimumab at a dosage of 3 mg/kg given monthly x 6 doses (d1 of courses 1-6). (Cohort Expansion) IX. Determine objective response by post-therapy measurable disease changes using RECIST criteria. (Cohort Expansion)

OUTLINE: This is a multicenter, dose-escalation study of ipilimumab.

Patients receive ipilimumab intravenously (IV) over 90 minutes on day 1 and sargramostim (GM-CSF) subcutaneously (SC) on days 1-14. Treatment repeats every 28 days for 4-6 courses. GM-CSF continues beyond 4 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of ipilimumab until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Some patients undergo blood sample collection periodically for laboratory and pharmacokinetic studies. Samples are analyzed for human anti-human antibodies, IgG antibodies to ipilimumab semi-quantitative ELISA assay, and plasma concentrations of ipilimumab via quantitative ELISA assay.

Patients are followed at 30 days.

Conditions

Recurrent Prostate Carcinoma; Stage IV Prostate Cancer AJCC v7

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Treatment (monoclonal antibody, colony-stimulating factors)

Patients receive ipilimumab IV over 90 minutes on day 1 and sargramostim (GM-CSF) SC on days 1-14. Treatment repeats every 28 days for 4-6 courses. GM-CSF continues beyond 4 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of ipilimumab until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Some patients undergo blood sample collection periodically for laboratory and pharmacokinetic studies. Samples are analyzed for human anti-human antibodies, IgG antibodies to ipilimumab semi-quantitative ELISA assay, and plasma concentrations of ipilimumab via quantitative ELISA assay.

Group Type: EXPERIMENTAL

Ipilimumab

Intervention Type: BIOLOGICAL

Given IV

Laboratory Biomarker Analysis

Intervention Type: OTHER

Correlative studies

Pharmacological Study

Intervention Type: OTHER

Correlative studies

Sargramostim

Intervention Type: BIOLOGICAL

Given SC

Interventions

Ipilimumab

Given IV

Intervention Type: BIOLOGICAL

Laboratory Biomarker Analysis

Correlative studies

Intervention Type: OTHER

Pharmacological Study

Correlative studies

Intervention Type: OTHER

Sargramostim

Given SC

Intervention Type: BIOLOGICAL

Other Intervention Names

Anti-Cytotoxic T-Lymphocyte-Associated Antigen-4 Monoclonal Antibody; BMS-734016; MDX-010; MDX-CTLA4; Yervoy; 23-L-Leucinecolony-Stimulating Factor 2; DRG-0012; Leukine; Prokine; rhu GM-CFS; Sagramostim; Sargramostatin

Eligibility Criteria

Inclusion Criteria

• Histologically confirmed prostate cancer

• Metastatic disease
• Progressive disease after prior androgen deprivation as defined by at least 1 of the following criteria:

• Patients with measurable disease must have an increase of at least 20% in the sum of the longest diameter of target lesions OR the appearance of 1 or more new lesions
• Patients with nonmeasurable disease must have a positive bone scan and a prostate-specific antigen (PSA) level of at least 5 ng/mL, which has risen on at least 2 successive occasions at least 2 weeks apart*

• At least 1 PSA level must be obtained at least 4 weeks after flutamide (6 weeks after bicalutamide or nilutamide)
• Testosterone no greater than 50 ng/dL

• Patients with no prior orchiectomy must continue luteinizing hormone-releasing hormone agonist therapy
• No history or radiologic evidence of CNS metastases
• Performance status - ECOG 0-2
• At least 12 weeks
• Absolute neutrophil count greater than 1,500/mm^3
• Platelet count at least 100,000/mm^3
• Hemoglobin at least 8 g/dL
• Bilirubin less than 1.5 times upper limit of normal (ULN)
• SGOT and SGPT no greater than 2.5 times ULN
• Creatinine no greater than 1.5 times ULN
• No significant cardiovascular disease
• No New York Heart Association class III or IV congestive heart failure
• No active angina pectoris
• No myocardial infarction within the past 6 months
• Not pregnant or nursing
• Fertile patients must use effective contraception prior to, during, and for 3 months after study participation
• No history of autoimmune disease including, but not limited to, any of the following:

• Autoimmune hemolytic anemia
• Ulcerative and hemorrhagic colitis
• Endocrine disorders (e.g., thyroiditis, hyperthyroidism, hypothyroidism of immune etiology, autoimmune hypophysitis/hypopituitarism, or adrenal insufficiency)
• Sarcoid granuloma
• Myasthenia gravis
• Polymyositis
• Guillain-Barre syndrome
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Inflammatory bowel disease
• No other medical or psychiatric illness that would preclude study participation or giving informed consent
• No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer or stage I or II cancer currently in complete remission
• No prior immunotherapy (e.g., vaccines or investigational)
• No other concurrent colony-stimulating factors
• No prior chemotherapy
• No concurrent chemotherapy
• See Disease Characteristics
• At least 4 weeks since prior systemic corticosteroids
• At least 4 weeks since other prior hormonal therapy, including megestrol and finasteride
• No concurrent systemic steroid therapy except inhaled or topical steroids
• No other concurrent hormonal therapy

• Hormones administered for nondisease-related conditions (e.g., insulin for diabetes) allowed
• At least 4 weeks since prior radiotherapy and recovered
• More than 8 weeks since prior radiopharmaceuticals (e.g., strontium chloride Sr 89 and samarium Sm 153 lexidronam pentasodium)
• Prior irradiation of a symptomatic lesion or one that may produce disability (e.g., unstable femur) allowed
• No concurrent palliative radiotherapy
• See Disease Characteristics
• At least 4 weeks since prior herbal products known to decrease PSA levels (e.g., PC-SPES or saw palmetto)

• Minimum Eligible Age: 18 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Eric J Small

Role: PRINCIPAL_INVESTIGATOR

UCSF Medical Center-Mount Zion

Locations

UCSF Medical Center-Mount Zion

San Francisco, California, United States

Countries

United States

References

Cham J, Zhang L, Kwek S, Paciorek A, He T, Fong G, Oh DY, Fong L. Combination immunotherapy induces distinct T-cell repertoire responses when administered to patients with different malignancies. J Immunother Cancer. 2020 May;8(1):e000368. doi: 10.1136/jitc-2019-000368.

Reference Type: DERIVED

PMID: 32376721 (View on PubMed)

Kavanagh B, O'Brien S, Lee D, Hou Y, Weinberg V, Rini B, Allison JP, Small EJ, Fong L. CTLA4 blockade expands FoxP3+ regulatory and activated effector CD4+ T cells in a dose-dependent fashion. Blood. 2008 Aug 15;112(4):1175-83. doi: 10.1182/blood-2007-11-125435. Epub 2008 Jun 3.

Reference Type: DERIVED

PMID: 18523152 (View on PubMed)

Other Identifiers

NCI-2009-00036

Identifier Type: REGISTRY

Identifier Source: secondary_id

UCSF-02558

Identifier Type: -

Identifier Source: secondary_id

CDR0000309054

Identifier Type: -

Identifier Source: secondary_id

NCI-6032

Identifier Type: -

Identifier Source: secondary_id

02558

Identifier Type: OTHER

Identifier Source: secondary_id

6032

Identifier Type: OTHER

Identifier Source: secondary_id

NCI-2009-00036

Identifier Type: -

Identifier Source: org_study_id

NCT01648361

Identifier Type: -

Identifier Source: nct_alias