Vaccine Therapy in Treating Patients With Liver or Lung Metastases From Colorectal Cancer

NCT ID: NCT00103142

Last Updated: 2015-10-14

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 74 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2005-02-28
• Study Completion Date: 2013-03-31

Brief Summary

RATIONALE: Vaccines made from a gene-modified virus and a person's white blood cells may make the body build an effective immune response to kill tumor cells. Biological therapies, such as Granulocyte-macrophage colony-stimulating factor (GM-CSF), may stimulate the immune system in different ways and stop tumor cells from growing. Combining different types of biological therapies may kill more tumor cells.

PURPOSE: This randomized phase II trial is studying giving vaccine therapy together with dendritic cells to see how well it works compared to giving vaccine therapy together with GM-CSF in treating patients with liver or lung metastases from colorectal cancer removed by surgery.

Detailed Description

OBJECTIVES:

Primary

• Compare 2-year disease-free survival of patients with completely resected hepatic or pulmonary metastases secondary to colorectal cancer treated with adjuvant vaccine therapy comprising vaccinia-Carcinoembryonic antigen (CEA)-mucin 1 (MUC-1)- Triad of costimulatory molecules TRICOM vaccine (PANVAC-V) and fowlpox-CEA-MUC-1-TRICOM vaccine (PANVAC-F) administered with autologous dendritic cells or with sargramostim (GM-CSF).

Secondary

• Compare the rate and magnitude of immune response, as determined by enzyme-linked immunosorbent spot (ELISpot), in patients treated with these regimens.

OUTLINE: This is a randomized study. Patients are randomized to 1 of 2 treatment arms.

• Arm I: Patients undergo leukapheresis to obtain leukocytes for generation of autologous dendritic cells (DC). Patients then receive autologous DC loaded with vaccinia-CEA-MUC-1-TRICOM (PANVAC-V) vaccine subcutaneously (SC) and intradermally (ID) on day 1 and autologous DC loaded with fowlpox-CEA-MUC-1-TRICOM (PANVAC-F) vaccine subcutaneously (SC) and intradermally (ID) on days 28, 56, and 84.
• Arm II: Patients receive PANVAC-V SC on day 1 and PANVAC-F SC on days 28, 56, and 84. Patients also receive sargramostim (GM-CSF) SC into the same injection site once daily on days 0-3, 28-31, 56-59, and 84-87.

After completion of study treatment, patients are followed for 2 years.

PROJECTED ACCRUAL: A total of 72 patients (36 per treatment arm) will be accrued for this study within 2 years.

Conditions

Colorectal Cancer; Metastatic Cancer

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

PANVAC-V + PANVAC-F + DC

Patients undergo leukapheresis to obtain leukocytes for generation of autologous dendritic cells (DC). Patients then receive autologous DC loaded with vaccinia-CEA-MUC-1-TRICOM (PANVAC-V) vaccine subcutaneously (SC) and intradermally (ID) on day 1 and autologous DC loaded with fowlpox-CEA-MUC-1-TRICOM (PANVAC-F) vaccine SC and ID on days 28, 56, and 84.

Group Type: EXPERIMENTAL

falimarev

Intervention Type: BIOLOGICAL

Given subcutaneously and intradermally

inalimarev

Intervention Type: BIOLOGICAL

Given subcutaneously and intradermally

therapeutic autologous dendritic cells

Intervention Type: BIOLOGICAL

Given subcutaneously and intradermally

PANVAC-V + PANVAC-F + GM-CSF

Patients receive PANVAC-V SC on day 1 and PANVAC-F SC on days 28, 56, and 84. Patients also receive sargramostim (GM-CSF) SC into the same injection site once daily on days 0-3, 28-31, 56-59, and 84-87.

Group Type: EXPERIMENTAL

falimarev

Intervention Type: BIOLOGICAL

Given subcutaneously and intradermally

inalimarev

Intervention Type: BIOLOGICAL

Given subcutaneously and intradermally

sargramostim

Intervention Type: BIOLOGICAL

Given subcutaneously

Interventions

falimarev

Given subcutaneously and intradermally

Intervention Type: BIOLOGICAL

inalimarev

Given subcutaneously and intradermally

Intervention Type: BIOLOGICAL

sargramostim

Given subcutaneously

Intervention Type: BIOLOGICAL

therapeutic autologous dendritic cells

Given subcutaneously and intradermally

Intervention Type: BIOLOGICAL

Eligibility Criteria

Inclusion Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed hepatic or pulmonary metastases secondary to adenocarcinoma of the colon and rectum
• Must have undergone complete resection of hepatic or pulmonary metastases with curative intent

• No evidence of gross residual disease after surgery
• One or more resected and ablated lesions allowed provided all gross residual tumor was destroyed by ablation
• Repeated resections of hepatic metastatic disease or resections of extrahepatic metastases prior to resection of the hepatic metastases allowed provided the most recent hepatic metastatic resection included total disease resection and/or ablation
• Must have received at least 2 months of perioperative systemic chemotherapy (including preoperative and/or postoperative chemotherapy) that was completed at least 1 month ago

PATIENT CHARACTERISTICS:

Age

• At least 18

Performance status

• Karnofsky 70-100%

Life expectancy

• At least 6 months

Hematopoietic

• Platelet count ≥ 75,000/mm^3
• Hemoglobin ≥ 8.5 g/dL (transfusion or epoetin alfa allowed)

Hepatic

• Bilirubin ≤ 2.0 mg/dL
• Hepatitis B surface antigen negative
• Hepatitis C antibody negative
• No other serious chronic or acute hepatic disease

Renal

• Creatinine ≤ 1.5 mg/dL OR
• Creatinine clearance > 60 mL/min

Cardiovascular

• No New York Heart Association class III or IV cardiac disease
• No other serious chronic or acute cardiac disease

Pulmonary

• No asthma
• No chronic obstructive pulmonary disease
• No other serious chronic or acute pulmonary disease

Immunologic

• No history of autoimmune disease, including, but not limited to, any of the following:

• Inflammatory bowel disease
• Systemic lupus erythematosus
• Ankylosing spondylitis
• Scleroderma
• Multiple sclerosis
• No human immunodeficiency virus (HIV) infection by enzyme-linked immunosorbent assay (ELISA) and western blot
• Not immunocompromised (by disease or therapy)
• No allergy to eggs or any component of the study vaccine
• No history of allergy or untoward reaction to prior vaccinia (smallpox) vaccination
• No allergy or untoward reaction to sargramostim (GM-CSF)
• No active acute or chronic infection, including urinary tract infection within the past 72 hours
• No inflammatory bowel conditions, including, but not limited to, the following:

• Active infectious enteritis
• Eosinophilic enteritis
• No acute, chronic, or exfoliative skin disorders, including any of the following:

• Extensive psoriasis
• Burns
• Impetigo
• Disseminated zoster
• Varicella zoster
• Severe acne
• Other open rashes or wounds

Other

• Not pregnant or nursing
• Fertile patients must use effective contraception
• Able to avoid close contact or household contact for 3 weeks after each vaccination with the following individuals:

• Children under 5 years of age
• Pregnant or nursing women
• Individuals with prior or concurrent extensive eczema, other eczematoid skin disorders, or other acute or chronic skin conditions
• Immunosuppressed or immunodeficient individuals
• No medical or psychological condition that would preclude study compliance
• No extensive eczema
• No other serious chronic or acute illness that would preclude study participation
• No other malignancy within the past 5 years except nonmelanoma skin cancer, controlled superficial bladder cancer, or previously treated carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No other concurrent immunotherapy

Chemotherapy

• See Disease Characteristics
• No concurrent chemotherapy

Endocrine therapy

• More than 6 weeks since prior and no concurrent steroid therapy

Radiotherapy

• No concurrent radiotherapy

Surgery

• See Disease Characteristics

Other

• No other concurrent immunosuppressants (e.g., azathioprine or cyclosporine)

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

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

Michael Morse, MD

OTHER

Sponsor Role: lead

Responsible Party

Michael Morse, MD

Professor of Medicine

Responsibility Role: SPONSOR_INVESTIGATOR

Principal Investigators

Michael A. Morse, MD

Role: STUDY_CHAIR

Duke Cancer Institute

Locations

Lombardi Comprehensive Cancer Center at Georgetown University Medical Center

Washington D.C., District of Columbia, United States

H. Lee Moffitt Cancer Center and Research Institute at University of South Florida

Tampa, Florida, United States

Duke Comprehensive Cancer Center

Durham, North Carolina, United States

Wake Forest University Baptist Medical Center

Winston-Salem, North Carolina, United States

Providence Cancer Center at Providence Portland Medical Center

Portland, Oregon, United States

Hollings Cancer Center at Medical University of South Carolina

Charleston, South Carolina, United States

Countries

United States

References

Morse MA, Niedzwiecki D, Marshall JL, Garrett C, Chang DZ, Aklilu M, Crocenzi TS, Cole DJ, Dessureault S, Hobeika AC, Osada T, Onaitis M, Clary BM, Hsu D, Devi GR, Bulusu A, Annechiarico RP, Chadaram V, Clay TM, Lyerly HK. A randomized phase II study of immunization with dendritic cells modified with poxvectors encoding CEA and MUC1 compared with the same poxvectors plus GM-CSF for resected metastatic colorectal cancer. Ann Surg. 2013 Dec;258(6):879-86. doi: 10.1097/SLA.0b013e318292919e.

Reference Type: DERIVED

PMID: 23657083 (View on PubMed)

Other Identifiers

DUMC-5883-04-6RO

Identifier Type: OTHER

Identifier Source: secondary_id

CDR000041079

Identifier Type: OTHER

Identifier Source: secondary_id

Pro00007616

Identifier Type: -

Identifier Source: org_study_id