Testing a Combination of Vaccines for Cancer Prevention in Lynch Syndrome

NCT ID: NCT05419011

Last Updated: 2026-02-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE2

Total Enrollment

186 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-08

Study Completion Date

2028-01-01

Brief Summary

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This phase IIb trial tests whether Tri-Ad5 in combination with N-803 works to prevent colon and other cancers in participants with Lynch syndrome. Each of the three injections in Tri-Ad5 vaccine contain a different substance that is in precancer and cancer cells. Injecting these substances may cause the immune system to develop a defense against cancer that recognizes and destroys any precancer and cancer cells that produce these proteins in the future. N-803 may increase immune responses to other vaccines. Giving Tri-Ad5 in combination with immune enhancing N-803 may lower the chance of developing colon and other cancers in participants with Lynch syndrome.

Detailed Description

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PRIMARY OBJECTIVE:

I. To evaluate if the combination of trivalent adenovirus-5 (Tri-Ad5) vaccines and IL-15 superagonist nogapendekin alfa inbakicept (N-803) reduces the incidence of colorectal neoplasms in patients with Lynch syndrome (LS).

SECONDARY OBJECTIVES:

I. To evaluate the safety and tolerability of the Tri-Ad5 vaccines + N-803 in combination.

II. To correlate clinical factors such as use of aspirin and non-steroidal anti-inflammatory drugs (NSAID), smoking and alcohol intake with immune responses.

III. To evaluate the effect of Tri-Ad5 vaccines on the incidence of LS-related extracolonic cancers.

IV. To systematically measure the participants' behavior and experience in terms of vaccine uptake, cancer-specific distress and quality of life.

EXPLORATORY OBJECTIVES:

I. To determine the ability of the Tri-Ad5 vaccines + N-803 to generate a 2-fold increase in T cell responses (cell-mediated immunity) at week 12 (early immune response) and at week 56 (long-term memory response).

II. To evaluate circulating anti-MUC1 IgG (antibody-mediated immunity) after Tri-Ad5 vaccines + N-803.

III. To compare the expression of the three tumor associated antigen (TAAs): MUC1, carcinoembryonic antigen (CEA) and brachyury in colorectal neoplasms before and after Tri-Ad5 vaccines + N-803.

IV. To evaluate changes in the immune profile and abundance of resident immune cell types in colonic mucosa after vaccination with Tri-Ad5 vaccines + N-803 using messenger ribonucleic acid sequencing (mRNAseq) and immunohistochemistry (IHC).

V. To test the effects of the vaccines alone or in combination with N-803 on specific immune subsets of peripheral blood mononuclear cells (PBMCs) and serum soluble factors and cytokines.

VI. To compare the expression of stem cell markers in colorectal neoplasms before and after Tri-Ad5 vaccines + N-803.

VII. To compare the number of mismatch repair deficient (MMR-deficient) crypts at baseline to the number of MMR-deficient crypts at the one year post-vaccination colonoscopy both overall and on a per patient basis.

OUTLINE:

SAFETY PHASE I: Participants receive Tri-Ad5 subcutaneously (SC) at weeks 0, 4, 8, and 52. Participants also undergo standard of care (SOC) colonoscopy with biopsy at baseline, at 52 weeks and 104 weeks.

SAFETY PHASE II: Participants receive Tri-Ad5 SC and N-803 SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline, 52 weeks and 104 weeks.

RANDOMIZED CONTROL PHASE: Participants are randomized into 1 of two arms.

ARM I: Participants receive Tri-Ad5 SC and N-803 SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline and at 52 and 104 weeks.

ARM II: Participants receive placebo SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline and at 52 and 104 weeks.

Participants undergo blood sample collection throughout the study.

Conditions

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Colorectal Carcinoma Colorectal Neoplasm Lynch Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Arm I (Tri-Ad5, N-803)

Participants receive Tri-Ad5 SC and N-803 SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline and at 52 and 104 weeks. Participants undergo blood sample collection throughout the study.

Group Type EXPERIMENTAL

Adenovirus 5 CEA/MUC1/Brachyury Vaccine Tri-Ad5

Intervention Type BIOLOGICAL

Given SC

Biopsy Procedure

Intervention Type PROCEDURE

Undergo biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Colonoscopy

Intervention Type PROCEDURE

Undergo SOC colonoscopy

Nogapendekin Alfa

Intervention Type DRUG

Given nogapendekin alfa inbakicept (N-803) SC

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Arm II (placebo)

Participants receive placebo SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline and at 52 and 104 weeks. Participants undergo blood sample collection throughout the study.

Group Type PLACEBO_COMPARATOR

Biopsy Procedure

Intervention Type PROCEDURE

Undergo biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Colonoscopy

Intervention Type PROCEDURE

Undergo SOC colonoscopy

Placebo Administration

Intervention Type DRUG

Given SC

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Safety phase I (Tri-Ad5)

Participants receive Tri-Ad5 SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline and at 52 weeks and 104 weeks. Participants undergo blood sample collection throughout the study.

Group Type EXPERIMENTAL

Adenovirus 5 CEA/MUC1/Brachyury Vaccine Tri-Ad5

Intervention Type BIOLOGICAL

Given SC

Biopsy Procedure

Intervention Type PROCEDURE

Undergo biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Colonoscopy

Intervention Type PROCEDURE

Undergo SOC colonoscopy

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Safety phase II (Tri-Ad5 , N-803)

Participants receive Tri-Ad5 SC and N-803 SC at weeks 0, 4, 8, and 52. Participants also undergo SOC colonoscopy with biopsy at baseline and at 52 weeks and 104 weeks. Participants undergo blood sample collection throughout the study.

Group Type EXPERIMENTAL

Adenovirus 5 CEA/MUC1/Brachyury Vaccine Tri-Ad5

Intervention Type BIOLOGICAL

Given SC

Biopsy Procedure

Intervention Type PROCEDURE

Undergo biopsy

Biospecimen Collection

Intervention Type PROCEDURE

Undergo blood sample collection

Colonoscopy

Intervention Type PROCEDURE

Undergo SOC colonoscopy

Nogapendekin Alfa

Intervention Type DRUG

Given nogapendekin alfa inbakicept (N-803) SC

Questionnaire Administration

Intervention Type OTHER

Ancillary studies

Interventions

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Adenovirus 5 CEA/MUC1/Brachyury Vaccine Tri-Ad5

Given SC

Intervention Type BIOLOGICAL

Biopsy Procedure

Undergo biopsy

Intervention Type PROCEDURE

Biospecimen Collection

Undergo blood sample collection

Intervention Type PROCEDURE

Colonoscopy

Undergo SOC colonoscopy

Intervention Type PROCEDURE

Nogapendekin Alfa

Given nogapendekin alfa inbakicept (N-803) SC

Intervention Type DRUG

Placebo Administration

Given SC

Intervention Type DRUG

Questionnaire Administration

Ancillary studies

Intervention Type OTHER

Other Intervention Names

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Ad5 CEA/MUC1/Brachyury Vaccine Tri-Ad5 Ad5-CEA/Ad5-MUC1/Ad5-Brachyury Vaccine Tri-Ad5 Adenoviral CEA/MUC1/Brachyury Vaccine Tri-Ad5 Tri Ad5 Tri-Ad5 TriAd5 Biopsy BIOPSY_TYPE Bx Biological Sample Collection Biospecimen Collected Specimen Collection

Eligibility Criteria

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Inclusion Criteria

* Participants with LS defined as one of the following:

* Mutation positive: MLH1, MSH2/EPCAM and MSH6 genotypes with prior history of ≥1 colorectal neoplasms\*\* (tubular or tubulovillous adenoma\[s\] or sessile serrated polyps/adenomas/lesion\[s\] or traditional serrated adenoma\[s\]), and/or colorectal cancer\[s\] (but no active cancer for 6 months) OR
* PMS2 genotype with prior history of colon cancer(s) (but no active cancer for 6 months)

* Note: Should be confirmed by pathology report or letter from endoscopist to participant
* Participants must have at least part of the descending/sigmoid colon and/or rectum intact
* Participants must be at least 6 months from any cancer-directed treatment (such as surgical resection, chemotherapy, immunotherapy or radiation). Ongoing adjuvant endocrine therapy is allowed
* Participants \>= 18 years will be enrolled. Because the risk of LS related cancers is very low in participants \< 18 years of age, children and adolescents are excluded from this study
* Eastern Cooperative Oncology Group (ECOG) performance status =\< 1 (Karnofsky \>= 70%)
* Leukocytes \>= 3,000/microliter
* Absolute neutrophil count \>= 1,500/microliter
* Platelets \>= 100,000/microliter
* Total bilirubin =\< institutional upper limit of normal

* Note: Higher bilirubin levels (\<= 3 mg/dL) can be allowed if due to a known benign liver condition, i.e. Gilbert's
* Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 1.5 x institutional upper limit of normal
* Creatinine =\< institutional upper limit of normal or estimated glomerular filtration rate (eGFR) \>= 60 ml/min/1.73m\^2
* The effects of the Tri-Ad5 vaccines and N-803 on the developing human fetus at the recommended therapeutic dose are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately
* Ability to understand and the willingness to sign a written informed consent document
* Participants must be willing and able to space coronavirus disease (COVID) vaccines at least 2 weeks prior to and 2 weeks after receipt of study agent

Exclusion Criteria

* History of organ allograft or other history of immunodeficiency
* Known human immunodeficiency virus (HIV) with CD4 count \< 540, hepatitis B virus (HBV), or hepatitis C virus (HCV) infection. Subjects with laboratory evidence of cleared HBV and HCV infection will be permitted. Poorly controlled HIV may prevent an adequate immune response to the vaccine and will be an exclusion criterion
* Subjects requiring systemic treatment with corticosteroids (\> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 3 months of vaccination
* Participants may not be receiving any other investigational agents
* History of allergic reactions attributed to compounds of similar chemical or biologic composition to adenovirus-based vaccines and N-803
* Uncontrolled intercurrent illness or psychiatric illness/social situations that would limit compliance with study requirements
* Pregnant women are excluded from this study because of the unknown effects of the vaccine and N-803 on the fetus. Because there is an unknown but potential risk for adverse events (AEs) in nursing infants secondary to treatment of the mother with the vaccine plus N-803, breastfeeding should be discontinued if the mother is treated with the vaccine plus N-803
* History of untreated thrombotic disorders
* Participants who experienced severe side effects or allergic reactions to previous adenovirus-based vaccines (such as Johnson and Johnson COVID vaccine) will be excluded
* History of atrial fibrillation
* History of gastrointestinal hemorrhage and intracranial hemorrhage
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Cancer Institute (NCI)

NIH

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ajay Bansal

Role: PRINCIPAL_INVESTIGATOR

University of Kansas

Locations

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Mayo Clinic Hospital in Arizona

Phoenix, Arizona, United States

Site Status

University of Arizona Cancer Center - Prevention Research Clinic

Tucson, Arizona, United States

Site Status

UCSF Medical Center-Parnassus

San Francisco, California, United States

Site Status

University of Colorado

Denver, Colorado, United States

Site Status

Northwestern University

Chicago, Illinois, United States

Site Status

University of Kansas Cancer Center

Kansas City, Kansas, United States

Site Status

Dana-Farber Cancer Institute

Boston, Massachusetts, United States

Site Status

University of Michigan Rogel Cancer Center

Ann Arbor, Michigan, United States

Site Status

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Site Status

Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status

Ohio State University Comprehensive Cancer Center

Columbus, Ohio, United States

Site Status

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

Site Status

M D Anderson Cancer Center

Houston, Texas, United States

Site Status

University of Puerto Rico

San Juan, , Puerto Rico

Site Status

Countries

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United States Puerto Rico

Other Identifiers

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NCI-2021-14234

Identifier Type: REGISTRY

Identifier Source: secondary_id

NCI 21-05-01

Identifier Type: -

Identifier Source: secondary_id

NCI21-05-01

Identifier Type: OTHER

Identifier Source: secondary_id

INT21-05-01

Identifier Type: OTHER

Identifier Source: secondary_id

P30CA060553

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1CA242596

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1CA242609

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1CA242632

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1CA242635

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG1CA242643

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2021-14234

Identifier Type: -

Identifier Source: org_study_id

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