In Situ, Autologous Therapeutic Vaccination Against Solid Cancers With Intratumoral Hiltonol®

NCT02423863 | Completed Phase 2 DMC

• 2 other identifiers: ONC2014-0011R44CA183075-01A1
• Study Type: interventional
• Target: 26
• Locations: 1 country
• Sites: 5

Brief Summary

The purpose of this study is to evaluate the safety of sequential intratumoral (IT) plus intramuscular (IM) Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC, Hiltonol®) for treatment of study subjects with accessible solid tumors, with or without checkpoint blockers. Enrolled study subjects will receive Poly-ICLC (Hiltonol®) treatment alone or in combination with anti-PD-1 (Nivolumab, Pembrolizumab or Cemiplimab) or anti-PD-L1 (Atezolizumab or Durvalumab) over 6 months as defined in study treatment described below. MRI or CT imaging will be done per SOC at screening, 3 and 6-month time points.

Conditions

Melanoma; Head and Neck Cancer; Sarcoma; Non-Melanoma Skin Cancers

Keywords

Cancer; Immunotherapy; Intratumoral Injection; Multicenter Study; Autovaccination; Solid Tumors; anti-PD1; anti-PDL1

Outcome Measures

Primary Outcomes (2)

• Evaluate safety of intratumoral (IT) plus intramuscular (IM) Polyinosinic-polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC, Hiltonol®) for treatment of patients with accessible solid tumors, with or with

  Wk 26 study subject's response will be defined as BOR (CR, PR, SD) or PD.

  Evaluation of response wk 26

• Evaluate therapeutic efficacy assessed by Disease Control (CR, PR, or SD) as defined by the RECIST 1.1 Criteria.

  Week 26 tumor assessment will be performed, an optional biopsy may be performed.

  6 months

Secondary Outcomes (5)

• Determine whether the study regimen of Poly-ICLC will induce an innate and/or an adaptive, specific anti-tumor T cell immune response in the injected tumor lesion and systemically.

  26 weeks

• Determine the response in injected lesions as defined by change in size at 16 weeks and 26 weeks as assessed by bi-dimensional measurement using RECIST 1.1 criteria.

  16 weeks and 26 weeks

• Determine the response in non-injected tumor lesions, both visceral and non-visceral as defined by change in size at 16 weeks and 26 weeks as assessed by bi- dimensional measurement.

  16 weeks and 26 weeks

• Determine progression free survival at 12, 24, and 36 months in treated study subjects.

  12, 24 and 36 months

• Determine overall survival (OS) in treated study subjects.

  Up to 36 months

Study Arms (1)

Hiltonol Poly-ICLC

EXPERIMENTAL

Open labeled, non randomized adaptive 2-stage design protocol. 21 study subjects were enrolled in stage I of the protocol. Up to an additional 60 patients. . Enrolled study subjects will receive Poly-ICLC (Hiltonol®) treatment alone or in combination with anti-PD-1 (Nivolumab, Pembrolizumab or Cemiplimab) or anti-PD-L1 (Atezolizumab or Durvalumab) over 6 months as defined in study treatment described below. MRI or CT imaging will be done per SOC at screening, 3 and 6-month time points. For purposes of analysis patients enrolled in Stage II of this study will be prospectively identified at initial screening as belonging to statistical Cohorts A, B, or C, which are based on patient status with regard to aPD1/aPDL1 therapy at study entry, (PD, SD, or treatment naïve). For purposes of this study, patient status is considered to be the primary eligibility variable, although sub analyses will also consider histology and particular checkpoint blocker used when possible.

Biological: Hiltonol

Interventions

Hiltonol BIOLOGICAL

Wk 1 Days 1, 3 and 5: Poly-ICLC (Hiltonol®) 1 mg (0. 5 ml) IntraTumoral (priming treatment course). Weeks 2-25 Poly-ICLC (Hiltonol®) 1 mg (0.5 ml) IM twice a week with a 48-72 hour interval between the two injections, AND either: No additional immunotherapy OR ONLY ONE of the Anti-PD1 or anti-PDL-1 regimens will be administered, per manufacturer's dosing and clinical oncologist's discretion as follows: (Not to be Administered on the same day as Poly-ICLC \[Hiltonol®\]) Either Nivolumab, OR Pembrolizumab, OR Atezolizumab, OR Cemiplimab, OR Durvalumab

Also known as: Poly-ICLC, Nivolumab, Pembrolizumab, Atezolizumab, Cemiplimab, Durvalumab

Hiltonol Poly-ICLC

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• )1) Histologically confirmed diagnosis of one of the following:
• Melanoma
• Squamous head and neck cancer
• Sarcoma
• Non-Melanoma skin cancers 2) Sarcoma Patients must be 14 years of age or older. All other patients must be 18 years of age or older.
• \) Unresectable disease. Patients with resectable disease may be enrolled after having refused surgery after a documented consultation with a surgeon.
• \) Radiographic or visually measurable disease based on Response Evaluation Criteria In Solid Tumors, Version 1.1 criteria.
• \) At least one accessible primary or metastatic tumor site that can be readily injected IT with poly-ICLC with or without ultrasound guidance. This lesion can be superficial cutaneous, subcutaneous, or within a readily accessible location, including a lymph node, and must measure ≥ 15mm short axis for target.
• \) Patients who have received at least 8 weeks of aPD1 or aPDL1 immunotherapy and who have either progressive disease, stable disease or partial response based on RECIST 1.1 criteria are elegible for participation as separate cohorts B or C, with continuation of the aPD1 or aPDL1 therapy at their physician's discretion.
• \) ECOG performance status of ≤ 2. 8) Acceptable hematologic, renal and liver function as follows: A) Absolute neutrophil count \> 1000/mm3 B) Platelets \> 50,000/mm3, C) Creatinine ≤ 2.5 mg/dl, D) Total bilirubin ≤ 1.5 mg/dl, E) Transaminases ≤ 2 times above the upper limits of the institutional normal. F) INR\<2 if off of anticoagulation. Patients on anticoagulation therapy with an INR\>2 may be enrolled at the discretion of the investigator if they have not had any episodes of severe hemorrhage and if the site to be injected is not located in the oropharynx or another area where achieving homeostasis would be complicated by local anatomy.
• \) Patients must be able to provide informed consent. 10) Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. Contraception must be continued for at least 2 months following the last dose of poly-ICLC. Women of childbearing potential must have a negative pregnancy test. While animal reproductive studies have been negative, the simulated viral infection and anti-proliferative activity of this experimental drug may theoretically affect the developing fetus or nursing infant.
• Cohort A) 11) Patients who are not receiving an anti-PD-1 or anti-PD-L1 agent,
• Cohort B 12) Patients who have received at least 8 weeks of aPD1 or aPDL1 immunotherapy. 13) Patients have progressive disease based on RECIST 1.1 criteria.
• Cohort C) 14) Patients who have received at least 8 weeks of aPD1 or aPDL1 immunotherapy. 15) Patients have stable disease or a partial response based on RECIST 1.1 criteria.

You may not qualify if:

• Patients with any of the following are ineligible for this research study:
• Serious concurrent infection or medical illness, which would jeopardize the ability of the patient to receive the treatment outlined in this protocol with reasonable safety.
• Bulky intracranial metastatic disease with shift of midline structures or progressive brain metastasis such that ongoing therapy for these brain metastasis is required at the time of enrollment.
• In the opinion of the local PI: Head and neck cancer patients with airway tumor recurrence that may compromise breathing or swallowing if inflammation or edema is transiently aggravated by Hiltonol® injection. Head and neck cancer patients with tumor invading major blood vessels for whom there may be a risk of blockage or bleeding if inflammation or edema is transiently increased by Hiltonol® injections.
• AIDS defined as a CD4 count less than 200 in the context of HIV sero-positivity or chronically is taking immunosuppressive medication such as steroids or transplant related medications.
• Life expectancy of less than 6 months in the judgment of the study physician.
• Persistent toxicity from recent therapy that has not sufficiently resolved in the judgment of the study physician.
• History of active cancer vaccine immunotherapy in the previous month. Patients who have received at least 8 weeks of aPD1 or aPDL1 immunotherapy and who have either progressive disease, stable disease or partial response based on RECIST 1.1 criteria are elegible for participation and continuation of the aPD1 or aPDL1 therapy at their physician's discretion.

Sponsors & Collaborators

• Oncovir, Inc.: lead
• National Institutes of Health (NIH): collaborator
• Icahn School of Medicine at Mount Sinai: collaborator
• Bay Hematology Oncology: collaborator
• National Cancer Institute (NCI): collaborator
• University of Missouri-Columbia: collaborator
• Chevy Chase Regional Cancer Care Associates LLC: collaborator
• Dermatologic Surgery Center of Washington LLC and Skin Cancer Treatment Center: collaborator

Study Sites (5)

Chevy Chase RCCA

Chevy Chase, Maryland, 20815, United States

Location

Dermatologic Surgery Center Washington DC

Chevy Chase, Maryland, 20815, United States

Location

Bay Hematology Oncology

Easton, Maryland, 2160l, United States

Location

University of Missouri School of Medicine

Columbia, Missouri, 65211-0001, United States

Location

Icahn School of Medicine at Mount Sinai

New York, New York, 10029, United States

Location

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MeSH Terms

Conditions

Melanoma; Head and Neck Neoplasms; Sarcoma; Neoplasms

Interventions

poly ICLC; Nivolumab; pembrolizumab; atezolizumab; cemiplimab; durvalumab

Condition Hierarchy (Ancestors)

Neuroendocrine Tumors; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms, Nerve Tissue; Nevi and Melanomas; Skin Neoplasms; Neoplasms by Site; Skin Diseases; Skin and Connective Tissue Diseases; Neoplasms, Connective and Soft Tissue

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Antibodies; Immunoglobulins; Immunoproteins; Blood Proteins; Proteins; Amino Acids, Peptides, and Proteins; Serum Globulins; Globulins

Study Officials

• Nina Bhardwaj, MD, PhD

  Icahn School of Medicine at Mount Sinai

  PRINCIPAL INVESTIGATOR

• David H Smith, MD

  Bay Hematology Oncology

  PRINCIPAL INVESTIGATOR

• Kevin Staveley-O'Carroll, MD

  University Missouri

  PRINCIPAL INVESTIGATOR

• Frederick P Smith, MD

  Chevy Chase, RCCA

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 13, 2015
• First Posted: April 22, 2015
• Study Start: March 1, 2015
• Primary Completion: August 31, 2020
• Study Completion: August 31, 2020
• Last Updated: December 17, 2020

Record last verified: 2017-09

Data Sharing

• IPD Sharing: Will not share

Locations

US (5)