DNAJB1-PRKACA Fusion Kinase Peptide Vaccine Combined With Nivolumab and Ipilimumab for Patients With Fibrolamellar Hepatocellular Carcinoma

NCT04248569 | Recruiting Phase 1 DMC FDA Drug

• 2 other identifiers: J19140IRB00222681
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

The primary objective of the trial is the safety and tolerability of administering a vaccine targeting the DNAJB1-PRKACA fusion kinase, in combination with nivolumab and ipilimumab in patients with unresectable or metastatic FLC and with non-FLC solid tumors and to assess the T-cell response.

Conditions

Fibrolamellar Hepatocellular Carcinoma (FLC)

Keywords

DNAJB1-PRKACA Peptide Vaccine; Nivolumab; Ipilimumab; Anti-PD-1 (receptor blocking antibody); Anti-CTLA-4 (receptor blocking antibody); Neoantigen Vaccines; Cancer Vaccines; Immunotherapy; Fibrolamellar Hepatocellular Cancer (FLC)

Outcome Measures

Primary Outcomes (3)

• All Cohorts: Number of participants experiencing study drug-related toxicities

  Number of participants experiencing study drug-related adverse events Grade 3 or higher as defined by CTCAE v5.0

  4 years

• All Cohorts: Fold change in interferon-producing DNAJB1-PRKACA-specific CD4 and CD8 T cells at 10 weeks

  Evaluated by the fold change in interferon-producing DNAJB1-PRKACA-specific CD8 cells after vaccination at 10 weeks compare to pre-vaccination baseline.

  Baseline and 10 weeks

• Cohort A only: Progression-free survival (PFS)

  PFS at 6 months, will be estimated as the proportion of subjects who remain alive and free of disease progression at 6 months from the start of treatment. Disease progression will be determined using RECIST 1.1 criteria. The proportion of subjects achieving PFS at 6 months will be estimated using the Kaplan-Meier method, and the corresponding 95% confidence interval will be reported.

  6 months

Secondary Outcomes (5)

• Objective response rate (ORR)

  4 years

• Duration of response (DoR)

  4 years

• Disease control rate (DCR)

  4 years

• Progression-free survival (PFS)

  4 years

• Overall survival (OS)

  4 years

Study Arms (2)

DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab

EXPERIMENTAL

Cohort A: Patients with FLC cancer with no prior checkpoint inhibitor treatment. Cohort B: Patients with FLC cancer with prior checkpoint inhibitor treatment. Cohort C: Patients with non-FLC cancer (solid tumors) with prior checkpoint inhibitor treatment eligible.

Drug: DNAJB1-PRKACA peptide vaccine; Drug: Nivolumab; Drug: Ipilimumab

R- Enrollment: DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab

EXPERIMENTAL

Re-enrolling patients: Patients previously treated with the vaccine targeting the DNAJB1-PRKACA fusion kinase in combination with nivolumab and ipilimumab, who, in the opinion of the principal investigator, had clinical or radiological benefits. Re-enrolling patients who come off treatment ≤ 12 months from last dose may resume therapy at the study timepoint that they stopped study therapy. Patients who came off study therapy \> 12 months of last dose (i.e. to pursue alternative therapies (for example, surgical debulking), or after completion of the 2 years of study therapy), may restart study therapy at C1D1. In both cases, if the investigator assesses a drug-related toxicity to be related to anti-CTLA4 (ie. not anti-PD(L)1) therapy, patients can be enrolled in the study with nivolumab plus FLC peptide vaccine only.

Drug: DNAJB1-PRKACA peptide vaccine; Drug: Nivolumab; Drug: Ipilimumab

Interventions

DNAJB1-PRKACA peptide vaccine DRUG

1. DNAJB1-PRKACA peptide vaccine: Day 1, 8, 15 of cycle 1 and on Day 1 of cycle 2, 3 and 4 (priming phase). Boost vaccinations: every 3 cycles beginning C5D1. 2. Drug: 0.3 mg DNAJB1-PRKACA peptide vaccine + 0.5mg Poly-ICLC

Also known as: Hiltonol® (Poly-ICLC)

DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab; R- Enrollment: DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab

Nivolumab DRUG

1. Nivolumab 3mg/kg will be administered as a 30 minute IV infusion (-10/+15min) on Day 1 of Cycle 1-4 during the priming phase. Boost/maintenance vaccinations will be administered as a flat dose of 480mg every 4 weeks starting on Day 1 of Cycle 5. 2. Drug: 3mg/kg and 480mg IV

Also known as: OPDIVO

DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab; R- Enrollment: DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab

Ipilimumab DRUG

1. Ipilimumab (1 mg/kg) will be administered as a 30 minute IV infusion (-10/+15min) on Day 1 of Cycles 1, 2, 3 and 4 of the study, every 3 weeks of the priming phase. 2. Drug: 1mg/kg IV

Also known as: YERVOY®

DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab; R- Enrollment: DNAJB1-PRKACA peptide vaccine, Nivolumab, and Ipilimumab

Eligibility Criteria

• Age: 12 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Cohort A and B: Must have histologically confirmed FLC (fibrolamellar hepatocellular cancer) that is metastatic or unresectable.
• Cohort C: Patients with histologically proven metastatic or unresectable DNAJB1-PRKACA fusion transcript positive solid tumor malignancies, non-FLC solid tumors.
• Cohort A and B: Age \> 12 years. Note: Subjects age \> 12 years but \<18 are eligible to enroll only after 6 adult patients have enrolled on the study.
• Cohort A and B: Patients \< 18 years old must have a body weight ≥40 kg.
• Cohort C: Patients must be Age ≥ 18 years.
• All Cohorts:
• Presence of DNAJB1-PRKACA fusion transcript, assessed by RNA-sequencing, DNA-sequencing, or in situ hybridization in the archival tissue.
• ECOG performance status of ≤2 (Karnofsky ≥60%)
• Patients must have adequate liver, kidney and marrow function defined by study-specified laboratory tests prior to initial study drug.
• Patients must have measurable disease per RECIST 1.1.
• Must be willing to provide tissue and blood samples for mandatory translational research.
• Woman of childbearing potential must have a negative pregnancy test and follow contraceptive guidelines as defined per protocol.
• Men must use acceptable form of birth control while on study.
• Ability to understand and willingness to sign a written informed consent document.

You may not qualify if:

• Cohort A and C: Patients with a history of prior treatment with checkpoint inhibitors, such as anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-OX-40, anti-CD40, anti-CTLA-4, or anti-LAG-3 antibodies. NOTE: Prior therapy with interferon-alpha is allowed.
• Cohort B: Participants a with history of unacceptable, life-threatening toxicity related to prior immune therapy (eg, anti-CTLA-4 or anti-PD-1/PD-L1 treatment, any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways) except those that are unlikely to re-occur with standard countermeasures (eg, hormone replacement after endocrinopathy).
• All Cohorts:
• Have had chemotherapy or other systemic therapy or radiotherapy, as follows:
• Have had chemotherapy, biological cancer therapy, or radiation 14 days prior to the first dose of study drug.
• Have had surgery within 28 days of dosing of investigational agent, excluding minor procedures (dental work, skin biopsy, etc.), celiac plexus block, and biliary stent placement.
• Have received other approved or investigational agents or device within 28 days of the first dose of study drug.
• Have not recovered from acute adverse events to grade ≤1 or baseline due to agents administered.
• Have received any non-oncology live vaccine therapy used for prevention of infectious diseases within 28 days of study treatment
• Known sensitivity to or history of allergic reactions to investigational drug (s).
• Hypersensitivity reaction to any monoclonal antibody.
• Has active autoimmune disease that has required systemic treatment in the past 2 years, or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents.
• Presence of any tissue or organ allograft, regardless of need for immunosuppression, including corneal allograft. Patients with a history of allogeneic hematopoeitic stem cell transplant will be excluded.
• Has a diagnosis of immunodeficiency.
• Systemic treatment with either corticosteroids (\>10 mg daily prednisone equivalents) or other immunosuppressive medications within 7 days of study drug administration.

Sponsors & Collaborators

• Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins: lead
• Fibrolamellar Cancer Foundation: collaborator

Study Sites (1)

Sidney Kimmel Comprehensive Cancer Center

Baltimore, Maryland, 21231, United States

RECRUITING

Related Publications (3)

• Baretti M, Kirk AM, Ladle BH, Kamdar Z, Bendinelli KJ, Ho WJ, Adhikari S, Clark NA, Sundararaman B, Wang H, Kung HC, Hernandez J, Qi H, Shin SM, Hernandez A, Nakazawa M, Schattgen SA, Crawford JC, Furth M, Anders RA, Thoburn C, Zaidi N, Huff AL, Nauroth J, Jaffee E, Pogorelyy MV, Thomas PG, Yarchoan M. A therapeutic peptide vaccine for fibrolamellar hepatocellular carcinoma: a phase 1 trial. Nat Med. 2025 Dec;31(12):4246-4255. doi: 10.1038/s41591-025-03995-y. Epub 2025 Nov 24.

  PMID: 41286513 DERIVED

• Short SS, Kastenberg ZJ, Wei G, Bondoc A, Dasgupta R, Tiao GM, Watters E, Heaton TE, Lotakis D, La Quaglia MP, Murphy AJ, Davidoff AM, Mansfield SA, Langham MR, Lautz TB, Superina RA, Ott KC, Malek MM, Morgan KM, Kim ES, Zamora A, Lascano D, Roach J, Murphy JT, Rothstein DH, Vasudevan SA, Whitlock R, Lal DR, Hallis B, Butter A, Baertschiger RM, Lapidus-Krol E, Putra J, Tracy ER, Aldrink JH, Apfeld J, Le HD, Park KY, Rich BS, Glick RD, Fialkowski EA, Utria AF, Meyers RL, Riehle KJ. Histologic type predicts disparate outcomes in pediatric hepatocellular neoplasms: A Pediatric Surgical Oncology Research Collaborative study. Cancer. 2022 Jul 15;128(14):2786-2795. doi: 10.1002/cncr.34256. Epub 2022 May 13.

  PMID: 35561331 DERIVED

• O'Neill AF, Church AJ, Perez-Atayde AR, Shaikh R, Marcus KJ, Vakili K. Fibrolamellar carcinoma: An entity all its own. Curr Probl Cancer. 2021 Aug;45(4):100770. doi: 10.1016/j.currproblcancer.2021.100770. Epub 2021 Jul 1.

  PMID: 34272087 DERIVED

MeSH Terms

Conditions

Fibrolamellar hepatocellular carcinoma

Interventions

poly ICLC; Nivolumab; Ipilimumab

Intervention Hierarchy (Ancestors)

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

Study Officials

• Mark Yarchoan, MD

  Johns Hopkins Medical Institution

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Colleen Apostol, RN

CONTACT

410-614-3644; GIClinicalTrials@jhmi.edu

Marina Baretti, MD

CONTACT

410-614-1058; mbarett1@jhu.edu

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 28, 2020
• First Posted: January 30, 2020
• Study Start: April 20, 2020
• Primary Completion (Estimated): March 1, 2029
• Study Completion (Estimated): March 1, 2034
• Last Updated: December 3, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)