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Prostvac in Patients With Biochemically Recurrent Prostate Cancer

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ClinicalTrials.gov Identifier: NCT02649439
Recruitment Status : Recruiting
First Posted : January 7, 2016
Last Update Posted : July 6, 2018
Sponsor:
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) )

Brief Summary:

Background:

Some people who have been treated for prostate cancer still have high prostate-specific antigen (PSA) levels. This may indicate cancer. These people have non-metastatic castration sensitive prostate cancer (nmCSPC) or biochemical recurrent prostate cancer. Researchers think the immune system can be taught to fight and kill cancer cells. They think an immunotherapy vaccine called prostvac could help reduce PSA levels in people with this type of prostate cancer.

Objective:

To test if prostvac can decrease tumor growth rate as measured by PSA compared to getting surveillance alone.

Eligibility:

Men ages 18 or older who have nmCSPC or biochemical recurrent prostate cancer

Design:

Participants will be screened with:

Medical history

Physical exam

Blood and urine tests

Bone scan

CT scan, or MRI and PET scan: They lie in a machine that takes pictures of the body.

Electrocardiogram: Soft electrodes are stuck to the skin to record heart signals.

Participants will be part of 1 of 2 arms: Arm A will get prostvac for 6 months. Arm B will have surveillance for 6 months followed by prostvac for 6 months.

During the prostvac period, participants will get prostvac as a shot under the skin on weeks 1, 3, and 5, and then monthly for a total of 5 months.

Participants will have follow-up visits at least every month until they recover from prostvac side effects or their cancer worsens. Visits may include repeats of screening tests.

Participants will be followed for up to 15 years. They will have a physical exam every year for the first 5 years. They will have phone calls once a year.


Condition or disease Intervention/treatment Phase
Prostate Cancer Biological: PROSTVAC -V Biological: PROSTVAC-F Phase 2

Detailed Description:

BACKGROUND

  • Androgen deprivation therapy (ADT) and surveillance are treatment options for prostate cancer patients with biochemical progression after localized therapy (biochemically recurrent prostate cancer). The primary goal in these patients is to prevent morbidity from their cancer and to do so with limited toxicity.
  • Prostvac (Prostvac ; developed by the National Cancer Institute [NCI] and licensed to BN Immunotherapeutics, Mountain View, CA) is a novel candidate prostate cancer immunotherapy for the treatment of prostate cancer. It is a viral vector based therapeutic cancer vaccine that is administered via subcutaneous injections. In a randomized controlled Phase 2 trial, Prostvac therapy was associated with a prolongation of survival in men with metastatic castrate-resistant prostate cancer. A phase III trial recently completed accrual of patients in this same population.
  • There is also rationale to use therapeutic cancer vaccines such as Prostvac in earlier stage prostate cancer patients to maximize the potential therapeutic effect of immune stimulating therapy.
  • Analysis of previous trials using therapeutic cancer vaccines alone suggests that such therapies may alter tumor growth rate.

OBJECTIVE

Primary Objective:

-Determine if the therapeutic cancer vaccine prostvac can decrease tumor growth rate as measured by PSA rise after 6 months compared to a group getting surveillance alone.

KEY ELIGIBILITY CRITERIA

  • Histologically confirmed adenocarcinoma of the prostate
  • Patients with negative CT Scan and Tc-99m Bone Scan
  • Patients with a PSA over 0.8 ng/ml for patients following radical prostatectomy or for patients following definitive radiation therapy: a rise in PSA of greater than or equal to 2 ng/mL above the nadir
  • Patients with a PSA doubling time of 5-15 months
  • No history of active autoimmune disease or history of organ compromising autoimmune disease
  • ECOG 0-1

DESIGN

  • Randomized study
  • Accrual goal is 36 evaluable patients per arm; randomized 1:1 to:

    • Arm A: Prostvac for 6 months with an additional optional year of maintenance for eligible patients OR
    • Arm B: Surveillance for 6 months, then Prostvac for 6 months with an additional year of maintenance for eligible patients

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 110 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Prostvac in Patients With Biochemically Recurrent Prostate Cancer
Study Start Date : January 6, 2016
Estimated Primary Completion Date : October 1, 2020
Estimated Study Completion Date : October 1, 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: A/PROSTVAC treatment
PROSTVAC treatment for 6 months with an additional optional year of maintenance for eligible patients
Biological: PROSTVAC -V
Recombinant Vaccinia Virus Vector Vaccine of the Genus Orthopopoxvirus

Biological: PROSTVAC-F
Recombinant Fowlpox Virus Vector Vaccine of the Genus Avipoxvirus

Experimental: B/ Delayed PROSTVAC treatment
Surveillance for 6 month followed by PROSTVAC treatment for 6 months with an additional year of maintenance for eligible patients
Biological: PROSTVAC -V
Recombinant Vaccinia Virus Vector Vaccine of the Genus Orthopopoxvirus

Biological: PROSTVAC-F
Recombinant Fowlpox Virus Vector Vaccine of the Genus Avipoxvirus




Primary Outcome Measures :
  1. Determine if Prostvac can slow the growth rate of prostate cancer relative to a group of patients on surveillance. [ Time Frame: 2-3 years ]
    Time to progression.


Secondary Outcome Measures :
  1. Observe the effects of the vaccine on PSA growth rate when Prostvac is initiated after 6 months of surveillance [ Time Frame: 6 months, 12 months post treatment ]
    Magnitude of the change in PSA growth rate as well as rate of decline of PSA rate.

  2. Evaluate immune response [ Time Frame: 6 months-12 months ]
    Evaluation of various markers to determine immune response.

  3. Associate immunologic outcomes with PSA responses/changes in growth rates [ Time Frame: 6 months-12 months ]
    Compare immune response with growth/decline in PSA rate.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 100 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Histopathological documentation of prostate cancer confirmed in either the Laboratory of Pathology at the National Institutes of Health (NIH) Clinical Center, Walter Reed National Military Medical Center, MSKCC, DFCI or BIDMC prior to enrollment. If no pathologic specimen is available, patients may enroll with a pathologist s report showing a histologic diagnosis of prostate cancer and a clinical course consistent with the disease.
  • Biochemical progression after definitive radiation or surgery defined as follows:

    • For patients following definitive therapy: a rise in PSA of greater than or equal to 2ng/mL above the nadir (per RTOG-ASTRO consensus criteria).
    • For patients following radical prostatectomy: rising PSA after surgical procedure. (Patients must have a PSA greater than or equal to 0.8 ng/ml)
  • ECOG performance status of 0 1 (Karnofsky greater than or equal to 80%).
  • Patients must have a PSA doubling time of 5-15 months.
  • Patients must have a rising PSA as confirmed by 3 values done at least 1 week apart and over no less than 1 month.
  • Recovery from acute toxicity related to prior therapy, including surgery and radiation, or no toxicity greater than or equal to grade 2.
  • Negative CT scan/MRI and bone scan for metastatic prostate cancer.
  • Hematological eligibility parameters (within 16 days before starting therapy)

    • Granulocyte count greater than or equal to 1000/mm3
    • Platelet count greater than or equal to 100 000/mm3
    • Hgb greater than or equal to 10g/dL
  • Biochemical eligibility parameters (within 16 days before starting therapy):

    --Hepatic function: bilirubin less than or equal to 1.5mg/dL (OR in patients with Gilbert s syndrome normal.

  • No other active malignancies within the past 36 months (with the exception of nonmelanoma skin cancers or carcinoma in situ of the bladder) or life-threatening illnesses, in the opinion of the investigator
  • Willing to travel to the NIH, MSKCC, DFCI, BIDMC for follow-up visits.
  • 18 years of age or older.
  • Able to understand and sign informed consent.
  • Baseline testosterone greater than or equal to 100 ng/dl
  • PSA less than or equal to 30 ng/mL.
  • The effects PROSTVAC on the developing human fetus are unknown. For this reason, men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study therapy and at least one month post therapy. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately.

EXCLUSION CRITERIA:

  • Immunocompromised status due to:

    • Human immunodeficiency virus (HIV) positivity.
    • Active autoimmune diseases such as Addison's disease, Hashimoto's thyroiditis, systemic lupus erythematosus, Sjogren syndrome, scleroderma, myasthenia gravis, Goodpasture syndrome or active Grave's disease. Patients with a history of autoimmunity that has not required systemic immunosuppressive therapy or does not threaten vital organ function including CNS, heart, lungs, kidneys, skin, and GI tract will be allowed.
    • Other immunodeficiency diseases
    • Splenectomy
  • Chronic administration (defined as daily or every other day for continued use > 14 days) of corticosteroids deemed systemic by investigator within 28 days before the first planned dose of PROSTVAC. Use of inhaled steroids, nasal sprays, intra-articular

injections and topical creams for small body areas is allowed.

  • Serious intercurrent medical illness that, in the judgment of the investigator, would interfere with patient s ability to carry out the treatment program.
  • Other medications used for urinary symptoms including 5-alpha reductase inhibitors (finasteride and dutasteride) and alternative medications known to alter PSA (eg phytoestrogens and saw palmetto)
  • History of prior chemotherapy
  • History of prior immunotherapy within the last 3 years
  • Major surgery within 4 weeks prior to enrollment (Day 1 visit).
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to poxviral vaccines (e.g., vaccinia vaccine)
  • Known allergy to eggs, egg products, aminoglycoside antibiotics (for example, gentamicin or tobramycin).
  • History of atopic dermatitis or active skin condition (acute, chronic, exfoliative) that disrupts the epidermis
  • Previous serious adverse reactions to smallpox vaccination
  • Unable to avoid close contact or household contact with the following high-risk individuals for three weeks after the Day 1 vaccination: Day 1 vaccination: (a) children less than or equal to 3 years of age, (b) pregnant or nursing women, (c) individuals with current or extensive eczema or other eczemoid skin disorders, or (d) immunocompromised individuals, such as those with HIV.
  • Receipt of an investigational agent within 28 days (or 56 days for an antibody-based therapy) before the first planned dose of study drugs.
  • Patients who test positive for HBV or HCV
  • Uncontrolled hypertension (SBP>170/ DBP>105)
  • Recruitment Strategies

This study will be listed on available websites (www.clinicaltrials.gov,

https://ccr.cancer.gov/clinical-trials-search-start) and participants will be recruited from the

current patient population at NIH.


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02649439


Contacts
Contact: Anna C Couvillon, C.R.N.P. (301) 443-6211 couvilla@mail.nih.gov

Locations
United States, Massachusetts
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02115
Beth Israel Deaconess Medical Center Recruiting
Boston, Massachusetts, United States
Contact: Glenn Bubley, M.D.    617-735-2062    gbubley@bidmc.harvard.edu   
United States, New York
Memorial Sloan Kettering Cancer Center Recruiting
New York, New York, United States, 10021
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
Principal Investigator: Ravi A Madan, M.D. National Cancer Institute (NCI)

Additional Information:
Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT02649439     History of Changes
Other Study ID Numbers: 160035
16-C-0035
First Posted: January 7, 2016    Key Record Dates
Last Update Posted: July 6, 2018
Last Verified: June 14, 2018

Studies a U.S. FDA-regulated Drug Product: Yes

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Cancer Institute (NCI) ):
Vaccine
PSA
Surveillance
Immunotherapy

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Vaccines
Immunologic Factors
Physiological Effects of Drugs