A Phase III Trial Evaluating Chemotherapy and Immunotherapy for Advanced Nasopharyngeal Carcinoma (NPC) Patients (VANCE)

• ClinicalTrials.gov Identifier: NCT02578641
• Recruitment Status: Active, not recruiting
• First Posted: October 19, 2015
• Last Update Posted: March 8, 2021
• Sponsor: Tessa Therapeutics
• Information provided by (Responsible Party): Tessa Therapeutics

Tracking Information

• First Submitted Date: October 12, 2015
• First Posted Date: October 19, 2015
• Last Update Posted Date: March 8, 2021
• Study Start Date: July 2014
• Estimated Primary Completion Date: January 2023 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: October 15, 2015)

Prolonging Overall Survival [ Time Frame: through study completion, an average of 1 year ]

Assess the efficacy of CTL following first line chemotherapy in prolonging Overall Survival (OS) of patients with advanced NPC

• Original Primary Outcome Measures: Same as current

Current Secondary Outcome Measures (submitted: October 15, 2015)

• Disease Progression [ Time Frame: through study completion, an average of 1 year ]
  Assess the efficacy of CTL in delaying disease progression (PFS) in patients with advanced NPC
• Overall Response Rate [ Time Frame: through study completion, an average of 1 year ]
  Tumor assessment will be according to RECIST 1.1 criteria. Compare the Overall Response Rate under the 2 treatment arms. This is based on the proportion of individuals who achieve a further response (Complete Response or Partial Response) after immunotherapy using preimmunotherapy imaging as baseline
• Clinical Benefit Rate [ Time Frame: through study completion, an average of 1 year ]
  Compare the Clinical Benefit Rate under the 2 treatment arms.Clinical Benefit rate (CBR) is defined as the proportion of patients who achieve Complete Response, Partial Response, Stable Disease to both chemotherapy and then, for Arm A, to immunotherapy using pre immunotherapy (post cycle 4 chemotherapy) imaging as a baseline. Tumor assessment will be according to RECIST 1.1 criteria.
• Quality of Life of patients [ Time Frame: through study completion, an average of 1 year ]
  Compare the Quality of Life of patients based on EORTC QLQ-C30 under the 2 treatment arms

• Original Secondary Outcome Measures: Same as current
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: A Phase III Trial Evaluating Chemotherapy and Immunotherapy for Advanced Nasopharyngeal Carcinoma (NPC) Patients
• Official Title: A Multicentre, Randomized, Open-Label, Phase III Clinical Trial Of Gemcitabine And Carboplatin Followed By Epstein-Barr Virus-Specific Autologous Cytotoxic T Lymphocytes Versus Gemcitabine And Carboplatin As First Line Treatment For Advanced Nasopharyngeal Carcinoma(NPC) Patients

Brief Summary

This study is a multi-center, randomized, open label, Phase III clinical trial for advanced Nasopharyngeal Carcinoma(NPC) Patients.

Drugs used in chemotherapy, such as gemcitabine and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving an infusion of a person's cytotoxic T cells (CTL) that have been treated in the laboratory may help the body build an effective immune response to kill tumor cells. Giving combination chemotherapy together with laboratory-treated T cells may kill more tumor cells. This Phase III trial is to assess if combined gemcitabine-carboplatin (GC) followed by adoptive T-cell therapy would improve clinical outcome for patients with advanced nasopharyngeal carcinoma (NPC). It is also the world's first, and largest, Phase 3 T-cell therapy cancer trial ever conducted, and enrollment is ongoing for 330 patients from 30 hospital centers across Asia and the United States.

This clinical trial is conducted on the back of a successful Phase 2 NPC trial involving 38 patients at the National Cancer Centre, Singapore. This trial produced the best published 2-year (62.9%), and median overall survival (OS) data (29.9 months) in 35 patients with advanced NPC who received autologous EBV-specific CTL. Kindly see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978790/ for the Phase 2 publication titled "Adoptive T-cell Transfer and Chemotherapy in the First line treatment of Metastatic and/or Locally Recurrent Nasopharyngeal Carcinoma".

Detailed Description

330 patients will be randomized after their eligibility status has been fully determined and informed consent has been obtained. Patients will be randomly allocated to receive either Arm A (Gemcitabine and Carboplatin (GC) x 4* cycles and EBV-specific CTL) or Arm B (GC x 6 cycles alone) in a 1:1 ratio using a stratified block randomization scheme. The stratification variables are country and disease stage (metastatic vs locally recurrent). *Additional 1-2 chemotherapy cycles (up to total 6 chemo cycles) might be given upon discretion of Investigator, if EBV-specific CTL infusions are not available in time for the 1st scheduled infusion.

After randomization, patients in Arm A will have their peripheral blood taken for the establishment of cytotoxic T cell line and EBV transformed lymphoblastoid cell line (CTL). Within two weeks of enrollment, patients will commence combination GC chemotherapy for a total of 4 cycles. Patients in Stage 2 of study will receive the EBV-specific CTL immunotherapy.

As of 1 May 2020, patients who have not received the first infusion of EBV-specific CTLs, will instead continue to receive a total of 6 cycles combination of Gemcitabine (1000 mg/m2) and carboplatin (AUC2) on Days 1, 8, 15 every 28 days

• Study Type: Interventional
• Study Phase: Phase 3
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: None (Open Label); Primary Purpose: Treatment
• Condition: Nasopharyngeal Carcinoma

Intervention

• Biological: autologous EBV specific Cytotoxic T cells
  The CTL line will be prepared by co-cultivation of the irradiated EBV-LCL with patient PBMC. A proportion of peripheral blood will be used to generate EBV specific CTLs.
• Drug: combination IV gemcitabine and IV carboplatin (AUC2)
  4 cycles for Arm A and 6 cycles for Arm B

Study Arms

• Experimental: Arm A

  4 cycles* of combination IV Gemcitabine (1000 mg/m2) and IV carboplatin (AUC2) on Days 1, 8, 15 every 28 days, followed sequentially by T-cell immunotherapy (2 cycles) of autologous EBV specific Cytotoxic T cells every 2 weeks, followed by EBV-specific CTL immunotherapy (4 cycles) every 8 weeks after 6 weeks from the second cycle.

  *Additional 1-2 chemotherapy cycles (up to total 6 chemo cycles) might be given upon discretion of Investigator, if EBV-specific CTL infusions are not available in time for the 1st scheduled infusion.

  As of 1 May 2020, patients who have not received the first infusion of EBV-specific CTLs, will instead continue to receive a total of 6 cycles combination of Gemcitabine (1000 mg/m2) and carboplatin (AUC2) on Days 1, 8, 15 every 28 days

  Interventions:

  • Biological: autologous EBV specific Cytotoxic T cells
  • Drug: combination IV gemcitabine and IV carboplatin (AUC2)
• Active Comparator: Arm B
  6 cycles of combination IV gemcitabine (1000 mg/m2) and IV carboplatin (AUC2) on Days 1, 8, 15 every 28 days.
  Intervention: Drug: combination IV gemcitabine and IV carboplatin (AUC2)

• Publications *: Not Provided

Recruitment Information

• Recruitment Status: Active, not recruiting
• Estimated Enrollment (submitted: October 15, 2015): 330
• Original Estimated Enrollment: Same as current
• Estimated Study Completion Date: January 2023
• Estimated Primary Completion Date: January 2023 (Final data collection date for primary outcome measure)

Eligibility Criteria

Key Inclusion Criteria

1. Metastatic or locally recurrent EBV-positive, non-keratinizing and/ or undifferentiated NPC* who do not have curative options such as chemo-radiation or surgery

   *Subjects will be enrolled based on confirmed histology diagnosis of the NPC

2. Radiologically measurable disease as per RECIST 1.1

3. Human Immunodeficiency Virus (HIV) negative*

   * Status of HIV must be confirmed via a HIV antibody test or other confirmatory tests available within 4 weeks of screening

4. Bilirubin <2 x upper limit of normal (ULN) and aspartate aminotransferase (AST), alanine aminotransferase (ALT) <3 x ULN
5. Calculated creatinine clearance (CRCL) ≥40 mL/min. Glomerular Filtration Rate (GFR) is calculated based on Cockcroft-Gault method.
6. Normal corrected calcium levels
7. Absolute neutrophil count >1200/mm3, hemoglobin (Hb) ≥10 g/dL and platelets ≥100,000/mm3
8. Male or female
9. Age ≥ 18 years or according to local legal age of consent
10. Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) ≤2
11. Written informed consent
12. Life expectancy >6 months

Key Exclusion Criteria

1. Severe concomitant illness i.e. chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), active congestive cardiac failure (CCF), active angina pectoris, uncontrolled arrhythmia, uncontrolled hypertension

2. HIV Positive*

   * Status of HIV must be confirmed via a HIV antibody test or other confirmatory tests available within 4 weeks of screening

3. Pregnant or lactating females
4. Refuse of use of contraception during trial (both male and female patients)
5. Investigational therapy less than one month prior to study entry
6. Pre-existing peripheral neuropathy (National Cancer Institute Common Terminology Criteria for Adverse Events [NCI CTCAE] ≥2)
7. Central nervous system metastasis
8. Previous or concurrent cancer that is distinct in primary site or histology from the cancer being evaluated in this study, EXCEPT cervical carcinoma in situ, treated basal cell carcinoma, superficial bladder tumors [Ta, Tis and T1] or any cancer curatively treated >3 years prior to study entry
9. Positive hepatitis B surface antigen (HBsAg) results
10. Known history of hepatitis C and recovery status has not been determined at time of screening

11. Prior anti-cancer treatment for metastatic or locally recurrent disease, EXCEPT:

    For metastatic or locally recurrent disease, localised palliative radiotherapy is allowed.

    For locally recurrent disease, the following treatment is allowed

    • Prior radiotherapy with curative intent
    • Prior chemo-radiotherapy with curative intent
    • Adjuvant chemotherapy
    • Localised palliative radiotherapy Prior chemotherapy must be > 6 months before screening
12. Severe intercurrent infections
13. Prior immunotherapy for metastatic or locally recurrent disease

The following is allowable:

• Adjuvant immunotherapy/ biologics Prior adjuvant immunotherapy/ biologics must be > 6 months before screening

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 18 Years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Malaysia, Singapore, Taiwan, Thailand, United States

Administrative Information

• NCT Number: NCT02578641
• Other Study ID Numbers: FF01
• Has Data Monitoring Committee: Yes
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Responsible Party: Tessa Therapeutics
• Study Sponsor: Tessa Therapeutics
• Collaborators: Not Provided

Investigators

• Study Chair: Han Chong TOH; National Cancer Centre Singapore (NCCS)

• PRS Account: Tessa Therapeutics
• Verification Date: July 2020