Axalimogene Filolisbac (ADXS11-001) High Dose in Women With Human Papillomavirus (HPV) + Cervical Cancer

To evaluate the tolerability and safety of axalimogene filolisbac 1 x 10\^10 colony forming units (cfu) administered with prophylactic premedication in repeating 3-dose study cycles in women with persistent, metastatic, or recurrent squamous and non-squamous carcinoma, adenosquamous, or adenocarcinoma of the cervix. To evaluate tumor response and progression-free survival (PFS) by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and immune-related Response Evaluation Criteria in Solid Tumors (irRECIST).

In this Phase 1, open-label, multicenter dose-escalation study, participants with persistent, metastatic, or recurrent carcinoma of the cervix who failed conventional therapy received axalimogene filolisbac every 3 weeks in repeating 12-week treatment cycles. Axalimogene filolisbac was administered intravenously (IV) on Day 1 of Weeks 1, 4, 7, and 10 of each cycle. Participants received a prophylactic regimen that was completed prior to each axalimogene filolisbac infusion to mitigate and manage potential immune responses seen with immunotherapy administration. The pretreatment prophylaxis regimen included commercially available antihistamines, nonsteroidal anti-inflammatory drugs (NSAIDs), antiemetics, histamine H2-receptor antagonists, and IV hydration. Additional NSAID doses and antiemetic administration were given post initial administration on Day 1 and Day 2, at the discretion of the investigator.

Participants received a 7-day course of oral antibiotic therapy starting approximately 72 hours (Day 4) after each administration of axalimogene filolisbac. Antibiotic therapy consisted of trimethoprim (80 mg)/sulfamethoxazole (400 mg) tablets (Bactrim) or trimethoprim (160 mg)/ sulfamethoxazole (800 mg) tablets (Bactrim DS), administered 3 times during the 7 consecutive days or ampicillin 500 mg 4 times daily for 7 consecutive days for participants with sulfa allergy.

Axalimogene filolisbac doses were to be escalated/de-escalated in the standard 3 + 3 fashion, starting with 5x10\^9 cfu to a maximum dose level of 1x10\^10 cfu. Dose cohorts of 3 participants each were to be treated. All decisions regarding dose escalation/de-escalation were made by the sponsor in consultation with investigators. In the absence of dose-limiting toxicity (DLT) assessed during the first 28 days in Cycle 1, the dose was to be escalated to the next dose level for the next 3 participants. If DLT was seen in 1 of 3 participants, another 3 participants were to be treated at that same dose. If DLT was seen in 2 of 6 participants, then that dose level was considered the Maximum Tolerated Dose (MTD) and the previous dose level was selected as the Recommended Phase 2 dose (RP2D). Specific hematologic and non-hematologic DLT criteria were prospectively defined in protocol. The RP2D was to be selected based on an observed DLT rate of \<33%.

Additional participants were to be enrolled into an expansion cohort to allow approximately 15 participants to be treated at that dose level.

Treatment cycles were repeated at the RP2D (or less) for an individual participant until a discontinuation criterion was met. Discontinuation criteria included documented disease progression, intolerable side effects not resolved with dose reduction or change in premedication or the participant completed 1 cycle of treatment post observation of complete response (CR per RECIST 1.1 and immune-realted complete response \[irCR\] per irRECIST). Participants who experienced a DLT during the dose-escalation portion of the study or experienced events meeting the definition of a DLT as described in the protocol in any subsequent treatment cycle were to be discontinued from study treatment. However, if a participant who experienced a DLT showed significant response to axalimogene filolisbac, the participant could receive subsequent axalimogene filolisbac treatment at a lower dose level following discussion and agreement between the investigator and sponsor.

Efficacy was assessed by tumor imaging at the end of every cycle. Safety was assessed by analyzing treatment-related adverse events (AEs), changes in physical examinations, vital sign measurements, and clinical laboratory abnormalities. All toxicities were graded using Common Terminology Criteria for Adverse Events (CTCAE) 4.03.

After the study treatment period, all participants were to participate in a 3-year Lm surveillance monitoring period that included a 6-month course of antibiotics to be initiated 72 hours after completion of treatment or immediately following study discontinuation and monitoring (Complete blood count \[CBC\], comprehensive metabolic panel, and blood cultures for the detection of Lm) every 3 months (±2 weeks).

Eligibility Criteria:
Inclusion Criteria:

* Participants with histologically-confirmed, persistent, metastatic or recurrent squamous or non-squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix with documented disease progression (disease not amenable to surgery or standard radiotherapy).
* Participants who have received no more than 1 prior cytotoxic treatment regimen.
* Participant may have received ≤2 prior regimens for the treatment of their metastatic disease.
* Participant is able to provide written informed consent.
* Participant must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

Exclusion Criteria:

* In the opinion of the investigator, participant has rapidly progressing disease, OR has life expectancy of less than 6 months, OR would be unable to receive at least one cycle of therapy.
* Participant has received chemotherapy and/or radiation therapy (except palliative radiation therapy for disease-related pain) within ≤2 weeks of first axalimogene filolisbac infusion.
* Participant has a known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy.
* Has a contraindication to administration of trimethoprim/sulfamethoxazole or ampicillin.
* Has implanted medical device(s) that pose a high risk for colonization and/or cannot be easily removed (e.g., prosthetic joints, artificial heart valves, pacemakers, orthopedic screw(s), metal plate(s), bone graft(s), or other exogenous implant(s). NOTE: More common devices and prosthetics which include arterial and venous stents, dental and breast implants, and venous access devices (e.g., Port-a-Cath or Mediport) are permitted. Sponsor must be contacted prior to consenting any participant who has any other device and/or implant.