Vaccine Therapy Plus Sargramostim and Interleukin-2 Compared With Nilutamide Alone in Treating Patients With Prostate Cancer

Study Overview
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Brief Summary
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RATIONALE: Vaccines made from prostate cancer cells may make the body build an immune response to kill tumor cells. Colony-stimulating factors such as sargramostim may increase the number of immune cells found in bone marrow or peripheral blood. Interleukin-2 may stimulate a person's white blood cells to kill prostate cancer cells. Androgens can stimulate the growth of prostate cancer cells. Hormone therapy using nilutamide may fight prostate cancer by reducing the production of androgens. It is not yet known which treatment regimen is more effective for treating prostate cancer. PURPOSE: Randomized phase II trial to compare the effectiveness of vaccine therapy plus sargramostim and interleukin-2 with that of nilutamide alone in treating patients who have prostate cancer that has not responded to hormone therapy.

Detailed Description
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OBJECTIVES: Compare the difference in time to radiographic evidence of disease progression at 6 months in patients with hormone-refractory prostate cancer when treated with vaccine containing recombinant vaccinia-prostate-specific antigen (PSA) admixed with rV-B7.1 plus recombinant fowlpox-PSA vaccine, sargramostim (GM-CSF), and interleukin-2 vs nilutamide alone. Evaluate the vaccination therapy in relation to the change in T-cell precursor frequency and to the rise of serum PSA in this patient population. OUTLINE: This is a randomized study. Patients are stratified according to HLA-A2 typing (positive vs negative). Patients are randomized to one of two treatment arms. Arm I: Patients receive vaccine containing recombinant vaccinia-prostate-specific antigen (PSA) and rV-B7.1 subcutaneously (SC) on day 2 only. Beginning on day 30, patients receive recombinant fowlpox-PSA vaccine SC every 4 weeks for 12 vaccinations and then every 12 weeks thereafter. Patients also receive sargramostim (GM-CSF) SC daily on days 1-4 and interleukin-2 SC daily on days 8-12 with each vaccination. Patients without disease progression after 12 courses receive the vaccine regimen every 12 weeks. Arm II: Patients receive oral nilutamide daily. Treatment continues in both arms for at least 6 months in the absence of disease progression or unacceptable toxicity. After 6 months of therapy, patients with a rising PSA and no radiographic evidence of disease progression may receive therapy in the other arm in addition to the therapy to which they were randomized. Patients are followed monthly for 6 months and then every 2 months thereafter. PROJECTED ACCRUAL: A total of 56-78 patients (28-39 per treatment arm) will be accrued for this study within 1.5-2 years.

Official Title
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A Randomized Phase II Study of Either Immunotherapy With a Regimen of Recombinant Pox Viruses That Express PSA/B7.1 Plus Adjuvant GM-CSF and IL2 or Hormone Therapy With Nilutamide in Patients With Hormone Refractory Prostate Cancer and No Radiographic Evidence of Disease

Conditions
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Prostate Cancer

Intervention / Treatment
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* Biological: aldesleukin
* Biological: recombinant fowlpox-prostate specific antigen vaccine
* Biological: recombinant vaccinia prostate-specific antigen vaccine
* Biological: recombinant vaccinia-B7.1 vaccine
* Biological: sargramostim
* Drug: nilutamide


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed hormone-refractory adenocarcinoma of the prostate Rising PSA after orchiectomy and/or while receiving at least 1 regimen of luteinizing hormone-releasing hormone (LHRH) PSA must have risen at least 0.5 ng/mL from baseline on 2 successive measurements during and/or after hormonal therapy PSA greater than 1.0 ng/mL If on antiandrogen therapy, must undergo antiandrogen withdrawal for at least 6 weeks and still have evidence of rising PSA After prior bicalutamide, must undergo withdrawal for at least 6 weeks and still have evidence of rising PSA Testosterone no greater than 50 ng/mL if no prior orchiectomy No metastatic disease by bone scan and CT scan or MRI of the abdomen and pelvis and by CT scan or x-ray of the chest No active or prior CNS metastases PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Zubrod 0-2 OR ECOG 0-2 Life expectancy: Not specified Hematopoietic: Absolute lymphocyte count at least 600/mm^3 Platelet count at least 100,000/mm^3 Hemoglobin at least 8.0 g/dL Hepatic: Bilirubin no greater than 1.6 mg/dL AST and ALT no greater than 4 times normal Renal: Creatinine no greater than 1.5 mg/dL OR Creatinine clearance greater than 60 mL/min Urinalysis normal OR Proteinuria no greater than 1 g/24-hour urine collection No hematuria or abnormal sediment unless underlying cause is nonrenal Immunologic: HIV negative No altered immune function No autoimmune disease, including the following: Autoimmune neutropenia, thrombocytopenia, or hemolytic anemia Systemic lupus erythematosus, Sjogren's syndrome, or scleroderma Myasthenia gravis Goodpasture syndrome Addison's disease, Hashimoto's thyroiditis, or active Graves' disease No known allergy or untoward reaction to prior vaccination with vaccinia virus No known allergy to eggs No active or prior eczema or other eczematoid skin disorders No other acute, chronic, or exfoliative skin conditions (e.g., atopic dermatitis, impetigo, varicella zoster, burns, severe acne, or other open rashes or wounds) Other: No other serious concurrent illness No active infections within the past 3 days No history of seizures, encephalitis, or multiple sclerosis No close or household contact for at least 2 weeks after each vaccinia virus inoculation with the following high-risk individuals: Children under 5 years of age Pregnant or nursing women Individuals with active or prior eczema or other eczematoid skin disorders, atopic dermatitis, impetigo, varicella zoster, burns, severe acne, or other open rashes or wounds Immunosuppressed or immunodeficient (by disease or therapy) individuals, including those with HIV infection No other malignancy within the past 3 years except squamous cell or basal cell skin cancer or other curatively treated malignancy PRIOR CONCURRENT THERAPY: Biologic therapy: Must have prior vaccinia for smallpox immunization No other concurrent biologic therapy Chemotherapy: No prior chemotherapy for prostate cancer No concurrent chemotherapy Endocrine therapy: See Disease Characteristics At least 4 weeks since prior hormonal therapy (6 weeks for bicalutamide) and recovered If disease progression on LHRH antagonist, must continue to receive that LHRH agent or undergo surgical castration No concurrent steroids unless topical or inhaled No other concurrent hormonal therapy Radiotherapy: At least 4 weeks since prior radiotherapy and recovered No prior radiotherapy to more than 50% of nodal groups No concurrent radiotherapy Surgery: See Disease Characteristics See Endocrine therapy At least 4 weeks since prior surgery and recovered No prior splenectomy Other: No concurrent homeopathic therapy with PC-SPES or genistein

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized


Arms and Interventions

| Intervention/Treatment |
| --- |
|Biological: aldesleukin|nan|
|Biological: recombinant fowlpox-prostate specific antigen vaccine|nan|
|Biological: recombinant vaccinia prostate-specific antigen vaccine|nan|
|Biological: recombinant vaccinia-B7.1 vaccine|nan|
|Biological: sargramostim|nan|
|Drug: nilutamide|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adenocarcinoma of the prostate, recurrent prostate cancer