Clinical trial NCT04082182: MIDRIX4-LUNG Dendritic Cell Vaccine in Patients With Metastatic Non-small Cell Lung Cancer
Official title: Phase Ia Study of MIDRIX4-LUNG, a Tetravalent Autologous Dendritic Cell Vaccine, in Patients With Metastatic Non-small Cell Lung Cancer
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE1
Conditions: Non-small Cell Lung Cancer Metastatic
Keywords: dendritic cell
vaccine
immunotherapy
Lead sponsor: University Hospital, Ghent
Sponsor class: OTHER
Collaborators: name: University Ghent
name: Kom Op Tegen Kanker
First posted: 2019-09-09
Enrollment: 7
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: intra-patient dose escalation scheme
Primary purpose: TREATMENT

Brief summary: MIDRIX4-LUNG is a novel tetravalent autologous dendritic cell vaccine in metastatic non-small cell lung cancer patients. This first-in-human study aims to primarily establish maximal tolerated dose of MIDRIX4-LUNG administered i.v.

Detailed description: Immunotherapy, in the shape of immune checkpoint inhibitors, is transforming the therapeutic landscape of non-small cell lung cancer. Checkpoint inhibitors can deliver durable tumor regressions, however only a minority of patients derive this kind of benefit, even with recent combinatorial approaches. It is clear from these clinical results that the full anti-tumoral power of the immune system is not being leveraged yet.

Vaccination aims to prime and/or expand tumor antigen-targeting T-cells and induce immunological memory against later disease relapse. Whereas immune checkpoint blockade boosts inactivated responses of effector T cells, vaccination can potentially activate naive T cells with tumor specificity and in this way broaden the tumor-specific immune responses that are the target of immune checkpoint inhibition.

However, the optimal vaccination modality for NSCLC still needs to be established.

Dendritic cells (DCs) are specialized antigen presenting leukocytes that are now recognized as the central controllers of the immune response. The DCs unique capacity to induce robust, highly antigen-specific cytotoxic T-cell responses has led to the use of in vitro-generated autologous DCs as cancer vaccines.

The investigators have developed a method for the rapid production of DCs with all the required features for the induction of anti-tumor immunity. The cells are particularly potent in inducing type 1-polarized T-helper cell and antigen-specific cytolytic T-cell responses. The DCs are loaded with a proprietary selection of 4 antigens that cover \>90% of all NSCLC patients.

With the objective of ultimately combining this DC vaccine with immune checkpoint inhibition, the investigators will first establish feasibility and maximal tolerated dose of DC vaccination as monotherapy using an intra-patient dose escalation scheme.

Eligibility criteria: Inclusion Criteria:

* Male and female patients older than 18 years with histologically or cytologically proven diagnosis of non-small cell lung cancer, newly diagnosed or recurrent stage IV, or stage IIIB not amenable to radical chemoradiotherapy (TNM 8th Edition), and for which no standard-of-care therapy is applicable or available at the time of enrollment
* Documented brain metastasis must be either asymptomatic or stabilized after adequate radiotherapeutic treatment as per institutional practice
* WHO-ECOG performance status 0 to 2 and absence of any persisting and assessable toxicity \> CTC grade 2 due to a previous therapy (e.g. brain radiotherapy)
* Before patient registration and screening, written informed consent must be given for the interventional study and for the "Prelevation and storage of human tissues and cells" according to ICH/GCP and institutional practice.
* Adequate organ function, including:

  * Adequate bone marrow reserve: absolute neutrophil count \> 1.5\*10E9/L, platelet count \> 100\*10E9/L, and Hb \> 9.0 g/dL
  * Sufficient renal function as defined by eGFR \> 40 ml/min
  * Sufficient hepatic function as defined by total bilirubin ≤1.5× ULN OR direct bilirubin within normal limits for participants with total bilirubin levels \>1.5× ULN; AST and ALT ≤ 2.5x ULN
  * Having passed all tests defined in the institutional Leukapheresis Donor Fitness Screening, including:
  * Adequate peripheral vein access to perform leukapheresis
  * Adequate coagulation function defined as international normalized ratio (INR) or prothrombin time (PT) ≤ 1.5 x ULN and activated partial thromboplastin time (aPTT) ≤ 1.5 x ULN unless the participant is receiving anticoagulant therapy
  * Negative test results for HBs-antigen, anti-HBc-serology, anti-HCV serology, anti-HIV1-2 serology, anti-CMV IgM, anti-Syphilis (Treponema pallidum) serology
  * Negative test results for Epstein-Barr virus (IgG and IgM) and for toxoplasmosis (IgG and IgM)
  * For female participants: a negative serum beta-HCG test result less than 1 week before the day of leukapheresis
* For female participants with child-bearing potential, the willingness to follow contraceptive guidance and pregnancy testing during the projected duration of the trial (see Appendix B for Contraceptive Guidance and Pregnancy Testing)
* For male participants having a partner with child-bearing potential: agreement to use contraception during the projected duration of the trial, starting with the screening visit through 90 days after the last dose of trial treatment. Sperm donation must have been performed before anti-cancer treatment as per standard practice

Exclusion Criteria:

* Presence of oncogenic driver genomic alterations for which a targeted therapy is available
* Concomitant participation in another clinical interventional trial
* Prior treatment with autologous or allogeneic dendritic cell-based vaccines
* NSCLC with large-cell neuro-endocrine or sarcomatoid histology
* Prior malignancy, except for adequately treated basal cell, superficial or in situ cancer of the bladder or the cervix, or other cancer for which the patient has been disease-free for at least five years.
* Dermatological pathology interfering with the in vivo immunomonitoring readout (DTH skin test)
* Untreated brain metastases with neurological symptoms or brain metastasis requiring a daily intake of steroids of \> 10 mg oral prednisolone or equivalent.
* Disease requiring chronic treatment with systemic glucocorticosteroids with a daily dose \> 10 mg oral prednisolone or equivalent, or other immunosuppressive drugs. Inhaled corticosteroids and topical corticosteroids on skin sites other than those used for DTH are allowed.
* Chronic or active concomitant infection requiring active therapy, including including HIV, viral hepatitis (HBV, HCV), CMV or fungal infection
* Autoimmune disease requiring active treatment at the time of the study
* Organ allograft
* Chronic comorbidity (such as asthma, COPD, heart failure, renal failure, arterial hypertension or diabetes mellitus) that is uncontrolled or not stabilized under medication at the time of study enrollment, OR stable yet severe enough to constitute an unwarranted high risk for the investigational cellular therapy.
* For female participants: pregnancy or lactation, or expecting to conceive or father children within the projected duration of the trial, starting with the screening visit through 90 days after the last dose of trial treatment
* Any organic brain syndrome or other significant psychiatric abnormality which would comprise the ability to give informed consent and preclude participation in the full protocol and follow-up.
* Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial.

Primary outcomes:
measure: Toxicity as defined by common toxicity criteria v5.0
timeFrame: From the day of leukapheresis until 3-4 weeks after the last vaccine dose level, i.e. 3 to 5 months depending on the number of doses that can be administered
measure: Maximal tolerated dose
timeFrame: From the day of leukapheresis until 3-4 weeks after the last vaccine dose level, i.e. 3 to 5 months depending on the number of doses that can be administered
Secondary outcomes:
measure: Success rate (%) of producing sufficient dendritic cells for vaccination
timeFrame: From the day of leukapheresis until the last vaccine dose level, i.e. 2 to 4 months depending on the number of doses that can be administered
measure: Number of vaccine-induced immunological responses as measured by in vitro immunomonitoring assays.
timeFrame: From the day of leukapheresis until 3-4 weeks after the last vaccine dose level, i.e. 3 to 5 months depending on the number of doses that can be administered. Whenever possible, repeat testing will be performed 3 and 6 months after the last vaccine dose.
measure: Number of vaccine-induced immunological responses as measured by in vivo immunomonitoring test.
timeFrame: From the day of leukapheresis until 3-4 weeks after the last vaccine dose level, i.e. 3 to 5 months depending on the number of doses that can be administered. Whenever possible, repeat testing will be performed 3 and 6 months after the last vaccine dose.
measure: Clinical activity of this type of vaccine as reflected by relapse-free survival
timeFrame: From the day of leukapheresis onwards during 1 year
measure: Clinical activity of this type of vaccine as reflected by median progression-free survival
timeFrame: From the day of leukapheresis onwards during 1 year
measure: Clinical activity of this type of vaccine as reflected by progression-free survival at landmark timepoints (%)
timeFrame: From the day of leukapheresis onwards during 1 year
Other outcomes:
Locations:
city: Ghent
country: Belgium
facility: Ghent University Hospital
Study officials:
affiliation: University Hospital, Ghent
name: Karim Y Vermaelen, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Brabants E, Heyns K, De Smet S, Devreker P, Ingels J, De Cabooter N, Debacker V, Dullaers M, VAN Meerbeeck JP, Vandekerckhove B, Vermaelen KY. An accelerated, clinical-grade protocol to generate high yields of type 1-polarizing messenger RNA-loaded dendritic cells for cancer vaccination. Cytotherapy. 2018 Sep;20(9):1164-1181. doi: 10.1016/j.jcyt.2018.06.006. Epub 2018 Aug 16.