Clinical trial NCT05964361: First-in-human Interleukin-15-transpresenting Wilms' Tumor Protein 1-targeting Autologous Dendritic Cell Vaccination in Cancer Patients
Official title: First-in-human Interleukin-15-transpresenting Wilms' Tumor Protein 1-targeting Autologous Dendritic Cell Vaccination in Cancer Patients
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: PHASE1
PHASE2
Conditions: Esophageal Cancer
Pancreas Cancer
Ovarian Cancer
Liver Cancer
Lead sponsor: University Hospital, Antwerp
Sponsor class: OTHER
Collaborators: name: Kom Op Tegen Kanker
name: Stichting tegen Kanker
First posted: 2023-07-27
Enrollment: 10
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The goal of this clinical trial is to investigate a new type of dendritic cell vaccine in patients with refractory or advanced solid tumors of the esophagus, liver, pancreas and ovaries. The main questions it aims to answer are:

* is it feasible to produce and administer these dendritic cell vaccines?
* is treatment with these dendritic cell vaccines safe?

Participants will first need to undergo a leukapheresis procedure to collect the cellular starting material for the dendritic cell vaccine production. The treatment consists of 6 vaccines, administered at biweekly intervals. Participants will be followed-up until 90 days after the last vaccine.

Detailed description: The investigational medicinal product concerns dendritic cells that were engineered to target the tumor antigen Wilms' Tumor-1 (WT1) and in addition transpresent the cytokine IL15 on their cell surface. By inclusion of the IL15-transpresentation mechanism, the intention is to render the dendritic cell more immunogenic (i.e. they have a higher capacity to stimulate the immune system to recognize and attack WT1-expressing cancer cells).

Eligibility criteria: Inclusion Criteria:

* Signed informed consent (i.e. date of study entry (T0))
* Age ≥ 18 years at the time of signing informed consent
* Diagnosis with a histologically or cytologically confirmed solid tumor of the pancreas, esophagus, liver or ovaries that is advanced, recurrent or progressing after at least first-line anti-cancer treatment, or for which no alternative standard therapy is available due to intolerance to or refusal of standard-of-care treatment.
* Adequate hematological blood values following previous anti-cancer treatments, as judged by the Principal Investigator
* All treatment-related toxicities must have resolved to CTCAE grade ≤ 2 or must be stable and well controlled with minimal, local or non-invasive intervention, as judged by the Principal Investigator
* Reasonable life expectancy of at least 3 months, as estimated by the Principal Investigator
* At least 1 measurable or evaluable lesion as defined by the latest version of Immune-related Response Evaluation Criteria in Solid Tumors (iRECIST) guidelines
* Adequate hematologic and end-organ function, defined by the following laboratory test results, obtained at the time of screening:

  * Absolute neutrophil count (ANC) ≥ 1.5 x 109/L (1500/µL) without granulocyte colony-stimulating factor support
  * Lymphocyte count ≥ 0.5 x 109/L (500/µL)
  * Platelet count ≥ 100 x 109/L (100,000/µL) without transfusion
  * Hemoglobin ≥ 90 g/L (9 g/dL) (Patients may be transfused to meet this criterion)
  * Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) ≤ 2.5 x upper limit of normal (ULN), with the following exceptions:

    * Patients with documented liver metastases: AST and ALT ≤ 5 x ULN
    * Patients with documented liver or bone metastases: ALP ≤ 5 x ULN
  * Total bilirubin ≤ 2 x ULN with the following exception:

    * Patients with known Gilbert disease: total bilirubin ≤ 3 x ULN
  * Creatinine ≤ 1.5 x ULN
  * Albumin ≥ 25 g/L (2.5 g/dL)
  * Phosphorus ≥ 0.78 mmol/L
* World Health Organization (WHO) performance status 0-2
* Willing or able to comply with the protocol, as judged by the Principal Investigator
* Women of child bearing potential must have a negative serum or urine pregnancy test at the time of screening. Women of child bearing potential and men must agree to use effective contraception before, during and for at least hundred days after the last study treatment administration.

Exclusion Criteria:

* Use of any investigational agent within 4 weeks before the planned day of leukapheresis
* Corticosteroid treatment within 1 week before leukapheresis, unless the Principal Investigator rationalizes otherwise
* Active or history of autoimmune disease or immune deficiency, including, but not limited to, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, anti-phospholipid antibody syndrome, Wegener granulomatosis, Sjögren syndrome, Guillain-Barré syndrome, or multiple sclerosis, with the following exceptions:

  * Patients with a history of autoimmune-related hypothyroidism who are on thyroid replacement hormone are eligible for the study.
  * Patients with controlled Type 1 diabetes mellitus who are on an insulin regimen are eligible for the study.
  * Patients with eczema, psoriasis, lichen simplex chronicus, or vitiligo with dermatologic manifestations only (e.g., patients with psoriatic arthritis are excluded) are eligible for the study provided all of following conditions are met:

    * Rash must cover \< 10% of body surface area
    * Disease is well controlled at baseline and requires only low-potency topical corticosteroids
    * No occurrence of acute exacerbations of the underlying condition requiring psoralen plus ultraviolet A radiation, methotrexate, retinoids, biologic agents, oral calcineurin inhibitors, or high potency or oral corticosteroids within the previous 12 months
* Non-treated brain or meningeal mestases, or priorly treated brain or meningeal metastases with magnetic resonance imaging (MRI) evidence of progression in the last 8 weeks
* Pregnant or breastfeeding. Female subjects who are breastfeeding should discontinue nursing prior to the first dose of study treatment and until at least hundred days after the last study treatment administration
* Any other condition, either physical or psychological, or reasonable suspicion thereof on clinical or special investigation, which contraindicates the use of the vaccine, or may negatively affect patient compliance, or may place the patient at higher risk of potential treatment complications.

Primary outcomes:
measure: Feasibilty of leukapheresis
timeFrame: Upon completion of leukapheresis, on average 4 weeks after inclusion (baseline)
measure: Feasibility of IL15/IL15Ra/WT1 DC vaccine production
timeFrame: Upon completion of vaccine production and quality testing (i.e. from leukapheresis until 4 weeks after), on average 8 weeks after inclusion (baseline)
measure: Feasibility of study treatment scheme
timeFrame: Study treatment scheme (i.e. from administration of first to 6th vaccine (+- 10 weeks))
measure: Feasibility of DC vaccine administration (administration of 1st vaccine)
timeFrame: At administration of first vaccine
measure: Safety of IL15/IL15Ra/WT1 DC vaccine administration: Related (Severe) Adverse Events ((S)AEs)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Safety of IL15/IL15Ra/WT1 DC vaccine administration: total (S)AEs (number)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Safety of IL15/IL15Ra/WT1 DC vaccine administration: total (S)AEs (grade)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
Secondary outcomes:
measure: Indicators of clinical efficacy: Best Overall Response (BOR)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Indicators of clinical efficacy: Duration of Response (DOR)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Indicators of clinical efficacy: Objective Response Rate (ORR)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Indicators of clinical efficacy: Disease Control Rate (DCR)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Indicators of clinical efficacy: Progression-free Survival (PFS)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months. PFS may be updated after study completion.
measure: Indicators of clinical efficacy: Overall Survival (OS)
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months. OS may be updated after study completion.
measure: Immunogenicity of vaccination with IL15/IL15Ra/WT1 DC: occurrence of WT1-specfic CD8+ T cells
timeFrame: done on the day of administration of the first vaccine, the fourth vaccine, and on the day at the first follow-up visit following administration of V6 (i.e. +- 10 weeks after V6).
measure: Evaluation of changes in quality of life: How patients experience the study therapy
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Evaluation of changes in quality of life: How patient-reported disease-related symptoms evolve over time
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Evaluation of changes in quality of life: How patient-reported quality of life evolves over time
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
measure: Evaluation of changes in quality of life: How patient-reported quality of life evolves over time
timeFrame: over the entire study duration (i.e. from inclusion (baseline) to end of follow-up, which lasts until 90 days after the last DC vaccine), on average 7 months
Other outcomes:
Locations:
city: Edegem
country: Belgium
facility: Antwerp University Hospital
Study officials:
affiliation: University Hospital, Antwerp
name: Timon Vandamme, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Van den Bergh JM, Lion E, Van Tendeloo VF, Smits EL. IL-15 receptor alpha as the magic wand to boost the success of IL-15 antitumor therapies: The upswing of IL-15 transpresentation. Pharmacol Ther. 2017 Feb;170:73-79. doi: 10.1016/j.pharmthera.2016.10.012. Epub 2016 Oct 21.
citation: Van den Bergh J, Willemen Y, Lion E, Van Acker H, De Reu H, Anguille S, Goossens H, Berneman Z, Van Tendeloo V, Smits E. Transpresentation of interleukin-15 by IL-15/IL-15Ralpha mRNA-engineered human dendritic cells boosts antitumoral natural killer cell activity. Oncotarget. 2015 Dec 29;6(42):44123-33. doi: 10.18632/oncotarget.6536.