Vaccine Therapy With or Without Cyclophosphamide in Treating Patients Undergoing Chemotherapy and Radiation Therapy for Stage I or Stage II Pancreatic Cancer That Can Be Removed by Surgery
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Cancer, Pancreatic Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - 120 |
| Updated: | 1/13/2017 |
| Start Date: | July 2008 |
| End Date: | March 2018 |
A Randomized Three-arm Neoadjuvant and Adjuvant Feasibility and Toxicity Study of a GM-CSF Secreting Allogeneic Pancreatic Cancer Vaccine Administered Either Alone or in Combination With Either a Single Intravenous Dose or Daily Metronomic Oral Doses of Cyclophosphamide for the Treatment of Patients With Surgically Resected Adenocarcinoma of the Pancreas
RATIONALE: Vaccines made from gene-modified tumor cells may help the body build an effective
immune response to kill pancreatic cancer cells. Drugs used in chemotherapy, such as
cyclophosphamide, work in different ways to stop the growth of tumor cells, either by
killing the cells or by stopping them from dividing. Giving vaccine therapy together with
cyclophosphamide may kill more tumor cells. It is not yet known whether vaccine therapy is
more effective with or without cyclophosphamide in treating patients with pancreatic cancer.
PURPOSE: This randomized clinical trial is studying the side effects of vaccine therapy and
to see how well it works when given with or without cyclophosphamide in treating patients
undergoing chemotherapy and radiation therapy for stage I or stage II pancreatic cancer that
can be removed by surgery.
immune response to kill pancreatic cancer cells. Drugs used in chemotherapy, such as
cyclophosphamide, work in different ways to stop the growth of tumor cells, either by
killing the cells or by stopping them from dividing. Giving vaccine therapy together with
cyclophosphamide may kill more tumor cells. It is not yet known whether vaccine therapy is
more effective with or without cyclophosphamide in treating patients with pancreatic cancer.
PURPOSE: This randomized clinical trial is studying the side effects of vaccine therapy and
to see how well it works when given with or without cyclophosphamide in treating patients
undergoing chemotherapy and radiation therapy for stage I or stage II pancreatic cancer that
can be removed by surgery.
OBJECTIVES:
Primary
- To evaluate the safety and feasibility of a GVAX pancreatic cancer vaccine (GM-CSF
gene-transfected allogeneic pancreatic cancer vaccine) when administered alone or in
combination with a single intravenous dose or daily metronomic oral doses of
cyclophosphamide as neoadjuvant and adjuvant treatment in patients with resectable
stage I or II adenocarcinoma of the head, neck, or uncinate process of the pancreas.
- To assess the immune cell infiltrates, particularly T-regulatory cells (Tregs) and CD4+
and CD8+ effector T cells, after neoadjuvant GVAX pancreatic cancer vaccination.
- To assess the changes in the number and function of peripheral mesothelin-specific CD8+
T cells and CD4+, FoxP3+, and GITR+ Tregs after each GVAX pancreatic cancer vaccination
when administered alone or in combination with a single dose or metronomic doses of
cyclophosphamide.
Secondary
- To estimate disease-free and overall survival of patients treated with these regimens.
- To estimate the effect of immune parameters on disease-free and overall survival of
these patients.
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
- Arm A: Patients receive GVAX pancreatic cancer vaccine intradermally (ID) on day 1 and
undergo pancreaticoduodenectomy on day 15. Approximately 6-10 weeks after surgery,
patients receive an additional dose of the vaccine. Beginning approximately 1 month
after vaccination, patients receive standard adjuvant chemoradiotherapy comprising
gemcitabine, fluorouracil or capecitabine, and radiotherapy over 26-28 weeks. Beginning
approximately 4-8 weeks after the completion of chemoradiotherapy, patients receive the
vaccine on day 1. Treatment with the vaccine repeats every 28 days for 4 courses.
- Arm B: Patients receive low-dose cyclophosphamide IV on day 0 and GVAX pancreatic
cancer vaccine ID on day 1. Patients undergo pancreaticoduodenectomy on day 15.
Approximately 6-10 weeks after surgery, patients receive low-dose cyclophosphamide IV
on day 0 and the vaccine on day 1. Beginning approximately 1 month after vaccination,
patients receive standard adjuvant chemoradiotherapy comprising gemcitabine,
fluorouracil or capecitabine, and radiotherapy over 26-28 weeks. Beginning
approximately 4-8 weeks after the completion of chemoradiotherapy, patients receive
low-dose cyclophosphamide IV on day 0 and the vaccine on day 1. Treatment with
cyclophosphamide and the vaccine repeats every 28 days for 4 courses.
- Arm C: Patients receive GVAX pancreatic cancer vaccine ID on day 1 and low-dose oral
cyclophosphamide twice daily on days 1-7. Patients undergo pancreaticoduodenectomy on
day 15. Approximately 6-10 weeks after surgery, patients receive the vaccine on day 1
and low-dose oral cyclophosphamide twice daily on days 1-7 and 15-21. Beginning
approximately 1 month after vaccination, patients receive standard adjuvant
chemoradiotherapy comprising gemcitabine, fluorouracil or capecitabine, and
radiotherapy over 26-28 weeks. Beginning approximately 4-8 weeks after the completion
of chemoradiotherapy, patients receive the vaccine on day 1 and low-dose oral
cyclophosphamide twice daily on days 1-7 and 15-21. Treatment with the vaccine and
cyclophosphamide repeats every 28 days for 4 courses.
Patients undergo blood sample collection periodically for correlative laboratory studies,
including immune cell analysis. Immune cell analysis includes monitoring the quantitative
change of peripheral blood lymphocytes, including regulatory T cells (Tregs), and functional
analysis of T-cell immune response. Tumor tissue samples collected at the time of surgery
are analyzed for tumor antigens and infiltrating immune cells by immunohistochemistry and
quantitative real-time PCR.
After completion of study treatment, patients are followed periodically.
Primary
- To evaluate the safety and feasibility of a GVAX pancreatic cancer vaccine (GM-CSF
gene-transfected allogeneic pancreatic cancer vaccine) when administered alone or in
combination with a single intravenous dose or daily metronomic oral doses of
cyclophosphamide as neoadjuvant and adjuvant treatment in patients with resectable
stage I or II adenocarcinoma of the head, neck, or uncinate process of the pancreas.
- To assess the immune cell infiltrates, particularly T-regulatory cells (Tregs) and CD4+
and CD8+ effector T cells, after neoadjuvant GVAX pancreatic cancer vaccination.
- To assess the changes in the number and function of peripheral mesothelin-specific CD8+
T cells and CD4+, FoxP3+, and GITR+ Tregs after each GVAX pancreatic cancer vaccination
when administered alone or in combination with a single dose or metronomic doses of
cyclophosphamide.
Secondary
- To estimate disease-free and overall survival of patients treated with these regimens.
- To estimate the effect of immune parameters on disease-free and overall survival of
these patients.
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
- Arm A: Patients receive GVAX pancreatic cancer vaccine intradermally (ID) on day 1 and
undergo pancreaticoduodenectomy on day 15. Approximately 6-10 weeks after surgery,
patients receive an additional dose of the vaccine. Beginning approximately 1 month
after vaccination, patients receive standard adjuvant chemoradiotherapy comprising
gemcitabine, fluorouracil or capecitabine, and radiotherapy over 26-28 weeks. Beginning
approximately 4-8 weeks after the completion of chemoradiotherapy, patients receive the
vaccine on day 1. Treatment with the vaccine repeats every 28 days for 4 courses.
- Arm B: Patients receive low-dose cyclophosphamide IV on day 0 and GVAX pancreatic
cancer vaccine ID on day 1. Patients undergo pancreaticoduodenectomy on day 15.
Approximately 6-10 weeks after surgery, patients receive low-dose cyclophosphamide IV
on day 0 and the vaccine on day 1. Beginning approximately 1 month after vaccination,
patients receive standard adjuvant chemoradiotherapy comprising gemcitabine,
fluorouracil or capecitabine, and radiotherapy over 26-28 weeks. Beginning
approximately 4-8 weeks after the completion of chemoradiotherapy, patients receive
low-dose cyclophosphamide IV on day 0 and the vaccine on day 1. Treatment with
cyclophosphamide and the vaccine repeats every 28 days for 4 courses.
- Arm C: Patients receive GVAX pancreatic cancer vaccine ID on day 1 and low-dose oral
cyclophosphamide twice daily on days 1-7. Patients undergo pancreaticoduodenectomy on
day 15. Approximately 6-10 weeks after surgery, patients receive the vaccine on day 1
and low-dose oral cyclophosphamide twice daily on days 1-7 and 15-21. Beginning
approximately 1 month after vaccination, patients receive standard adjuvant
chemoradiotherapy comprising gemcitabine, fluorouracil or capecitabine, and
radiotherapy over 26-28 weeks. Beginning approximately 4-8 weeks after the completion
of chemoradiotherapy, patients receive the vaccine on day 1 and low-dose oral
cyclophosphamide twice daily on days 1-7 and 15-21. Treatment with the vaccine and
cyclophosphamide repeats every 28 days for 4 courses.
Patients undergo blood sample collection periodically for correlative laboratory studies,
including immune cell analysis. Immune cell analysis includes monitoring the quantitative
change of peripheral blood lymphocytes, including regulatory T cells (Tregs), and functional
analysis of T-cell immune response. Tumor tissue samples collected at the time of surgery
are analyzed for tumor antigens and infiltrating immune cells by immunohistochemistry and
quantitative real-time PCR.
After completion of study treatment, patients are followed periodically.
DISEASE CHARACTERISTICS:
- Newly diagnosed adenocarcinoma of the head, neck, or uncinate process of the pancreas
- Stage I or II disease
- Surgically resectable disease (R0 or R1) by spiral CT scan
- No distant metastases
- A clear fat plane is present around the celiac and superior mesenteric arteries
- Patent superior mesenteric and portal veins
- Candidate for a pancreaticoduodenectomy
PATIENT CHARACTERISTICS:
- ECOG performance status 0-1
- Hemoglobin ≥ 9 g/dL
- ANC ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Serum creatinine ≤ 2 mg/dL
- AST and ALT ≤ 2 times upper limit of normal (ULN)
- Amylase ≤ 2 times ULN
- Alkaline phosphatase ≤ 5 times ULN
- Hyperbilirubinemia secondary to tumor-associated extrahepatic biliary obstruction
allowed
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for ≥ 4 weeks after the
completion of study treatment
- No history of autoimmune disease, including systemic lupus erythematosus,
sarcoidosis, rheumatoid arthritis, glomerulonephritis, or vasculitis
- No uncontrolled medical problems
- No active infections
- No other cancer within the past 5 years except for superficial bladder cancer,
nonmelanoma skin cancer, or low-grade prostate cancer not requiring therapy
PRIOR CONCURRENT THERAPY:
- More than 28 days since prior anticancer therapy
- No prior cancer immunotherapy, including the same pancreatic cancer vaccine used in
this study
- More than 28 days since prior systemic steroid therapy or immunosuppressive therapy
- No systemic steroid therapy or immunosuppressive therapy during and within 28 days
after vaccine administration
- No other concurrent immunotherapy, chemotherapy, radiotherapy, gene therapy, biologic
therapy, or investigational therapy for the treatment of pancreatic cancer
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Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins The name Johns Hopkins has become synonymous...
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