Overview

PROSTVAC in Combination With Nivolumab in Men With Prostate Cancer

Status:
Recruiting
Trial end date:
2022-08-01
Target enrollment:
0
Participant gender:
Male
Summary
Background: The immune system is the cells and organs in the body that recognize and fight infection and cancer. The PROSTVAC vaccine might teach the immune system to find and kill certain prostate cancer cells. Nivolumab is a drug that allows the immune system to fight tumors. Itmight help PROSTVAC work better. Objective: To test the safety and effectiveness of the combination of PROSTVAC and nivolumab. To test this for people with castration resistant prostate cancer and then for other people with localized prostate cancer who are candidates for surgical removal of the prostate. Eligibility: Men ages 18 and older with prostate cancer Design: Participants will be screened with: Medical history Physical exam Blood and urine tests Electrocardiogram Bone scan CT scan or MRI Tumor sample. This may be from a previous procedure. All participants will get a combination of the study drugs over 8 weeks. They will have 1 visit for the initial injection then 3 booster injection / nivolumab infusion visits. Blood will be tested at these visits. Over the next 4 weeks, some participants will have: An exam of the large intestine through the rectum. CT and bone scans Standard hormonal treatment Option to continue treatment every 3 weeks if their disease does not get worse. They will be have scans every 12 weeks. Other participants will have surgery to remove the prostate in week 9. Participants will have a safety visit about a month after their last treatment. This will include a physical exam, blood tests, and possibly scans. If their cancer progresses, participants will leave the study and may enroll in a long-term follow-up study. They will be contacted once a year to ask about their cancer and treatment. ...
Phase:
Phase 1/Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
National Cancer Institute (NCI)
Treatments:
Antibodies, Monoclonal
Nivolumab
Criteria
- INCLUSION CRITERIA:

For the neoadjuvant cohort, patients must have histopathological documentation of
adenocarcinoma of the prostate prior to starting this study and evaluable biopsy tissue
(e.g., unstained slides or blocks) available for analysis. If evaluable tissue is not
available, the patient must agree to undergo a pre-vaccination prostate biopsy on study.
For the CRPC lead in cohort, if histopathological documentation is unavailable, a rising
PSA and a clinical course consistent with prostate cancer would be acceptable.

- Age greater than or equal to 18 years. Because no dosing or adverse event data are
currently available on the use of PROSTVAC in combination with nivolumab, ipilimumab
or both in patients <18 years of age, children are excluded from this study, but will
be eligible for future pediatric trials.

- ECOG performance status of 0 or 1.

- Patients must not have other active invasive malignancies within the past 2 years
(with the exception of non-melanoma skin cancers) (for CRPC cohort only).

- Patients must be willing to travel to the study site for follow-up visits

- All patients who have received prior vaccination with vaccinia virus (for smallpox
immunization) must not have a history of serious adverse reaction to the vaccine.

- The effects of PROSTVAC in combination nivolumab, ipilimumab or both on the developing
human fetus are unknown. For this reason men must agree to use adequate contraception
(abstinence, vasectomy) or female partner must use (intrauterine device (IUD),
hormonal [birth control, pills, injections, or implants], tubal ligation] prior to
study entry and for up to 7 months after the last dose.

- Patients must understand and sign informed consent that explains the neoplastic nature
of their disease, the procedures to be followed, the experimental nature of the
treatment, alternative treatments, potential risks and toxicities, and the voluntary
nature of participation.

- Patients must have normal organ and marrow function as defined below:

- hemoglobin greater than or equal to 8 g/dL

- granulocytes greater than or equal to 1,500/mcL

- platelets greater than or equal to 100,000/mcL

- total bilirubin < 1.5 mg/dL (or less than or equal to 3.0 mg/dL in patients with
Gilbert syndrome)

- AST(SGOT)/ALT(SGPT) less than or equal to 2.5 X institutional upper limit of
normal

- creatinine less than or equal to 1.5 X ULN

- For the lead in cohort:

- Castrate testosterone level (<50ng/dl or 1.7nmol /L)

- Progressive disease at study entry defined as one or more of the following
criteria occurring in the setting of castrate levels of testosterone:

- Radiographic progression defined as any new or enlarging bone lesions or
growing lymph node disease, consistent with prostate cancer OR

- PSA progression defined by sequence of rising values separated by >1 week (2
separate increasing values over a minimum of 2ng/ml (PCWG2 PSA eligibility
criteria). If patients had been on flutamide, PSA progression is documented
4 weeks or more after withdrawal. For patients on bicalutamide or nilutamide
disease progression is documented 6 or more weeks after withdrawal.

- Patients must agree to continuation of androgen deprivation therapy (ADT) with a
gonadotropin-releasing hormone agonist/antagonist or bilateral orchiectomy

- For all other cohorts:

- Patients must be a surgical candidate for radical prostatectomy based on standard
workup of PSA, biopsy results, and if necessary supplemental imaging.

- Patients must have chosen radical prostatectomy as their definitive treatment of
choice for management of their prostate cancer.

- No systemic steroid or steroid eye drop use within 2 weeks prior to initiation of
experimental therapy. Limited doses of systemic steroids to prevent IV contrast,
allergic reaction or anaphylaxis (in patients who have known contrast allergies)
are allowed.

EXCLUSION CRITERIA:

- Prior splenectomy.

- The recombinant vaccinia vaccine should not be administered if the following apply to
either recipients or, for at least 3 weeks after vaccination, their close household
contacts (Close household contacts are those who share housing or have close physical
contact):

- persons with active or a history of eczema or other eczematoid skin disorders

- those with other acute, chronic or exfoliative skin conditions (e.g., atopic
dermatitis, burns, impetigo, varicella zoster, severe acne or other open rashes
or wounds) until condition resolves

- pregnant or nursing women; children under 3 years of age

- Patients should have no evidence, as listed below, of being immunocompromised:

- HIV positivity due to the potential for decreased tolerance and risk for severe
side effects.

- Hepatitis B or C positivity.

- Concurrent use of systemic steroids or steroid eye drops. This is to avoid
immunosuppression which may lead to potential complications with vaccinia (priming
vaccination). Nasal, topical or inhaled steroid use is permitted.

- Patients with known allergy to eggs or to compounds with a similar chemical or
biologic composition to PROSTVAC, ipilimumab or nivolumab.

- No prior immune checkpoint inhibitors (e.g., anti-CTLA4, anti-PD-1 or anti-PDL1) are
allowed.

- Other serious intercurrent illness.

- Patients with a history of unstable or newly diagnosed angina pectoris, recent
myocardial infarction (within 6 months of enrollment) or New York Heart Association
class II IV congestive heart failure.

- Patients with significant autoimmune disease that is active or potentially life
threatening if activated.

- Patients with clinically significant cardiomyopathy requiring treatment.

- Patients with ongoing toxicities related to prior therapies targeting T cell
coregulatory proteins (immune checkpoints) such as anti-PD-1, anti-PD-L1, or
anti-CTLA-4 antibody are excluded

- No transfusion of blood or blood products within 2 weeks and no G-CSF or GM-CSF within
2 weeks prior to initiations of experimental therapy.

- Contraindication to biopsy or prostatectomy (for sequential neoadjuvant cohorts only):

- Bleeding disorders

- Artificial heart valve

- PT/PTT greater than or equal to 1.5 in patients not taking anticoagulation.
Patients on anticoagulation (e.g. enoxaparin, oral anticoagulants) are eligible
regardless of PT/PTT. Prior to biopsy, anticoagulation will be held per standard
practice.

- For patients with localized prostate cancer contraindication to MRI:

- Patients weighing >136 kilograms (weight limit for the scanner tables)

- Allergy to MR contrast agent

- Patients with pacemakers, cerebral aneurysm clips, shrapnel injury or implantable
electronic devices

- History of radiation proctitis (for lead-in CRPC cohort only)