Overview

Vaccine + Durvalumab in Human Papilloma Virus (HPV) Cancers

Status:
Not yet recruiting
Trial end date:
2020-01-01
Target enrollment:
77
Participant gender:
All
Summary
Objectives: Primary: To evaluate the anti-tumor activity of MEDI0457 in combination with durvalumab. Secondary: To determine the safety profile of MEDI0457 in combination with durvalumab in patients with recurrent/metastatic human papilloma virus (HPV) 16- or 18- associated cancer. To evaluate the progression-free survival (PFS) and overall survival (OS) of patients with recurrent/metastatic incurable HPV-16/18 positive solid malignancies receiving the combination of MEDI0457and durvalumab. To evaluate objective response rate (ORR) by immune-related criteria of the combination of MEDI0457 and durvalumab in patients with recurrent/metastatic incurable HPV-16/18 positive solid malignancies. To evaluate the disease control rate at 24 weeks.
Phase:
Phase 2
Accepts Healthy Volunteers?
No
Details
Lead Sponsor:
M.D. Anderson Cancer Center
Collaborators:
AstraZeneca
Inovio Pharmaceuticals
Treatments:
Antibodies, Monoclonal
Criteria
Inclusion Criteria:

1. Written informed consent in accordance with institutional guidelines.

2. Male and female patients age 18 years or older who are able and willing to comply with
all study procedures.

3. For patients who are not HIV positive, cervical, anal, penile, vulvar, or vaginal
cancer positive for HPV-16 and/or HPV-18 by the institutionally approved assay. For
patients who are HIV positive, histologically or cytologically confirmed diagnosis of
cancer at any site that is positive for HPV-16 and/or HPV-18 by the institutionally
approved assay. Tumors may be positive for more than 1 HPV subtype as long as HPV-16
and/or HPV-18 is present. Note: For the first 6 patients, only cervical, vulvar, or
vaginal cancers will be enrolled.

4. Patients with cancer that is refractory to standard therapy, that have either relapsed
after standard therapy or has no standard therapy that increases survival by at least
three months, and/or that are not curable by salvage approaches including resection
and/or re-irradiation.

5. Has measurable disease, defined as at least one lesion that can be accurately measured
in at least one dimension (longest diameter to be recorded) with a minimum size of 10
mm by computed tomography (CT) scan, except lymph nodes which must have minimum short
axis size of 15 mm (CT scan slice thickness no greater than 5 mm in both cases).
Indicator lesions must not have been previously treated with surgery, radiation
therapy, or radiofrequency ablation unless there is documented Response Evaluation
Criteria In Solid Tumors (RECIST) version 1.1 progression in the lesion after such
therapy.

6. All patients must consent to pre-treatment biopsy of the tumor if it can be done
safely (as judged by the investigator) during screening. Week 10 on-treatment biopsies
will be required for a minimum 10 patients. After 10 paired biopsies have been
obtained then Week 10 on-treatment biopsy will be made optional.

7. World Health Organization (WHO)/Eastern Cooperative Oncology Group (ECOG) performance
status of 0 or 1.

8. Adequate organ and bone marrow function within 28 days of Day 0. Criteria a. to c.
cannot be met with recent (within 28 days of screening test except as noted below)
blood transfusions or require ongoing growth factor support: a. Hemoglobin >/= 9 g/dL
(Note: No Transfusion within 56 days. Ongoing growth factor support is acceptable if
on a stable dose for the past 56 days.), b. Absolute neutrophil count >/= 1,000/mm^3,
c. Platelet count >/= 100,000/mm^3 and no transfusion in prior 4 weeks, d. Total
bilirubin (TBL) Gilbert's syndrome (> 3 × ULN), e. Alanine aminotransferase (ALT) and aspartate
aminotransferase (AST) clearance >/= 40 mL/min (measured or calculated according to the method of Cockcroft
and Gault), and g. For Human Immunodeficiency Virus (HIV)+ patients: Documented HIV-1
infection with CD4 count > 200 cells/mm^3 and viral load < 75 copies/mL.

Exclusion Criteria:

1. Any concurrent chemotherapy, investigational product (IP), biologic, or hormonal
therapy for cancer treatment; receipt of any investigational or approved anticancer
therapy (chemotherapy, targeted therapy, biologic therapy, monoclonal antibodies,
etc.) within 21 days or 5 half lives, whichever is shorter, prior to the first dose of
MEDI0457; concurrent enrollment in another clinical study, unless it is an
observational (non-interventional) clinical study or during the follow-up period of an
interventional study.

2. Major surgical procedure or significant traumatic injury within 28 days before the
first dose of study drug or anticipation of the need for major surgery during the
course of study treatment.

3. 3. Any unresolved toxicity (National Cancer Institute Common Terminology Criteria for
Adverse Event [CTCAE] version 4.03 [v4.03]) Grade 2 or greater from previous
anticancer therapy with the exception of alopecia, and the laboratory values defined
in the inclusion criterion 8. Hearing loss of Grade 3 or lower and peripheral
neuropathy of Grade 2 or lower is allowed. Subjects with Grade >/= 2 neuropathy will
be evaluated on a case-by-case basis after consultation with the Study Physician.
Subjects with irreversible toxicity not reasonably expected to be exacerbated by
treatment with durvalumab may be included only after consultation with the Study
Physician.

4. Current or prior use of immunosuppressive medication within 14 days prior to first
study dose, with the exception of intranasal and inhaled corticosteroids or systemic
corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or
equivalent. Steroids as premedication for hypersensitivity reactions due to
radiographic contrast agents are allowed.

5. Patients requiring therapeutic anticoagulation and irreversible platelet inhibitors
(e.g. clopidogrel, prasugrel, or ticagrelor). Low dose aspirin for cardiac prophylaxis
is allowed.

6. History of primary immunodeficiency.

7. Patients who have had prior exposure to immune-mediated therapy defined as prior
exposure to T-cell and natural killer cell directed therapy (e.g. anti-PD-1,
anti-PD-L1, anti-CD137, and anti-CTLA4, etc).

8. History of allogeneic organ transplantation.

9. Active or prior documented autoimmune or inflammatory disorders (including
inflammatory bowel disease [e.g. colitis, ulcerative colitis or Crohn's disease],
diverticulitis [with the exception of diverticulosis], systemic lupus erythematosus,
Sarcoidosis syndrome, or Wegener syndrome [granulomatosis with polyangiitis, Graves'
disease, rheumatoid arthritis, hypophysitis, uveitis, etc.]). The following are
exceptions to this criterion: Patients with vitiligo or alopecia, Patients with
hypothyroidism (e.g. following Hashimoto syndrome) stable on hormone replacement, Any
chronic skin condition that does not require systemic therapy, Patients without active
disease in the last 5 years may be included but only after consultation with the study
physician, and Patients with celiac disease controlled by diet alone.

10. Uncontrolled intercurrent illness, including, but not limited to, ongoing or active
infection, uncontrolled hypertension, interstitial lung disease, serious chronic
gastrointestinal conditions associated with diarrhea, or psychiatric illness/social
situations that would limit compliance with study requirement, substantially increase
risk of incurring adverse events, or compromise the ability of the patient to give
written informed consent.

11. Patients with spinal cord compression or a history of leptomeningeal carcinomatosis.
At the time of Day 1 of the study, patients with central nervous system metastases
must have been treated and must be asymptomatic and meet the following criteria. 1. No
concurrent treatment, inclusive of, but not limited to, surgery, radiation, and/or
corticosteroids. (Note: patients are allowed on systemic steroids as detailed in
Exclusion Criterion 4 unless these are being administered to manage central nervous
system metastases.); 2. Neurologic stability (lack of signs or symptoms greater than
baseline prior to radiotherapy) until the time of dosing of MEDI0457; (Continued in
next criterion)

12. (Continued from Criterion 11) 3. For radiation treatment, patients must be: At least
14 days between last day of stereotactic radiosurgery or gamma-knife treatment and Day
1 of protocol treatment, At least 28 days between last day of whole brain radiation
therapy and Day 1 of protocol treatment, and/or At least 14 days since last dose of
corticosteroids and Day 1 of protocol treatment.

13. Patients with cardiovascular (CV) disease conditions including New York Heart
Association Class 3 or 4 congestive heart failure, unstable angina pectoris, or
clinically important cardiac arrhythmias OR a recent (< 3 months) CV event, including
myocardial infarction, unstable angina pectoris, or stroke.

14. Mean QT interval corrected for heart rate (QTc) >/= 470 ms calculated from ECG using
Fridericia's Correction by manual read.

15. Active tuberculosis (clinical evaluation that includes clinical history, physical
examination and radiographic findings, and tuberculosis testing in line with local
practice) infection.

16. Presence of acute or chronic hepatitis B (HBV) or active hepatitis C (HCV). Patients
with a past or resolved HBV infection (defined as the presence of hepatitis B core
antibody [anti-HBc] and absence of HBsAg) are eligible. Patients positive for HCV
antibody are eligible only if polymerase chain reaction is negative for HCV RNA.

17. Receipt of live, attenuated vaccine within 30 days prior to study entry or the first
dose of MEDI0457. Note: Patients, if enrolled, should not receive live vaccine during
the study and up to 30 days after the last dose of IP.

18. Other untreated coexisting HIV related malignancies.

19. History of another primary malignancy except for: malignancy treated with curative
intent and with no known active disease >/= 2 years before the first dose of IP and of
low potential risk for recurrence, adequately treated non-melanoma skin cancer or
lentigo maligna without evidence of disease, or adequately treated carcinoma in situ
without evidence of disease.

20. Pregnant or breastfeeding female patients.

21. Known allergy or hypersensitivity to study treatment or any of the study drugs
excipients.

22. Any medical condition that, in the opinion of the investigator, would interfere with
evaluation of the study treatment or interpretation of patient safety or study
results.

23. Patients with active or prior digestive tract bleeding.

24. Patients with uncontrolled seizures.

25. Fewer than two acceptable sites exist for intramuscular (IM) injection and
electroporation (EP) between the deltoid and lateral quadriceps muscles. Note: A site
for injection/EP is not acceptable if there are tattoos or scars within 2 cm of the
proposed injection/EP site or if there is implanted metal within the same limb. Any
device implanted in the chest (e.g. cardiac pacemaker or defibrillator) excludes the
use of the deltoid muscle on the same side of the body.

26. Patients who are unable to provide informed consent, are incarcerated, or are unable
to follow protocol requirements.