JOURNAL ONKOLOGIE – STUDIE

Autologous Dendritic Cells, Metronomic Cyclophosphamide and Checkpoint Blockade in Children With Relapsed HGG

Studien-Informationen Einschlusskriterien Studien-Rationale Geprüfte Regime

Rekrutierend

NCT-Nummer:
NCT03879512

Studienbeginn:
Februar 2018

Letztes Update:
12.12.2023

Wirkstoff:
depletion of regulatory T cells, cancer vaccine, checkpoint blockade

Indikation (Clinical Trials):
Glioblastoma

Geschlecht:
Alle

Altersgruppe:
Alle

Phase:
-

Sponsor:
Wuerzburg University Hospital

Collaborator:
-

Studienleiter

Kramm Christof, MD
Study Chair
Children's Hospital, University Medical Center Göttingen

Kontakt

Matthias Eyrich, MD
Kontakt:
Phone: +49-931-201
Phone (ext.): 27728
E-Mail: eyrich_m@ukw.de» Kontaktdaten anzeigen

Paul G Schlegel, MD
Kontakt:
Phone: +49-931-201
Phone (ext.): 27915
E-Mail: schlegel_p@ukw.de» Kontaktdaten anzeigen

Studienlocations
(1 von 1)

University Children's Hospital
D-97080 Würzburg
(Bayern)
GermanyRekrutierend» Google-Maps
Ansprechpartner:
Matthias Eyrich, MD
Phone: +49-931-201-27728
E-Mail: eyrich_m@ukw.de

Paul G Schlegel, MD
Phone: +49-931-201-27915
E-Mail: schlegel_p@ukw.de» Ansprechpartner anzeigen

Studien-Informationen

Detailed Description:

Relapsed high-grade gliomas (in the following addressed as high-grade gliomas = HGG) in

children and adolescents represent a very bad prognosis group for which a recommended

standard salvage therapy is currently not available.

Combination of Dendritic Cell (DC) vaccination, metronomic cyclophosphamide, and checkpoint

blockade will be investigated in the present trial as a new treatment strategy for these

patients: metronomic cyclophosphamide has been shown to significantly reduce numbers of

regulatory T cells (Treg) without inducing general leukopenia. DCs might induce

tumour-directed immune responses thereby facilitating long-term remissions. Efficacy of

primed T-cell responses by the vaccine will potentially be enhanced by the application of

checkpoint inhibitors Nivolumab (antiPD-L1) and Ipilimumab (antiCTLA4) in the post-vaccine

phase and during maintenance.

Cyclophosphamide is an established drug used as an anti-cancer or immunosuppressive substance

since decades, with extensive experience when used in low, non-myeloablative dosages. DCs

represent an innovative new strategy in cellular immunotherapy. DCs in cancer patients have

been used in a number of smaller studies, and in some of these trials, promising results

could be obtained. Several studies showed a trend towards a prolonged overall survival with a

few long-term survivors which is otherwise extremely rare in this high-risk population.

Results seemed to be more favourable in pediatric than in adult patients. Checkpoint

inhibitors (antiPD-L1 and/or antiCTLA4) have been shown to exhibit synergistic effects with

vaccines in preclinical models, and prelimnary data of several early stage trials have shown

promising results. Therefore, our study aims to improve the efficacy of a DC-based

therapeutic vaccine by optimizing the conditions upfront of the vaccine (Treg depletion) and

improving T-cell responses by checkpoint blockade after the vaccine in the effector phase.

In conclusion, this study will exploit the optimal efficacy of a therapeutic vaccine in

children and adolescents with relapsed HGG.

Ein-/Ausschlusskriterien

Inclusion Criteria:

1. Diagnosis of relapsed high-grade malignant glioma confirmed by central

neuropathological and neuroradiological review (last magnetic resonance imaging

diagnosis not older than 4 weeks) - including glioblastoma multiforme (WHO IV),

anaplastic astrocytoma World Health Organization (WHO III), anaplastic

oligodendroglioma (WHO III), anaplastic oligoastrocytoma (WHO III), anaplastic

pilocytic astrocytoma (WHO III), anaplastic ganglioglioma (WHO III), anaplastic

pleomorphic xanthoastrocytoma (analogous to WHO III), giant cell glioblastoma (WHO

IV), and gliosarcoma (WHO IV) relapsed after first-line therapy.

2. Patients aged 3 years and older but under 21 years at time of relapse diagnosis

3. Written informed consent of the patient (mandatory from 14 years of age) or the

parents (mandatory till 18 years of age).

4. Prospect of resection of relapse tumour by neurosurgery (total, subtotal or partial)

Exclusion Criteria:

1. Known hypersensitivity or contraindication to cyclophosphamide

2. Known hypersensitivity or contraindications to Nivolumab or Ipilimumab.

3. Other malignancies, either simultaneous or within the last 2 years

4. Active, known or suspected autoimmune disease. Participants with type I diabetes

mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as

vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not

expected to recur in the absence of an external trigger are permitted to enroll.

5. Pregnancy and / or lactation

6. Patients who are sexually active refusing to use effective contraception (oral

contraception, intrauterine devices, barrier method of contraception in conjunction

with spermicidal jelly or surgical sterile)

7. Current or recent (within 4 weeks prior to start of trial treatment) treatment with

another investigational drug or participation in another investigational trial

8. Severe concomitant diseases (e.g. immune deficiency syndrome)

9. Severe psychological disease or neurological damage without possibility to communicate

10. Clinical signs of intracranial pressure

11. Intracerebral hemorrhage, gliomatosis

12. No severe blood count abnormalities: leukocytes < 2.000/µl, Hb <10 g/dl, thrombocytes

< 100.000/µl

13. No severe liver enzyme elevation (> 2-3x fold of normal)

14. Ongoing reirradiation or chemotherapy (within the last 4 weeks) (irradiation of

formerly non-involved fields is allowed, but not part of this study)

15. Estimated life expectancy of less than 2 months

16. Preexisting severe cardiac disease

17. Presence of unresectable spinal metastases

18. Karnofsky index < 50%

19. Active infection within the last 2 weeks

20. Previous infection with Human Immunodeficiency, Hepatitis C, Human T-Lymphocyte 1/2,

Hepatitis B Virus, Lues, protozoan parasites, or other chronic bacterial infections.

21. With regard to prevention of variant Creutzfeldt-Jakob disease the following patients

have to be excluded.

22. Patients receiving systemic immunosuppressive or immunoactivating substances.

Studien-Rationale

Primary outcome:

1. 6 month overall survival (Time Frame - 6 months):
overall survival 6 months after diagnosis of relapse

Secondary outcome:

1. overall survival (Time Frame - 12-24 months):
overall survival

2. progression-free survival (Time Frame - 12-24 months):
progression-free survival

3. toxicity metronomic cyclophosphamide (Time Frame - 12-24 months):
frequency of adverse events associated with metronomic cyclophosphamide

4. toxicitiy vaccine (Time Frame - 12-24 months):
frequency of adverse events associated with the vaccine

5. toxicity checkpoint blockade (Time Frame - 12-24 months):
frequency of AEs/SAEs associated with Nivolumab and/or Ipilimumab

6. Treg frequency (Time Frame - 12-24 months):
frequency of CD4+CD25+CD127- regulatory T cells under metronomic cyclophosphamide in % of CD3+

7. Treg numbers (Time Frame - 12-24 months):
absolute numbers of CD4+CD25+CD127- regulatory T cells under metronomic cyclophosphamide per µl blood

8. T-cell response (Time Frame - 12-24 months):
Interferon-gamma Cytotoxic T cell (CTL) assay

9. serum cytokine levels (Time Frame - 12-24 months):
Tru Culture cytokine array

10. correlation with histopathological tumor characteristics (Time Frame - 12-24 months):
correlation of outcome/immune response with histopathology etc.

Geprüfte Regime

depletion of regulatory T cells:
oral metronomic cyclophosphamide
reoperation:
resection of relapsed tumor in order to improve clinical condition of the patient and to acquire tumor tissue for vaccine generation
cancer vaccine:
4 weekly intradermal injections of lysate-loaded dendritic cells, followed by 3 monthly boost vaccines with tumor lysate and further boost vaccines every three months
checkpoint blockade:
Immediately one week after the DC-induction vaccines, patients will receive four applications of Nivolumab/Ipilimumab double checkpoint blockade in threeweekly intervals, followed by Nivolumab monotherapy every month for a total duration of one year.

Quelle: ClinicalTrials.gov

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