The purpose of this study is to find out what effects taking ipilimumab, as an immediate or delayed treatment, following completion of sipuleucel-T (SipT) treatment, has on patients and their prostate cancer.
This is an open-label randomized multicenter Phase 2 clinical trial combining SipT with ipilimumab in patients with chemotherapy-naïve metastatic castration resistant prostate cancer (CRPC). All patients will be treated with standard SipT (Q2wks x 3). Patients will be randomized to one of two arms: Arm 1 (Immediate Treatment): Ipilimumab Q3wks x 4 started 1 day following the final dose of SipT (Day 0). Arm 2 (Delayed Treatment): Ipilimumab Q3wks x 4 started 3 weeks following the final dose of SipT (Day 0). Following this ipilimumab treatment, patients will then be followed monthly for 3 months and then quarterly until disease progression. The definition of unacceptable toxicity is grade 3 or higher treatment-related toxicities (NCI CTCAE v4) excluding immune-related adverse events (irAEs). The study will assess for the immunogenicity and clinical activity of sequential sipuleucel-T treatment followed by ipilimumab. Patients who experience an initial clinical response to ipilimumab followed by subsequent disease progression will be offered reinduction treatment with ipilimumab.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
50
All patients will receive standard of care SipT treatment every two weeks for a total of 3 treatments. The three treatments usually take about 30 days to complete. SipT treatment is given in three 1 hour infusions. Each SipT treatment is generated from a standard blood cell-collection procedure (called leukapheresis) performed 2-3 days prior to the infusion.
Ipilimumab will be given by IV over 90 minutes every 3 weeks. Patients will be monitored during the infusion and up to 1 hour post-infusion.
University of California San Francisco
San Francisco, California, United States
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Percentage of Participants With an Immune Response to Prostatic Acid Phosphatase (PAP) and/or PA2024
Immune response will be tested using the single sample binomial exact test when induction therapy is completed. The Immunoglobulin M (IgM) and Immunoglobulin G (IgG) antibody responses to PAP and/or PA2024 will be assessed by ELISA assay at baseline and week 20 after start of sipT treatment (day 113 of study treatment). A positive response is defined as a titer \> 1:400. The positive immune percentage for both IgG and IgM antibodies to PAP and to PA2024 will be used to summarize the results for each study arm.
Time frame: Up to 20 weeks
Proportion of Participants With Highest Grade, Treatment-related, Immune Response Adverse Events (IRAEs)
Immune Response Adverse Events (IRAEs) will be reported for each study arm by tabulating the frequency of the maximum grade occurring for each patient for each type of iRAE using NCI Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0. IRAEs will be reported as a proportion of the participants in the treatment arm with the associated highest grade IRAE occurrences during protocol therapy.
Time frame: Up to 20 weeks
Proportion of Patients Achieving a Prostate-specific Antigen (PSA) Decline of at Least 30% Below Baseline
Descriptive statistics will be calculated to characterize the proportion of patients achieving a PSA decline of at least \>30% after 1 cycle of treatment and presented along with the 95% confidence intervals for each study arm.
Time frame: Up to 3 weeks
Proportion of Patients Achieving a PSA Decline of at Least 50% Below Baseline
Descriptive statistics will be calculated to characterize the proportion of patients achieving a PSA decline of at least \>50% and presented along with the 95% confidence intervals for each study arm.
Time frame: Up to 3 weeks
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Proportion of Patients Achieving an Objective Response
Proportion of patients achieving an objective response as defined by Immune-related Response Evaluation Criteria In Solid Tumors (irRECIST) as complete response (irCR), partial response (irPR) will be reported along with 95% confidence intervals
Time frame: Up to 2 years
Proportion of Patients Achieving an Objective Response Stratified by Prior Radical Prostatectomy (RP)
Proportion of patients achieving an objective response as defined by irRECIST as irCR +irPR and stratified by history of prior RP will be reported along with 95% confidence intervals.
Time frame: Up to 2 years
Proportion of Patients Achieving an Objective Response Stratified by Radiation Therapy (RT)
Proportion of patients achieving an objective response as defined by irRECIST as irCR + irPR stratified by prior RT will be reported along with 95% confidence intervals
Time frame: Up to 2 years
Radiographic Clinical Response Rate
For each treatment arm, for patients with objective disease, using immune-related response criteria (irRC) criteria, the proportion of patients achieving a complete or partial response will be determined and reported with 95% confidence intervals
Time frame: Up to 6 months
Median Time to PSA Progression
Time to PSA progression is defined as the start of protocol therapy to progression status at the end of 4 cycles of treatment as determined by the irRECIST.
Time frame: Up to 12 weeks