This research study is evaluating a new type of melanoma vaccine called "Personalized NeoAntigen Cancer Vaccine". The purpose of this study is to determine if it is possible to make and administer safely a vaccine against melanoma by using information gained from specific characteristics of the participant's own melanoma. It is known that melanomas have mutations (changes in genetic material) that are specific to an individual patient and tumor. These mutations can cause the tumor cells to produce proteins that appear very different from the body's own cells. It is possible that these proteins used in a vaccine may induce strong immune responses, which may help the participant's body fight any tumor cells that could cause the melanoma to come back in the future. The study will examine the safety of the vaccine when given at several different time points and will examine the participant's blood cells for signs that the vaccine induced an immune response.
The study is an open label, phase I trial in which patients with high-risk melanoma are immunized with up to 20 peptides that are both specific to the patient's tumor cells (i.e., not found in their normal cells) and unique to the patient (i.e., "personal"). These peptides are encoded by missense mutations, in-frame gene fusions and novel open reading frame mutations (collectively known as "neoantigens") that have occurred within that patient's tumor cells and are identified through DNA and RNA sequencing. Up to 20 peptides about 20-30 amino acids in length will be prepared for each patient and will be administered together with the immune adjuvant poly-ICLC. The personalized NeoAntigen Cancer Vaccine consists of peptides + poly-ICLC and is called "NeoVax." This phase 1 study is designed to demonstrate that the combination of personalized neoantigen peptides and poly-ICLC is safe, feasible, and induces strong tumor-specific T cell immunity. The trial has a two-stage enrollment process. Eligible patients will be initially entered into the trial to undergo surgery with the intent to resect all melanoma detectable clinically and on radiographic scans. Patients will be reassessed for eligibility prior to the first vaccination and will continue onto the treatment phase of the trial if secondary eligibility criteria are met. Patients with tumors that are not completely resected and/or that provide inadequate DNA and/or RNA for sequencing will be removed from the trial and replaced. After NeoVax has been prepared, the vaccine will be administered on days 1, 4, 8, 15, and 22 (priming phase), and on days 78 and 134 (booster phase). Five patients will be entered for the initial safety evaluation (Cohort 1). If none or only 1 patient experiences a DLT on Cohort 1, an additional 10 patients will be treated at this dose to increase the likelihood of detecting serious toxicities, to complete biologic correlative endpoints, and to gain preliminary experience with clinical tumor activity. If two or more patients in Cohort 1 experience dose limiting toxicity (DLT) during the first 7 weeks of treatment, then the dose of poly-ICLC will be reduced by 50% and 5 patients will be enrolled into Cohort -1. If none or only 1 patient experiences a DLT on Cohort -1, then an additional 10 patients will be enrolled as described above. If two or more patients in Cohort -1 experience a DLT, then the study will be stopped. If four or more patients in the expansion cohort experience dose limiting toxicity (DLT) during the first 7 weeks of treatment, then the dose expansion cohort will be determined to have unacceptable toxicity and the study will be stopped prior to completion of enrollment of the expansion cohort.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
15
Brigham and Women's Hospital
Boston, Massachusetts, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Number of Participants Experiencing Clinical and/or Laboratory Dose-limiting Toxicities
Number of participants experiencing any of the following: * Grade-3 or -4 toxicity that is definitely, probably, or possibly related to the administration of vaccine * Grade-3 or -4 abnormal laboratory value that is definitely, probably, or possibly related to the administration of vaccine if it persists for more than 7 days, requires hospitalization, or medical intervention * Any grade-3 or grade- 4 toxicity that is considered, in the opinion of the investigator, to be dose-limiting * Any death related to study treatment A minimum of 3 vaccinations and absence of DLTs are required for a patient to complete the 7-week DLT observation period successfully.
Time frame: 7 weeks from first study drug administration
Proportion of Participants for Whom Sequencing and Analysis Leads to Identification of at Least 10 Actionable Peptides to Initiate Vaccine Production
The proportion of participants for whom sequencing and analysis leads to identification of at least 10 actionable peptides to initiate vaccine production. The primary assessment of feasibility will be based on on all participants enrolled with a confirmation of completely resected tumor and with adequate DNA and RNA for sequencing. NeoVax would be feasible if no more than 50% of participants have fewer than 10 actionable peptides or have NeoVax available more than 12 weeks after confirmation of complete resection. If 4 or fewer of the first 15 participants have insufficient vaccine or first dose delays of more than 12 weeks, then the upper bound of the one-sided 90% exact confidence interval will be less than 50% and we will consider the process feasible. If 5 or more of the first 15 patients have insufficient or delayed vaccine, we will consider the vaccine not feasible. The planned vaccination regimen will be administered even if the feasibility endpoints are not met.
Time frame: 12 weeks
Proportion of Participants With Specific Cellular Immune Responses Following Administration of NeoVax
The induction of IFN-γ T-cell response will be based on ELISPOT assessments taken prior to vaccine administration and at week 16. The proportion of participants who achieve more than 55 SFU/10\*\*6 PBMC or 3 times their baseline level will be presented with a 90% exact binomial confidence interval. Based on a cohort of size 15, the confidence interval will be no wider than 0.46.
Time frame: 16 weeks
Proportion of Participants Alive Without Progression at Two Years After Surgery Following Administration of NeoVax
The proportion of participants alive, without disease progression at two years after resection estimated using the method of Kaplan-Meier. The endpoint is calculated as the time between pathological confirmation of complete resection and the first of disease recurrence or death. The follow-up of participants disease-free at the time of study reporting is censored at the time of the last study visit. Participants disease-free at the time of their last assessment and who have either been lost to follow-up or withdrawn consent will have their follow-up censored at the time of the last study assessment.
Time frame: 2 Years
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