Hypothesis The incidence of toxicity in patients receiving the tumor DNA-transfected fibroblast vaccine will be acceptably low and the immunologic response rate sufficiently high to warrant further study of this therapy The study of the vaccine will proceed in two stages after the method of Simon (102). In the first stage, 15 patients will be accrued and treated. If two or fewer objective immunologic responses occur, the study will be terminated. If 3 or more responses are observed, the study will proceed to the second stage, accruing an additional 22 patients. If the second stage is complete and a total of 9 or more immunologic responses are observed among the 37 patients treated, the treatment response rate for the vaccine will be considered high enough to warrant further study. Conversely, if the evaluation of the vaccine concludes at the first stage, or if 8 or fewer total immunologic responses occur after completing the second stage, the vaccine will not be considered for further study.
This is a single institution open-label phase Ib clinical trial designed to determine the safety of immunization of patients with resected Head and Neck Squamous Cell Carcinoma (HNSCC) with lethally irradiated semi-allogeneic human fibroblasts (MRC-5) transfected with DNA derived from the subject's own tumor and to measure the immune response to the autologous tumor vaccine. Briefly, the plan is to use a two-stage trial design and to initially enroll 15 patients with Head and Neck Squamous Cell Carcinoma (HNSCC). The patients will undergo surgical resection to provide complete removal of the primary lesion with negative gross and microscopic margins. A portion of the primary tumor specimen not necessary for the pathologic diagnosis will be obtained to serve as a source of DNA for preparing the vaccine. Each DNA-based vaccine will contain 1 x 10e7 DNA-transfected human allogeneic fibroblasts. The vaccine will be lethally irradiated before it is used for immunization. It will be administered intradermally in the Outpatient Clinic for a total of four vaccinations delivered at weekly intervals. Patients delayed-type hypersensitivity (DTH) responses will be tested but will not be an eligibility criterion. Immunologic response to the vaccine will be evaluated. If there is no evidence of toxicity, and \>3 of the 15 initial patients show immunologic response, the second stage of the study will be opened for accrual of 22 patients. To determine patient's response to the DNA-based vaccines, the frequency of T cells reactive with recipient cells transfected with the autologous tumor DNA will be measured by ELISPOT for IFN-y and compared with the response to non-transfected fibroblasts prior to and after vaccination. All patients will be monitored for Immunologic response by assays include ELISPOT, flow cytometry for lymphocyte markers, Annexin V binding, TcR expression, caspase3 activity and serum antibodies.
Each vaccination consists of up to 1 x 10e7 (not less than 7 x 10e6) DNA-transfected irradiated fibroblasts. Each vaccination will be administered intradermally using a 1 mL syringe and a 25 gauge needle.The first immunization will be administered at least 12 weeks after surgery or completion of adjuvant chemotherapy and/or radiotherapy.Three additional vaccines will be administered once a week for a total of four vaccines. Patients will have vaccinations administered at 4 different sites as follows: Site #1: Right arm Site #2: Left arm Site #3: Right thigh Site #4: Left thigh. Approximately equal numbers of transfected fibroblasts will be administered at each site.
University of Pittsburgh Medical Center Presbyterian Hospital
Pittsburgh, Pennsylvania, United States
University of Pittsburgh Cancer Institute-Hillman Cancer Center
Pittsburgh, Pennsylvania, United States
University Of Pittsburgh Medical Center- Shadyside Hospital
Pittsburgh, Pennsylvania, United States
Immunization Safety
Toxicity will be monitored continuously from the first vaccination through the 6 month post follow up study visit for each subject. Patients will have a follow-up visit at 1 week after last vaccination (day 29, off treatment), at 1 month, 3 months and 6 months after last vaccination or after removal from study or until death, whichever occurs first. After the 6 month follow-up visit, subjects will be followed for survival only (no additional clinical trial site visits). Patients removed from study for unacceptable adverse event(s) will be followed until resolution or stabilization of the adverse event. All subjects should be enrolled within 2 years and follow up studies complete within 3 years.
Time frame: 2.5 years
Immunologic Response Rate to the the tumor DNA-transfected fibroblast vaccine
Immunologic evidence of a response to the DNA-based vaccine will depend on the results of ELISPOT assays performed at five to seven time points: pre-surgery, pre-vaccine (either at the day -28 or Day 1 prior to vaccination), on day 15, on day 29, 1 month, 3 months (if clinically indicated at 1 and 3 months) and at the 6 month post treatment follow-up appointment. A significant difference in the frequency of vaccine reactive or anti-tumor-reactive T cells between pre- and post-vaccine determinations will be considered as a positive immune response to the vaccine. Additionally, immune competence and the presence/absence of immune suppression will be evaluated before and after vaccine administration. The ability of DNA-based vaccines to reverse or diminish demonstrated effects in signaling defects, lymphocyte apoptosis or proportions of T(reg) in the peripheral circulation will be measured but will not be used as a criterion for evaluation of the immune response.
Time frame: 2.5 years
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Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE