This phase I/II trial studies the best dose and side effects of recombinant human EGF-rP64K/montanide ISA 51 vaccine (CIMAvax) and nivolumab and to see how well they work in treating patients with non-small cell lung cancer or squamous head and neck cancer that has spread to other places in the body. Vaccine therapy, such as CIMAvax vaccine may help slow down and stop tumor growth. Immunotherapy with monoclonal antibodies, such as nivolumab and pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving CIMAvax vaccine together with nivolumab or pembrolizumab may work better in treating patients with non-small cell lung cancer or squamous head and neck cancer.
PRIMARY OBJECTIVES: * I. To identify the maximum dose of CIMAvax in combination with nivolumab based on dose limiting toxicities (DLTs) as assessed by Common Terminology Criteria for Adverse Events version 4.03 (CTCAE version \[v\] 4.03). (Phase I) * II. To evaluate the 12-month overall survival of CIMAvax combined with nivolumab in patients with advanced non-small cell lung cancer (NSCLC). (Phase II-Study A) * III. To evaluate the 6-month progression free survival (PFS) of CIMAvax combined with nivolumab in patients with advanced recurrent squamous cell carcinoma of the head and neck. (Phase II-Study B) * IV. To evaluate the objective response rate of pembrolizumab in combination with CIMAvax as first-line therapy in patients with advanced NSCLC (PD-L1 expression \>= 50%). (Phase II-Study C) * V. To evaluate the 12-month PFS of pembrolizumab in combination with CIMAvax as maintenance therapy in patients with advanced squamous NSCLC (PD-L1 expression \< 50%) (Phase II-Study D) * VI. To evaluate the 12-month PFS of pembrolizumab in combination with CIMAvax as maintenance therapy in patients with advanced NON-squamous NSCLC without EGFR/ALK/ROS-1/KRAS mutations (PD-L1 expression \< 50%) (Phase II- Study E) SECONDARY OBJECTIVES * I. To assess the toxicity of CIMAvax combined with nivolumab using the Cancer Therapy Evaluation Program (CTEP) National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE version 4.03). (Phase I) * II. Determine the preliminary efficacy of the combination of anti-PD1 therapy with CIMAvax. (Phase I) III. To evaluate progression free survival (PFS) for the combination of CIMAvax and nivolumab in patients with advanced NSCLC. (Phase II-Study A) IV. To evaluate the 12-month overall survival of patients with advanced recurrent squamous cell carcinoma of the head and neck who received nivolumab in combination with CIMAvax. (Phase II-Study B) * V. To evaluate the PFS and 12-month overall survival of CIMAvax in combination with pembrolizumab as first-line therapy in patients with advanced NSCLC (PD-L1 expression \>= 50%). (Phase II-Study C) * VI. To evaluate the PFS and overall survival of CIMAvax in combination with pembrolizumab as maintenance therapy in patients with advanced squamous NSCLC (PD-L1 expression \< 50%). (Phase iI- Study D) * VII. To evaluate the PFS and overall survival of CIMAvax in combination with pembrolizumab as maintenance treatment in non-squamous NSCLC patients without EGFR/ALK/ROS-1/KRAS mutations after induction chemoimmunotherapy (PD-L1 expression \< 50%).(Phase II - Study E) * VIII. To assess the toxicity of CIMAvax combined with nivlumab or pembrolizumab suing the CTEP NCI Common Terminology Criteria for Adverse Events (CTCAE version 4.03). (Phase II) TERTIARY OBJECTIVES: I. To conduct correlative studies comparing blood EGF levels, platelet levels, markers of immune response and functionality of antibody response. (Phase I) II. To examine the association of EGFR (total and activated), PD-1 and PD-L1 expression and mutations in tumor tissue with biomarkers of genetic and immune response. (Phase I and II) III. Comparison of response assessment criteria for a prospective analysis (immune-related \[ir\] Response Evaluation Criteria in Solid Tumors \[RECIST\] response assessment versus \[vs.\] immune-related Response Criteria \[irRC\] vs. RECIST 1.1). (Phase I and II) IV. To characterize the blood EGF levels and other blood-based biomarkers of patients censored from the trial because of low titer response. (Phase II) OUTLINE: This is a phase I dose escalation study of CIMAvax followed by a phase II study. LOADING PHASE I: Patients receive CIMAvax intramuscularly (IM) and nivolumab intravenously (IV) over 60 minutes on day 1. Treatment repeats every 2 weeks for up to 4 doses in the absence of disease progression or unacceptable toxicity. Within 4 weeks after the 4th dose, patients receive CIMAvax IM at the same time as the next nivolumab dose. MAINTENANCE PHASE I: Patients who do not experience a DLT receive CIMAvax every 4 weeks and nivolumab every 2 weeks. PHASE II STUDY A and B: Patients receive CIMAvax IM and nivolumab IV over 60 minutes. Treatment with CIMAvax repeats every 2 weeks for 4 doses during the loading phase and every 4 weeks during the maintenance phase in the absence of disease progression or unacceptable toxicity. Courses for nivolumab repeat every 2 weeks in the absence of disease progression or unacceptable toxicity. Patients in Study A with antibody titer \>= 1:4000 at the end of the loading phase may receive CIMAvax IM every 8 or 12 weeks during the maintenance phase. PHASE II STUDY C: Patients with PD-L1expression \>= 50% receive CIMAvax IM and pembrolizumab IV over 30 minutes. Treatment with CIMAvax repeats every 2 weeks for 4 doses during the loading phase and every 4 weeks during the maintenance phase in the absence of disease progression or unacceptable toxicity. Courses for pembrolizumab repeat every 2 weeks for 2 years in the absence of disease progression or unacceptable toxicity. PHASE II STUDY D: Patients with PD-L1 expression \< 50% after 4 cycles of induction chemotherapy with pembrolizumab, receive CIMAvax IM and pembrolizumab IV over 30 minutes. Treatment repeats every 4 weeks for 2 years in the absence of disease progression or unacceptable toxicity After completion of study treatment, patients are followed up every 30 days for 120 days.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
51
Indiana University Melvin and Bren Simon Comprehensive Cancer Center
Indianapolis, Indiana, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
St. Francis Hospital
Roslyn, New York, United States
Good Samaritan Hospital
West Islip, New York, United States
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States
Dose limiting toxicity (DLT) as graded by Common Terminology Criteria for Adverse Events version 4.03 (CTCAE v. 4.03) (Phase I)
No formal analyses of DLTs are planned. Presentation of DLTs will be limited to DLT-evaluable patients.
Time frame: Up to 4 weeks (2 doses of study drugs)
Overall survival (Phase II)
Overall survival will be defined as the number of months between Loading Phase enrollment and death from any cause. Overall survival will be presented using Kaplan-Meier plots and associated statistics.
Time frame: At 12 months
Progression-free survival (PFS) - Phase II
Number of months between Loading Phase and documentation of disease progression, death or censoring, whichever occurs first.
Time frame: At 12 monts
Incidence of adverse events (AEs) graded according to National Cancer Institute version 4.03 (NCI CTCAE v4.03) (Phase I and II)
The maximum grade for each type of AEs will be recorded for each patient based on NCI CTCAE version 4.0. The frequency of AEs will be tabulated by maximum grade per event across all dose levels and cycles. All patients who receive any study treatment will be considered evaluable for toxicity.
Time frame: Up to 120 days after the last dose of study treatment
Progression free survival (PFS) based on immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) (Phase II)
PFS will be defined as the number of months between Loading Phase enrollment and documentation of disease progression or death, whichever is observed first. PFS will be presented using Kaplan-Meier plots and associated statistics.
Time frame: Up to 12 months
Overall Survival (OS)
Time between study enrollment to the Loading Phase and death from any cause
Time frame: UP to 12 months
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