Both metastatic squamous non-small cell lung cancer (NSCLC) and extensive stage small cell lung cancer (SCLC) are incurable with current therapies, but due to mutations induced by cigarette smoke, typically express a large number of altered proteins that can be recognized as foreign by the immune system. This antigenicity is thought to explain the efficacy of pembrolizumab as either a first or second line treatment in this disease. For patients who receive chemotherapy plus immunotherapy as a first line therapy, there is sound rationale for combination treatment with immunotherapy and a therapeutic antitumor vaccine as a maintenance strategy. Regardless of PD-L1 expression in the tumor, monoclonal antibodies that block PD-1/PD-L1 interactions are effective second line therapies after chemotherapy in both NSCLC and SCLC. In addition, by targeting the immune system against tumor specific antigens using a peptide vaccine, the efficacy of pembrolizumab alone is expected to be enhanced, with an improved response rate and prolonged overall survival with no additional toxicity. This pilot study will provide a preliminary test of the feasibility of generating a personalized, tumor neoantigen-specific therapeutic vaccine and the safety of combining it with checkpoint blockade immunotherapy.
Please note that this study originally opened with ID# 201707041 but was withdrawn due to change in standard of care chemotherapy. This study was revised and submitted as an amendment to the same IND but our IRB required it to be submitted as a new study and it received a new ID#.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
-Pembrolizumab will be given intravenously over the course of 30 minutes
-Generation of the vaccine is expected to take approximately 12 weeks
-Surgical or core needle biopsy of an accessible site for DNA and RNA sequencing, immunological analysis, and generation of NEO-PV-01 vaccine
-NEO-PV-01 is combined with the adjuvant poly-ICLC prior to administration.
-Peripheral blood mononuclear cells (PBMCs) for comprehensive immune system monitoring will be obtained from leukapheresis samples collected up to 7 days prior to initiation of NEO PV-01 vaccination and at 7 days (Week 20) following the first NEO-PV-01 booster vaccination.
-Blood samples (80 mL) for immune monitoring will be obtained prior to study treatment and at Weeks 6, 14, 16, 24, 36, 48, 63, 75, 87, and 99.
Safety and feasibility of the combined regimen as measured by number of participants who experience a serious adverse event
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Time frame: 30 days following the completion of treatment (estimated to be 2 years and 16 weeks)
Objective response rate as measured by RECIST 1.1
--Percentage of participants who experience a complete or partial response * Complete Response (CR): Disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm * Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters
Time frame: Through completion of treatment (estimated to be 108 weeks)
Progression-free survival (PFS) as measured by RECIST 1.1
* PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. * Progressive disease: At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions). Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. Unequivocal progression should not normally trump target lesion status. It must be representative of overall disease status change, not a single lesion increase.
Time frame: Through completion of follow-up (estimated to be 7 years)
Overall survival (OS)
Time frame: Through completion of follow-up (estimated to be 7 years)
Clinical benefit rate (CBR)
Time frame: Through completion of treatment (estimated to be 108 weeks)
Duration of response (DOR)
Time frame: Through completion of treatment (estimated to be 108 weeks)
Response conversion rate (RCR)
Time frame: Through completion of treatment (estimated to be 108 weeks)
Objective response rate (ORR) as measured per iRECIST
Time frame: Through completion of treatment (estimated to be 108 weeks)
Progression-free survival (PFS) as measured per iRECIST
-PFS is defined as the duration of time from start of personalized vaccine treatment (\~12 weeks after baseline) to time of progression or death, whichever occurs first.
Time frame: Through completion of follow-up (estimated to be 7 years)
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