This is a Phase 2 non-randomized, open label, uncontrolled, efficacy and safety study. Study participants will receive two priming doses of 0.5mL of DPX-Survivac 21 days apart and up to six 0.1ml maintenance injections every two months with low dose metronomic oral cyclophosphamide (50 mg BID) for one year or until disease progression, whichever occurs first. Pembrolizumab 200 mg will be administered every 3 weeks for up to one year or until disease progression, whichever occurs first.
This is a Phase 2, non-randomized, open-label, uncontrolled, efficacy and safety trial. Participants will receive 2 priming injections (0.5ml) of DPX-Survivac 3 weeks apart on Study Days 7 and 28. In addition, up to 6 maintenance injections (0.1ml) over the course of the study occurring on Study Days 84, 140, 196, 252, 308, and 364. All injections will be given under the skin of the upper thigh. Participants will receive metronomic oral cyclophosphamide (50mg BID; 7 days on / 7 days off) for study period. Pembrolizumab 200mg will be administered intravenously every 3 weeks, commencing on study day 7, to a total of 18 infusions. If a participant is removed from the trial prior to the completion of at least 4 doses of Pembrolizumab and 3 injections of DPX-Survivac, that particiapnt may be replaced to determine the efficacy of treatment in a minimum of 16 participants. DPX-Survivac injection sites will be evaluated throughout the study and if evidence of significant reaction, an Injection site reaction biopsy will be sought. During the course of the study, blood will be drawn to evaluate immune cells and the effect that DPX Survivac will have on the participants immune system. During all treatment cycles a physical exam and questions about the participants general health will be performed. Participants will undergo "re-staging" to assess the status of their disease at approximately study day 70 (if there is evidence of Grade 2 or greater injection site reaction or ulceration evident on study day 49) or routinely at approximately study day 91, and again at end of study or study withdrawal for all participants. A follow-up tumour biopsy will be requested between study day 77-83 for participants with any grade 2 or greater Injection site reaction or ulceration on SD49 or between SD98 and SD104 if no evidence of injection site reaction or ulceration. Upon completion of study, participants will be monitored every 2 months for 1 year.
Study Type
INTERVENTIONAL
Allocation
NA
DPX-Survivac Priming dose of 0.5ml on Study days 7 and 28. DPX-Survivac Booster dose of 0.1ml on Study days 84, 140, 196, 252, 308, and 364.
Pembrolizumab 200mg administered intravenously every 3 weeks, commencing on study day 7 to a total of 18 infusions
Cyclophosphamide 50mg twice daily by mouth, administered 7 days on / 7 days off, stating at study day 0, until study day 384
Tom Baker Cancer Centre - Alberta Health Services
Calgary, Alberta, Canada
Nova Scotia Health Authority: Queen Elizabeth II Health Sciences Centre
Halifax, Nova Scotia, Canada
London Health Sciences Centre
London, Ontario, Canada
Ottawa Hospital Research Institute
Ottawa, Ontario, Canada
Objective Response Rate Using Modified Cheson Criteria to Treatment With DPX-Survivac and Low Dose Cyclophosphamide Administered Together With Pembrolizumab in Participants With Recurrent, Survivin-expressing B Cell Lymphomas
Objective Response Rate is the combined Complete Response (CR) and Partial Response (PR) rates using Cheson Criteria (2007) for evaluation. Site Qualified Investigators use radiological reports to calculate the decrease in tumour size from baseline at protocol specified time points.
Time frame: 1 Year
Duration of Response Using Modified Cheson Criteria.
Completing response assessment post radiology using the Cheson criteria
Time frame: 2 Years
Time to Next Treatment
time lapse between current and next treatment
Time frame: 42 months
Evidence of Regression Using Waterfall Analyses
Waterfall analysis is describing visually the participants best clinical response using the Modified Cheson Criteria (2007) and irRC (immune related response criteria). This includes Complete (CR), Partial (PR), Stable disease (SD) and Progressive Disease (PD). Participants are then categorized by their PD-L1 bio-marker response to show their tumour size decrease (in %) from baseline to their best response. Overall Response Rate (ORR) = CR+PR. Disease Control Rate (DCR) = CR+PR+SD.
Time frame: 1 year
Toxicity Profile
Safety will be assessed through patient reported and investigator observed Adverse Events (AE's) and graded using CTCAE version 4.03. This will also include physical examination and clinical laboratory tests. Specific attention will be placed upon injection site reactions and potential immune mediated AE's. Reporting will be on all AE's, regardless of relatedness, causality or severity and will include and AE's recorded from the time of participant consent to 30 days after treatment completion, resolution or lost-to-follow-up. Injection site reactions will be documented as grades of erythema, induration, pain, edema, ulceration or other. See Adverse Event section below for details.
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Purpose
TREATMENT
Masking
NONE
Enrollment
25
Sunnybrook Health Sciences Centre, Odette Cancer Centre
Toronto, Ontario, Canada
McGill University Health Centre
Montreal, Quebec, Canada
Time frame: 1 year