The purpose of this phase I trial is to test the safety of combining GMCI, an immunostimulator, plus nivolumab, an immune checkpoint inhibitor (ICI), with standard of care radiation therapy, and temozolomide in treating patients with newly diagnosed high-grade gliomas. Gene Mediated Cytotoxic Immunotherapy (GMCI) involves the use of aglatimagene besadenovec (AdV-tk) injection into the tumor site and oral valacyclovir to kill tumor cells and stimulate the immune system. Nivolumab is an immune checkpoint inhibitor that may also stimulate the immune system by blocking the PD-1 immune suppressive pathway. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors and temozolomide is a chemotherapy drug that kills tumor cells. Giving GMCI, nivolumab, radiation therapy, and temozolomide may work better in treating patients with high-grade gliomas
PRIMARY OBJECTIVES: I. To assess the safety/maximum tolerated dose (MTD) of the combination of aglatimagene besadenovec (AdV-tk) given intra-cranially at the time of initial tumor resection followed by valacyclovir (GMCI), nivolumab, and standard of care (radiation therapy \[RT\]+temozolomide \[TMZ\]) in patients with high-grade gliomas (HGG). PRIMARY OBJECTIVES: I. To assess the safety/maximum tolerated dose (MTD) of the combination of aglatimagene besadenovec (AdV-tk) given intra-cranially at the time of initial tumor resection followed by valacyclovir (GMCI), nivolumab, and standard of care (radiation therapy \[RT\]+temozolomide \[TMZ\]) in patients with high-grade gliomas (HGG). SECONDARY OBJECTIVES: I. To evaluate safety and toxicity of this combined treatment regimen. II. To estimate overall survival. III. To estimate progression free survival. IV. Immune biomarkers, including serum extracellular vesicles (EVs). OUTLINE: Patients undergo tumor resection and receive AdV-tk injection into the wall of the resection cavity. Patients then receive valacyclovir orally three times per day for 14 days. Beginning on approximately day 8, patients undergo radiation therapy five days per week for 6 weeks. Temozolomide will be initiated on approximately day 15 after valacyclovir is completed and will continue until MGMT methylation status is known. If unmethylated, temozolomide will be discontinued: these patients will constitute Cohort 1. In Cohort 2 - patients with methylated MGMT - temozolomide will continue. If methylation status is unable to be determined, those patients will also continue receiving temozolomide (Cohort 2). Both cohorts will receive nivolumab intravenously every two weeks for up to 52 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 2 months for 2 years, and then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
41
Given IT
Given PO days 1-14; 1-3 days post surgery
Undergo RT, 60Gy in 30 daily fractions M-F for 6weeks
Given PO during RT 75mg/m2 daily during RT Post RT cycle 1: 150mg/m2 days 1-5 150mg/m2 cycle 2-6: days 1-5 (150-200mg/m2)
day 15 post surgery 240mg IV q2wks x 26 doses , up to 52 weeks
correlative studies
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Henry Ford Hospital
Detroit, Michigan, United States
Wake Forest University Comprehensive Cancer Center
Winston-Salem, North Carolina, United States
Abrams Cancer Center of the University of Pennsylvania
Philadelphia, Pennsylvania, United States
Hillman Cancer Center at University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania, United States
Incidence of adverse events
National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 will be used for scoring toxicity and adverse events. The severity and frequency of toxicity will be tabulated by the tested dose or doses using descriptive statistics. The proportions of subjects who experienced grade 3 or above toxicities will be estimated, along with 95% confidence intervals by each type of toxicity.
Time frame: Up to 2 years
Overall survival (death)
To estimate overall survival - endpoint is death. Median time of survival along with 95% confidence interval will be estimated using the Kaplan-Meier method.
Time frame: From initial diagnosis to the date of death/or censored at the time of last known alive, assessed for up to 2 years
Progression-free survival (progression)
To estimate progression-free survival - endpoint is progression. Median time of progression-free survival along with 95% confidence interval will be estimated using Kaplan-Meier method.
Time frame: From initial diagnosis to the date progression is defined, assessed for up to 2 years
Immune profiling - Tumor Tissue
Tumor profiling by immunohistochemistry and Nanostring at baseline and when samples available after treatment.
Time frame: Up to 2 years
Tumor mutation - Tumor Tissue
Mutational profiling by sequence or transcriptome analysis from tumor tissue
Time frame: Up to 2 years
Peripheral blood mononuclear cells (PBMCs) in serum samples
Standard descriptive statistics will be used to summarize proportion of PBMCs.
Time frame: Up to 2 years
Immune characterization as determined by Cytokines
Immune characterization of surface and content proteins is determined by presence of cytokines in serum.
Time frame: Up to 2 years
Immune characterization as determined by Extracellular vesicles (EVs) proteins
Immune characterization of surface and content proteins based on presence of extracellular vesicles in serum samples.
Time frame: Up to 2 years
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