This is an open-label, dose-finding, Phase 2A/2B study of Ad5.F35-hGCC-PADRE as a vaccine for gastrointestinal (GI) malignancies (pancreatic, colorectal, esophageal, gastric, and small bowel adenocarcinomas) who have received surgical resection and standard adjuvant therapy. In Phase 2A, patients will be given multiple administrations of Ad5.F35-hGCC-PADRE intramuscularly at 1 of 3 dose levels. Treatment-related toxicity and development of immune responses to GCC will be evaluated at Weeks 5, 9, and 13 after the initial vaccination (Week 1). Primary safety endpoints will examine adverse events (AEs), injection-site reactions and clinically-significant changes in safety laboratory tests. Primary efficacy endpoints include the development of GCC-specific T-cell responses at different dose levels (1011, 1012, and 5x1012 virus particles or vp). In Phase 2B Dose Expansion cohort, a group of 20 colon cancer patients who are ctDNA+ by CLIA-certified standard of care assays will receive a single administration of Ad5.F35-hGCC-PADRE vaccine intramuscularly at prespecified dose of 1012 vp. Phase 2b is NOT randomized. Primary safety endpoints will examine AEs, injection-site reactions and clinically significant changes in safety laboratory tests. The primary efficacy endpoints include GCC-specific T-cell responses at 1012 vp in ctDNA+ patients. Additional exploratory endpoint will determine elimination of minimal residual disease (MRD) by ctDNA clearance.
PRIMARY OBJECTIVES: 1. Evaluate the safety and tolerability of sequential Ad5.F35-hGCC-PADRE vaccine administration, delivered intramuscularly (IM) at three dose levels (1011, 1012, and 5x1012 vp) four weeks apart in subjects with high-risk colorectal, pancreatic, gastric, esophageal, or small bowel adenocarcinomas with no evidence of disease after surgery and standard therapy. 2. For Cohort 2B, evaluate the safety and tolerability of single Ad5.F35-hGCC-PADRE vaccine at 1012 dose level in MRD+ colon cancer patients with no evidence of radiographic disease 3. Evaluate the cellular (T-cell) responses to Ad5.F35-hGCCPADRE at three different dose levels (1011, 1012, and 5x1012 vp) administered intramuscularly (IM) as three sequential doses four weeks apart in subjects with high-risk colorectal, pancreatic, gastric, esophageal, or small bowel adenocarcinomas with no evidence of disease after surgery and standard therapy. 4. For cohort 2B, evaluate the cellular (T-cell) responses to Ad5.F35-hGCC-PADRE vaccine at 1012 dose administered IM as one dose in subjects with MRD+ colon cancer with no evidence of radiographic disease after surgery and standard therapy. EXPLORATORY OBJECTIVES: * Evaluate the humoral (antibody) responses to Ad5.F35- hGCC-PADRE at three different dose levels (1011, 1012, and 5x1012 vp) administered IM as three sequential doses four weeks apart in subjects with high-risk colorectal, pancreatic, gastric, esophageal, or small bowel adenocarcinomas with no evidence of disease after surgery and standard therapy * Evaluate the association of neutralizing antibodies to Ad5 with immunologic response * Evaluate the correlation of the immune response to the GCC protein expression in tumors to assess immune tolerance * Evaluate disease-free survival (DFS) * Evaluate overall survival (OS), where feasible * Evaluate the circulatory tumor DNA (ctDNA) status and correlation with clinical recurrence, where feasible * Evaluate the ctDNA dynamics after single dose of 1012 Ad5.F35-hGCC-PADRE vaccine in an expansion cohort of ctDNA+ colon cancer patients
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
48
Given as intramuscular injection
Sidney Kimmel Cancer Center at Thomas Jefferson University
Philadelphia, Pennsylvania, United States
Incidence of adverse events (AEs)
AEs classified by System Organ Class, preferred term, severity, and relationship to study treatment, and graded in accordance with the document entitled "Common Terminology Criteria for Adverse Events" (CTCAE), National Cancer Institute version 5 issued by the United States Department of Health and Human Services. Injection-site reactions including, but not necessarily limited to, local skin erythema, induration, pain and tenderness at administration site. Clinically-significant changes in safety laboratory tests. The percentage of subjects with AEs and DLTs will be summarized along with corresponding 95% confidence intervals for each treatment arm and overall.
Time frame: 13 weeks
Antigen-specific T-cell response to guanylyl cyclase C (GCC)
Will be measured by enzyme-linked immunosorbent spot (ELISpot) assay. the immune parameters will be summarized via percentages of responders and mean/median values, along with corresponding 95% confidence intervals, by treatment arm and measurement time. Antibody and T-cell data will be summarized by positive response rates (each subject recorded as yes/no) and exact 2-sided 95% confidence intervals. For this study, a statistically significant increase in GCC-specific T-cell response at Weeks 5, 9, or 13 compared with baseline will be considered a response at that time. Significance of the change from baseline will be assessed using the modified distribution-free resampling (DFR) method. Will estimate response rates across disease types.
Time frame: 13 weeks
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