Intralesional Influenza Vaccine for Patients With Melanoma
Trial Snapshot
- Phase
- Phase 1
- Status
- Recruiting
- Sponsor
- Enrollment
- 36
- Locations
- 2
- Primary Endpoint
- Incidence of adverse events (AEs)
Study Overview
Brief Summary
This phase I trial investigates the effects of influenza vaccine in treating patients with stage I-IV melanoma. While intramuscular administration of influenza vaccine provides immunization against the influenza virus, giving influenza vaccine directly into the tumor (intralesional) may decrease the size of the injected melanoma tumor, or the extent of the melanoma within the body.
Detailed Description
PRIMARY OBJECTIVE:
I. To evaluate the safety and tolerability and determine the maximum tolerated dose of intralesional (quadrivalent inactivated influenza vaccine (unadjuvanted influenza vaccine) for patients with a) resectable melanoma as monotherapy, and b) metastatic melanoma, concurrent with standard of care (single- or dual-agent) checkpoint inhibition.
SECONDARY OBJECTIVES:
I. To evaluate tumor dimensions of injected (Cohorts #1-2) and non-injected lesions (Cohort #2 only), by caliper or ultrasound measurement. (Clinical endpoint) II. To determine time to disease progression (local or distant). (Clinical endpoint) III. To evaluate immunohistochemistry density, cells/mm^2: CD4, CD8, PD-L1, PD1, CD56, CD20, CD45RO, FOXP3. (Tumor-based endpoint) IV. To evaluate granzyme B H-score. (Tumor-based endpoint) V. To evaluate NanoString Pan Cancer Immune Profiling Panel. (Tumor-based endpoint) VI. To evaluate tumor-infiltrating lymphocytes: not identified, present (non-brisk), present (brisk), cannot be determined. (Tumor-based endpoint) VII. To evaluate degree of tumor regression (percent). (Tumor-based endpoint) VIII. To evaluate changes in micro ribonucleic acid (microRNA) expression. (Tumor-based endpoint) IX. To evaluate of flow cytometry for T-cell subset evaluation and changes in circulating microRNA. (Blood draw endpoint)
EXPLORATORY OBJECTIVE:
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to 99 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Males or females
- •18 to 99 years of age
- •Histologically confirmed cutaneous melanoma by historical pathology report review, clinical Stage I-III (Cohort #1), or Stage IV (Cohort #2) cutaneous melanoma
- •At least one, biopsy-proven, palpable melanoma tumor deposit suitable for intralesional injection measuring ≥ 1 cm by digital caliper (with digital photography documentation) or ultrasound (with ultrasound image documentation)
- •Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1
- •Absolute neutrophil count (ANC) >= 1.5 x 10^3/mm^3 (drawn at or not more than 30 days prior to the screening visit)
- •Hemoglobin (Hgb) >= 8 g/dL (drawn at or not more than 30 days prior to the screening visit)
- •Platelet count >= 100 x 10^3/mm^3 (drawn at or not more than 30 days prior to the screening visit)
- •Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) or =< 5 x ULN in patients with liver metastases (Cohort 2 only) (drawn at or not more than 30 days prior to the screening visit)
- •Prothrombin time =< 1.5 x ULN (drawn at or not more than 30 days prior to the screening visit)
- •Total bilirubin =< 1.5 x ULN (unconjugated bilirubin of < 3 x ULN for patients with known Gilbert syndrome) (drawn at or not more than 30 days prior to the screening visit)
- •Creatinine clearance of >= 50 ml/min by Cockcroft-Gault equation (drawn at or not more than 30 days prior to the screening visit)
- •Women of childbearing potential (WOCBP) must agree to use effective contraceptive methods from screening until at least:
- •Cohort 1: 14 days after the surgical resection for subjects in Cohort 1
- •Cohort 2:
- •Nivolumab: 5 months after the last dose of either nivolumab or intralesional Flucelvax, whichever is later
- •Pembrolizumab: 4 months after the last dose of either pembrolizumab or intralesional Flucelvax, whichever is later
- •Ipilimumab: 3 months after the last dose of either ipilimumab or intralesional Flucelvax, whichever is later
- •Relatlimab + nivolumab (marketed under the trade name Opdualag): 5 months after the last dose of either Opdualag or intralesional Flucelvax, whichever is later.
- •Combination ipilimumab with other checkpoint inhibitor: Whichever is later:
- •3 months after the last dose of either ipilimumab or intralesional Flucelvax
- •Above-bulleted recommendation for nivolumab or pembrolizumab
- •Non-childbearing potential is defined as a woman who meets either of the following criteria: a) postmenopausal state defined as no menses for 12 months without an alternative medical cause, or b) documented hysterectomy, bilateral tubal ligation, or bilateral oophorectomy
- •Effective contraception methods are defined as one of the following:
- •True abstinence, defined as refraining from heterosexual intercourse, when this is in line with the preferred and usual lifestyle of the subject
- •Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods), declaration of abstinence for the duration of a trial, and withdrawal are not acceptable methods of contraception
- •Condoms and spermicide
- •Diaphragm and spermicide
- •Oral or implanted hormonal contraceptive
- •An intra-uterine device
- •WOCBP must have a negative pregnancy test (serum or urine)
Exclusion Criteria
- •Known allergy or intolerance to influenza vaccination
- •Subjects with condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone/equivalent) or other immunosuppressive medications within 14 days of study drug administration
- •Active, known or suspected autoimmune disease
- •Active brain metastasis or leptomeningeal metastasis
- •Diagnostic biopsy of ocular or mucosal melanoma
- •Any melanoma therapy within 6 months of enrollment; though prior surgical resection is permitted
- •Incarcerated patients
- •Patients known to be HIV positive are eligible if they meet the following criteria within 30 days prior to randomization: stable and adequate CD4 counts (≥ 350 mm^3), and serum HIV viral load of < 25,000 IU/ml. Patients may be on or off anti-viral therapy so long as they meet the CD4 count criteria
- •Pregnant or lactating patients
- •Patients incapable of independently providing consent
Arms & Interventions
Cohort I (resectable Stage I-III melanoma)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2 and 14 in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on day 28.
Intervention: Quadrivalent Inactivated Influenza Vaccine (Biological)
Cohort I (resectable Stage I-III melanoma)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2 and 14 in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on day 28.
Intervention: Resection (Procedure)
Cohort II (unresectable Stage IV)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2, 14, 28, 42, 56, 70, 84, and 98 in the absence of disease progression or unacceptable toxicity. Patients also receive standard of care (single- or dual-agent) ipilimumab, nivolumab, relatlimab, or pembrolizumab.
Intervention: Quadrivalent Inactivated Influenza Vaccine (Biological)
Cohort II (unresectable Stage IV)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2, 14, 28, 42, 56, 70, 84, and 98 in the absence of disease progression or unacceptable toxicity. Patients also receive standard of care (single- or dual-agent) ipilimumab, nivolumab, relatlimab, or pembrolizumab.
Intervention: Nivolumab + Relatlimab (Biological)
Cohort II (unresectable Stage IV)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2, 14, 28, 42, 56, 70, 84, and 98 in the absence of disease progression or unacceptable toxicity. Patients also receive standard of care (single- or dual-agent) ipilimumab, nivolumab, relatlimab, or pembrolizumab.
Intervention: Ipilimumab (Biological)
Cohort II (unresectable Stage IV)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2, 14, 28, 42, 56, 70, 84, and 98 in the absence of disease progression or unacceptable toxicity. Patients also receive standard of care (single- or dual-agent) ipilimumab, nivolumab, relatlimab, or pembrolizumab.
Intervention: Nivolumab (Biological)
Cohort II (unresectable Stage IV)
Patients receive an influenza vaccine IM on day 0 and intratumorally on days 2, 14, 28, 42, 56, 70, 84, and 98 in the absence of disease progression or unacceptable toxicity. Patients also receive standard of care (single- or dual-agent) ipilimumab, nivolumab, relatlimab, or pembrolizumab.
Intervention: Pembrolizumab (Biological)
Outcomes
Primary Outcomes
Incidence of adverse events (AEs)
Time Frame: Up to 1 year after the last intra-tumoral dose
Frequency and severity of AEs and tolerability of the regimen will be collected and summarized by descriptive statistics. The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns. All patients who have received at least one dose of the therapeutic agents will be evaluable for toxicity and tolerability.
Maximum tolerated dose (MTD) in Cohorts #1 and #2
Time Frame: Up to 98 days
Will employ the Bayesian optimal interval design to find the MTD.
Secondary Outcomes
- Time to disease progression (local or distant)(From the start of treatment until the documentation of local or distant disease progression, assessed up to 1 year)
- NanoString Pan Cancer Immune Profiling Panel(Up to 1 year after the last intra-tumoral dose)
- Changes in micro ribonucleic acid (RNA) expression(Baseline up to 1 year after the last intra-tumoral dose)
- Tumor dimensions of injected (Cohorts #1)(Up to 1 year after the last intra-tumoral dose)
- Biomarker analysis(Up to 1 year after the last intra-tumoral dose)
- Granzyme B H-score(Up to 1 year after the last intra-tumoral dose)
- T-cell subset evaluation and changes in circulating microRNA(Up to 1 year after the last intra-tumoral dose)
- Tumor dimensions of non-injected lesions (Cohort #2)(Up to 1 year after the last intra-tumoral dose)
- Tumor-infiltrating lymphocytes analysis(Up to 1 year after the last intra-tumoral dose)
- Degree of tumor regression (percent)(Up to 1 year after the last intra-tumoral dose)
Investigators
Carlo Contreras
Principal Investigator
Ohio State University Comprehensive Cancer Center