Study of GVAX (With CY) and Pembrolizumab in MMR-p Advanced Colorectal Cancer

Phase 2

Completed

Conditions: Metastatic Colorectal Cancer

Interventions: Drug: CY
Biological: GVAX
Drug: Pembrolizumab

Registration Number: NCT02981524

Lead Sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Brief Summary: This study will be looking at the objective response rate (ORR) as measured by RECIST in in patients with mismatch repair-proficient (MMR-p), advanced colorectal cancer that treated with CY/GVAX in combination with Pembrolizumab.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 17

Inclusion Criteria

Documented mismatch repair-proficient cancer of colorectum, who have received at least two prior lines of therapy for metastatic disease
Measurable disease by RECIST v1.1
Age >18 years
ECOG Performance Status of 0 to 1
Estimated life expectancy of greater than 3 months.
Adequate organ function as defined by study-specified laboratory tests
Must use acceptable form of birth control through the study and for 120 days after final dose of study drug
Signed informed consent form
Willing and able to comply with study procedures

Exclusion Criteria

Has a known additional malignancy that is progressing or requires active treatment.
Has known central nervous system (CNS) metastases and/or carcinomatous meningitis.
Has known malignant small bowel obstruction within the last 6 months.
Currently have or have history of certain study-specified heart, liver, kidney, lung, neurological, immune or other medical conditions.
Systemically active steroid use.
Has an active infection requiring systemic therapy.
Has a known history of active TB (Bacillus Tuberculosis).
Infection with HIV or hepatitis B or C.
Has history of (non-infectious) pneumonitis that required steroids.
Must not require supplemental oxygen or have a pulse oximetry < 92% on room air.
Conditions, including therapy, laboratory abnormalities, psychiatric or substance abuse disorders, intercurrent illness, or lack of sufficient peripheral venous access, that would affect the patient's ability to comply with study visits and procedures.
Pregnant or lactating.
Another investigational product within 28 days prior to receiving study drug.
Major surgery or significant traumatic injury (or unhealed surgical wounds) occurring within 28 days prior to receiving study drug.
Chemotherapy, radiation, hormonal, or biological cancer therapy within 28 days prior to receiving study drug.
Has received a live vaccine within 30 days of planned start of study therapy.
Prior treatment with immunotherapy agents (including, anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA4, etc.).
Patients receiving growth factors including, but not limited to, granulocyte-colony stimulating factor (G-CSF), GM-CSF, erythropoietin, within 14 days of study drug administration.
Hypersensitivity to pembrolizumab or any of its excipients.
Patient has a known or suspected hypersensitivity to GM-CSF, hetastarch, corn, dimethyl sulfoxide, fetal bovine serum, trypsin (porcine origin), yeast or any other component of GVAX vaccine.
Presence of any tissue or organ allograft and history of allogeneic hematopoietic stem cell transplant.
Unwilling or unable to comply with study procedures.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
CY/GVAX with Pembrolizumab	CY	During each 21 day cycles, Cyclophosphamide (CY) is administered on Day 1 at 200 mg/m2 followed by Pembrolizumab at 200mg, the colon cancer vaccine (GVAX) is administered on Day 2 at 5E8 colon cancer cells + 5E7 GM-CSF secreting cells for the first 4 cycles of treatment. After cycle 4, cyclophosphamide and GVAX will be administered with every 4th cycle.
CY/GVAX with Pembrolizumab	GVAX	During each 21 day cycles, Cyclophosphamide (CY) is administered on Day 1 at 200 mg/m2 followed by Pembrolizumab at 200mg, the colon cancer vaccine (GVAX) is administered on Day 2 at 5E8 colon cancer cells + 5E7 GM-CSF secreting cells for the first 4 cycles of treatment. After cycle 4, cyclophosphamide and GVAX will be administered with every 4th cycle.
CY/GVAX with Pembrolizumab	Pembrolizumab	During each 21 day cycles, Cyclophosphamide (CY) is administered on Day 1 at 200 mg/m2 followed by Pembrolizumab at 200mg, the colon cancer vaccine (GVAX) is administered on Day 2 at 5E8 colon cancer cells + 5E7 GM-CSF secreting cells for the first 4 cycles of treatment. After cycle 4, cyclophosphamide and GVAX will be administered with every 4th cycle.

Primary Outcome Measures

Name	Time	Method
Objective Response Rate (ORR)	up to 1 year	ORR is defined as the number of patients achieving a complete response (CR) or partial response (PR) based on the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) at any time during the study. CR = disappearance of all target lesions, PR is =\>30% decrease in sum of diameters of target lesions, progressive disease (PD) is \>20% increase in sum of diameters of target lesions, stable disease (SD) is \<30% decrease or \<20% increase in sum of diameters of target lesions.

Secondary Outcome Measures

Name	Time	Method
Progression Free Survival (PFS)	up to 1 year	Progression-free Survival (PFS) is defined as the number of days from cycle 1, day 1 of immunotherapy until first documented local progression or death due to any cause. PD is \>20% increase in sum of diameters of target lesions as assessed using RECIST (version 1.1).
Number of Participants With Adverse Events as a Measure of Safety and Tolerability	up to 1 year	Number of participants who experience treatment related adverse events ≥ grade 3 as defined by CTCAE 4.0.
Duration of Response (DOR)	1 year	Number of weeks from the start date of PR or CR (whichever response is recorded first) and subsequently confirmed to the first date that recurrent or progressive disease or death is documented. Per RECIST 1.1, CR = disappearance of all target lesions, PR is =\>30% decrease in sum of diameters of target lesions.
Overall Survival (OS)	Up to 1 year	OS is defined as the number of days from start of study treatment to time of death. Individuals will be censored at the date of the last study visit if no event occurs. The estimation method used was Kaplan-Meier.