J19140: A pilot study of a DNAJB1-PRKACA fusion kinase peptide vaccine combined with nivolumab and ipilimumab for patients with fibrolamellar hepatocellular carcinoma
Details
Status
Open: Currently recruiting participants.
Closed: Recruitment either has not started or has paused or completed.
Study Type
Interventional (clinical trials): Test treatments.
Observational: Conduct surveys and interviews, study medical records and otherwise observe people or groups over time.
Interventional
Study Phase
Each study phase tests different aspects of the medication or treatment:
- Phase I: safety and dosing
- Phase II: effectiveness and side effects
- Phase III: efficacy compared to standard treatments
- Phase IV: long-term safety after approval for use
I
Location(s)
Johns Hopkins study sites. Additional study locations may be found on ClinicalTrials.gov.
The Johns Hopkins Hospital
1800 Orleans St Baltimore, MD 21287
Brief Summary
Treatment will be administered on an outpatient basis. During cycle 1 (cycle = 3 weeks) patiens 1-3 will receive the FLC peptide vaccine alone once a week. During cycles 2-5 (cycle = 3 weeks) patients 1-3 will receive the FLC peptide vaccine in combination with nivolumab and ipilimumab every 3 weeks. From cycle 6 (cycle = 4 weeks) and beyond patients 1-3 will receive nivolumab every 4 weeks and the FLC peptide vaccine every 12 weeks. During cycle 1 (cycle = 3 weeks) patients 4-12 will receive the FLC peptide vaccine in combination with nivolumab and ipilimimab on day 1, then the FLC vaccine alone once a week. During cycles 2-4 (cycle = 3 weeks) patients 4-12 will receive the FLC peptide vaccine in combination with nivolumab and ipilimumab once a week. From cycle 5 and beyond (cycle = 4 weeks) patients 4-12 will receive nivolumab every 4 weeks and the FLC peptide vaccine every 12 weeks.
Eligibility
Inclusion Criteria:
- Cohort A and B: Must have histologically confirmed FLC (fibrolamellar hepatocellular cancer) that is metastatic or unresectable.
- Cohort C: Patients with histologically proven metastatic or unresectable DNAJB1-PRKACA fusion transcript positive solid tumor malignancies, non-FLC solid tumors.
- Cohort A and B: Age > 12 years. Note: Subjects age > 12 years but <18 are eligible to enroll only after 6 adult patients have enrolled on the study.
- Cohort A and B: Patients < 18 years old must have a body weight ≥40 kg.
- Cohort C: Patients must be Age ≥ 18 years.
All Cohorts:
- • Presence of DNAJB1-PRKACA fusion transcript, assessed by RNA-sequencing, DNA-sequencing, or in situ hybridization in the archival tissue.
- ECOG performance status of ≤2 (Karnofsky ≥60%)
- Patients must have adequate liver, kidney and marrow function defined by study-specified laboratory tests prior to initial study drug.
- Patients must have measurable disease per RECIST 1.1.
- Patients > 18 years old must have an accessible non-bone tumor lesion from which serial core biopsy specimens can be obtained.
- Must be willing to provide tissue and blood samples for mandatory translational research.
- Woman of childbearing potential must have a negative pregnancy test and follow contraceptive guidelines as defined per protocol.
- Men must use acceptable form of birth control while on study.
- Ability to understand and willingness to sign a written informed consent document.
Exclusion Criteria:
- Cohort A and C: Patients with a history of prior treatment with checkpoint inhibitors, such as anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, anti-OX-40, anti-CD40, anti-CTLA-4, or anti-LAG-3 antibodies. NOTE: Prior therapy with interferon-alpha is allowed.
- Cohort B: Participants a with history of unacceptable, life-threatening toxicity related to prior immune therapy (eg, anti-CTLA-4 or anti-PD-1/PD-L1 treatment, any other antibody or drug specifically targeting T-cell co-stimulation or immune checkpoint pathways) except those that are unlikely to re-occur with standard countermeasures (eg, hormone replacement after endocrinopathy).
All Cohorts:
Have had chemotherapy or other systemic therapy or radiotherapy, as follows:
- Have had chemotherapy, biological cancer therapy, or radiation 14 days prior to the first dose of study drug.
- Have had surgery within 28 days of dosing of investigational agent, excluding minor procedures (dental work, skin biopsy, etc.), celiac plexus block, and biliary stent placement.
- Have received other approved or investigational agents or device within 28 days of the first dose of study drug.
- Have not recovered from acute adverse events to grade ≤1 or baseline due to agents administered.
Have received any non-oncology live vaccine therapy used for prevention of infectious diseases within 28 days of study treatment
Known sensitivity to or history of allergic reactions to investigational drug (s).
Hypersensitivity reaction to any monoclonal antibody.
Has active autoimmune disease that has required systemic treatment in the past 2 years, or a documented history of clinically severe autoimmune disease, or a syndrome that requires systemic steroids or immunosuppressive agents.
Presence of any tissue or organ allograft, regardless of need for immunosuppression, including corneal allograft. Patients with a history of allogeneic hematopoeitic stem cell transplant will be excluded.
Has a diagnosis of immunodeficiency.
Systemic treatment with either corticosteroids (>10 mg daily prednisone equivalents) or other immunosuppressive medications within 7 days of study drug administration.
Symptomatic interstitial lung disease.
Has a pulse oximetry of <92% on room air or is on supplemental home oxygen.
Active or untreated brain metastases or leptomeningeal metastases.
Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmia, metastatic cancer, or psychiatric illness/social situations that would limit compliance with study requirements.
Are pregnant or breastfeeding.
Infection with HIV or hepatitis B or C.
Have had evidence of active or acute diverticulitis, intra-abdominal abscess, or GI obstruction.
Unwilling or unable to follow the study schedule for any reason.
Any other sound medical, psychiatric, and/or social reason as determined by the Investigator.
Any illicit drugs or other substance abuse.
Clinically meaningful ascites.