A Phase 2 interventional study of DEC-205/NY-ESO-1 Fusion Protein CDX-1401 and Poly ICLC in Cutaneous Melanoma, Melanoma and Melanoma of Unknown Primary, sponsored by National Cancer Institute (NCI). Completed at 7 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-11-16.
Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment
This phase II trial studies the effect of a vaccine called CDX-1401 given with or without a biologic drug called CDX-301 in treating patients with stage IIB-IV melanoma. The cancer vaccine CDX-1401 attaches to a protein that is made in tumor cells. The vaccine helps the body recognize the tumor to fight the cancer. The biologic drug CDX-301 may help the body make more of the tumor fighting cells, known as dendritic cells. Another biologic drug, poly-ICLC, may stimulate the immune system and help these dendritic cells mature so that they can recognize the tumor. Giving CDX-301 may make the immune response to a combination of CDX-1401 and poly-ICLC better.
PRIMARY OBJECTIVE:
I. To determine whether the immune response to NY-ESO-1 elicited by vaccination with DEC-205/NY-ESO-1 fusion protein CDX-1401 (CDX-1401) plus polyinosinic-polycytidylic acid stabilized with poly-L-lysine and carboxymethylcellulose (poly-ICLC) is substantially increased by prior expansion in the number of circulating dendritic cells (DC) by therapy with recombinant Flt3 ligand (CDX-301) (fms-related tyrosine kinase 3 ligand [Flt3L]).
SECONDARY OBJECTIVES:
I. To assess the effect of the vaccine regimen on immune responses to other ongoing and nascent antitumor response antigens associated with melanoma (e.g., PRAME, MAGE-A3, p53, and gp100) as well as memory viral responses (influenza A) and chronic viral responses (cytomegalovirus [CMV], Epstein-Barr virus [EBV]).
II. To assess the effect of the vaccine regimen on the frequency and phenotypic character of peripheral blood mononuclear cell (PBMC) subsets including DCs, monocyte populations, T cells, and natural killer (NK) cells.
III. To assess the safety, tolerability, and clinical efficacy of the vaccine regimens.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive recombinant Flt3 ligand (CDX-301) subcutaneously (SC) on days -7 to -1, 1-3, and 22-28 of cycle 1 and only on days 1-3 of cycle 2. Patients also receive CDX-1401 SC or intradermally (ID) on day 1 of each cycle and poly-ICLC SC on days 1-2 of each cycle. Treatment repeats every 28 days for 4 cycles in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive CDX-1401 and poly-ICLC as in Arm I. Treatment repeats every 28 days for 4 cycles in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 4 and 12 weeks and then annually thereafter.
3,006 studies on the registry are indexed under Melanoma; 520 are open to participants now.
This study's enrollment of 60 is above the median of 38 across 2,351 interventional studies indexed under Melanoma.
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Patients with fully resected stage IIb through IV melanoma, with melanoma validated by histology or cytology, who have NOT received prior therapy.
Age >= 18 years
The first six patients enrolled in the Flt3L arm of the study cannot be human immunodeficiency virus (HIV)-positive. After the evaluation of safety in the first 6 patients, HIV-positive patients with adequate immune function as evidenced by stable CD4 counts >= 350/mm\^3 are allowed to participate if the following criteria are met:
Females of childbearing potential must have a negative pregnancy test within 7 days before the initiation of protocol therapy.
Exclusion Criteria:
Steroid therapy, or steroid therapy with more than 7 consecutive days of steroids within the prior 4 weeks
Current or history of systemic autoimmune disease requiring systemic therapy.
NOTE: The following will not be exclusionary:
Cirrhosis or chronic hepatitis C virus positivity or chronic hepatitis B infection
Extensive active brain disease including symptomatic brain metastases or presence of leptomeningeal disease
Pregnancy or nursing or unwilling to take adequate birth control during therapy
Vaccinations other than those given as part of this research study (with the exception of influenza vaccine) are prohibited throughout the duration of study participation.
Patients receive recombinant Flt3 ligand (CDX-301) SC on days -7 to -1, 1-3, and 22-28 of cycle 1 and only on days 1-3 of cycle 2. Patients also receive CDX-1401 SC or ID on day 1 of each cycle and poly-ICLC SC on days 1-2 of each cycle. Treatment repeats every 28 days for 4 cycles in the absence of disease progression or unacceptable toxicity.
Biological: DEC-205/NY-ESO-1 Fusion Protein CDX-1401 · Drug: Poly ICLC · Biological: Recombinant Flt3 Ligand
Patients receive CDX-1401 and poly-ICLC as in Arm I. Treatment repeats every 28 days for 4 cycles in the absence of disease progression or unacceptable toxicity.
Biological: DEC-205/NY-ESO-1 Fusion Protein CDX-1401 · Drug: Poly ICLC
Given SC or ID
Also known as: CDX-1401
Given SC
Also known as: Hiltonol, Poly I:Poly C with Poly-L-Lysine Stabilizer, poly-ICLC, PolyI:PolyC with Poly-L-Lysine Stabilizer, Polyinosinic-Polycytidylic Acid Stabilized with Polylysine and Carboxymethylcellulose, Polyriboinosinic-Polyribocytidylic Acid-Polylysine Carboxymethylcellulose, Stabilized Polyriboinosinic/Polyribocytidylic Acid
Given SC
Also known as: CDX-301, FLT 3 Ligand, FLT3 Ligand, Flt3-Ligand, Flt3L, Mobist, Mobista, rhuFlt3L
Immune T-cell Response to NY-ESO-1
Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10.
Time frame: At 12 weeks after final vaccination
T Cell Responses to Other Ongoing and Nascent Antitumor Response Antigens Associated With Melanoma (e.g. PRAME, MAGE-A3, p53, and gp1000) as Well as Memory and Chronic Viral Responses (CMV, EBV)
Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10.
Time frame: Up to 12 weeks after final vaccination
Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold)
Graphical and tabular summaries of the assay data will be made. Linear mixed effects model and possibly weighted generalized estimating equation methods will be considered for a supportive analysis of the longitudinal data over time.
Time frame: Up to 12 weeks after final vaccination
Tumor Recurrence
Time to first recurrence from first vaccine among subjects who have experienced recurrence. (days)
Time frame: Up to 600 days from first vaccine
Overall Survival
Overall survival not assessed
Time frame: Up to 1 year after patient's 12 week visit
| Milestone | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| Started | 30 | 30 |
| Completed | 30 | 30 |
| Not completed | 0 | 0 |
Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10.
| Participants | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| Immune T-cell Response to NY-ESO-1 | 15 | 10 |
Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10.
| Participants | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| T Cell Responses to Other Ongoing and Nascent Antitumor Response Antigens Associated With Melanoma (e.g. PRAME, MAGE-A3, p53, and gp1000) as Well as Memory and Chronic Viral Responses (CMV, EBV) | 7 | 7 |
Graphical and tabular summaries of the assay data will be made. Linear mixed effects model and possibly weighted generalized estimating equation methods will be considered for a supportive analysis of the longitudinal data over time.
| log 2 fold change | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| cDCs | 30.4 ± 16.98 | 0.9 ± 0.26 |
| Monocytes | 6.1 ± 2.11 | 1.0 ± 0.18 |
| CD4 T cells | 1.2 ± 0.28 | 1.1 ± 0.27 |
| NK CD56br cells | 5.8 ± 2.84 | 1.26 ± 0.32 |
| CD8 T cells | 1.3 ± 0.36 | 1.0 ± .26 |
| pDC | 16.5 ± 7.27 | 0.8 ± 0.24 |
Time to first recurrence from first vaccine among subjects who have experienced recurrence. (days)
| days | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| Tumor Recurrence | 360.3 ± 191.1 | 389.2 ± 223.2 |
Overall survival not assessed
No measurements were reported for this outcome.
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | — | 0/30 (0%) | 30/30 (100%) |
| Arm II (CDX-1401 and Poly-ICLC) | — | 4/30 (13.3%) | 30/30 (100%) |
| Event | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| General disorders and administration site conditionsGeneral disorders | 0/30 | 1/30 |
| Infections and infestationsInfections and infestations | — | 1/30 |
| Nervous system disordersNervous system disorders | — | 1/30 |
| Pregnancy, puerperium and perinatal conditionsPregnancy, puerperium and perinatal conditions | — | 1/30 |
| Event | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) |
|---|---|---|
| General disorders and administration site conditionsGeneral disorders | 30/30 | 30/30 |
| Musculoskeletal and connective tissue disordersMusculoskeletal and connective tissue disorders | 20/30 | 18/30 |
| Nervous system disordersNervous system disorders | 17/30 | 19/30 |
| Gastrointestinal disordersGastrointestinal disorders | 15/30 | 17/30 |
| Skin and subcutaneous tissue disordersSkin and subcutaneous tissue disorders | 15/30 | 14/30 |
| Metabolism and nutrition disordersMetabolism and nutrition disorders | 15/30 | 12/30 |
| InvestigationsInvestigations | 14/30 | 14/30 |
| Respiratory, thoracic and mediastinal disordersRespiratory, thoracic and mediastinal disorders | 13/30 | 13/30 |
| Blood and lymphatic system disordersBlood and lymphatic system disorders | 13/30 | 10/30 |
| Injury, poisoning and procedural complicationsInjury, poisoning and procedural complications | 10/30 | 1/30 |
| Age, Categorical(Participants) | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 22 | 25 | 47 |
| >=65 years | 8 | 5 | 13 |
| Age, Continuous(years) | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) | Total |
|---|---|---|---|
| Mean | 54.6 ± 13.4 | 51.6 ± 14.5 | 53.1 ± 13.9 |
| Sex: Female, Male(Participants) | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) | Total |
|---|---|---|---|
| Female | 10 | 9 | 19 |
| Male | 20 | 21 | 41 |
| Ethnicity (NIH/OMB)(Participants) | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) | Total |
|---|---|---|---|
| Hispanic or Latino | 0 | 1 | 1 |
| Not Hispanic or Latino | 30 | 28 | 58 |
| Unknown or Not Reported | 0 | 1 | 1 |
| Race (NIH/OMB)(Participants) | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 1 | 1 |
| White | 30 | 28 | 58 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 1 | 1 |
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