Clinical Trial: A Phase II Study of PROSTVAC-V (Vaccinia)/TRICOM and PROSTVAC-F (Fowlpox)/TRICOM With GM-CSF in Patients With PSA Progression After Local Therapy for Prostate Cancer

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: A Phase II Study of PROSTVAC-V (Vaccinia)/TRICOM and PROSTVAC-F (Fowlpox)/TRICOM With GM-CSF in Patients With PSA Progression After Local Therapy for Prostate Cancer

Brief Summary: Vaccines made from a gene-modified virus may help the body build an effective immune response to kill tumor cells. Biological therapies, such as GM-CSF, may stimulate the immune system in different ways and stop tumor cells from growing. Androgens can cause the growth of prostate cancer cells. Drugs, such as bicalutamide and goserelin, may stop the adrenal glands from making androgens in patients whose tumor cells continue to grow. Giving vaccine therapy together with GM-CSF and, when needed, androgen ablation may be a more effective treatment for prostate cancer. This phase II trial is studying how well giving vaccine therapy together with GM-CSF works in treating patients with prostate cancer that progressed after surgery and/or radiation therapy.

Detailed Summary:

PRIMARY OBJECTIVES:

I. To evaluate the effect of PROSTVAC-V/TRICOM (Vaccinia) on cycle 1 followed by PROSTVAC-F/TRICOM (Fowlpox) and GM-CSF on biochemical PSA progression at 6 months.

II. To determine the change in PSA velocity pre-treatment to post-treatment.

SECONDARY OBJECTIVES:

I. To evaluate the percentage of patients experiencing a >50% decline in serum PSA repeated at 4 weeks.

II. To evaluate tolerability and any toxicity related to treatment with PSA vaccine and GM-CSF.

III. To determine the effect of GM-CSF on PSA immediately after treatment (day 4) compared to a delayed effect (day 15).

IV. To determine the PSA nadir, and percentage of patients with undetectable PSA, treated with combined vaccine and androgen ablation therapy over 12 months.

OUTLINE: This is a multicenter study.

Patients receive vaccinia-PSA-TRICOM vaccine subcutaneously (SC) on day 1 and sargramostim (GM-CSF) SC on days 1-4 during weeks 1-4. Beginning in week 5, patients receive fowlpox-PSA-TRICOM vaccine SC on day 1 and GM-CSF SC on days 1-4. Treatment with fowlpox-PSA-TRICOM vaccine and GM-CSF repeats every 4 weeks for 3 courses (weeks 5-16). Beginning in week 17, patients receive fowlpox-PSA-TRICOM vaccine and GM-CSF as above every 12 weeks in the absence of clinical or biochemical disease progression or unacceptable toxicity.

Patients with biochemical or clinical disease progression receive androgen ablation therapy comprising oral bicalutamide o
Sponsor: National Cancer Institute (NCI)

Current Primary Outcome: Proportion of Patients Free of PSA Progression at 6 Months (Prior to the Start of Androgen Ablation) [ Time Frame: Assessed at 6 months ]

For patients who achieved a > 50% decline in PSA, an increase in PSA value by 50% over the nadir, confirmed by a second PSA two weeks later is considered progressive disease. The PSA rise must be at least 5 ng/mL or back to pretreatment baseline, whichever is greater.

Changes in PSA below 5 ng/mL will not be considered assessable for progression.

For patients whose PSA has not decreased by 50%, an increase in PSA value > 50% of baseline (on trial) or nadir PSA, whichever is lower, confirmed by a repeat PSA two weeks later is considered progressive disease. The PSA must have risen by at least 5 ng/mL.



Original Primary Outcome:

Current Secondary Outcome:

  • Proportion of Patients With PSA Response [ Time Frame: Assessed monthly during the first 24 weeks and then every 3 months for a maximum total of 24 months ]

    PSA response is defined as complete biochemical response or partial response.

    Complete Response:

    A PSA < 0.2 ng/mL confirmed by a repeat PSA one month later is considered a complete biochemical response for patients with prior radical prostatectomy. A PSA < 1 ng/mL on three separate occasions taken at least one month apart is considered a complete biochemical response in patients with radiation therapy only.

    Partial Response:

    A reduction in PSA by > 50% from baseline, confirmed by repeat PSA 1 month later.

  • Difference Between Day 4 PSA Level and Day 15 PSA Level [ Time Frame: Assessed at day 4 and day 15 of cycle 1 ]
    PSA level was assessed on Day 4 and Day 15 of cycle 1, and a comparison between the two measurements was done.
  • The Difference Between PSA Slopes Before and After Treatment [ Time Frame: Assessed monthly during the first 24 weeks and then every 3 months for a maximum total of 24 months ]
    PSA slopes were assessed by multiple PSA values obtained prior to registration and during treatment. Only patients who completed at least 3 months of treatment were included in this analysis. The PSA slopes were calculated by a piecewise linear model using the three or four PSA values obtained prior to registration and PSA measurements obtained every 4 weeks for the first six months of treatment. Natural log transformed PSA levels were used in this analysis, and the difference between PSA slopes before and after treatment was calculated.


Original Secondary Outcome:

Information By: National Cancer Institute (NCI)

Dates:
Date Received: April 18, 2005
Date Started: February 2006
Date Completion:
Last Updated: June 3, 2015
Last Verified: December 2013