UCSF BTC Clinical Trials

H3.3K27M Peptide Vaccine for Children With Newly Diagnosed DIPG and Other Gliomas

 

Summary

Immunotherapies, including vaccine-based immunotherapies, have the potential to develop as an effective and safe treatment strategy for patients with pediatric malignant gliomas. This approach takes advantage of known mutations that exist in brain tumor cells, but not normal cells. Vaccines targeting molecules that are specific to certain tumors (called tumor-specific antigens), may induce a more efficient T-cell response.

For example, many pediatric gliomas (including a majority of diffuse intrinsic pontine gliomas; DIPGs) have a mutation identified as H3.3K27M. By designing synthetic molecules that match the corresponding portion of the mutated H3.3K27M protein, these can be used in a vaccine that trains the immune system against cells carrying the H3.3K27M mutation. Once injected, the vaccine will initiate an immune response that activates T-cells and antibodies. The T-cells and antibodies will then recognize, attack, and continually “remember” how to identify tumor cells with the H3.3K27M mutation.

This Phase I clinical trial will investigate the safety and efficacy of the H3.3K27M peptide vaccine, in treating children and young adults with newly diagnosed DIPG, or other pediatric gliomas. All participants must test positive for the H3.3K27M mutation in their tumor. The H3.3K27M peptide vaccine will be administered in combination with poly-ICLC, a compound shown (in laboratory tests) to enhance tumor-killing activity in various immune cells.  

All eligible participants will receive the H3.3K27M peptide vaccine, but will be divided into groups based on their diagnosis:

  • Experimental Group 1 (newly diagnosed DIPG): H3.3K27M peptide vaccine + TT peptide + poly-ICLC
  • Experimental Group 2 (newly diagnosed glioma, non-DIPG): H3.3K27M peptide vaccine + TT peptide + poly-ICLC

 

Inclusion Criteria

Stratum A:

  1. Newly diagnosed children (3-21 years old) with DIPG who are positive for the H3.3K27M mutation (positive testing in CLIA laboratory) that underwent standard radiation therapy.

Stratum B:

  1. Newly diagnosed children (3-21 years old) with diagnosis of glioma other than DIPG who are positive for the H3.3K27M mutation (positive testing in CLIA laboratory) including spinal cord gliomas that underwent standard radiation therapy.

The following eligibility criteria apply to both Stratum A and B:

  1. The patient must test positive for HLA-A2 (human leukocyte antigen A2)(CLIA approved laboratory) 
  2. The patient must have evaluable disease as defined in section 7.2.1.2
  3. The patient must be either off steroids or be on stable dose of dexamethasone (max 0.1 mg/kg/day; maximum 4mg/day) at time of enrollment
  4. Patients must not have received any prior chemotherapy, immunotherapy or bone marrow transplant for the treatment of their tumor. Prior use of temozolomide during radiation at the standard pediatric dosing or dexamethasone is allowed.
  5. Patients must have undergone radiation therapy and surgery as part of their standard of care. 
    1. Radiation therapy must have started within 28 days of diagnosis by imaging or surgery, whichever is later.
  6. Karnofsky ≥ 50 for patients ≥ 16 years of age, and Lansky ≥ 50 for patients < 16 years of age (See Appendix A). Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
  7. The patient must have adequate organ function defined as:
    1. Adequate Bone Marrow Function Defined as:
      1. Peripheral absolute neutrophil count (ANC) ≥ 1000/mm3 and
      2. Platelet count ≥ 100,000/mm3 (transfusion independent, defined as not receiving platelet transfusions for at least 7 days prior to enrollment).
    2. Adequate Renal Function Defined as:
      1. Creatinine clearance or radioisotope glomerular filtration rate (GFR) ≥ 70mL/min/1.73 m2 or
      2. A serum creatinine based on age/gender as follows:
        1. Age 1 to 2 years: 0.6 (male), 0.6 (female)
        2. Age 2 to <6 years: 0.8 (male), 0.8 (female)
        3. Age 6 to <10 years: 1.0 (male), 1.0 (female)
        4. Age 10 to <13 years: 1.2 (male), 1.2 (female)
        5. Age 13 to <16 years: 1.5 (male), 1.4 (female)
    3. Adequate Liver Function Defined as:
      1. Bilirubin (sum of conjugated + unconjugated) ≤ 1.5 x upper limit of normal (ULN) for age and
      2. SGPT (ALT) ≤ 110 U/L and
      3. Serum albumin ≥ 2 g/dL.
    4. Adequate Neurologic Function Defined as:
      1. Patients with seizure disorder may be enrolled if seizure disorder is well controlled.
  8. The effects of the H3.3K27M vaccine on the developing human fetus are unknown. For this reason, females of child-bearing potential and men must agree to use adequate contraception. Adequate methods include: hormonal or barrier method of birth control; or abstinence prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study and for the duration of study participation.
  9. Ability to understand a written informed consent document, and the willingness to sign it. Assent will be obtained when appropriate based on the subjects age.

For the most up-to-date list of criteria, please visit clinicaltrials.gov.

Exclusion Criteria
  1. Investigational Drugs: Patients who are currently receiving another investigational drug are not eligible.
  2. Anti-cancer Agents: Patients who are currently receiving other anti-cancer agents are not eligible.
  3. Patients with a history of auto-immune disorder requiring systemic cytotoxic or immunosuppressive therapy are not eligible.

For the most up-to-date list of criteria, please visit clinicaltrials.gov.

Investigator(s)

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