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A phase IB clinical trial on neoadjuvant and intraoperative intracranial administration of triple immune checkpoint blockade plus myeloid dendritic cells in patients with recurrent high-grade glioma
EU CTIS ID: 2024-517842-33-01
What this study is testing
To document the safety and feasibility of of the proposed investigational treatment regimen, consisting of neoadjuvant intratumoral triple ICI administration, followed by a MSR with peroperative intracerebral triple ICI plus myDC injections, and subsequent adjuvant biweekly ICav and IV nivolumab administrations.
- Human Pharmacology (Phase I)- Other
A plain-language read of the study's public EU CTIS listing. The study team confirms the details.
Who can take part
You may be able to join if
- Subjects must have signed and dated an approved written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol related procedures that are not part of normal subject care
- Resolution of all acute treatment related adverse effects of prior surgical procedures, radiotherapy and temozolomide to NCI CTCAEv5.0 grade 0 or 1 except for alopecia;
- Adequate organ function as defined by the following criteria: a) Total serum bilirubin < 1.5 x ULN (patients with Gilbert’s disease exempt who should have bilirubin < 2x ULN) b) AST and ALT < 2.5 x upper limit of normal (ULN); c) Serum creatinine ≤1.5 x ULN or calculated creatinine clearance ≥60 mL/min d) Absolute neutrophil count (ANC) > 1500/mm³ without growth factor support e) Platelets > 75 000 cells/mm³ f) Hemoglobin ≥9 g/dL (which may be obtained by transfusion or growth factor support) g) FT4 hormone levels within normal range
- Subjects requiring systemic treatment with either corticosteroids (> 8 mg daily methylprednisolone equivalent) or other immunosuppressive medications within 14 days of study enrollment. Inhaled or topical steroids are permitted in the absence of active autoimmune disease.
- Adequate venous access to undergo a leukapheresis procedure.
- Female patients must be surgically sterile or be postmenopausal (A postmenopausal state is defined as no menses for 12 months without an alternative medical cause). If a female patient is a woman of childbearing potential (WOCBP) they must agree to use highly effective contraception measures during the period of therapy, which should be continued for at least 5 months following the last dose of nivolumab as indicated in the SmPC. A list of highly effective contraceptive measures is included in appendix 2. All female patients with reproductive potential must have a negative pregnancy test (serum or urine) prior to enrollment and pregnancy testing should be conducted within 24h prior to the first dose of immune checkpoint inhibitors and thereafter monthly until 5 months following the last dose of study treatment. Women must not be breastfeeding at initiation of screening.
You likely can't join if
- Contra-indication for a maximal safe resection of the recurrent high-grade glioma;
- Subjects with active, known, or suspected autoimmune disease are not eligible. Subjects with type I diabetes mellitus, residual hypothyroidism due to autoimmune thyroiditis only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment are permitted to enroll.
- Active uncontrolled seizure disorder
- Myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure or any unstable arrhythmia, cerebrovascular accident or transient ischemic attack, within the 12 months prior to study drug administration. No current or recent (within 1 month) use of a thrombolytic agent or a thrombo-embolic event
- Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness;
- Serious uncontrolled medical disorder or active infection that would impair their ability to receive study treatment;
See the full eligibility criteria
Who can join
- Subjects must have signed and dated an approved written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol related procedures that are not part of normal subject care
- Resolution of all acute treatment related adverse effects of prior surgical procedures, radiotherapy and temozolomide to NCI CTCAEv5.0 grade 0 or 1 except for alopecia;
- Adequate organ function as defined by the following criteria: a) Total serum bilirubin < 1.5 x ULN (patients with Gilbert’s disease exempt who should have bilirubin < 2x ULN) b) AST and ALT < 2.5 x upper limit of normal (ULN); c) Serum creatinine ≤1.5 x ULN or calculated creatinine clearance ≥60 mL/min d) Absolute neutrophil count (ANC) > 1500/mm³ without growth factor support e) Platelets > 75 000 cells/mm³ f) Hemoglobin ≥9 g/dL (which may be obtained by transfusion or growth factor support) g) FT4 hormone levels within normal range
- Subjects requiring systemic treatment with either corticosteroids (> 8 mg daily methylprednisolone equivalent) or other immunosuppressive medications within 14 days of study enrollment. Inhaled or topical steroids are permitted in the absence of active autoimmune disease.
- Adequate venous access to undergo a leukapheresis procedure.
- Female patients must be surgically sterile or be postmenopausal (A postmenopausal state is defined as no menses for 12 months without an alternative medical cause). If a female patient is a woman of childbearing potential (WOCBP) they must agree to use highly effective contraception measures during the period of therapy, which should be continued for at least 5 months following the last dose of nivolumab as indicated in the SmPC. A list of highly effective contraceptive measures is included in appendix 2. All female patients with reproductive potential must have a negative pregnancy test (serum or urine) prior to enrollment and pregnancy testing should be conducted within 24h prior to the first dose of immune checkpoint inhibitors and thereafter monthly until 5 months following the last dose of study treatment. Women must not be breastfeeding at initiation of screening.
- Subjects must be willing and able to comply with scheduled visits, treatment schedule, laboratory tests, tumor biopsies, and other requirements of the study
- Patients with a confirmed prior histopathological diagnosis of glioblastoma (= WHO grade IV, IDH-wildtype glioma) or astrocytoma (= WHO grade III or IV, IDH-mutant glioma) are eligible for study participation;
- Diagnosis of glioblastoma recurrence and/or progression following prior treatment with surgery consisting of a total or partial tumor resection, radiation therapy and temozolomide chemotherapy (recurrence/progression is defined as significant [according to the investigators assessment] growth and/or recurrence of the glioblastoma tumor mass on sequential MRI of the brain);
- The following disease characteristics should be present: a) Presence of a measurable tumor lesion that is characterized by gadolinium (Gd) enhancement on T1-MRI of the brain (with a longest diameter of > 10 mm and a perpendicular diameter of >5mm). b) No evidence of clinically relevant spontaneous intra-tumor hemorrhage on baseline MRIimaging or in the prior disease history;
- The recurrent tumor mass should be amenable to a safe stereotactic (or open) biopsy [according to the investigators assessment];
- ECOG performance status score of 0, 1 or 2;
- An interval of at least 4 months (: 16 weeks) after the end of postoperative radiation therapy for the high-grade glioma, unless progression is confirmed on an MRI of the brain obtained > 4 week after the first observation of progression; and with an interval of at least 4 weeks after the last administration of temozolomide;
- Male or female, 18 years of age or older;
What rules you out
- Contra-indication for a maximal safe resection of the recurrent high-grade glioma;
- Subjects with active, known, or suspected autoimmune disease are not eligible. Subjects with type I diabetes mellitus, residual hypothyroidism due to autoimmune thyroiditis only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment are permitted to enroll.
- Active uncontrolled seizure disorder
- Myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure or any unstable arrhythmia, cerebrovascular accident or transient ischemic attack, within the 12 months prior to study drug administration. No current or recent (within 1 month) use of a thrombolytic agent or a thrombo-embolic event
- Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)-related illness;
- Serious uncontrolled medical disorder or active infection that would impair their ability to receive study treatment;
- History of a malignancy (other than glioma) except those treated with curative intent for skin cancer (other than melanoma) or in situ breast or cervical cancer or those treated with curative intent for any other cancer with no evidence of disease for 5 years;
- Other severe acute or chronic medical or psychiatric condition, or laboratory abnormality that would impart, in the judgment of the investigator, excess risk associated with study participation or study drug administration, or which, in the judgment of the investigator, would make the patient inappropriate for entry into this study;
- Dementia or significantly altered mental status that would prohibit the understanding or rendering of informed consent and compliance with the requirements of this protocol;
- Contra-indication for the insertion of an intracavitary catheter connected to a subcutaneous Ommaya reservoir;
- Ventriculo-peritoneal drain;
- Contraindication for evaluation by Gd-enhanced MRI, FET-PET of the brain or wholebody contrast enhanced CT;
- Prior treatment on a nivolumab and/or ipilimumab trial;
- Prior treatment with an anti-CTLA-4 or anti-PD-1/-L1 targeted therapy;
- Gastrointestinal abnormalities including: a) Inability to take oral medication. b) Requirement for intravenous alimentation. c) Prior surgical procedures affecting absorption including gastric resection. d) Treatment for active peptic ulcer disease in the past 6 months. e) Malabsorption syndromes. f) Active gastrointestinal bleeding, unrelated to cancer, as evidenced by hematemesis, hematochezia or melena in the past 3 months without evidence of resolution
- Evidence of pre-existing uncontrolled hypertension as documented by baseline blood pressure reading. The baseline systolic blood pressure reading must be ≤140 mm Hg, and the baseline diastolic blood pressure readings must be ≤90 mm Hg. If baseline blood pressure reading exceeds the inclusion values a second blood pressure reading (taken at least 1 hour apart) must be documented in order to confirm the absence of uncontrolled hypertension. Patients whose hypertension is controlled by antihypertensive therapies are eligible;
- Concurrent treatment: a) In another therapeutic clinical trial; b) No requirement for permanent therapeutic anticoagulation therapy.
The study team makes the final eligibility decision.
Questions & answers
Do participants get paid in this trial?
This listing doesn't specify compensation. Many trials still reimburse travel or offer a stipend, so it's worth asking the study team when you connect.
Is it free to join, and do I need insurance?
Searching and applying through BridgeMD is free. In clinical trials the study-related treatment and visits are generally provided at no cost to you. You usually don't need insurance to take part - confirm specifics with the study team.
How long does this study last?
The listing doesn't state an exact length. The study team walks you through the schedule and number of visits before you decide to enroll.
Who can join this trial?
This study is enrolling all sexes, 65+ years, 18-64 years. The study team makes the final eligibility decision.
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BridgeMD is an information and trial-matching tool - not medical advice, and not the study sponsor. Details come from EU CTIS; the study team decides eligibility.