Intralesional Influenza Vaccine for Patients With Melanoma
Summary
This phase I trial investigates the effects of influenza vaccine in treating patients with stage I-IV melanoma. While intramuscular administration of influenza vaccine provides immunization against the influenza virus, giving influenza vaccine directly into the tumor (intralesional) may decrease the size of the injected melanoma tumor, or the extent of the melanoma within the body.
Detailed description
PRIMARY OBJECTIVE: I. To evaluate the safety and tolerability and determine the maximum tolerated dose of intralesional (quadrivalent inactivated influenza vaccine (unadjuvanted influenza vaccine) for patients with a) resectable melanoma as monotherapy, and b) metastatic melanoma, concurrent with standard of care (single- or dual-agent) checkpoint inhibition. SECONDARY OBJECTIVES: I. To evaluate tumor dimensions of injected (Cohorts #1-2) and non-injected lesions (Cohort #2 only), by caliper or ultrasound measurement. (Clinical endpoint) II. To determine time to disease progression (local or distant). (Clinical endpoint) III. To evaluate immunohistochemistry density, cells/mm\^2: CD4, CD8, PD-L1, PD1, CD56, CD20, CD45RO, FOXP3. (Tumor-based endpoint) IV. To evaluate granzyme B H-score. (Tumor-based endpoint) V. To evaluate NanoString Pan Cancer Immune Profiling Panel. (Tumor-based endpoint) VI. To evaluate tumor-infiltrating lymphocytes: not identified, present (non-brisk), present (brisk), cannot be determined. (Tumor-based endpoint) VII. To evaluate degree of tumor regression (percent). (Tumor-based endpoint) VIII. To evaluate changes in micro ribonucleic acid (microRNA) expression. (Tumor-based endpoint) IX. To evaluate of flow cytometry for T-cell subset evaluation and changes in circulating microRNA. (Blood draw endpoint) EXPLORATORY OBJECTIVE: I. To evaluate the evidence of immunologic activation in blood and tissue specimens. OUTLINE: This is dose-escalation study. Patients are assigned to 1 of 2 cohorts. COHORT I: Patients receive quadrivalent inactivated influenza vaccine intramuscularly (IM) on day 0 and intratumorally on days 2 and 14 in the absence of disease progression or unacceptable toxicity. Patients then undergo surgery on day 28. COHORT II: Patients receive quadrivalent inactivated influenza vaccine IM on day 0 and intratumorally on days 2, 14, 28, 42, 56, 70, 84, and 98 in the absence of disease progression or unacceptable toxicity. Patients also receive standard of care ipilimumab, nivolumab, pembrolizumab, or Opdualag. After completion of study treatment, patients are followed up for up to 1 year.
Arms & interventions
- BiologicalIpilimumab
immune checkpoint inhibitor
- BiologicalNivolumab
immune checkpoint inhibitor
- BiologicalPembrolizumab
immune checkpoint inhibitor
- BiologicalQuadrivalent Inactivated Influenza Vaccine
Given IM and intratumorally. For this protocol the U.S. F.D.A recently approved the use of recently expired influenza vaccine (only until new seasonal vaccine is available anticipated Sept 1). Use of expired vaccine will not exceed 4 months past June 30th expiry date (October 30th).
- ProcedureResection
Undergo surgical resection
- BiologicalNivolumab + Relatlimab
immune checkpoint inhibitor
Outcome measures
Primary
Incidence of adverse events (AEs)
Frequency and severity of AEs and tolerability of the regimen will be collected and summarized by descriptive statistics. The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns. All patients who have received at least one dose of the therapeutic agents will be evaluable for toxicity and tolerability.
Time frame: Up to 1 year after the last intra-tumoral dose
Maximum tolerated dose (MTD) in Cohorts #1 and #2
Will employ the Bayesian optimal interval design to find the MTD.
Time frame: Up to 98 days
Secondary
Tumor dimensions of injected (Cohorts #1)
Time frame: Up to 1 year after the last intra-tumoral dose
Tumor dimensions of non-injected lesions (Cohort #2)
Time frame: Up to 1 year after the last intra-tumoral dose
Time to disease progression (local or distant)
Time frame: From the start of treatment until the documentation of local or distant disease progression, assessed up to 1 year
Biomarker analysis
Time frame: Up to 1 year after the last intra-tumoral dose
Granzyme B H-score
Time frame: Up to 1 year after the last intra-tumoral dose
NanoString Pan Cancer Immune Profiling Panel
Time frame: Up to 1 year after the last intra-tumoral dose
Tumor-infiltrating lymphocytes analysis
Time frame: Up to 1 year after the last intra-tumoral dose
Degree of tumor regression (percent)
Time frame: Up to 1 year after the last intra-tumoral dose
Changes in micro ribonucleic acid (RNA) expression
Time frame: Baseline up to 1 year after the last intra-tumoral dose
T-cell subset evaluation and changes in circulating microRNA
Time frame: Up to 1 year after the last intra-tumoral dose
Eligibility criteria
Study locations (1)
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, 43210