Provenge With or Without pTVG-HP DNA Booster Vaccine in Prostate Cancer
Provenge With or Without pTVG-HP DNA Booster Vaccine in Prostate Cancer
This randomized pilot clinical trial studies sipuleucel-T with or without deoxyribonucleic
 acid (DNA) vaccine therapy in treating patients with prostate cancer that has not responded
 to previous treatment with hormones and has spread to other places in the body. Vaccines may
 help the body build an effective immune response to kill tumor cells. It is not yet known
 whether giving sipuleucel-T vaccine works better with or without DNA vaccine therapy in
 treating prostate cancer.
Inclusion Criteria:

 -  Histologically confirmed diagnosis of prostate cancer (adenocarcinoma of the prostate)

 -  Metastatic disease as evidenced by the presence of soft tissue and/or bone metastases
 on imaging studies (computed tomography [CT] of abdomen/pelvis, bone scintigraphy)

 -  Castrate-resistant disease, defined as follows:

 -  All patients must have received standard of care androgen deprivation treatment
 before trial entry (surgical castration versus gonadotropin-releasing hormone
 [GnRH] analogue or antagonist treatment), and subjects receiving GnRH analogue or
 antagonist must continue this treatment throughout the time on this study

 -  Patients may have been treated previously with a nonsteroidal antiandrogen, with
 evidence of disease progression subsequently; subjects must be off use of
 anti-androgen for at least 4 weeks (for flutamide) or 6 weeks (for bicalutamide
 or nilutamide) prior to registration

 ** Subjects who demonstrate an anti-androgen withdrawal response, defined as a >=
 25% decline in PSA within 4-6 week of stopping a nonsteroidal antiandrogen are
 not eligible until the PSA rises above the nadir observed after antiandrogen
 withdrawal

 -  Castration levels of testosterone (< 50 ng/dL) within 2 weeks of registration

 -  Progressive disease while receiving androgen deprivation therapy defined by any one of
 the following as per the Prostate Cancer Clinical Trials Working Group 2 (PCWG2) bone
 scan criteria or Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 during or
 after completing last therapy:

 -  PSA: at least two consecutive rises in serum PSA, obtained at a minimum of 1-week
 intervals, and each value >= 2.0 ng/mL

 -  Measurable disease: >= 50% increase in the sum of the cross products of all
 measurable lesions or the development of new measurable lesions; the short axis
 of a target lymph node must be at least 15 mm by spiral CT to be considered a
 target lesion

 -  Non-measurable (bone) disease: the appearance of two or more new areas of uptake
 on bone scan consistent with metastatic disease compared to previous imaging
 during castration therapy; the increased uptake of pre-existing lesions on bone
 scan will not be taken to constitute progression, and ambiguous results must be
 confirmed by other imaging modalities (e.g. X-ray, CT or magnetic resonance
 imaging [MRI])

 -  Must have >= 3 serum PSA values obtained over at least a 12 week period of time prior
 to registration, including the day of screening, to calculate a PSA doubling time;
 Note: PSA's are not required to be obtained at the same laboratory; use all PSA values
 that have been done in last 6 months to calculate PSA doubling time

 -  Life expectancy of at least 6 months

 -  Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of
 0, 1, or 2

 -  White blood cell >= 2000/mm^3

 -  Absolute neutrophil count >= 1000/mm^3

 -  Hemoglobin (HgB) >= 9.0 mg/dL

 -  Platelets >= 100,000/mm^3

 -  Creatinine =< 2.0 mg/dL

 -  Aspartate aminotransferase (AST), alanine aminotransferase (ALT) =< 2.5 x
 institutional upper limit of normal

 -  Negative serology tests for human immunodeficiency virus (HIV) 1 and 2, and for active
 hepatitis B or hepatitis C, within 14 days of first peripheral blood collection for
 sipuleucel-T

 -  Patients must be at least 4 weeks from any prior treatments and have recovered (to <
 grade 2) from acute toxicity attributed to this prior treatment

 -  Patients must be informed of the experimental nature of the study and its potential
 risks, and must sign an Institutional Review Board (IRB)-approved written informed
 consent form indicating such an understanding

 Exclusion Criteria:

 -  Small cell or other variant prostate cancer histology

 -  Patients may not be receiving other investigational agents or be receiving concurrent
 anticancer therapy other than androgen deprivation

 -  Symptomatic metastatic disease, as defined by the need for opioid analgesics for the
 treatment of pain attributed to a prostate cancer metastatic lesion; patients
 receiving opioids must receive approval from the principal investigator (PI) for
 eligibility

 -  Patients may not have been treated with prior sipuleucel-T

 -  Treatment with any of the following medications within 28 days of registration, or
 while on study, is prohibited:

 -  Systemic corticosteroids (at doses over the equivalent of 1 mg prednisone daily);
 inhaled, intranasal or topical corticosteroids are acceptable

 -  Prostate cancer (PC)-SPES

 -  Saw palmetto

 -  Megestrol

 -  Ketoconazole

 -  5-alpha-reductase inhibitors-patients already taking 5-alpha-reductase inhibitors
 prior to 28 days prior to registration may stay on these agents throughout the
 course of therapy, but these should not be started while patients are on study

 -  Diethyl stilbestrol

 -  Abiraterone

 -  Any other hormonal agent or supplement being used with the intent of cancer
 treatment

 -  External beam radiation therapy within 4 weeks of registration is prohibited, or
 anticipated need for radiation therapy (e.g. imminent pathological fracture or spinal
 cord compression) within 3 months of registration

 -  Major surgery within 4 weeks of registration is prohibited

 -  Prior cytotoxic chemotherapy (e.g. docetaxel, mitoxantrone, cabazitaxel) within 6
 months of registration is prohibited

 -  Patients with a history of life-threatening autoimmune disease

 -  Patients who have undergone splenectomy

 -  Patients must not have other active malignancies other than non-melanoma skin cancers
 or carcinoma in situ of the bladder; subjects with a history of other cancers who have
 been adequately treated and have been recurrence-free for >= 3 years are eligible

 -  Patients with known brain metastases

 -  Any antibiotic therapy or evidence of infection within 1 week of registration

 -  Any other medical intervention or condition, which, in the opinion of the PI could
 compromise patient safety or adherence with the study requirements

 -  Patients cannot have concurrent enrollment on other phase I, II, or III
 investigational treatment studies