E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
HPV-16 AND/OR HPV-18 RELATED HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESIONS (HSIL) OF THE CERVIX |
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E.1.1.1 | Medical condition in easily understood language |
A vaccine and study device combination to treat women with precancerous cells on the cervix caused by human papillomavirus (HPV). |
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E.1.1.2 | Therapeutic area | Diseases [C] - Virus Diseases [C02] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10064328 |
E.1.2 | Term | Human papilloma virus test positive |
E.1.2 | System Organ Class | 10022891 - Investigations |
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E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10066237 |
E.1.2 | Term | Cervical high grade squamous intraepithelial lesion |
E.1.2 | System Organ Class | 100000004872 |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Determine the efficacy of VGX-3100 compared with placebo with respect to combined histopathologic regression of cervical HSIL and virologic clearance of HPV-16 and/or HPV-18 |
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E.2.2 | Secondary objectives of the trial |
1.Evaluate the safety and tolerability of VGX-3100 delivered IM followed by EP with CELLECTRA™ 5PSP.
2.Determine VGX-3100 efficacy compared to placebo as measured by histopathologic regression of cervical HSIL.
3.Determine VGX-3100 efficacy compared to placebo as measured by virologic clearance of HPV-16/HPV-18.
4.Determine VGX-3100 efficacy compared to placebo as measured by complete histopathologic regression of cervical HSIL to normal.
5.Determine VGX-3100 efficacy compared to placebo as measured by both complete histopathologic regression of cervical HSIL to normal and virologic clearance of HPV-16/HPV-18.
6.Determine the efficacy of VGX-3100 compared with placebo as measured by histopathologic non-progression
7.Describe clearance of HPV-16 and/or HPV-18 infection from non-cervical anatomic locations.
8.Determine the humoral and cellular immune response following administration of VGX-3100 compared with placebo at post dose 3, Week 36 and Week 88 visits compared to baseline. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
Each subject must meet all of the following criteria to be enrolled in the study:
1. Women aged 18 years and above and meets the minimum age of
consent per local regulations;
2. Confirmed cervical infection with HPV types 16 and/or 18 at screening by cobasTM HPV test;
3. Cervical tissue specimen/slides provided to Study Pathology Adjudication Committee for diagnosis must be collected within 10 weeks prior to anticipated date of first dose of study drug;
4. Histologic evidence of cervical HSIL as confirmed by PAC at screening;
5. Must understand, agree and be able to comply with the requirements of the protocol. Subjects must be willing and able to provide voluntary consent to participate and sign a Consent Form prior to study-related activities;
6. Must be judged by Investigator to be an appropriate candidate for the protocol-specified procedure (i.e. excision, 4-quadrant biopsy with ECC, or 4-quadrant biopsy) required at Week 36;
7. Satisfactory colposcopy at screening, defined as full visualization of the squamo-columnar junction (Type I or II transformation zone) and complete visualization of the upper limit of aceto-white epithelium or suspected CIN disease;
8. Cervical lesion that is accessible for sampling by biopsy instrument (e.g. Mini-Tischler device);
9. Cervical lesion of adequate size to ensure that a visible lesion remains after screening biopsy;
10. Must meet one of the following criteria with respect to their reproductive capacity:
a) Is post-menopausal as defined by spontaneous amenorrhea for more than 12 months
b) Is surgically sterile due to absence of ovaries or due to a bilateral tubal ligation/occlusion performed more than 12 months prior to screening
c) WOCBP is willing to use a contraceptive method with failure rate of less than 1% per year when used consistently and correctly from screening until Week 36. The following methods are acceptable:
- Hormonal contraception: either combined or progestin-alone including oral contraceptives, injectable, implants, vaginal ring, or percutaneous patches. Hormonal contraceptives must not be used in subjects with a history of hypercoagulability (e.g., deep vein thrombosis, pulmonary embolism).
- Abstinence from penile-vaginal intercourse when this is the subject’s preferred and usual lifestyle
- Intrauterine device or intrauterine system
- Male partner sterilization at least 6 months prior to the female subject’s entry into the study, and this male is the sole partner for that subject
11. Normal screening ECG or screening ECG with no clinically significant findings, as judged by the investigator. |
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E.4 | Principal exclusion criteria |
Subjects meeting any of the following criteria will be excluded from enrollment in the study:
1. Microscopic or gross evidence of adenocarcinoma-in-situ (AIS), high grade vulvar, vaginal (inclusive of cervical HPV-related lesions that extend into the vaginal vault), or anal intraepithelial neoplasia or invasive cancer in any histopathologic specimen at screening;
2. Cervical lesion(s) that cannot be fully visualized on colposcopy due to extension high into cervical canal at screening;
3. ECC that shows a potentially untreated carcinoma, untreated HSIL, indeterminate, or insufficient for diagnosis (ECC is not required to be performed as part of study screening);
4. Treatment for cervical HSIL within 4 weeks prior to screening;
5. Pregnant, breastfeeding or considering becoming pregnant through Week 36 visit;
6. History of previous therapeutic HPV vaccination (licensed prophylactic HPV vaccines are allowed, e.g. Gardasil™, Silgard ™, Cervarix™);
7. Presence of any unresolved abnormal clinical screening laboratory values of Grade 1 or greater per Common Toxicity Criteria for Adverse Events (CTCAE) v 4.03 and deemed clinically significant by the investigator within 45 days prior to Day 0;
8. Immunosuppression as a result of underlying illness or treatment including:
a) History of or positive serologic test for HIV at screening (performed within 40 days prior to Day 0)
b) Primary immunodeficiencies
c) Long term use (≥ 7 days) of oral or parenteral glucocorticoids at a dose of ≥20 mg/day of prednisone equivalent; (use of inhaled, otic, and ophthalmic corticosteroids are allowed)
d) Current or anticipated use of disease modifying doses of anti-rheumatic drugs (e.g., azathioprine, cyclophosphamide, cyclosporine, methotrexate), and biologic disease modifying drugs such as TNF-α inhibitors (e.g. infliximab, adalimumab or etanercept)
e) History of solid organ or bone marrow transplantation
f) Any prior history of other clinically significant immunosuppressive or clinically diagnosed autoimmune disease that may jeopardize the safety of the subject or require therapy that would interfere with study assessments or endpoint evaluation, or otherwise impact the validity of the study results.
g) Subjects who are malnourished (i.e. medically significant
unintentional weight loss, kwashiorkor, or marasmus) based on
screening labs, medical history and physical exam per the investigator's
clinical judgment.
9. Receipt of any non-study, non-live vaccine within 2 weeks of dosing;
10. Receipt of any non-study, live vaccine (e.g. measles vaccine) within 4 weeks of dosing;
11. Current or history of clinically significant, medically unstable disease which, in the judgment of the investigator, would jeopardize the safety of the subject, interfere with study assessments or endpoint evaluation, or otherwise impact the validity of the study results (e.g. chronic renal failure; angina, myocardial ischemia or infarction, class 3 or higher congestive heart failure, cardiomyopathy, or clinically significant arrhythmias);
12. Malignancy or systemic treatment for malignancy within 2 years of screening (with the exception of curatively treated, localized anogenital cancers and superficial skin cancers which are permitted)
13. Presence of acute or chronic bleeding or clotting disorder that would contraindicate IM injections, or use of blood thinners (e.g. anticoagulants or antiplatelet drugs) within 2 weeks of Day 0;
14. History of seizures unless seizure free for 5 years with the use of one or fewer antiepileptic agents;
15. Sustained, manually confirmed, sitting systolic blood pressure >150 mm Hg or <90 mm Hg or a diastolic blood pressure >95 mm Hg at Screening or Day 0;
16. Resting heart rate <50 bpm (unless attributable to athletic conditioning) or >100 bpm at screening or Day 0;
17. Prior major surgery within 4 weeks of Day 0;
18. Participation in an interventional study with an investigational compound or device within 30 days of signing informed consent; participation in an observational study is permitted;
19. Less than two acceptable sites available for IM injection considering the deltoid and anterolateral quadriceps muscles;
20. Tattoos, keloids or hypertrophic scars located within 2 cm of intended treatment site;
21. Cardioverter-defibrillator or pacemaker (to prevent a life-threatening arrhythmia) that is located in ipsilateral deltoid injection site (unless deemed acceptable by a cardiologist);
22. Metal implants or implantable medical device within the electroporation area;
23. Active drug or alcohol use or dependence that, in the opinion of the investigator, would interfere with adherence to study requirements;
24. Prisoner or subject who is compulsorily detained (involuntarily incarcerated) for treatment of either a psychiatric or physical (i.e. infectious disease) illness; |
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E.5 End points |
E.5.1 | Primary end point(s) |
Proportion of subjects with no evidence of cervical HSIL on histology (i.e. biopsy or excisional treatment) and no evidence of HPV-16 and/or HPV-18 in cervical samples by type specific HPV testing at Week 36 visit |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
1a. Incidence and severity of local and systemic events for 7 and 28 days following each investigational treatment and for the duration of the study (through Week 88 visit)
1b.Incidence and severity of all adverse events including Serious adverse events (SAEs) (e.g. Suspected unexpected serious adverse reaction (SUSAR), Unexpected adverse device effect (UADE) and other unexpected AEs) for the duration of the study (through Week 88 visit)
2. Proportion of subjects with no evidence of cervical HSIL on histology (i.e. biopsies or excisional treatment) at Week 36 visit
3. Proportion of subjects with no evidence of HPV-16 and/or HPV-18 in cervical samples by type specific HPV testing at Week 36 visit
4. Proportion of subjects with no evidence of Low grade squamous intraepithelial lesion (LSIL) or HSIL (i.e. no evidence of CIN1, CIN2 or CIN3) on histology (i.e. biopsies or excisional treatment) at Week 36 visit
5. Proportion of subjects with no evidence of LSIL or HSIL (i.e. no evidence of CIN1, CIN2 or CIN3 on biopsies or excisional treatment) on histology (i.e. biopsies or excisional treatment) and no evidence of HPV-16 and/or HPV-18 by type specific HPV testing at Week 36 visit
6. Proportion of subjects with no progression of cervical HSIL to cervical carcinoma from baseline on histology (i.e. biopsies or excisional treatment) at Week 36 visit
7. Proportion of subjects who have cleared HPV-16 and/or HPV-18 on specimens from non-cervical anatomic locations (i oropharynx, vagina and intra-anal) at Week 36 Visit
8a. Levels of serum anti-HPV-16 and anti-HPV-18 antibody concentrations at Weeks 15 and 36 visits
8b. Interferon-γ ELISpot response magnitudes at baseline, Weeks 15, and 36 visits
8c. Flow Cytometry response magnitudes at baseline and Week 15 visits |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1.a - 7 and 28 days following each investigational treatment through to week 88 visit
1.b - 7 and 28 days following each investigational treatment through to week 88 visit
2. Week 36 visit
3. Week 36 visit
4. Week 36 visit
5. Week 36 visit
6. Week 36 visit
7. Week 36 visit
8a. Baseline, Week 15, and 36 visits
8b. Baseline, Week 15, and 36 visits
8c. Base and Week 15 visits
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 2 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 47 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Argentina |
Belgium |
Brazil |
Canada |
Czech Republic |
Estonia |
Finland |
Germany |
Italy |
Lithuania |
Mexico |
Netherlands |
Peru |
Philippines |
Poland |
Portugal |
Slovakia |
South Africa |
Spain |
Thailand |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 9 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 11 |