SurVaxM Vaccine Therapy and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma

PRIMARY OBJECTIVES:

I. To evaluate 6-month progression-free survival (PFS6) in patients with survivin positive
newly diagnosed glioblastoma multiforme (GBM) treated with at least 4 doses of
SVN53-67/M57-keyhole limpet hemocyanin (KLH) peptide vaccine (SurVaxM) and standard of care
temozolomide.

SECONDARY OBJECTIVES:

I. To determine the safety and tolerability of SurVaxM in patients receiving standard care
adjuvant temozolomide.

II. To evaluate overall survival (OS) in patients with survivin positive newly diagnosed GBM
treated with SurVaxM and adjuvant temozolomide.

III. To describe the immune response in patients treated with SurVaxM and predictors of
response.

IV. To evaluate objective tumor response rate (applicable only for patients with evaluable
disease at study entry, as defined per Response Assessment in Neuro-Oncology [RANO] criteria)
and predictors of response.

OUTLINE:

Patients receive the first priming dose of SVN53-67/M57-KLH peptide vaccine in emulsion with
montanide ISA 51 subcutaneously (SC) and sargramostim SC within 7-28 days after completion of
chemoradiation. Treatment repeats every 2 weeks for a total of 4 doses in the vaccine priming
phase and then every 12 weeks during the adjuvant phase in the absence of disease progression
or unacceptable toxicity. Patients also receive standard adjuvant temozolomide orally (PO) or
intravenously (IV) on days 1-5. Treatment repeats every 28 days for 6 courses or more (at the
discretion of the investigator) in the absence of disease progression or unacceptable
toxicity. Patients may then receive maintenance SVN53-67/M57-KLH peptide vaccine in emulsion
with montanide ISA 51 SC and sargramostim SC every 12 weeks in the absence of disease
progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 12 weeks.

Inclusion Criteria:

- Have a Karnofsky performance status >= 70 (i.e. the patient must be able to care for
himself/herself with occasional help from others)

- Documented survivin-positive tumor status

- Pathologically confirmed diagnosis of glioblastoma multiforme (GBM); or World Health
Organization (WHO) grade IV [gliosarcoma]

- Absolute neutrophil count (ANC) >= 1.5 x 10^9/L

- Platelets >= 100 x 10^9/L

- Hemoglobin (Hgb) > 9.0 g/dL

- Serum total bilirubin: =< 1.5 x upper limit of normal (ULN)

- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 4.0 x ULN

- Patients on full-dose anticoagulants (e.g., warfarin or low molecular weight [LMW]
heparin) must meet the following criteria:

- No active bleeding or pathological condition that carries a high risk of bleeding
(e.g., tumor involving major vessels or known varices)

- Creatinine =< 1.8 mg/dl

- Human leukocyte antigen (HLA)-A*02, HLA-A*03, HLA-A*11 or HLA-A*24 positive patients

- No evidence of progressive disease from the postoperative period to the
post-chemoradiation period, based on changes in the neurologic exam, steroid use, or
evident radiographic progression, according to RANO criteria; Patients with increased
or new gadolinium enhancement may continue on protocol if in the investigator's
judgment that enhancement is likely due to pseuodoprogresion. The use of correlative
imaging studies (including PWI) or diffusion weighted imaging (DWI) and repeat imaging
after an interval of 2-4 weeks is strongly encouraged to help distinguish between
pseudoprogression and true progression.

- Magnetic resonance imaging (MRI) (ideally completed within 96 hours after surgery)
documenting gross total resection consisting of no gadolinium enhancement; or subtotal
resection consisting of linear enhancement with (or without) nodular gadolinium
enhancement measuring no greater than 1 cm x 1 cm x 1 cm total volume or 100 mm^2 in
cross sectional area

- Participants of child-bearing potential must agree to use adequate contraceptive
methods (e.g., hormonal or barrier method of birth control; abstinence) prior to study
entry, and have a negative pregnancy test prior to starting study treatment; 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

- Dexamethasone dose less than or equal to 4 mg daily at time of study enrollment

- Patients must have completed initial radiation therapy (RT) and temozolomide (TMZ) for
the treatment of their glioblastoma (i.e., completed 6-week course of RT and,
completed >= 75% of 6-week course of induction TMZ chemotherapy)

- Participant or legal representative must understand the investigational nature of this
study and sign an independent Ethics Committee/Institutional Review Board approved
written informed consent form prior to receiving any study related procedure

Exclusion Criteria:

- The patient must not have received any immunotherapy for their brain tumor

- Patients with serious concurrent infection or medical illness, which in the treating
physician's opinion would jeopardize the ability of the patient to receive the
treatment outlined in this protocol with reasonable safety

- Patients who are pregnant or breast-feeding

- Patients receiving concurrent therapy for their tumor (i.e. chemotherapeutics or
investigational agents) other than temozolomide

- Patients with a concurrent or prior malignancy are ineligible unless they are patients
with curatively treated carcinoma-in-situ or basal cell carcinoma of the skin;
patients who have been free of disease (any prior malignancy) for at least 3 years are
eligible for this study

- Patients who have had repeat craniotomy for tumor therapy after receiving RT and TMZ
treatment

- Patients who received other chemotherapeutics or investigational agents in addition to
their radiation therapy and concomitant temozolomide treatment

- Patients who have received Gliadel wafers or alternating electrical field therapy
(ETTF) are not eligible for this study

- Known history of an autoimmune disorder

- Known human immunodeficiency virus (HIV) positivity or acquired immunodeficiency
syndrome (AIDS) related illness or other serious medical illness

- Patients who have contraindication to MRI

- Unwilling or unable to follow protocol requirements

- Any condition which in the investigator's opinion deems the participant an unsuitable
candidate to receive study drug

- Received an investigational agent within 30 days prior to registration