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Vaccines

Participants receive 3-dose Gardasil-9 vaccine series.

Subunit vaccine against 9 genotypes of human papillomavirus (6, 11, 16, 18, 31, 33, 45, 52, 58)

Human papillomavirus 9-valent vaccine, recombinant

Vice Chancellor for Academic Affairs and Research

Executive Director, Office of Research Services

Jyotsna Fuloria

Jennifer E Cameron, PhD

Michael E Hagensee, MD PhD

Michael E Hagensee, MD, PhD

The primary objective of this study is to determine the magnitude and breadth of the serum antibody response to the nonavalent HPV vaccine (Gardasil-9) in adults with well-controlled HIV infection.

The secondary objective of the study is to observe short term clinical outcomes of prevalent HPV genotype-specific anogenital infections in adults living with HIV who complete the three-dose Gardasil-9 vaccine series.

The clinical hypothesis is that adults with virologically controlled HIV mount a serum antibody response to the nonavalent HPV vaccine that is comparable to HIV negative counterparts. We also postulate that HPV vaccination will provide short-term clinical benefit against HPV infections and disease associated with vaccine genotypes.

BACKGROUND AND SIGNIFICANCE

HPV is the etiological agent for most if not all cervical and anal cancer and for over 50% of head and neck squamous cell carcinomas. HPV infection, pre-cancerous and cancerous lesions are more prevalent in people living with HIV (PLWHIV), including those with HIV infection that is well-controlled with anti-retroviral therapy. HPV vaccines have been developed based on expression of the L1 major capsid protein to make virus-like particles and demonstrate impressive efficacy, with type-specific protection against persistent infection and incident pre-cancer (cervical/anal intraepithelial neoplasia, CIN/AIN) in HIV uninfected populations. These vaccines include quadrivalent Gardasil (4vHPV) and the more recent nonavalent Gardasil (Gardasil-9).

The 4vHPV has been utilized to immunize PLWHIV. In general, excellent seroconversion rates (over 90%) were seen with slightly lower rates seen for HPV-18, and in those with low CD4 cell count, low CD4 cell count nadir or uncontrolled HIV replication. The seroconversion rates appear to be slightly lower than that seen in HIV-negative populations (\>95%). Additionally, titers for HPV-6 and 18 were noted to be lower compared to HIV-negative historical controls in children ages 7-12. This is consistent with observations that vaccination of PLWHIV for influenza, hepatitis A or hepatitis B has resulted in lower than desirable seroconversion rates (50-70%) with higher rates in those on cART and with higher CD4 cell count. To date, only one study has described immunogenicity of Gardasil-9 in adult PLWHIV. Investigators have reported seroconversion to all 9 HPV types in all 100 immune-intact/virally suppressed PLWHIV who received Gardasil-9, and higher antibody GMTs in those with pre-existing seroreactivity. This cohort study conducted in Belgium included predominantly Caucasian (68%) males (85%) with a mean age of 38 years at enrollment. There is a paucity of literature exploring the immunogenicity of Gardasil-9 in diverse demographic populations of adults living with HIV.

Efficacy studies using 4vHPV in HIV-positive adults have provided mixed results at best. One study in HIV-positive men and women who had significant prior HPV exposure showed no efficacy of HPV vaccination in preventing future AIN2/3 development. This may be related to the inclusion of men and women with AIN2/3 at baseline (30% and 50%, respectively) and the older age (average, 47) of this cohort. In another study of females aged 9-65 (average, 39) with 2 years of follow up, 4vHPV showed modest efficacy with rates of 1.0/100 patient-years for a composite endpoint of the development of warts or persistent infection with the vaccine types. This compares to rates of 0.1/100 patient-years for HIV-uninfected women and 1.5 for HIV-negative unvaccinated women. The reason for this modest efficacy is not clear but may be due to deficiencies in cellular immunity and/or the age of the cohorts. In addition, many of these HIV infected individuals have been previously exposed to some of the vaccine types and they often have concurrent infections with other oncogenic HPV types. These excessive HPV exposures may promote CIN/AIN and confound efficacy endpoints. Importantly, HIV positive women with CIN3+ have a nearly 4-fold higher prevalence of non-traditional oncogenic HPV types compared to HIV negative women with CIN3+. This finding suggests that the modest efficacy of 4vHPV in HIV positive women may be improved substantially by use of Gardasil-9. To date, no studies have reported efficacy of Gardasil-9 for prevention of HPV infections, CIN or AIN in adult PLWHIV.

There is clearly an unmet need to evaluate the immunogenicity and immune protection generated by Gardasil-9 vaccination in diverse populations of PLWHIV, who remain at increased risk of HPV infection and related pathology despite adequate management of their HIV. We hypothesize that people with well-controlled HIV will seroconvert following Gardasil-9 vaccination and will develop high titer antibodies to all 9 HPV types. In addition, we postulate that the well-controlled HIV-positive individual will also show short-term efficacy with fewer incident HPV infections and reduced incidence of CIN/AIN attributed to HPV types in the vaccine. This efficacy will primarily be seen in those who are seronegative and HPV DNA negative for a given type at baseline. It is predicted that those who are seropositive but HPV DNA negative for a given vaccine type will demonstrate higher titers of response after vaccination. Efficacy in this subset (seropositive, DNA negative) as well as the other subsets has not been studied in detail. The goal of these proposed studies is to show immunogenicity and short-term efficacy of Gardasil-9 in a well-controlled HIV-positive population.

STUDY DESIGN AND PROCEDURES

This study is a single-center, prospective, intervention trial evaluating the immunogenicity of Gardasil-9 in adult men and women living with adequately managed HIV infection. The study will include both men and women and will reflect the gender, race, ethnicity, sexual orientation and socioeconomic status of the patient population seeking care at University Medical Center.

After informed consent is secured, all enrolled participants will receive the 3-dose Gardasil-9 vaccine per product label at 0, 1 and 6 months. Subjects will be observed for at least 30 minutes after the vaccination is given. Participants consenting to the study will complete a sociodemographic survey at the enrollment visit. At 0, 7, 12, and 18-month visits, participants will complete a social history survey and whole venous blood, saliva, and anal swabs will be collected. A cervical/vaginal swab will also be collected from female participants. Whole blood will be processed to obtain serum, which will be aliquoted and stored at -80C. Serum samples will be tested for HPV antibodies by the competitive Luminex immunoassay (cLIA, Merck) to determine seroconversion rates and antibody titers. Genomic DNA isolates from saliva and swabs will be tested for HPV genotype-specific infection by high-throughput sequencing (HPV MY-Seq). Results of clinical laboratory tests pertinent to the study will be captured from the participant's electronic medical record. For patients who undergo cervical colposcopy or anoscopy with biopsy for clinical care, residual biopsy specimens will be obtained from UMC Pathology for HPV DNA genotype testing.

The immunological response of study participants will be compared to previously published historical (HIV negative adult) controls. Additionally, clinical outcomes of prevalent and incident HPV genotype-specific infection and anogenital dysplasia will be evaluated, comparing those participants who seroconvert/generate high titer antibodies to those who do not seroconvert/generate low titer antibodies, and comparing high-risk HPV genotypes included in the vaccine to high-risk HPV genotypes that are not included in the vaccine.

PLANNED ANALYSIS

The primary outcome of the study is seroconversion to the 9 HPV genotypes in the Gardasil-9 vaccine. This outcome will be analyzed as a binary variable (seropositive/seronegative) and as a continuous numerical value (antibody titers). Secondary outcomes of the study will evaluate the impact of vaccination on HPV infection and disease. Variables of interest include prevalent HPV infection, incident HPV infection, prevalent HPV-associated dysplasia, and incident dysplasia. Clinical outcome variables will also be interpolated from the data, including clearance and/or persistence of HPV infection and clearance, persistence or progression of HPV-associated disease. All disease will be evaluated on a per-site (mucosal tissue) basis and definitions for HPV related variables will depend on genotype-specificity. All variables will be collected at each 6-month timepoint. Time-to-event (e.g. viral clearance, progression of lesion) will also be extracted from the prospective data to evaluate clinical impacts of vaccination. Data will be stratified by demographic and social history variables to identify predictors of seroconversion and clinical outcomes and control for confounding factors.

Statistical Methods: Categorical covariates will be described by reporting counts and percentages, while continuous covariates will be reported using means and standard deviations. Categorical covariate distributions will be compared between seropositive/negative groups using a Fisher exact test, and continuous covariates will be compared using Wilcoxon rank sum tests. To test the primary hypothesis - that seropositivity rates do not differ from published rates of 95% in HIV-negative populations - a one-sided one-sample test of proportions will be used.

In order to determine what demographic factors influence variables in this population after potential confounder adjustment, several regression analyses will be used. For binary variables, logistic regression will be used, while for continuous variables typical linear regression is used. For time to event variables, Cox regression will be used, and for variables that are proportions, Beta regression will be used. When using repeated measurements, independence will be maintained by controlling for subject ID as a random or fixed effect. If necessary, Bayesian methods will be used.

Power/Sample Size: Assuming a seroconversion rate of 95% in HIV-negative patients, 150 enrolled patients would give power of about 99% to detect a seroconversion rate of 80%. The design also has a power of 80% if the true seroconversion rate in Gardasil patients is 89%. The design will not be well powered to detect decreases \<6% in seroconversion rates from the published literature.

Single-arm trial of serological response to Gardasil-9 HPV vaccine in immunocompetent adults (age 18-45) with HIV infection. All study participants will receive Gardasil-9 3-dose series.

Immunogenicity of Gardasil-9 HPV Vaccine in People Living With HIV

Prospective Observational Immunogenicity Trial of Gardasil-9 HPV Vaccine in People Living With Adequately Managed HIV

serum antibodies against human papillomavirus genotypes 6,11,16,18,31,33,45,52, and 58

time-to-clearance of prevalent HPV infection of the oral cavity, vaginal tract and/or anal canal

acquisition of genotype-specific HPV infection following Gardasil-9 immunization at mucosal sites (oral cavity, genital tract, anal canal)

Merck Sharp & Dohme LLC

Louisiana State University Health Sciences Center in New Orleans

Assistant Professor

Hormones

1x urine sampling for HPV analysis

1x survey

first-void urine is collected using Colli-Pee and subsequently analyzed using Anyplex™ II HPV HR Detection from Seegene.

Colli-Pee urine collection device

Subjects are asked to complete a survey that includes questions about sexual orientation, hormone therapy, gender reassignment surgery, number of sexual partners, HPV vaccination, and smoking

Survey

Elmar Joura, MD

In this study, Human Papilloma Virus (HPV) prevalence will be determined once in the urine of 200 trans people. In addition, subjects will be asked to complete a questionnaire about their sexual orientation, which is adapted from the largest published study.

All transpeople who visit the outpatient clinic are asked to participate in the study. After being informed and signing the Informed Consent Form, the subjects are asked to give first-void urine and fill out the survey. The urine samples are sent pseudonymously to the University of Ljubljana for analysis. The subjects will be informed about their results within 3 weeks.If the result is positive, the subjects will be offered voluntary further care in our HPV outpatient clinic. However, this will take place outside the study. The data collected there can be used for further analyses.

all study participants classify themselves as transmen, transwomen, genderqueer, non-binary or other gender identity

HPV Prevalence in Transpersons - a Prospective Study

Sophie Pils

Clinical Professor

Respiratory Tract (Lung and Bronchial) Diseases

Digestive System Diseases

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Ear, Nose, and Throat Diseases

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Carcinoma, Merkel Cell

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Pharmaceutical Solutions

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Immunoglobulins

Dose Escalation; Intervention: Drug: STAR0602

Dose Expansion; Recommended Phase 2 Dose (RP2D) identified from Phase 1 will be used in Phase 2; Intervention: Drug: STAR0602

STAR0602

Ke Liu, MD, PhD

Guru Sonpavde, MD

Marijo Billusic, MD

Erica Redmond

James Gulley, MD, PhD

Ryan Sullivan, MD

Claire Friedman, MD

Kai He, MD

Lillian Siu, MD

This is an open label, multicenter, phase 1/2 study to assess the safety/tolerability and preliminary clinical activity of STAR0602 as a single agent administered intravenously in participants with advanced solid tumors that are antigen-rich.

This Phase 1/2 study consists of two parts: Phase 1 Dose Escalation and Phase 2 Dose Expansion. In Phase 1 Dose Escalation, STAR0602 will be administered intravenously in participants with advanced solid tumors to assess safety/tolerability profile of STAR0602 and to determine the maximum tolerated dose (MTD) and/or recommended Phase 2 dose (RP2D) of STAR0602. In Phase 2 Dose Expansion, STAR0602 at RP2D will be administered to participants with advanced, antigen-rich solid tumors to further evaluate safety and assess preliminary clinical activity of STAR0602. Clinical activity will be evaluated by objective tumor response rate (ORR), duration of response (DOR), disease control rate (DCR), and progression free survival (PFS).

A Study of a Selective T Cell Receptor (TCR) Targeting, Bifunctional Antibody-fusion Molecule STAR0602 in Participants With Advanced Solid Tumors

A Phase 1/2, First-in-Human, Open-Label, Dose Escalation and Expansion Study of STAR0602, a Selective T Cell Receptor (TCR) Targeting, Bifunctional Antibody-fusion Molecule, in Subjects With Unresectable, Locally Advanced, or Metastatic Solid Tumors That Are Antigen-rich (START-001)

Complete response (CR) and partial response (PR)

Marengo Therapeutics, Inc.

Papilloma

Participants received blinded qHPV vaccination at Day 1, Month 2, and Month 6 of the Base Study

Participants received blinded placebo at Day 1, Month 2, and Month 6 in the Base Study. They were eligible to receive open-label qHPV vaccine in Extension 1

qHPV intramuscular injection in three 0.5 mL doses over 6 months in the Base Study or EXT1

Quadrivalent Human Papillomavirus (Types 6, 11, 16, 18) Recombinant Vaccine

Placebo intramuscular injection in three 0.5 mL doses over 6 months.

Comparator: Placebo

Medical Monitor

This study was conducted to assess the safety, immunogenicity, efficacy and long-term effectiveness of a vaccine being evaluated for the prevention of human papillomavirus (HPV) infection and disease in mid-adult women.

The Base study vaccination period (V501-019) encompassed Day 1 through Month 7, during which time participants received randomly assigned, blinded Gardasil™ (V501, qHPV vaccine) or placebo at Day 1, Month 2 and Month 6. The Base study follow-up period continued through approximately Month 48.

The base study was extended in protocol V501-019-10 (EXT1). Participants who received placebo and participants who received only 1 dose of qHPV vaccine in the Base Study were offered a complete, open-label, 3-dose qHPV vaccine regimen (administered at EXT1 Day 1, Month 2 and Month 6). Participants who received only 2 doses of qHPV vaccine in the base study were offered a single additional dose of qHPV vaccine (administered at EXT1 Day 1). Participants were followed to EXT1 Month 7.

A Long Term Follow-Up (LTFU) extension study V501-019-21 (EXT2) was added to observe the long term safety, effectiveness, and immunogenicity of qHPV vaccine in approximately 1,600 women who participated in the Base Study at sites in Colombia. Data were collected over a period of 6-10 years following participant's enrollment in the original Base Study.

A Study to Evaluate the Safety, Immune Response, and Efficacy of Gardasil (V501, qHPV) in Mid-Adult Women (V501-019)

Safety, Immunogenicity, and Efficacy of Gardasil (V501 (Human Papilloma Virus [Types 6, 11, 16, 18] Recombinant Vaccine) in Mid-Adult Women - The FUTURE III (Females United to Unilaterally Reduce Endo/Ectocervical Cancer) Study

http://www.merck.com/clinical-trials/pdf/Merck%20Procedure%20on%20Clinical%20Trial%20Data%20Access%20Final_Updated%20July_9_2014.pdf

http://engagezone.msd.com/ds_documentation.php

HPV 16/18: The two types of HPV (types 16/18) were determined by PCR testing

The four HPV types were determined by PCR testing. Cumulative incidence probability is the probability of becoming an endpoint case at any time from Day 1 to Year 4 conditional on having been event-free at Day 1.

The four HPV types were determined by PCR testing. Cumulative incidence probability is the probability of becoming an endpoint case at any time from Year 4 to Year 8 conditional on having been event-free from Day 1 to Year 4. The analysis windows were cut at the exact time points, e.g., Year 4. Visits and events which occurred after Year 4 due to visit window or follow-up investigations are included in the Year 4 to Year 8 time interval.

The four HPV types were determined by PCR testing. Cumulative incidence probability is the probability of becoming an endpoint case at any time from Year 6 to Year 10 conditional on having been event-free from Day 1 to Year 6.

The four HPV types were determined by PCR testing.

The four HPV types were determined by PCR testing. The analysis windows were cut at the exact time points, e.g., Year 4. Visits and events which occurred after Year 4 due to visit window or follow-up investigations are included in the Year 4 to Year 8 time interval.

The four HPV types were determined by polymerase chain reaction (PCR) testing. VIN = vulvar intraepithelial neoplasia; VaIN = vaginal intraepithelial neoplasia; AIS = adenocarcinoma in situ.

An adverse event (AE) is any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study vaccine. Any worsening of a preexisting condition which is temporally associated with the use of the study vaccine is also an adverse event. A serious adverse event (SAE) is an AE that results in death, is life threatening, results in persistent or significant disability or incapacity, results in or prolongs a hospitalization, is a congenital anomaly or birth defect, is a cancer, or is an overdose. Vaccine-related SAEs are those deemed by the investigator to be definitely, probably, or possibly related to study vaccine.

An adverse event (AE) is any unfavorable and unintended change in the structure, function, or chemistry of the body temporally associated with the use of the study vaccine. Any worsening of a preexisting condition which is temporally associated with the use of the study vaccine is also an adverse event. A serious adverse event (SAE) is an AE that results in death, is life threatening, results in persistent or significant disability or incapacity, results in or prolongs a hospitalization, is a congenital anomaly or birth defect, is a cancer, or is an overdose.

The four HPV types were determined by PCR testing. Cumulative incidence probability is the probability of becoming an endpoint case at any time from Day 1 to Year 4, conditional on having been event-free at Day 1.

The four HPV types were determined by PCR testing. Cumulative incidence probability is the probability of becoming an endpoint case at any time from Year 4 to Year 8, conditional on having been event-free from Day 1 to Year 4. The analysis windows were cut at the exact time points, e.g., Year 4. Visits and events which occurred after Year 4 due to visit window or follow-up investigations are included in the Year 4 to Year 8 time interval.

The four HPV types were determined by PCR testing. Cumulative incidence probability is the probability of becoming an endpoint case at any time from Year 6 to Year 10, conditional on having been event-free from Day 1 to Year 6.

Serum antibodies to the HPV Types were determined by Competitive Luminex Immunoassay (cLIA). Geometric Mean Titers (GMT) are reported in milli-Merck Units/mL (mMU/mL). This Outcome Measure evaluated age-specific immunogenicity responses, and applied only to participants who received qHPV in the Base Study.

Serum antibodies to HPV Types 6, 11, 16, and 18 were determined by Competitive Luminex Immunoassay (cLIA). The seropositive thresholds (in mMU/mL) were \>20 for Type 6, \>16 for Type 11, \>20 for Type 16, and \>24 for Type 18. This Outcome Measure evaluated age-specific immunogenicity responses, and applied only to participants who received qHPV in the Base Study.

HPV 6/11: The two types of HPV (types 6/11) were determined by PCR testing

This outcome measure was not analyzed because of diminished interest by experts in composite efficacy endpoints associated with these HPV types

Base Study: MedDRA v12.0; EXT1: MedDRA v14.1; LTFU (EXT2): MedDRA v18.1.

Adverse events are reported for all participants who received ≥1 dose of qHPV or placebo and had safety follow-up data.

Although other AEs were not solicited in EXT1 and LTFU (EXT2), some were voluntarily reported.

Participants received qHPV vaccination at Day 1, Month 2, and Month 6 and were followed up to approximately Month 48

qHPV Vaccine: Base Study

Participants received placebo at Day 1, Month 2, and Month 6 and were followed up to approximately Month 48

Placebo: Base Study

Participants who received placebo or an incomplete regimen of qHPV in the Base Study were offered open-label qHPV vaccine starting at approximately Month 60 (EXT1) and were followed up to Month 67

qHPV Vaccine: EXT1

Participants at sites in Colombia who received qHPV vaccination in the Base Study or in EXT1 were followed from Month 72 up to approximately Month 120 in LTFU (EXT2)

Long-term Follow-up: EXT2

Participants received qHPV vaccination at Day 1, Month 2, and Month 6 in the Base Study

qHPV Vaccine in Base Study

Participants received placebo at Day 1, Month 2, and Month 6 in the Base Study

Placebo in Base Study

Total

Age, Continuous

Although the upper age limit for this study was 45 years old, one subject 46 years of age was randomized into the study.

Sex: Female, Male

Asian

Black

Hispanic American

Native American

White

Multi-Racial

Polynesian

Race/Ethnicity, Customized

Senior Vice President, Global Clinical Development

qHPV in Base Study

Participants who had no major protocol violations, received all 3 vaccinations, were seronegative to the relevant HPV type at Day 1 and PCR negative to the relevant HPV type Day 1 through Month 7, and provided follow-up data after Month 7

Incidence Rate of HPV 6/11/16/18 Related Persistent Infection, Genital Warts, VIN, VaIN, Vulvar Cancer, Vaginal Cancer, Cervical Dysplasia, Cervical AIS, and Cervical Cancer

Participants received placebo at Day 1, Month 2, and Month 6 and were followed to Month 48 in the Base Study

Participants who received \>=1 qHPV vaccination or placebo injection in the Base Study and had safety follow-up

Number of Participants With Vaccine- or Placebo-Related Serious Adverse Events (SAEs) in the Base Study

Participants who received placebo or an incomplete qHPV regimen in the Base Study and were offered open-label qHPV vaccine starting at approximately Month 60 in EXT1

Participants who received \>=1 qHPV vaccination in the Base Study or EXT1 and had safety follow-up

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Immunogenicity of Gardasil-9 HPV Vaccine in People Living With HIV	NCT05266898	Papillomavirus ... Human Immunodef... Papillomavirus ... Serology Cervical Intrae... Anal Intraepith... Oral Cavity Inf...	Human papilloma...	18 Years - 45 Years	Louisiana State University Health Sciences Center in New Orleans
HPV Prevalence in Transpersons - a Prospective Study	NCT04864951	Papillomavirus ... Transsexualism	Colli-Pee urine... Survey	18 Years -	Medical University of Vienna
A Study of a Selective T Cell Receptor (TCR) Targeting, Bifunctional Antibody-fusion Molecule STAR0602 in Participants With Advanced Solid Tumors	NCT05592626	Advanced Solid ... Genital Neoplas... Urogenital Neop... Lung Neoplasm Neoplasms by Si... Papillomavirus ... Epstein-Barr Vi... Carcinoma Neoplasms Vulvar Neoplasm... Vulvar Diseases Abdominal Neopl...	STAR0602	18 Years -	Marengo Therapeutics, Inc.
A Study to Evaluate the Safety, Immune Response, and Efficacy of Gardasil (V501, qHPV) in Mid-Adult Women (V501-019)	NCT00090220	Healthy Adult F... Prevention Papillomavirus ... Human Papilloma...	Quadrivalent Hu... Comparator: Pla...	24 Years - 45 Years	Merck Sharp & Dohme LLC
Acceptability of Human Papillomavirus Self-sampling in Women Living With HIV	NCT05026047	Papillomavirus ...	HPV self-sampli...	30 Years -	Assistance Publique - Hôpitaux de Paris
HPV Self-Sampling in Somali Women	NCT05453006	Cervical Cancer Papillomavirus ... Uterine Disease... Uterine Cervica...	COPAN 552c.80 F...	30 Years - 65 Years	University of Minnesota
HPV Self-Sampling in Somali Women	NCT05453006	Cervical Cancer Papillomavirus ... Uterine Disease... Uterine Cervica...	COPAN 552c.80 F...	30 Years - 65 Years	University of Minnesota

Spots Global Cancer Trial Database for papillomavirus infection