Poly-ICLC (Hiltonol®) Vaccine In Malignant Pleural Mesothelioma

• To evaluate the safety and toxicity of IT Poly-ICLC, Hiltonol® prior to surgical resection for patients with MPM.
• To determine objective response rate by RECIST 1.1 using CT imaging.
• To determine recurrence free survival of subjects treated with IT Poly-ICLC followed by surgical resection defined as the time of injection until the first date that recurrent disease is confirmed or date of documented death.
• To evaluate IT Poly-ICLC induced immune changes in the tumor microenvironment by comparing pre-injection biopsy to surgically resected tissue for immune cell infiltration and T cell receptor (TCR) diversity.
• To characterize additional immune parameters in IT Poly-ICLC injected tumors including in-depth phenotypic and functional characterization of immune infiltrating cells.
• To evaluate IT Poly-ICLC induced serological changes and changes of circulating immune cells, including regulatory T cells and NK cells, by comparing pre-injection to post-surgical resection blood samples.

Inclusion criteria

• Biopsy proven MPM

a. If biopsied at an outside institution, must have a tissue block sample available

• Deemed to be surgically resectable by a dedicated thoracic surgeon.
• Acceptable hematologic, renal and liver function as follows:

• Absolute neutrophil count > 1000/mm3
• Platelets > 50,000/mm3,
• Creatinine ≤ 2.5 mg/dl,
• Total bilirubin ≤ 1.5 mg/dl, unless patient has known Gilberts syndrome
• Transaminases ≤ 2 times above the upper limits of the institutional normal.
• INR<1.6 if off of anticoagulation. Patients on anticoagulation therapy with an INR>1.6 may be enrolled at the discretion of the investigator if they have not had any episodes of severe hemorrhage and if the site to be injected is fully surrounded by pleura where achieving homeostasis would be complicated.
• Patient must be able to provide informed consent
• Subject is willing to adhere to the study visit schedule and other protocol requirements.

Exclusion criteria

• Serious concurrent infection or medical illness, which would jeopardize the ability of the patient to receive Poly-ICLC with reasonable safety.
• History of any pulmonary process that precludes a biopsy to be done safely.
• Known severe pulmonary hypertension; having a history of pulmonary hypertension or an estimated PA systolic pressure of >60mmHg as measured by tricuspid regurgitation on preoperative echocardiogram.
• Subject unable to cooperate in terms of maintaining position during the biopsy procedure.
• AIDS defined as a CD4 count less than 200 in the context of HIV seropositivity or chronically is taking immunosuppressive medication such as steroids or transplant related medications.
• Persistent toxicity from recent therapy that has not sufficiently resolved in the judgment of the study physician.
• Subject has an active infection requiring therapy.
• Subject has had an allogeneic tissue/solid organ transplant.
• Subject has active autoimmune disease that has required systemic treatment within the past 2 years (eg, with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
• Subject has known active Hepatitis B, Hepatitis C or tuberculosis. Active Hepatitis B is defined as a known positive HBsAg result. Active Hepatitis C is defined by a known positive Hep C Ab result and known quantitative HCV ribonucleic acid (RNA) results greater than the lower limits of detection of the assay.
• Concomitant comorbidities that are uncontrolled that would preclude the patient from being a surgical candidate including uncontrolled CHF, diabetes or heart disease
• Women with a positive serum or urine pregnancy test at baseline, or are pregnant or breastfeeding.

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