Targeted T Cells After Neoadjuvant Chemotherapy in Treating Women With Stage II or III Breast Cancer Undergoing Surgery

This study is currently recruiting participants. (see Contacts and Locations)
Verified February 2015 by Barbara Ann Karmanos Cancer Institute
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Amy Weise, Barbara Ann Karmanos Cancer Institute
ClinicalTrials.gov Identifier:
NCT01147016
First received: June 17, 2010
Last updated: February 4, 2015
Last verified: February 2015
  Purpose

RATIONALE: Neoadjuvant chemotherapy for women with stage II-III Her negative breast cancer followed by Her2Bi armed activated T cells (ATCs) may significantly improve the pathologic complete response (pCR) rate at the time of surgery. Arming ex vivo expanded T cells in the laboratory may help the T cells kill more tumor cells when they are put back in the body. Giving combination neoadjuvant chemotherapy followed by laboratory-treated T cells before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

PURPOSE: This phase II clinical trial is studying how well giving laboratory-treated T cells after neoadjuvant chemotherapy works in treating women with stage II or stage III breast cancer undergoing surgery.


Condition Intervention Phase
Breast Cancer
Biological: HER2Bi-armed activated T cells
Drug: cyclophosphamide
Drug: doxorubicin hydrochloride
Drug: paclitaxel
Other: laboratory biomarker analysis
Procedure: neoadjuvant therapy
Procedure: therapeutic conventional surgery
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Study of Anti-CD3 x Anti-HER2/Neu (Her2Bi) Armed Activated T Cells (ATC) After Neoadjuvant Chemotherapy in Women With HER2/Neu (0-2+), Hormone Receptor (HR) Negative Stage II-III Breast Cancers

Resource links provided by NLM:


Further study details as provided by Barbara Ann Karmanos Cancer Institute:

Primary Outcome Measures:
  • Pathologic complete response [ Time Frame: Every 8 weeks or as indicated ] [ Designated as safety issue: No ]
  • Recurrence-free survival [ Time Frame: Every 8 weeks or as indicated ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival [ Time Frame: Every 3 months for the first year, and then every 6 months for one more year. ] [ Designated as safety issue: No ]

Estimated Enrollment: 32
Study Start Date: July 2010
Estimated Study Completion Date: June 2015
Estimated Primary Completion Date: June 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: HER2Bi-armed activated T cells + Neoadjuvant Chemotherapy

HER2Bi-armed activated T cells - Total of 4 of the T cell infusions IV over a period of 1 month

Cyclophosphamide, doxorubicin hydrochloride, paclitaxel -As prescribed by physician, standard of care.

Biological: HER2Bi-armed activated T cells
Total of 4 of the T cell infusions intravenously over a period of 1 month.
Drug: cyclophosphamide
As prescribed by physician, standard of care.
Other Name: Cytoxan®
Drug: doxorubicin hydrochloride
As prescribed by physician, standard of care.
Other Names:
  • Adriamycin®
  • Rubex®
Drug: paclitaxel
As prescribed by physician, standard of care.
Other Names:
  • Abraxane®
  • Onxol®
  • Taxol
Other: laboratory biomarker analysis
Immune studies will be done pre-immunotherapy, prior to the third infusion of activated T-cells, at the time of surgery, and 1 month after immunotherapy. If there are positive findings, additional optional studies will be done at 3, 6, and 12 months, if the immune studies show changes worthy of follow-up studies.
Procedure: neoadjuvant therapy
As prescribed by physician, standard of care.
Procedure: therapeutic conventional surgery
As recommended by physician, post immunotherapy.

Detailed Description:

PRIMARY OBJECTIVES:

I. To estimate progression-free survival (PFS) in women with stage II-III triple-negative breast cancer without a complete pathologic response (cPR) who receive a regimen of neoadjuvant chemotherapy (chemoT), surgery, and/or irradiation followed by 8 infusions of ~10-15 x 10^9 Her2Bi-armed activated T cells (ATC) (aATC) given twice per week for 4 weeks in combination with IL-2 (aldesleukin) (300,000 IU/m^2/day) and GM-CSF (sargramostim) (250 μg/m^2/twice per week) beginning 3 days before the 1st infusion and ending 1 week after the last infusion (defined as immunotherapy).

II. To estimate the change from baseline (pre immunotherapy [IT]) to post-IT in specific cytotoxicity and interferon gamma (IFN-γ) enzyme-linked immunosorbent spots (Elispots) of lymphocytes in the blood directed at breast cancer cells.

III. To investigate if pathologic response and the changes in numbers and proportion of infiltrating cells and cancer stem cells in the tumor at the time of surgery are associated with progressive disease.

OUTLINE:

NEOADJUVANT CHEMOTHERAPY: Patients receive dose-dense AC-T regimen comprising doxorubicin hydrochloride intravenously (IV) and cyclophosphamide IV once every 2 weeks for 4 courses followed by paclitaxel IV once every 2 weeks for 4 courses or paclitaxel IV once weekly for 12 weeks. Or, patients receive TAC regimen comprising docetaxel IV, doxorubicin hydrochloride IV, and cyclophosphamide IV once every 3 weeks for 6 courses. Treatment continues in the absence of disease progression or unacceptable toxicity.

IMMUNOTHERAPY: Beginning 3 weeks after the last dose of chemotherapy, patients receive Her2Bi-armed activated T cells IV over 5-30 minutes twice weekly for 4 weeks. Patients also receive aldesleukin subcutaneously (SC) daily beginning 3 days before the first T cell infusion and ending 1 week after the last infusion.

SURGERY: Patients then undergo surgical resection of the breast 2 weeks later.

After completion of study treatment, patients may be followed up at 1, 3, 6, and 12 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

  • Signed and dated institutional review board (IRB)-approved consent form
  • Women of reproductive potential must agree to use an effective nonhormonal method of contraception during therapy
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1 and/or Karnofsky PS of >= 70%
  • Diagnosis of invasive adenocarcinoma of the breast made by core needle biopsy
  • Palpable primary breast tumor measuring >= 2.0 cm on physical exam or imaging prior to neoadjuvant chemotherapy
  • Patients with stage II-IIIB breast cancer that is HER2-negative by immunohistochemistry (IHC) (0-2+) and fluorescence in situ hybridization (FISH) (HER2/chromosome enumeration probe [CEP]17 amplification ratio < 2.0) who have completed "third generation" neoadjuvant chemoT and planned local treatment (surgery and radiation if indicated); estrogen receptor (ER) or progesterone receptor (PR) status should be negative
  • Patients may have lymph node positive or negative disease, as long as they have clinical/pathologic stage II or IIIB breast cancer; patients may have the lymph nodes assessed by any method deemed appropriate by the treating physicians, including pre-neoadjuvant therapy sentinel lymph node biopsy
  • Presence of residual disease measuring at least 5mm (as single foci or in aggregate) on final pathology following surgery
  • Patients must discontinue sex hormone therapy prior to registration, e.g. birth control pills, hormonal replacement therapy
  • Absolute neutrophil count (ANC) must be >= 1000/mm^3
  • Platelet count must be >= 100,000/mm^3
  • Hemoglobin must be >= 9.0 mg/dL
  • Total bilirubin must be =< the upper limit of normal (ULN) for the lab unless the patient has a grade 1 bilirubin elevation (> ULN to 1.5 x ULN) resulting from Gilbert's disease or similar syndrome due to slow conjugation of bilirubin; and
  • Alkaline phosphatase must be =< 2.5 x ULN for the lab
  • Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) must be =< 1.5 x ULN for the lab
  • Alkaline phosphatase and AST/ALT may not both be > the ULN; for example, if the alkaline phosphatase is > the ULN but =< 2.5 x ULN, then the AST/ALT must be =< the ULN; if the AST/ALT is > the ULN but =< 1.5 x ULN, then the alkaline phosphatase must be =< ULN
  • Patients with either skeletal pain or alkaline phosphatase that is > ULN must have a bone scan showing they do not have metastatic disease; suspicious findings on bone scan must be confirmed as benign by x-ray, magnetic resonance imaging (MRI), or biopsy
  • Patients with AST/ALT or alkaline phosphatase > ULN must have liver imaging that does not demonstrate metastatic disease
  • Patients with AST/ALT > ULN must have negative hepatitis studies
  • Patients with stage II disease and clinical suspicion for metastatic disease based on reported symptoms, physical examination findings, or laboratory abnormalities must have staging studies demonstrating no evidence of metastatic disease (with exception of axillary lymph nodes or mammary nodes); patients with stage IIIA disease must have staging studies demonstrating no evidence of metastatic disease (with exception of axillary lymph nodes or mammary nodes), even if asymptomatic with normal physical examination and laboratory values; such staging studies must include: chest imaging (chest X-ray, computed tomography [CT], or MRI), abdominal/pelvis imaging (CT or MRI), and bone imaging (bone scan or positron emission tomography [PET]-scan); abnormalities that are indeterminate and too small to biopsy should be followed with further imaging, as appropriate, but do not exclude patients from the study; abnormalities that are suspicious and large enough to biopsy exclude patients from the study, unless a biopsy is performed and is negative for metastatic disease
  • Serum creatinine =< 1.5 x ULN for the lab
  • Pre-entry core biopsy with sufficient material for correlative studies
  • Left Ventricular Ejection Fraction (LVEF) >= 45 % (by multigated acquisition scan [MUGA] or echocardiography)

Exclusion Criteria

  • Tumor determined to be HER2-positive by immunohistochemistry (3+) or by fluorescent in situ hybridization (HER2/CEP17 amplification ratio >= 2.0)
  • Tumors clinically staged as anyT with N3 disease or unresectable disease
  • Evidence of disease progression on neoadjuvant chemo T
  • Definitive evidence of metastatic disease with exception of axillary lymph nodes or mammary nodes
  • Synchronous bilateral breast cancer (invasive or ductal carcinoma in situ [DCIS])
  • Treatment with biotherapy, and/or hormonal therapy for the currently diagnosed breast cancer prior to study entry
  • Any sex hormonal therapy, e.g., birth control pills, ovarian hormonal replacement therapy, etc. within 2 weeks prior to the collection of cells
  • Prior history of invasive breast cancer (patients with a history of DCIS or lobular carcinoma in situ [LCIS] are eligible)
  • Other malignancies unless the patient is considered to be disease-free for 5 or more years prior to randomization and is deemed by the physician to be at low risk for recurrence; patients with the following cancers are eligible if diagnosed and treated within the past 5 years: carcinoma in situ of the cervix, carcinoma in situ of the colon, melanoma in situ, and basal cell or squamous cell carcinoma of the skin
  • Known cardiac disease which precludes their ability to receive planned treatments:

    • Angina pectoris that requires the use of anti-anginal medication
    • History of documented congestive heart failure
    • Serious cardiac arrhythmia requiring medication
    • Severe conduction abnormality
    • Valvular disease with documented cardiac function compromise; and
    • Uncontrolled hypertension defined as blood pressure (BP) that is consistently > 150/90 on antihypertensive therapy at the time of registration (Patients with hypertension that is well controlled on medication are eligible)
  • History of myocardial infarction (MI) documented by elevated cardiac enzymes with persistent regional wall motion abnormality on assessment of left ventricular (LV) function (patients with history of MI must have an echo instead of/in addition to a MUGA to evaluate LV wall motion)
  • Symptomatic peripheral vascular disease
  • Other non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that would preclude treatment with any of the treatment regimens or would prevent required follow-up
  • Chronic ongoing oral steroid use at the time of registration for any condition (such as asthma, rheumatoid arthritis, etc)
  • Administration of any investigational agents within 30 days before study entry
  • Pregnancy or lactation at the time of registration
  • Psychiatric or addictive disorders or other conditions that in the opinion of the investigators would preclude the patient from complying with the study protocol
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01147016

Locations
United States, Michigan
Barbara Ann Karmanos Cancer Institute Recruiting
Detroit, Michigan, United States, 48201-1379
Contact: Clinical Trials Office - Barbara Ann Karmanos Cancer Institute    800-527-6266      
Sub-Investigator: Rouba Ali-Fehmi, M.D.         
Sub-Investigator: Lydia Choi, M.D.         
Sub-Investigator: Abhinav Deol, M.D.         
Sub-Investigator: Neb Duric, Ph.D.         
Sub-Investigator: Lawrence Flaherty, M.D.         
Sub-Investigator: David Gorski, M.D., Ph.D.         
Sub-Investigator: Sayeh Lavasani, M.D.         
Sub-Investigator: Michael Simon, M.D., MPH         
Sub-Investigator: Archana Thakur, Ph.D.         
Sub-Investigator: Lawrence Lum, M.D.. D.Sc.         
Sponsors and Collaborators
Barbara Ann Karmanos Cancer Institute
Investigators
Principal Investigator: Amy Weise, M.D. Barbara Ann Karmanos Cancer Institute
  More Information

Additional Information:
No publications provided

Responsible Party: Amy Weise, Principal Investigator, Barbara Ann Karmanos Cancer Institute
ClinicalTrials.gov Identifier: NCT01147016     History of Changes
Obsolete Identifiers: NCT01658969
Other Study ID Numbers: CDR0000675211, P30CA022453, WSU-2010-056
Study First Received: June 17, 2010
Last Updated: February 4, 2015
Health Authority: United States: Food and Drug Administration

Keywords provided by Barbara Ann Karmanos Cancer Institute:
estrogen receptor-negative breast cancer
HER2-negative breast cancer
male breast cancer
progesterone receptor-negative breast cancer
recurrent breast cancer
stage IIA breast cancer
stage IIB breast cancer
stage IIIA breast cancer
stage IIIB breast cancer
triple-negative breast cancer

Additional relevant MeSH terms:
Breast Neoplasms
Breast Diseases
Neoplasms
Neoplasms by Site
Skin Diseases
Cyclophosphamide
Doxorubicin
Liposomal doxorubicin
Alkylating Agents
Antibiotics, Antineoplastic
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Antirheumatic Agents
Enzyme Inhibitors
Immunologic Factors
Immunosuppressive Agents
Molecular Mechanisms of Pharmacological Action
Myeloablative Agonists
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses
Topoisomerase II Inhibitors
Topoisomerase Inhibitors

ClinicalTrials.gov processed this record on April 23, 2015