Cyclophosphamide and Vaccine Therapy With or Without Trastuzumab in Treating Patients With Metastatic Breast Cancer - Full Text View

Purpose

RATIONALE: Vaccines made from gene-modified tumor cells may help the body build an effective immune response to kill tumor cells. Biological therapies, such as cyclophosphamide and trastuzumab, may increase the number of immune cells and make the immune response stronger. It is not yet known whether giving cyclophosphamide together with vaccine therapy is more effective with or without trastuzumab in treating patients with metastatic breast cancer.

PURPOSE: This randomized phase II trial is studying the side effects of giving cyclophosphamide together with vaccine therapy and to see how well it works compared with giving cyclophosphamide and vaccine therapy together with trastuzumab in treating patients with metastatic breast cancer.

Condition	Intervention	Phase
Breast Cancer	Biological: allogeneic GM-CSF-secreting breast cancer vaccine Biological: trastuzumab Drug: cyclophosphamide	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Randomized, Open-Label Comparative Study of Combination Therapy With Cyclophosphamide and an Allogeneic GM-CSF-secreting Breast Tumor Vaccine With or Without Trastuzumab for the Treatment of Metastatic Breast Cancer That Does NOT Over-express HER-2/Neu

Resource links provided by NLM:

Genetics Home Reference related topics: breast cancer

MedlinePlus related topics: Breast Cancer

Drug Information available for: Cyclophosphamide Trastuzumab

Genetic and Rare Diseases Information Center resources: Breast Cancer, Male

U.S. FDA Resources

Further study details as provided by Sidney Kimmel Comprehensive Cancer Center:

Primary Outcome Measures:

Toxicity as assessed by NCI CTCAE v3.0 [ Time Frame: 3 years ]
Progression-free survival at 6 months [ Time Frame: 3 years ]
HER-2/neu-specific immune responses [ Time Frame: 3 years ]
Pharmacodynamics of peripheral CD4+CD25+ regulatory T cells [ Time Frame: 3 years ]

Secondary Outcome Measures:

Immune priming in in-vivo vaccine-site biopsies [ Time Frame: 3 years ]
Enumeration of CD8+ T cells specific for hTERT by ELISPOT [ Time Frame: 3 years ]
Characterization of the T-cell memory pool pre- and post-vaccination [ Time Frame: 3 years ]


Estimated Enrollment:	60
Study Start Date:	July 2009
Estimated Primary Completion Date:	March 2016 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Arm I Patients receive cyclophosphamide IV over 30 minutes on day -1 and allogeneic GM-CSF-secreting breast cancer vaccine intradermally on day 0. Courses repeat every 4-6 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. Patients then receive a fourth vaccination at 6-8 months.	Biological: allogeneic GM-CSF-secreting breast cancer vaccine Given intradermally Drug: cyclophosphamide Given IV
Experimental: Arm II Patients receive cyclophosphamide and the vaccine as in arm I and trastuzumab IV over 30-90 minutes on day -1. Courses repeat every 4-6 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. Patients then receive a fourth vaccination at 6-8 months.	Biological: allogeneic GM-CSF-secreting breast cancer vaccine Given intradermally Biological: trastuzumab Given IV Drug: cyclophosphamide Given IV

Detailed Description:

OBJECTIVES:

Primary

To evaluate the safety of cyclophosphamide-modulated vaccination with vs without trastuzumab in patients with breast cancer that does not overexpress HER-2/neu.
To compare the clinical benefit of cyclophosphamide-modulated vaccination with vs without trastuzumab in these patients.
To measure HER-2/neu-specific CD4+ and CD8+ T-cell immunity by delayed-type hypersensitivity (DTH) and ELISPOT.
To measure the pharmacodynamics of CD4+CD25+ regulatory T cells by flow cytometry.

Secondary

To assess the impact of trastuzumab on immune priming in vivo by immunohistochemistry of vaccine-site biopsies at day +3 and day +7 of courses 1 and 3 on the two study arms, comparing cellular infiltrates to those seen in previous preclinical and clinical models.
To measure hTERT-specific CD8+ T-cell immunity by ELISPOT.
To characterize the peripheral-memory T-cell pool.

Tertiary

To determine baseline and change in vaccine site-draining lymph node immunohistology and gene expression profile.
To develop the tandem tetramer/CD107a cytotoxicity assay for HER-2/neu-specific CD8+ T cells.
To measure novel T-cell responses induced by trastuzumab and cyclophosphamide-modulated vaccination.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

Arm I: Patients receive cyclophosphamide IV over 30 minutes on day -1 and allogeneic GM-CSF-secreting breast cancer vaccine intradermally on day 0. Courses repeat every 4-6 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. Patients then receive a fourth vaccination at 6-8 months.
Arm II: Patients receive cyclophosphamide and the vaccine as in arm I and trastuzumab IV over 30-90 minutes on day -1. Courses repeat every 4-6 weeks for 3 courses in the absence of disease progression or unacceptable toxicity. Patients then receive a fourth vaccination at 6-8 months.

Skin punch and lymph node biopsies are collected at baseline and on days +3 and +7 of courses 1 and 3 for biomarker analysis.

After completion of study treatment, patients are followed periodically.

Eligibility


Ages Eligible for Study:	18 Years to 120 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

DISEASE CHARACTERISTICS:

Histologically confirmed adenocarcinoma of the breast
- Does not overexpress HER-2/neu, defined as FISH negative or 0, 1+, or 2+ by IHC
- Stage IV disease
Must not be eligible for therapy of known curative potential for metastatic breast cancer
Measurable or evaluable disease
Stable CNS disease allowed provided that it's adequately treated and not under active treatment
Hormone receptor status not specified

PATIENT CHARACTERISTICS:

Menopausal status not specified
ECOG performance status 0-1
ANC > 1,000/mm^3
Platelets > 100,000/mm^3
Serum bilirubin < 2.0 mg/dL (unless due to Gilbert syndrome)
AST and ALT < 2 times upper limit of normal (ULN)
Alkaline phosphatase < 5 times ULN
Serum creatinine < 2.0 mg/dL
Ejection fraction normal by MUGA OR ≥ 50% by echocardiogram
Not pregnant or nursing
Fertile patients must use effective contraception
HIV negative
Asthma or chronic obstructive pulmonary disease that does not require daily systemic corticosteroids allowed
No prior or concurrent autoimmune disease requiring management with systemic immunosuppression, including any of the following:
- Inflammatory bowel disease
- Systemic vasculitis
- Scleroderma
- Psoriasis
- Multiple sclerosis
- Hemolytic anemia or immune-mediated thrombocytopenia
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Sjogren syndrome
- Sarcoidosis
- Other rheumatologic disease
No other malignancies within the past 5 years, except carcinoma in situ of the cervix, superficial nonmelanoma skin cancer, superficial bladder cancer, or tamoxifen-related endometrial cancer that has been adequately treated
No active major medical or psychosocial problems that could be complicated by study participation
No symptomatic intrinsic lung disease or extensive tumor involvement of the lungs resulting in dyspnea at rest
No uncontrolled medical problems
No evidence of active acute or chronic infection
No known severe hypersensitivity to trastuzumab, except mild to moderate infusion reactions that are easily managed and do not recur
No allergy to corn

PRIOR CONCURRENT THERAPY:

See Disease Characteristics
More than 28 days since prior and no other concurrent chemotherapy, radiation therapy, or biologic therapy (except trastuzumab)
- Concurrent endocrine therapy and supportive therapy with bisphosphonates allowed
More than 28 days since prior and no other concurrent participation in an investigational new drug trial
More than 28 days since prior and no other concurrent systemic oral steroids
- Topical, ocular, and nasal steroids allowed
No prior vaccination with the allogeneic GM-CSF-secreting breast tumor vaccine

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: NCT00971737

Locations


United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231-2410

Sponsors and Collaborators

Sidney Kimmel Comprehensive Cancer Center

National Cancer Institute (NCI)

Investigators


Principal Investigator:	Leisha A. Emens, MD, PhD	Sidney Kimmel Comprehensive Cancer Center

More Information


Responsible Party:	Sidney Kimmel Comprehensive Cancer Center
ClinicalTrials.gov Identifier:	NCT00971737 History of Changes
Other Study ID Numbers:	J0947 CDR0000653173 P30CA006973 ( U.S. NIH Grant/Contract ) JHOC-J0947 NA_00024527 GENENTECH-JHOC-J0947
Study First Received:	September 3, 2009
Last Updated:	September 23, 2015

Keywords provided by Sidney Kimmel Comprehensive Cancer Center:


stage IV breast cancer male breast cancer

Additional relevant MeSH terms:


Breast Neoplasms Neoplasms by Site Neoplasms Breast Diseases Skin Diseases Vaccines Cyclophosphamide Trastuzumab Immunologic Factors	Physiological Effects of Drugs Immunosuppressive Agents Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Myeloablative Agonists

ClinicalTrials.gov processed this record on July 25, 2017