Laboratory Treated T Cells after Chemotherapy in Treating Patients with HER2-Negative Stage II-III Breast Cancer That Can Be Removed by Surgery
Basic Trial Information
|Phase II||Biomarker/Laboratory analysis, Treatment||18 and over||2010-056|
NCI-2011-02634, 1005008403, CDR0000675211, NCT01658969, WSU-2010-056, NCT01147016
This phase II trial studies how well giving laboratory treated T cells after chemotherapy works in treating patients with human epidermal growth factor receptor 2 (HER2)-negative stage II-III breast cancer that can be removed by surgery. Treating a patient's T cells in the laboratory may help the T cells kill more tumor cells when they are put back in the body. Drugs used in chemotherapy, such as paclitaxel, doxorubicin hydrochloride, and cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells stopping them from dividing, or by stopping them from spreading. Giving combination 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.
Further Study Information
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 interleukin (IL)-2 (aldesleukin) (300,000 IU/m^2/day) and GM-CSF (sargramostim) (250 ug/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-gamma) 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.
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.
Patients with stage II-III breast cancer that is HER2-negative by immunohistochemistry (IHC) (0-2+) or 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 can be ER negative (=< 10% by IHC) or PR negative (=< 10% by IHC)
Left ventricular ejection fraction (LVEF) >= 45 % (by multigated acquisition scan [MUGA] or echocardiography)
Serum creatinine =< 1.5 x ULN for the lab
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 III 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
Patients with AST/ALT > ULN must have negative hepatitis studies
Patients with AST/ALT or alkaline phosphatase > ULN must have liver imaging that does not demonstrate metastatic disease
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
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
Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) must be =< 1.5 x ULN for the lab
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
Hemoglobin must be >= 9.0 mg/dL
Platelet count must be >= 100,000/mm^3
Absolute neutrophil count (ANC) must be >= 1000/mm^3
Presence of residual disease on final pathology following surgery will be required for immunotherapy; patients with no residual disease at the time of surgery will be removed
Patients may have lymph node positive or negative disease, as long as they have clinical or pathologic stage II or III 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
Palpable primary breast tumor measuring >= 2.0 cm on physical exam or imaging prior to neoadjuvant chemotherapy
Diagnosis of invasive adenocarcinoma of the breast made by core needle biopsy
Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1 and/or Karnofsky PS of >= 70%
Women of reproductive potential must agree to use an effective non-hormonal method of contraception during therapy
Signed and dated Institutional Review Board (IRB)-approved consent form
Alkaline phosphatase must be =< 2.5 x ULN for the lab
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 echocardiogram (echo) instead of/in addition to a MUGA to evaluate LV wall motion)
Tumor determined to be HER2-positive by immunohistochemistry (3+) or by fluorescent in situ hybridization (HER2/CEP17 amplification ratio >= 2.0); tumors determined to be ER or PR positive by immunohistochemistry (> 10% )
Psychiatric or addictive disorders or other conditions that in the opinion of the investigators would preclude the patient from complying with the study protocol
Pregnancy or lactation at the time of registration
Administration of any investigational agents within 30 days before study entry
Chronic ongoing oral steroid use at the time of registration for any condition (such as asthma, rheumatoid arthritis, etc)
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
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)
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
Prior history of invasive breast cancer (patients with a history of DCIS or lobular carcinoma in situ [LCIS] are eligible)
Treatment with biotherapy, and/or hormonal therapy for the currently diagnosed breast cancer prior to study entry
Synchronous bilateral breast cancer (invasive or ductal carcinoma in situ [DCIS])
Definitive evidence of metastatic disease with exception of axillary lymph nodes or mammary nodes
Evidence of disease progression on neoadjuvant chemo T
Tumors clinically staged as unresectable disease
Trial Contact Information
Trial Lead Organizations / Sponsors / Collaborators
Wayne State University/Karmanos Cancer Institute
- National Cancer Institute
Wayne State University/Karmanos Cancer Institute
Amy M. Weise
Amy M. Weise
Link to the current ClinicalTrials.gov record.
NLM Identifer NCT01147016
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