A Cancer Vaccine (STEMVAC) in Combination with Chemotherapy for the Treatment of PD-L1 Negative Metastatic Triple-Negative Breast Cancer

Inclusion Criteria

• Patients must be at least ≥ 18 years of age * Note: Because no dosing or adverse event (AE) data are currently available on the use of STEMVAC in patients < 18 years of age, children and adolescents are excluded from this study but will be eligible for future pediatric trials, if applicable
• Patients with Eastern Cooperative Oncology Group (ECOG) Performance Status Score of ≤ 2
• Histologically confirmed triple-negative breast cancer * Tumors with estrogen receptor (ER)-low (≤ 5%) or negative and progesterone receptor (PR)-low (≤ 5%) or negative will be included * HER2-negative or HER2-low will be fined by the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) 2023 “Human Epidermal Growth Factor Receptor 2 (HER2) Breast Testing Guideline Update” which reaffirms the 2018 “HER2 Breast Testing Guideline Focused Update”
• Tumor is negative for PD-L1 marker testing per standard of care antibodies/clones in breast cancer at time of eligibility
• Metastatic disease that is measurable based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 or PET Response Criteria in Solid Tumors (PERCIST). Target lesions situated in a previously irradiated area are considered measurable if progression has been demonstrated in such lesions
• Have at least 1 site of disease confirmed by the treating oncologist that could be biopsied during treatment. This site should not be a site that is used to determine measurable disease for efficacy purposes. Lesions that will be biopsied should not be in a previously irradiated area unless progression has been demonstrated in such lesions
• Patients should not have received any prior cancer immunotherapy in the metastatic setting
• Prior Food and Drug Administration (FDA)-approved antibody drug conjugates are allowed
• Patients are appropriate candidates to receive standard of care chemotherapy as per treating oncologist’s clinical judgement * NOTE: Only chemotherapy partners listed in the protocol are allowed to be administered in metastatic setting concurrently with STEMVAC vaccine
• Patients who have received prior neoadjuvant or adjuvant chemotherapy are allowed
• A minimum of 14 days washout since last systemic therapy or any palliative radiotherapy is required
• Treatment with a bisphosphate or denosumab concurrently with protocol-specific therapy is allowed while on study (it is not exclusionary)
• Patients must be at least 28 days post systemic steroids prior to enrollment, unless this is a steroid administered concurrently with chemotherapy or used as part of prophylaxis to prevent intravenous (IV) contrast reactions
• Must have recovered from major infections and/or surgical procedures; and in the opinion of the investigator, not have any significant active concurrent medical illnesses or condition precluding protocol treatment
• Willing to undergo up to two serial biopsies while on study
• White blood cell (WBC) ≥ 2500/mm^3 (Within 28 days of receiving first study vaccine)
• Lymphocyte count ≥ 500/mm^3 (Within 28 days of receiving first study vaccine)
• Absolute neutrophil count (ANC) ≥ 1000/μL (Within 28 days of receiving first study vaccine)
• Hemoglobin (Hgb) ≥ 9 g/dl (Within 28 days of receiving first study vaccine)
• Platelets ≥ 75,000/μL (Within 28 days of receiving first study vaccine)
• Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN), except patients with Gilbert’s syndrome in whom total bilirubin must be < 3.0 mg/dL (Within 28 days of receiving first study vaccine)
• Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ≤ 1.5 X institutional ULN (Within 28 days of receiving first study vaccine)
• Creatinine ≤ 1.5 X ULN mg/dL or creatinine clearance > 60 ml/min (Within 28 days of receiving first study vaccine)
• Patients of child-bearing potential must agree to use dual methods of contraception and have a negative urine pregnancy test at screening, and male patients must use an effective barrier method of contraception if sexually active with a person of child-bearing potential. Acceptable methods of contraception are abstinence, condoms with contraceptive foam, oral, implantable or injectable contraceptives, contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual partner who is surgically sterilized or post-menopausal. Effective methods of contraception must be used throughout the study until the end of treatment on study

Exclusion Criteria

• Patient has received more than one line of prior therapy in metastatic setting
• Patients with tumors that are PD-L1-positive
• Enrollment in a concurrent interventional clinical trial. Biomarker or tissue collection or any other non-interventional clinical trial enrollment is allowed
• Patients with any of the following cardiac conditions: * Symptomatic restrictive cardiomyopathy * Dilated cardiomyopathy * Unstable angina within 4 months prior to enrollment * New York Heart Association functional class III-IV heart failure on active treatment * Symptomatic pericardial effusion
• Patients with any autoimmune disease or comorbidities requiring chronic steroids or immunosuppressants
• Known hypersensitivity reaction to the granulocyte-macrophage colony stimulating factor (GM-CSF) adjuvant; any known contra-indication to GM-CSF
• A non-breast malignancy requiring radiation or systemic therapy within last 5 years
• Pregnant and breastfeeding individuals
• Known history of human immunodeficiency virus (HIV) infection, hepatitis B (e.g., hepatitis B virus surface antigen [HBsAg] reactive), or hepatitis C (e.g., hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected)
• Major surgery within the 4 weeks prior to initiation of study vaccine
• Must be 14 days between a non-study and non-live vaccine and any STEMVAC vaccination * Note: The minimum of 14 days does not apply to the tetanus and diphtheria (Td) vaccine
• Any condition that may interfere with the patient’s participation in the study per treating physician