Phase II Trial of Combination Immunotherapy With NeuVax and Trastuzumab in High-risk HER2+ Breast Cancer Patients

Completed · Phase 2

Conditions studied: Breast Cancer

In brief

This will be a multi-center, prospective, randomized, single-blinded, placebo-controlled phase II trial of trastuzumab + nelipepimut-S/GM-CSF versus trastuzumab + GM-CSF alone. Our target study population is high-risk HER2-positive breast cancer patients. High-risk HER2-positive breast cancer patients are defined as: Those with HER2-positive breast cancer, regardless of hormone receptor status, who receive neoadjuvant therapy with an approved regimen that includes trastuzumab and at least four cycles (12 weeks) of taxane-containing chemotherapy, and fail to achieve a pCR. Those with HER2-positive breast cancer, regardless of hormone receptor status, who undergo surgery as a first intervention and are found to have ≥ 4 positive lymph nodes. Those with HER2-positive, hormone receptor negative breast cancer who undergo surgery as a first intervention and are found to have 1-3 positive lymph nodes. Disease-free subjects after standard of care multi-modality therapy will be screened and HLA-typed.

Key facts

Study ID

NCT02297698

Run by

Cancer Insight, LLC

People needed

100

Starts

2014-10-01

Expected to finish

2021-12-01

Last updated by the study team

2023-12-12

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• 18 years or older
• Eastern Cooperative Oncology Group (ECOG) performance status 0,1
• AJCC stage I - III non-inflammatory, HER2-positive (according to ASCO-CAP guidelines 5) breast cancer
• Completed neoadjuvant therapy with an approved regimen that includes trastuzumab and at least four cycles (12 weeks) of taxane-containing chemotherapy and underwent surgery with final pathology showing evidence of residual disease in the breast or axilla (residual ductal carcinoma in situ or microinvasive disease not eligible) or underwent surgery as a first intervention and was found to be pathologically node-positive: ≥ 4 positive lymph nodes (pN2 or pN3) regardless of hormone receptor status or 1-3 positive lymph nodes (pN1) if hormone receptor negative. Patients with micrometastases (pN1mi) are not eligible.
• Completed an approved regimen of neoadjuvant or adjuvant therapy with an approved regimen that includes trastuzumab and at least four cycles (12 weeks) of taxane-containing chemotherapy with plan for completion of one year of trastuzumab therapy.
• Completed appropriate surgical therapy to include:
• Total mastectomy and axillary staging with sentinel lymph node dissection or axillary lymph node dissection (level I/II). Patients with a positive sentinel lymph node must have undergone a completion axillary lymph node dissection.
• Breast conserving surgery (BCS) and axillary staging with sentinel lymph node dissection or axillary lymph node dissection. Patients undergoing surgery as a first intervention with a positive sentinel lymph node must have undergone a completion axillary dissection level I/II unless they had clinically node negative T1-T2 tumors and fewer than 3 involved lymph nodes. Patients receiving neoadjuvant chemotherapy that have a positive sentinel lymph node must have undergone a completion axillary lymph node dissection.
• Completed or receiving appropriate radiation therapy if indicated:
• For patients undergoing total mastectomy surgery as a first intervention, post-mastectomy radiation to the chest wall, infraclavicular and supraclavicular areas is required for patients with ≥ 4 positive lymph nodes. Radiation to the internal mammary lymph nodes is not required per protocol but is allowed at the discretion of the patient's treating radiation oncologist. For patients with 1-3 positive lymph nodes, post-mastectomy radiation to the chest wall, infraclavicular, supraclavicular, and internal mammary areas is not required per protocol but is allowed at the discretion of the patient's treating radiation oncologist.
• For patients undergoing breast conserving surgery (BCS) as a first intervention, whole breast irradiation with or without a boost, and radiation to the infraclavicular and supraclavicular areas is required for patients with ≥ 4 positive lymph nodes. Radiation to the internal mammary lymph nodes is not required but is allowed at the discretion of the patient's treating radiation oncologist. For patients with 1-3 positive lymph nodes, whole breast irradiation with or without a boost is required. Radiation to the infraclavicular, supraclavicular, and internal mammary areas is not required per protocol but is allowed at the discretion of the patient's treating medical oncologist.
• For patient's undergoing mastectomy after neoadjuvant chemotherapy post-mastectomy radiation to the chest wall, infraclavicular and supraclavicular areas is required for patients presenting with clinical N2 or N3 disease or with ≥ 4 positive lymph nodes identified pathologically at the time of surgery. Radiation to the internal mammary lymph nodes is not required per protocol but is allowed at the discretion of the patient's treating radiation oncologist. For patients with 0-3 positive lymph nodes identified pathologically, post-mastectomy radiation to the chest wall, infraclavicular, supraclavicular and internal mammary areas is not required per protocol but is allowed at the discretion of the patient's treating radiation oncologist.
• For patient's undergoing BCS after neoadjuvant chemotherapy, whole breast irradiation with or without a boost is required. For patients with clinical N2 or N3 disease or with ≥ 4 positive lymph nodes identified pathologically at the time of surgery, radiation to the infraclavicular and supraclavicular areas is required. Radiation to the internal mammary lymph nodes is not required per protocol but is allowed at the discretion of the patient's treating radiation oncologist. For patients with 0-3 positive lymph nodes identified pathologically, radiation to the infraclavicular, supraclavicular and internal mammary areas is not required per protocol but is allowed at the discretion of the patient's treating radiation oncologist.
• HLA-A2+ or HLA-A3+ or HLA-A24+ or HLA-A26+
• LVEF >50%, or an LVEF within the normal limits of the institution's specific testing (MUGA or ECHO)
• Adequate organ function as determined by the following laboratory values:
• ANC ≥ 1,000/μL
• Platelets ≥ 75,000/μL
• Hgb ≥ 9 g/dL
• Creatinine ≤ 1.5 x upper limit of normal (ULN) of institution's range or Creatinine clearance ≥ 50%
• Total bilirubin ≤ 1.5 ULN of institution's range
• ALT and AST ≤ 1.5 ULN of institution's range
• For women of child-bearing potential, agreement to use adequate birth control (abstinence, hysterectomy, bilateral oophorectomy, bilateral tubal ligation, oral contraception, IUD, or use of condoms or diaphragms)
• Signed informed consent

You may not qualify if…

• AJCC Stage IV breast cancer
• NYHA stage 3 or 4 congestive heart failure
• Immune deficiency disease or known history of HIV, HBV, HCV
• Receiving immunosuppressive therapy including chronic steroids, methotrexate, or other known immunosuppressive agents
• Pregnancy (assessed by urine HCG)
• Breast feeding
• Any active autoimmune disease requiring treatment, with the exception of vitiligo
• Active pulmonary disease requiring medication to include multiple inhalers (>3 inhalers including one containing steroids)
• Involved in other experimental protocols except with permission of other PI

Where it is running

• Sarcoma Oncology Research Center, LLC — Santa Monica, California, United States
• St Joseph Heritage Healthcare — Santa Rosa, California, United States
• Sibley Memorial Hospital — Washington D.C., District of Columbia, United States
• University of Miami — Deerfield Beach, Florida, United States
• Memorial Breast Cancer Center — Hollywood, Florida, United States
• University of Miami — Kendall, Florida, United States
• University of Miami — Miami, Florida, United States
• Florida Cancer Research Institute — Plantation, Florida, United States
• University of Miami — Plantation, Florida, United States
• Loyola University Medical Center — Maywood, Illinois, United States
• Memorial Hospital of South Bend — South Bend, Indiana, United States
• Cancer Center of Kansas — Wichita, Kansas, United States
• Medstar Health (Union Memorial Hospital) — Baltimore, Maryland, United States
• Medstar (Good Samaritan Hospital) — Baltimore, Maryland, United States
• The Valley Hospital — Paramus, New Jersey, United States
• University of New Mexico Cancer Center — Albuquerque, New Mexico, United States
• New Mexico Cancer Care Alliance/Presbyterian Cancer Center — Albuquerque, New Mexico, United States
• Tisch Cancer Institute/Icahn School of Medicine at Mount Sinai — New York, New York, United States
• North Shore Hematology Oncology Associates — The Bronx, New York, United States
• MD Anderson Cancer Center — Houston, Texas, United States
• Texas Oncology (Cancer Care Centers of South Texas) — San Antonio, Texas, United States
• University of Virginia Human Immune Therapy Center — Charlottesville, Virginia, United States
• Providence Regional Medical Center — Everett, Washington, United States
• Ascension/ Columbia St. Mary's — Milwaukee, Wisconsin, United States

Full record on ClinicalTrials.gov

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