Breast Cancer
Conditions
Keywords
stage IV breast cancer, recurrent breast cancer, ductal breast carcinoma
Brief summary
RATIONALE: Biological therapies use different ways to stimulate the immune system and stop cancer cells from growing. Combining different types of biological therapies may kill more tumor cells. PURPOSE: Phase I/II trial to study the effectiveness of combining different biological therapies in treating women who have stage IV breast cancer.
Detailed description
OBJECTIVES: * Determine the maximum tolerated dose of armed activated T cells given in combination with interleukin-2 and sargramostim (GM-CSF) in women with stage IV breast cancer. * Determine the toxicity profile of this regimen in these patients. * Determine the clinical response and overall and progression-free survival of patients treated with this regimen. OUTLINE: This is a dose-escalation study of armed activated T cells. Patients undergo peripheral blood mononuclear cell (PBMC) collection. The PBMCs are treated ex vivo with monoclonal antibody OKT3 to form armed activated T cells (ATC). The armed ATC are expanded for 14 days in interleukin-2 (IL-2). Patients receive armed ATC IV over 30 minutes twice weekly for 4 weeks. Patients also receive IL-2 subcutaneously (SC) once daily and sargramostim (GM-CSF) SC twice weekly beginning 3 days before the first infusion of armed ATC and continuing until 7 days after the last infusion of armed ATC. Cohorts of 3-6 patients receive escalating doses of armed ATC until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, additional patients are treated at that dose. Patients are followed at 1, 2, and 5 months and then every 6 months thereafter. PROJECTED ACCRUAL: A total of 15-30 patients will be accrued for the phase I portion of this study and a total of 18-33 patients will be accrued for the phase II portion of this study within 4-6 years. PLEASE NOTE: THIS STUDY WAS INTENDED TO BE A PHASE I/II STUDY, BUT NEVER MOVED FORWARD TO PHASE II. (4-22-09)
Interventions
Subcutaneous injections of IL-2 (3.0 × 105 IU/m2/day) starting 3 days before the 1st armed ATC infusion and ending 7 days after the last armed ATC infusion.
GM-CSF Injections will be given SQ GM-CSF (250 μg/m2/twice weekly), to start 3 days before the first ATC infusion and ending 1 week after the last ATC infusion.
The time for armed-ATC infusions will vary from patient to patient, but the dose of armed-ATC (up to 40 billion) will be given over 30 min.
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: Phase I: * Histologically confirmed infiltrating ductal carcinoma of the breast * Metastatic disease * Clinically asymptomatic with non-life-threatening metastases allowed * Measurable or evaluable disease by radiograph, CT scan, MRI, nuclear medicine bone scan, or physical examination * No measurable disease allowed if tumor or metastasis has been removed or successfully treated prior to study * No rapidly progressive symptomatic disease affecting major organ systems (e.g., lungs and liver) * Stable or unstable disease for 3 months on hormonal therapy * Stable or unstable disease for at least 1 month after chemotherapy * No active brain metastases * Brain metastases previously treated with definitive radiotherapy and/or surgical resection allowed * Hormone receptor status: * Estrogen and progesterone receptor status known Phase II: * All Phase I criteria * HER2/neu overexpression (2+ or 3+) by immunohistochemistry * Prior trastuzumab (Herceptin) allowed if disease still overexpresses HER2/neu PATIENT CHARACTERISTICS: Age: * 18 and over Sex: * Female Menopausal status: * Not specified Performance status: * Karnofsky 70-100% OR * ECOG 0-2 Life expectancy: * At least 3 months Hematopoietic: * Granulocyte count at least 1,500/mm\^3 * Platelet count at least 50,000/mm\^3 * Hemoglobin at least 8 g/dL Hepatic: * Bilirubin less than 1.5 times normal * SGOT less than 1.5 times normal Renal: * Creatinine no greater than 1.8 mg/dL * Creatinine clearance at least 60 mL/min * BUN no greater than 1.5 times normal Cardiovascular: * No myocardial infarction within the past year * No prior myocardial infarction with coronary symptoms requiring medication and/or depressed left ventricular function (LVEF less than 50% by MUGA) * No angina or coronary symptoms requiring medication and/or with depressed left ventricular function (LVEF less than 50% by MUGA) * No congestive heart failure requiring medical management * LVEF at least 50% at rest by MUGA * No uncontrolled hypertension (i.e., systolic blood pressure \[BP\] ≥ 130 mm Hg or diastolic BP ≥ 80 mm Hg) Pulmonary: * FEV1, DLCO, and FVC at least 50% predicted Other: * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * HIV negative * No other serious medical or psychiatric illness that would preclude study participation * No other prior or concurrent malignancy within the past 5 years except curatively treated squamous cell carcinoma in situ of the cervix, basal cell skin cancer, or any other curatively treated disease in complete remission PRIOR CONCURRENT THERAPY: Biologic therapy: * See Disease Characteristics * Prior trastuzumab allowed for phase I Chemotherapy: * See Disease Characteristics * At least 4 weeks since prior chemotherapy Endocrine therapy: * See Disease Characteristics * Concurrent hormonal therapy for breast cancer must continue during study * No other concurrent hormonal therapy except steroids for adrenal failure, septic shock, or pulmonary toxicity or hormonal therapy for non-disease-related conditions (e.g., insulin for diabetes) Radiotherapy: * See Disease Characteristics Surgery: * See Disease Characteristics
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Maximum tolerated dose | The dose at which dose-limiting toxicity occurs is defined as that dose at which 2 or more of 6 patients at that dose level have their infusions stopped due to toxicities or receive less than 80% of the planned dose. |
| Toxicity profile | Months 1, 2, 5 and 11, then every 6 months |
| Clinical responses | Months: 1, 2, 5 and 11, then every 6 months |
| Overall survival and progression-free survival | The interval from the beginning of immunotherapy to the time of death or for progression free survival it is defined as the interval from the beginning of immunotherapy to progression |
Secondary
| Measure | Time frame |
|---|---|
| Immune changes | 1 (+ 7 days), 2 (+ 7 days), 5 months (+ 7 days), then every 6months (+ 7 days) (immune evaluations will also be performed after the 4th and 8th infusion of Her2Bi armed ATC and within 1week of the completion of HER2Bi armed ATC) |
Countries
United States