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Trastuzumab, Cyclophosphamide, and Vaccine Therapy in Treating Patients With High-Risk or Metastatic Breast Cancer

A Safety and Bioactivity Study of Combination Therapy With Trastuzumab, Cyclophosphamide, and an Allogeneic GM-CSF-Secreting Breast Tumor Vaccine for the Treatment of Patients With High Risk/ Metastatic HER-2/Neu- Overexpressing Breast Cancer With No Evidence of Disease

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00847171
Enrollment
20
Registered
2009-02-19
Start date
2008-12-31
Completion date
2013-06-30
Last updated
2018-09-26

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Breast Cancer

Keywords

male breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer, stage IV breast cancer, HER2-positive breast cancer

Brief summary

RATIONALE: Monoclonal antibodies, such as trastuzumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Vaccines made from gene-modified tumor cells may help the body build an immune response to kill tumor cells. Giving trastuzumab together with cyclophosphamide and vaccine therapy may kill more tumor cells. PURPOSE: This phase II trial is studying the side effects of giving trastuzumab together with cyclophosphamide and vaccine therapy in treating patients with high-risk or metastatic breast cancer.

Detailed description

OBJECTIVES: Primary * To evaluate the safety of allogeneic sargramostim (GM-CSF)-secreting breast cancer vaccine in combination with trastuzumab (Herceptin®) and cyclophosphamide in patients with high-risk or metastatic HER2/neu-overexpressing breast cancer. * To measure the HER2/neu-specific CD4+ T-cell response by delayed-type hypersensitivity. * To measure the magnitude of HER2/neu-specific CD8+ T-cell responses by ELISPOT. Secondary * To assess the impact of trastuzumab on immune priming in vivo by IHC. * To measure the impact of cyclophosphamide pretreatment on CD4+CD25+ regulatory T cells by flow cytometry. * To determine the time to disease progression. Tertiary * To develop the tandem tetramer/CD107a cytotoxicity assay for HER2/neu-specific CD8+ T cells. * To measure novel T-cell responses induced by trastuzumab and cyclophosphamide-modulated vaccination. OUTLINE: Patients receive trastuzumab (Herceptin®) IV over 30-90 minutes once weekly beginning on day -1 of the first course of vaccination and continuing until the completion of the last course of vaccination. Patients also receive cyclophosphamide IV over 30 minutes on day -1 and allogeneic sargramostim (GM-CSF)-secreting breast cancer vaccine intradermally on day 0. Treatment with cyclophosphamide and the vaccine repeats every 27-42 days for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients then receive a fourth course of cyclophosphamide and vaccine approximately 6-8 months after the first course. Patients undergo delayed-type hypersensitivity testing and blood sample collection at baseline and periodically during study for immunologic laboratory studies. Blood samples are analyzed for serum GM-CSF levels by pharmacokinetic studies and for immune monitoring by ELISPOT and flow cytometry. Skin punch biopsies are also performed periodically and analyzed by IHC. After completion of study treatment, patients are followed periodically.

Interventions

Day 0 : Allogeneic GM-CSF-secreting Breast Cancer Vaccine administered as: 12 intradermal injections of a divided total dose of 5 x108 cells.

BIOLOGICALtrastuzumab

Patient HAS received prior Trastuzumab within the last two weeks, give Trastuzumab 2 mg/kg weekly on Day -1 for 5 weeks. Patient has NOT received Trastuzumab within the last two weeks, give On Cycle 1, Day -1 ONLY, Loading dose 4 mg/kg

DRUGcyclophosphamide

Cyclophosphamide 200mg/m2 IV in NS 100ml over 30 minutes on Day -1 ONLY. Note: there are no dose modifications for Cyclophosphamide.

OTHERflow cytometry

Samples will be analyzed by flow cytometry using Cell Quest software

OTHERimmunoenzyme technique
OTHERimmunohistochemistry staining method

Measuring Immune Priming In Vivo By Vaccine Site Biopsies

OTHERlaboratory biomarker analysis
OTHERpharmacological study
PROCEDUREbiopsy

skin biopsy to be performed on day 3 and day 7 for cycle 1 and 3 only

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 120 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed adenocarcinoma of the breast, meeting one of the following criteria: * Metastatic disease * High-risk disease, defined as early-stage disease with pathologic involvement of locoregional lymph nodes * Patients who are/will be receiving standard adjuvant trastuzumab \[Herceptin®\] for high-risk disease will participate in this study during the single-agent trastuzumab portion of their therapy * No clinical or radiographical evidence of active disease * Not eligible for therapy of known curative potential for metastatic breast cancer * HER2/neu-overexpressing disease, defined as HER2/neu positive by IHC 3+ staining or by FISH+ amplification * Stable CNS disease allowed provided it has been adequately treated and is 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 * Platelet count \> 100,000/mm\^3 * Serum creatinine \< 2.0 mg/dL * Serum bilirubin ≤ 2.0 mg/dL (unless elevation is due to known Gilbert's syndrome) * AST/ALT ≤ 2 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 5 times ULN * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * Cardiac ejection fraction normal by MUGA OR ≥ 45% by ECHO * No other malignancies within the past 5 years, except for carcinoma in situ of the cervix, superficial nonmelanoma skin cancer, or superficial bladder cancer * No prior or currently active 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 * Sjögren syndrome * Sarcoidosis * Other rheumatologic disease * No symptomatic intrinsic lung disease or extensive tumor involvement of the lungs resulting in dyspnea at rest * HIV-negative * No evidence of active acute or chronic infection * No uncontrolled medical problems * No active major medical or psychosocial problems that could be complicated by study participation * No corn allergy * No known severe hypersensitivity to trastuzumab (except for mild to moderate infusion reactions that are easily managed and do not recur) NOTE: \*Asthma or chronic obstructive pulmonary disease that does not require daily systemic corticosteroids allowed PRIOR CONCURRENT THERAPY: * Any number of prior chemotherapy regimens for metastatic breast cancer allowed * Prior or concurrent trastuzumab in the adjuvant or metastatic setting allowed * More than 28 days since prior and no concurrent systemic oral steroids * Topical, ocular, or nasal steroids allowed * More than 28 days since prior and no concurrent chemotherapy, radiotherapy, or biologic therapy (except trastuzumab) * More than 28 days since prior and no concurrent participation in another investigational clinical trial involving a new drug * Concurrent endocrine therapy or bisphosphonates allowed

Design outcomes

Primary

MeasureTime frameDescription
Safety as Assessed by Number of Participants Experiencing Toxicity4 yearsSafety as assessed by number of participants who experienced drug-related local and systemic toxicity, as defined by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v3.0) in response to CY-modulated immunization with a novel breast cancer vaccine in the setting of weekly Trastuzumab therapy.
Number of Participants With Immunologic Response as Determined by Delayed-type Hypersensitivity (DTH) Response to HER2/Neu-derived Peptides4 years

Secondary

MeasureTime frameDescription
Clinical Benefit as Assessed by Number of Participants With Progression-free Survival4 yearsNumber of participants without evidence of disease progression.

Countries

United States

Participant flow

Participants by arm

ArmCount
Trastuzumab, Cyclophosphamide, and a Breast Tumor Vaccine
Patients receive Trastuzumab (T), Cyclophosphamide (CY), and an allogeneic GM-CSF-secreting whole cell breast cancer vaccine
20
Total20

Baseline characteristics

CharacteristicTrastuzumab, Cyclophosphamide, and a Breast Tumor Vaccine
Age, Continuous47 years
Region of Enrollment
United States
20 Participants
Sex: Female, Male
Female
20 Participants
Sex: Female, Male
Male
0 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 20
other
Total, other adverse events
20 / 20
serious
Total, serious adverse events
0 / 20

Outcome results

Primary

Number of Participants With Immunologic Response as Determined by Delayed-type Hypersensitivity (DTH) Response to HER2/Neu-derived Peptides

Time frame: 4 years

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineNumber of Participants With Immunologic Response as Determined by Delayed-type Hypersensitivity (DTH) Response to HER2/Neu-derived PeptidesDTH-positive at baseline12 Participants
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineNumber of Participants With Immunologic Response as Determined by Delayed-type Hypersensitivity (DTH) Response to HER2/Neu-derived PeptidesIncreased DTH from baseline11 Participants
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineNumber of Participants With Immunologic Response as Determined by Delayed-type Hypersensitivity (DTH) Response to HER2/Neu-derived PeptidesConverted from DTH-negative to DTH-positive5 Participants
Primary

Safety as Assessed by Number of Participants Experiencing Toxicity

Safety as assessed by number of participants who experienced drug-related local and systemic toxicity, as defined by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE v3.0) in response to CY-modulated immunization with a novel breast cancer vaccine in the setting of weekly Trastuzumab therapy.

Time frame: 4 years

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineSafety as Assessed by Number of Participants Experiencing ToxicityPatients with grade 3+ drug-related toxicity0 Participants
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineSafety as Assessed by Number of Participants Experiencing ToxicityPatients with serious drug-related toxicity0 Participants
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineSafety as Assessed by Number of Participants Experiencing ToxicityPatients with drug-related toxicity20 Participants
Secondary

Clinical Benefit as Assessed by Number of Participants With Progression-free Survival

Number of participants without evidence of disease progression.

Time frame: 4 years

Population: Only 13/20 participants had early stage disease, and 7/20 participants had a history of metastatic disease at the start of the study. All participants were assigned to the same treatment group.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineClinical Benefit as Assessed by Number of Participants With Progression-free SurvivalPatients with early stage disease12 Participants
Trastuzumab, Cyclophosphamide, and a Breast Tumor VaccineClinical Benefit as Assessed by Number of Participants With Progression-free SurvivalPatients with metastatic disease6 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026