Stage II Breast Cancer, Stage III Breast Cancer
Conditions
Keywords
breast cancer, neoadjuvant chemotherapy, autologous dendritic cell vaccination
Brief summary
Molecular expression in breast cancer (BC) defines special fenotypes with different prognostic and predictive features.Since the addition of trastuzumab and lapatinib to chemotherapy, HER2 overexpressing tumors have become the best responders to systemic therapies, reaching pathologic complete response rates (pCR) around 50%. But HER2 negative tumors (luminal A and triple negative) are characterized by low chemosensitivity (luminal A) or early distant relapse after diagnosis (triple negative BC) . In this open, prospective, non-randomized and multicentric phase II study the investigators include stage II and III HER2 negative BC patients that are going to receive neoadjuvant sequential chemotherapy Epirubicin+Ciclofosfamide x 4 and then Docetaxel x 4)with an individualized vaccination with autologous dendritic cells pulsed with their own tumor. The hypothesis is that the reinforcement of the immune system with the autologous dendritic cell vaccination against HER2 negative BC could increase pathologic complete responses (pCR) and disease free survival(DFS), when added to chemo, surgery and radiation therapy and in a maintenance schedule.
Detailed description
Chemotherapy schedule: * dose dense epirubucin 100 mgr/m2 plus ciclofosfamide 600 mgr/m2 every two weeks for four cycles with with GM-CSF support on day +1 (pegylated filgastrim) or on days +5 to +9 (filgastrim) subcutaneously * docetaxel 80-100 mgr/m2 every three weeks for four cycles. Addition of GM-CSF if docetaxel doses are \> 85 mgr/m2
Interventions
Autologous dendritic cell vaccination. Dendritic cells are pulsed with their own tumor antigens
Sponsors
Study design
Eligibility
Inclusion criteria
* HER2 negative and stage II and III Breast cancer patients who benefit with neoadjuvant chemotherapy * age 18-75 * to get enough tumoral sample to elaborate the vaccine
Exclusion criteria
* pregnancy * severe diseases * hepatitis or HIV * need to be on immunosuppressant drugs
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| pathologic complete response (pCR) in the breast and the axilla | 6 months after starting chemotherapy |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants with adverse events | During the 6-24 months of administration of the vaccine | — |
| Impact of the vaccine on patients DFS and OS | three to five years after the diagnosis of breast cancer | We will compare our cohort of patients vaccinated and treated with chemotherapy, surgery and radiation therapy with an historic cohort in our center treated with the same schedule of chemotherapy , surgery and radiation therapy without the vaccine |
| EORTC quality of life | From 9 months and up to two years | — |
| Correlation among the specific immune response induced in patients and the pathologic response of the tumor | 6-24 months | Specific immune response will be evaluated as delayed hipesrsensitivity (DTH), humoral response by cuantification antibodies against tumoral cells (ELISA)and cellullar response (proliferation assay and citokines production) |
Countries
Spain