Breast Cancer
Conditions
Keywords
resectable breast cancer
Brief summary
The goal of this clinical trial is to study the safety, feasibility, histologic and immunological effects of Mitazalimab, a CD40 agonistic antibody, when administered either alone or in combination with PD-1 inhibition prior to surgical resection. The investigator hypothesizes that preoperative administration of CD40 agonist with or without PD-1 inhibitor intratumorally will demonstrate an acceptable safety profile, will not result in an unplanned delay in surgery, and will lead to increased immune activation. Subjects will receive a single intratumoral dose of CD40 agonist with or without PD-1 inhibitor 7 or more days prior to surgery and will be followed for safety, feasibility, immune, and pathologic responses.
Interventions
DRUGIntratumoral Mitazalimab
Intratumoral agonistic CD40
DRUGIntratumoral Nivolumab
Checkpoint inhibitor
Sponsors
Jennifer Zhang
Alligator Bioscience AB
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Signed and dated written IRB-approved informed consent. 2. Age ≥18 years. 3. Body weight \> 40kg 4. Stage I-III or recurrent resectable breast cancer to be treated with curative-intent 5. Planning to undergo upfront surgery as part of routine clinical care 6. Discussion with the treating or study medical oncologist re: the potential of sending an Oncotype evaluation (if ER+HER2-) on the core needle biopsy sample 7. Availability of the core needle biopsy sample for correlative studies 8. Surgery to be performed at a University of Pennsylvania Hospital 9. Life expectancy of at least 12 weeks. 10. Adequate bone marrow, hepatic, and renal function. ANC (Absolute Neutrophil Count) ≥ 1.5x109 cell/ml, platelets ≥75,000 /mm3, hemoglobin ≥9.0 g/dL, total serum bilirubin within 1.5 x upper limit of normal (ULN) unless Gilbert's, AST/ALT, within 2.5 x ULN, Albumin ≥3g/dL, and all tests performed within 4 weeks prior to administration of Study Treatment. 11. ECG with no clinically significant findings as assessed by the investigator. 12. ECOG (Eastern Cooperative Oncology Group) performance status of 0-1. 13. Female patients of childbearing potential who are not abstinent and intend to be sexually active with a non-sterilized male partner must use at least 1 highly effective method of contraception from the time of screening throughout the total duration of the drug treatment and the drug washout period (90 days after therapy). Non-sterilized male partners of a female patient of childbearing potential must use male condom plus spermicide throughout this period. Female patients should also refrain from breastfeeding throughout this period. 14. Able and willing to comply with all study procedures.
Exclusion criteria
1. Metastatic disease. 2. Planned neoadjuvant therapy, i.e., not undergoing upfront surgery. 3. Known history of hepatitis B or C with active viral replication. 4. Administration of any live vaccine within 28 days of first dose of study treatment. 5. Prior CD40 or anti-PD-1 agonist therapy. 6. Participation in another interventional clinical trial within 30 days before receiving first dose of study treatment. However, the subject may participate in observational studies. 7. Any illness or condition that in the opinion of the investigator may affect the safety of the subject or the evaluation of any study endpoint. 8. Current or prior use of immunosuppressive medication within 14 days before study treatment. The following are exceptions to this criterion: 1. Intranasal, inhaled, topical steroids, or local steroid injections (e.g., intra articular injection) 2. Systemic corticosteroids at physiologic doses not to exceed 10 mg/day of prednisone or its equivalent 9. Major surgical procedure (as defined by the Investigator) within 28 days prior to the first dose of IP. 10. History of allogenic organ transplantation 11. Active or prior documented autoimmune disease. Examples include inflammatory bowel disease \[e.g., colitis or Crohn's disease\], systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis\], Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc.\]. The following are exceptions to this criterion: 1. Patients with vitiligo or alopecia 2. Patients with hypothyroidism (e.g., following Hashimoto syndrome) stable on hormone replacement or type 1 DM controlled with insulin 3. Any chronic skin condition that does not require systemic therapy 4. Patients without active autoimmune disease in the last 5 years may be included but only after consultation with the study physician 5. Patients with celiac disease controlled by diet alone 12. Uncontrolled intercurrent illness, including but not limited to, ongoing or active infection, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, interstitial lung disease, serious chronic gastrointestinal conditions associated with diarrhea, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs or compromise the ability of the patient to give written informed consent 13. History of another active malignancy except for non-melanoma skin cancer, lentigo maligna or other carcinoma in situ 14. History of active primary immunodeficiency 15. Known allergy or hypersensitivity to any of the study drugs or any of the study drug excipients. 16. Body weight \> 110 kg. 17. Actively breastfeeding. -
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Occurrence of Grade 3 or higher adverse events as assessed by CTCAE v5.0 | Within 30 days of treatment | Type and severity of adverse events |
| Feasibility of CD40 agonist (Mitazalimab) with/without PD-1 inhibitor (Nivolumab) prior to surgery | 14 days after planned surgical date | Number of successful surgical resection without unanticipated delay in surgery \> 14 days after planned surgical date due to treatment-related issues |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Tumor response rate | 2 weeks after surgery | Rate of tumors with response (Residual Cancer Burden 0-II) |
| Recurrence of disease | up to 5 years post surgery | Occurrence of a breast cancer recurrence |
| Event-free survival | up to 5 years post surgery | Length of time between time of surgery and a breast cancer recurrence or death |
| Immunologic effects of CD40 agonist (Mitazalimab) with/without PD-1 inhibitor (Nivolumab) | Prior to treatment and up to 30 days post surgery | Immunophenotyping of PBMCs pre- and post-treatment |
| Number of participants with change in serum cytokine levels pre- and post-treatment | Prior to treatment and up to 30 days post surgery | Serum cytokine measurement |
| Number of participants with changes in tumor immune cell number pre- and post-treatment | Prior to treatment and up to 30 days post surgery | 10x genomics platform will be used to evaluate for changes in tumor immune cell number pre- and post-treatment |
| Number of participants with changes in TCR repertoire in peripheral blood pre- and post-treatment | Prior to treatment and up to 30 days post surgery | Comparison of TCR repertoire in peripheral blood via TCR sequencing pre- and post-treatment |
| Number of participants with changes in TCR repertoire in tumor pre- and post-treatment | Prior to treatment and up to 30 days post surgery | Comparison of TCR repertoire in tumor via TCR sequencing pre- and post-treatment |
| Number of patients with FDG PET/CT response or flair after treatment | between baseline and 1 week post-treatment | Change in FDG activity in tumor and/or lymph nodes between baseline (PET0) and post-treatment (PET1) FDG PET/CT scans. |
Countries
United States
Contacts
CONTACTJennifer Zhang, MD
CONTACTJulia Lewandowski
PRINCIPAL_INVESTIGATORJennifer Zhang, MD
University of Pennsylvania
Outcome results
None listed