Pilot Study of a Breast Cancer Vaccine Plus Poly-ICLC for Breast Cancer (Breast 41)

May 7, 2020 updated by: Craig L Slingluff, Jr

A Pilot Study of the Immunogenicity of a 9-Peptide Breast Cancer Vaccine Plus Poly-ICLC in Stage I-IV Breast Cancer

Despite advances in surgical, radiation and medical therapies of early stage breast cancer, some patients will experience disease recurrence. Because recurrence may not happen for years after definitive treatment, there is a period of time between resection and relapse when micrometastatic disease may be amenable to immune eradication or modulation. While the ultimate goal of any cancer treatment is clinical efficacy, the immediate urgency in breast immunotherapy is to define treatments that have immunologic efficacy. In this study, the investigators will determine whether a vaccine consisting of nine-class I breast specific peptides plus a class II tetanus toxoid helper peptide is immunogenic when administered with poly-ICLC to participants with stage IB to IIIA breast cancer in the adjuvant setting.

Study Overview

Detailed Description

The study is a single arm, open label, pilot study of safety and immune efficacy of peptide vaccination with poly-ICLC in patients with stage IB-IIIA resected breast cancer. Participants will be patients who have completed their last dose/treatment of any single treatment or combination of adjuvant surgery, radiation, chemotherapy or trastuzumab therapy between 45 days and 6 months (180 days) prior to enrollment.

Each vaccination will be administered on days 1, 8, 15, 36, 57, and 78. All participants will receive 9 class I MHC-restricted synthetic peptides (restricted by HLA-A1, -A2, -A3, or -A31) and a class II MHC-restricted tetanus helper peptide mixed with 1mg poly-ICLC and administered in sterile water. The vaccine will be administered intramuscular (IM) (1 ml) and intradermally (ID) (1 ml) at vaccination sites in the arm and leg. (Each vaccine given IM and ID at one site; site to alternate between arm site opposite the breast cancer and an anterior thigh site.) Participants will be screened for HLA type and must be HLA-A1, -A2, -A3, or -A31 (80% of the Virginia population in prior studies1).

Annual follow-up for progression and survival for 3 years after study withdrawal/completion.

Study Type

Interventional

Enrollment (Actual)

11

Phase

  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Virginia
      • Charlottesville, Virginia, United States, 22908
        • University of Virginia Health System

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion:

  • Patients who have been diagnosed with clinical or pathologic stage I to stage IV adenocarcinoma of the breast (any subtype) who have undergone, and recovered from primary therapy (any combination of surgery, radiation, and/or chemotherapy and/or HER2-directed therapy), with their last dose/treatment (of any single or combination treatment) being between 28 days and 36 months prior to enrollment. Staging will be based on the Seventh Edition AJCC staging system. (Systemic staging with CT or PET scans is not required by AJCC and is not required or exclusionary for this trial).
  • Stage IA patients must be high risk based upon triple negative status or HER2+ status
  • Patients may or may not be receiving hormonal therapy at the time of study entry.
  • Age ≥ 18 years at the time of enrollment
  • ECOG performance status of 0 or 1
  • Ability and willingness to give informed consent
  • HLA-A1, -A2, -A3, or -A31 positive
  • Adequate organ function
  • HIV and Hepatitis C negative
  • Subjects must have a minimum of two intact lymph node basins (any combination of axillary and inguinal basins that have not undergone complete nodal dissection)

Exclusion Criteria

  • Known or suspected allergies to any component of the vaccine
  • Active infection requiring antibiotics are excluded.
  • The following medications or treatments within the 4 weeks (28 days) prior to consenting. These medication and treatments may not be re-started at any time throughout the study in order to remain eligible.

    • Breast tumor resection surgery (reconstructive surgery permitted)
    • Chemotherapy
    • Radiation therapy
    • Allergy desensitization injections
    • Growth factors (e.g., Procrit®, Aranesp®, Neulasta®)
    • Other agents with putative immunomodulating activity (with the exception of non-steroidal anti-inflammatory agents)
    • Any investigational medication
  • Tthe following medications or treatments within the 4 weeks (28 days) prior to consenting:

    • Corticosteroids, administered parenterally, orally, or inhaled (Inhaled steroids, such as: Advair®, Flovent®, Azmacort.®)
    • Topical corticosteroids are acceptable.
  • Previous vaccination with any of the synthetic peptides included in this protocol.
  • Active tuberculosis and not on active antitubercular agents
  • Pregnancy.
  • Female subjects must not be breastfeeding
  • A medical contraindication or potential problem in complying with the requirements of the protocol, in the opinion of the investigator
  • New York Heart Association classification as having Class III or IV heart disease
  • Stage IV subjects who have anticipated chemotherapy need within the 108 day treatment period for this trial.
  • Subjects that have experienced active autoimmune disorders requiring cytotoxic or immunosuppressive therapy within the 6 weeks (42 days) prior to consenting.

    • The following will not be exclusionary:

      • The presence of laboratory evidence of autoimmune disease (e.g., positive ANA titer) without symptoms
      • Clinical evidence of vitiligo
      • Other forms of depigmenting illness
      • Mild arthritis requiring NSAID medications

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 9 Peptides from Her-2/neu, CEA, & CTA, peptide-tet, poly-ICLC
9 class I MHC-restricted synthetic peptides (100 mcg each peptide) derived from breast cancer associated proteins, a class II MHC-restricted tetanus derived peptide (200 mcg), plus polyICLC (1 mg).
poly-ICLC
9 synthetic peptides derived from Her-2/neu, CEA & CTA derived breast cancer proteins.
A class II MHC-restricted helper peptide derived from tetanus toxoid protein.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety (Frequency of dose limiting adverse events)
Time Frame: 30 days post-administration of the last vaccine
30 days post-administration of the last vaccine
Immune response rate
Time Frame: through day 108
Measured as the number of IFN-gamma producing cells in the blood in response to the vaccine.
through day 108

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Safety (adverse event profile)
Time Frame: 30 days post-administration of the last vaccine
30 days post-administration of the last vaccine
Immunogenicity- CD8+ T cell specificity
Time Frame: through day 108
Characterize vaccine specific peripheral CD8+ T-cell specificity by tetramer staining and flow cytometric analysis
through day 108
Immunogenicity- CD8+ cytokine production
Time Frame: through day 108
Estimate the Tc1/Tc2 cytokine production bias of circulating vaccine-specific T cells.
through day 108
Immunogenicity- immue responses among subjects treated with anti-estrogen therapies
Time Frame: through day 108
Using the ELIspot assay, describe the frequency of immune responses among patients treated with anti-estrogen therapies
through day 108

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

  • Principal Investigator: Patrick M Dillon, MD, University of Virginia

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2012

Primary Completion (Actual)

September 1, 2015

Study Completion (Actual)

September 1, 2015

Study Registration Dates

First Submitted

February 8, 2012

First Submitted That Met QC Criteria

February 14, 2012

First Posted (Estimate)

February 15, 2012

Study Record Updates

Last Update Posted (Actual)

May 8, 2020

Last Update Submitted That Met QC Criteria

May 7, 2020

Last Verified

May 1, 2020

More Information

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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