INVINCIBLE TRIAL: Intratumoral INT230-6 in Breast Cancer

A Phase II Randomized Window of Opportunity Trial Evaluating Clinical and Biological Effects of Intratumoral INT230-6 in Early Stage Breast Cancer: The INVINCIBLE Trial

This is a phase II, randomized, multi-center, parallel design, window of opportunity trial evaluating intratumoral INT230-6 in up to 90 patients with early stage breast cancer. In a 2:1 randomization, patients on the treatment arm will receive intratumoral INT230-6 injections prior to breast surgery.

Study Overview

• Status: Recruiting
• Conditions: Breast Cancer
• Intervention / Treatment: Drug: INT230-6; Other: Saline injection

Detailed Description

The study comprises 2 consecutive parts. The first part will be to test safety and feasibility of the dosing procedures. Results from Part I of the study will standardise the optimal dose and frequency of INT230-6 for participants in Part II.

Part I: Open-label 2:1 randomized study of up to 30 patients. Treatment arm patients will be given up to 3 doses of INT230-6 injected weekly prior to breast surgery, at a dose based on longest diameter. The control arm patients receive no treatment.

Part II: Double-blind, 2:1 randomized study of up to an additional 60 patients. The placebo arm includes a saline injection of similar dose and frequency as the treatment arm (up to 2 doses of INT230-6/saline injected weekly prior to breast surgery).

• Study Type: Interventional
• Enrollment (Anticipated): 90
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Angel Arnaout, MD; Phone Number: 6137985555; Email: anarnaout@toh.on.ca

Study Locations

• Canada
  • Ontario
    • Ottawa, Ontario, Canada, K1Y 4E9
      • Recruiting
      • The Ottawa Hospital Research Institute and Cancer Center
      • Contact: Angel Arnaout, MD; Phone Number: 79622 613-798-5555; Email: aarnaout@toh.on.ca

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

1. Female patients with newly diagnosed histologically confirmed primary invasive breast cancer currently not undergoing any treatment while awaiting surgery.
2. Patients with early, operable stage I to II breast cancer amendable for complete surgical resection as assessed by treating surgical oncologist.
3. Tumors must be clinically palpable by surgeon. Part I: ≥ 1.0 cm by palpation or on imaging. Part II: ≥ 1.5 cm by palpation or on imaging.
4. Histologic Bloom Richardson grade ≥2.

4. Invasive ductal or lobular carcinoma, invasive carcinoma Not Otherwise Specified (NOS).

5. ECOG PS 0-2 (Appendix A). 6. The participant (or legally acceptable representative if applicable) is able to provide written informed consent for the study.

Exclusion Criteria:

1. Locally advanced or metastatic breast cancer.
2. Prior therapy with chemotherapy or planned neoadjuvant chemotherapy.
3. Pre-dominant histology other than invasive ductal or lobular carcinoma or invasive carcinoma NOS.
4. Patients with an active infection.
5. Absolute Neutrophil Count < 1.5 x 10^9/L.
6. Patients with pre-existing renal impairment, Creatinine clearance calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation of less than 50 mL/min/1.73m2.
7. Any serious known immediate or delayed hypersensitivity reaction(s) to vinblastine or cisplatin or idiosyncrasy to drugs chemically related to the investigational drugs.
8. Known allergic reaction to local anesthetic (Xylocaine, Marcaine).
9. Concurrent medical condition requiring the use of immunosuppressive medications, or systemic corticosteroids at doses of greater than 10 mg Prednisone-equivalent Topical steroids and other localized corticosteroids are permitted. Use of steroids as prophylactic treatment for subjects with contrast allergies to diagnostic imaging contrast dyes will be permitted.
10. Concurrent use of a prohibited medication or planned use of any forbidden medications during treatment with INT230-6, or within 4 weeks prior to study drug administration, which include chemotherapy, immunotherapy (tumor vaccine, cytokine, or growth factor given to control the cancer: systemic or intratumoral), other biologic therapy, investigational therapy, or hormonal therapy, cisplatin containing agents, and vinblastine containing agents while on treatment in this study. Other prohibited concomitant medications that will interact with vinblastine and cisplatin include mitomycin, phenytoin, CYP3A4 inhibitors (ketoconazole, voriconazole, clarithromycin, erythromycin), nephrotoxic drugs (aminoglycosides, amphotericin), or pure pyridoxine (pyridoxine contained in multivitamin is permitted). Use of other investigational drugs (drugs not marketed for any indication) within 4 weeks prior to study drug administration not permitted.
11. Pregnancy if patient is of childbearing age) or breast feeding.
12. Subjects with signs/symptoms suggestive of COVID-19 or known COVID-19 positive contacts in the past 14 days would be tested as per local Public Health and/or Institutional Guidelines. If patients are COVID-19 positive at the time of screening, they would be excluded from the trial.
13. Any underlying medical condition that, in the Principal Investigator's opinion, will make the administration of study drug hazardous or obscure the interpretation of toxicity determination or adverse events, or renders the patient ineligible to be on study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: QUADRUPLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: INT230-6 Treated Arm; Part I: Patients will receive up to 3 doses of INT230-6 injected weekly prior to breast surgery Part II: Patients will receive up to 2 intratumoral doses of INT230-6 (over a 15-day period) prior to breast surgery	Drug: INT230-6; INT230-6 is a formulation of two well known chemotherapeutic agents, cisplatin (0.5mg/mL) and vinblastine sulfate (0.1mg/mL), combined with 2-hydroxybenzoylaminooctanoate (also known as SHAO-FA or SHAO as a sodium salt at 10mg/mL).; Other Names: Cisplatin; Vinblastine; 2-hydroxybenzoylaminooctanoate (SAHO); Other: Saline injection; Standard 0.9 % NaCl Normal Saline
PLACEBO_COMPARATOR: Control Arm; Part I: No intervention while awaiting surgery Part II: Placebo saline injection	Other: Saline injection; Standard 0.9 % NaCl Normal Saline

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of patients achieving a CCCA defined as a reduction in the proportion of cells staining positive for Ki67 as assessed by immunohistochemistry to less than a natural logarithm, or ≤2.7%, at the post-treatment specimen.	Tumor's viable plus necrotic tissue, at the post-treatment specimen.	presurgical window (period from diagnosis to surgery window of 3-6 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The proportion of patients that achieved a complete pathologic response on surgical pathology as measured by the residual cancer burden index	Assessed by the local pathologist at the time of definitive surgery in subjects with breast cancer	presurgical window (period from diagnosis to surgery of 3-6 weeks)
Immunohistochemical and gene expression markers of necrosis, apoptosis and tumor proliferation pathways.	Comparison of pre (diagnostic biopsy) and post treatment (surgical resection) samples	presurgical window (period from diagnosis to surgery of 3-6 weeks)
Markers of immunomodulation including macrophages, NK, DC, CD4 T-cells, CD8 T-cells, regulatory T-cells.	Comparison of pre (diagnostic biopsy) and post treatment (surgical resection) samples	presurgical window (period from diagnosis to surgery of 3-6 weeks)
Adverse effects of INT230-6 injected to breast cancers in healthy patients prior to surgery.	overall safety of INT230-6 injected prior to surgery	presurgical window (period from diagnosis to surgery of 3-6 weeks)

Collaborators and Investigators

• Sponsor: Ottawa Hospital Research Institute
• Collaborators: Ontario Institute for Cancer Research; Intensity Therapeutics, Inc.
• Investigators: Principal Investigator: Arif Awan, MD, Ottawa Hospital Research Institute; Principal Investigator: Angel Arnaout, MD, Ottawa Hospital Research Institute

Study record dates

Study Major Dates

• Study Start (ACTUAL): March 25, 2021
• Primary Completion (ANTICIPATED): March 1, 2022
• Study Completion (ANTICIPATED): March 1, 2023

Study Registration Dates

• First Submitted: January 25, 2021
• First Submitted That Met QC Criteria: March 1, 2021
• First Posted (ACTUAL): March 4, 2021

Study Record Updates

• Last Update Posted (ACTUAL): November 17, 2021
• Last Update Submitted That Met QC Criteria: November 9, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Keywords: cisplatin; immune activation; vinblastine; Ki67; intratumoral; INT230-6; window of opportunity; complete pathologic response (PCR); cell cycle arrest
• Additional Relevant MeSH Terms: Skin Diseases; Neoplasms; Neoplasms by Site; Breast Diseases; Breast Neoplasms; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Cisplatin; Vinblastine
• Other Study ID Numbers: OTT 20-11 (IT-02)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes