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Chemotherapy Followed by Peripheral Stem Cell Transplantation Plus Biological Therapy in Treating Women With Stage IV Breast Cancer

Primary Purpose

Breast Cancer

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
therapeutic autologous lymphocytes
Ifosfamide, carboplatin, and etoposide (ICE) regimen
Cyclophosphamide, Thiotepa, Carboplatin (CTC) or STAMP V (CTC)
Leukapheresis
peripheral blood stem cell transplantation (PBSCT)
Sponsored by
Barbara Ann Karmanos Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer focused on measuring stage IV breast cancer, recurrent breast cancer

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)FemaleDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Women with histologically documented metastatic carcinoma of the breast Bilateral disease allowed Concurrent intraductal or lobular carcinoma in situ allowed Measurable or evaluable recurrent metastatic disease (stage IV) documented by radiograph, CT scan, nuclear medicine scan, or physical exam Biopsy of recurrent site(s) recommended but not required Nonmeasurable disease allowed if tumor or metastatic disease has been previously removed or successfully treated 0 to 3+ HER2 amplification, as determined by FISH No clinical evidence of active brain metastases Patients with treated brain metastases (i.e., those who have received definitive radiation, chemotherapy, and/or underwent surgery) and are stable are eligible Hormone receptor status: Estrogen or progesterone receptor positive or negative PATIENT CHARACTERISTICS: Menopausal status not specified Karnofsky performance status 70-100% OR ECOG performance status 0-2 Life expectancy at least 3 months Granulocyte count at least 1,500/mm^3 Platelet count at least 50,000/mm^3 Hemoglobin greater than 8 g/dL Bilirubin less than 1.5 times normal AST, ALT, and alkaline phosphatase < 5 times upper normal Creatinine less than 1.8 mg/dL Creatinine clearance at least 60 mL/min BUN less than 1.5 times normal No myocardial infarction (MI) within the past year No history of MI (> 1 year ago) with current coronary symptoms requiring medication No current history of angina/coronary symptoms requiring medication No clinical evidence of congestive heart failure requiring medical management No significant congestive heart failure No other uncontrolled or significant cardiovascular disease Ejection fraction at least 45% at rest by MUGA Systolic BP < 130 mm Hg and diastolic BP < 80 mm Hg BP must be controlled to meet the standard by anti-hypertensive medications for at least 7 days prior to the first infusion PFT-FEV_1 at least 50% predicted DLCO2 at least 50% predicted FVC at least 50% predicted No other malignancy within the past 3 years No other serious medical or psychiatric illness that would preclude study participation HIV negative Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: See Disease Characteristics Prior chemotherapy regimens allowed, including prior treatment on protocol WSU-2006-130 Prior vaccine therapy on protocol WSU-2006-130 allowed More than 4 weeks to leukapheresis since prior hormonal therapy No radiation to the axial skeleton within 4 weeks of leukapheresis No concurrent hormonal therapy for breast cancer Hormones administered for non-disease-related condition (e.g. insulin for diabetes) allowed Concurrent steroids for adrenal failure, septic shock, or pulmonary toxicity allowed

Sites / Locations

  • Barbara Ann Karmanos Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

therapeutic autologous lymphocytes

Arm Description

Outcomes

Primary Outcome Measures

Disease-free Survival

Secondary Outcome Measures

Overall Survival

Full Information

First Posted
July 11, 2001
Last Updated
February 15, 2016
Sponsor
Barbara Ann Karmanos Cancer Institute
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00020722
Brief Title
Chemotherapy Followed by Peripheral Stem Cell Transplantation Plus Biological Therapy in Treating Women With Stage IV Breast Cancer
Official Title
Treatment of Stage IV Breast Cancer With Activated T Cells After Peripheral Blood Stem Cell Transplant (Pilot Phase II)
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Terminated
Why Stopped
Lack of funding to continue study.
Study Start Date
August 2007 (undefined)
Primary Completion Date
March 2013 (Actual)
Study Completion Date
March 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Barbara Ann Karmanos Cancer Institute
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining chemotherapy with peripheral stem cell transplantation plus biological therapy may allow the doctor to give higher doses of chemotherapy drugs and kill more tumor cells. PURPOSE: This phase II trial is studying how well chemotherapy followed by peripheral stem cell transplantation plus biological therapy works in treating women with stage IV breast cancer.
Detailed Description
OBJECTIVES: Determine whether the use of autologous peripheral blood stem cell transplantation followed by immunotherapy with activated T cells in women with stage IV breast cancer improves progression-free survival (PFS) compared to a reported mean PFS in patients treated with second-line chemotherapy with matching inclusion criteria by published trials. Determine if this regimen improves clinical response and overall survival. Perform sequential immune monitoring studies, including phenotyping, cytotoxic assays, EliSpots for IFNγ, selected T-cell repertoire (Vβ analysis), HER2/new tetramer analysis, and serum tumor markers. Test correlations between immune function tests and clinical endpoints. OUTLINE: Patients are stratified according to tumor classification (chemosensitive vs chemoresistant). Patients receive filgrastim (G-CSF) subcutaneously (SC) daily for 4 days followed by peripheral blood mononuclear cell (PBMC) collection for PBSCT and generation of activated T cells (ATC). The PBMC are treated ex vivo with monoclonal antibody OKT3 to form ATC. The ATC are expanded for 12-14 days in interleukin-2 (IL-2). Patients then receive high-dose chemotherapy. Patients with chemosensitive disease receive cyclophosphamide IV over 1 hour, thiotepa IV over 1 hour, and carboplatin IV over 1 hour on days -4, -3, and -2. Patients with chemoresistant disease receive ifosfamide IV over 1 hour, etoposide IV twice daily, and carboplatin IV over 1 hour on days -8 to -3. Patients undergo autologous PBSC transplantation on day 0 or on both day 0 and day 1. Patients then receive ATC IV over 15-20 minutes three times per week starting approximately on day +1 for three weeks and then once weekly for at least 6 doses. After completion of study therapy, patients are followed periodically for up to 2 years after PBSC.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
stage IV breast cancer, recurrent breast cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
7 (Actual)

8. Arms, Groups, and Interventions

Arm Title
therapeutic autologous lymphocytes
Arm Type
Experimental
Intervention Type
Biological
Intervention Name(s)
therapeutic autologous lymphocytes
Intervention Description
Immediately after pheresis, the lymphocytes will be activated with soluble monoclonal anti-CD3 antibody (OKT3) which cross-links the CD3 receptors on T cells and activates T cells. The time for ATC infusions will vary from patient to patient, but the infusion rate will be based on the rate calculated from the endotoxin level in the cell product. All patients will be observed for at least 1 hr after an infusion.
Intervention Type
Drug
Intervention Name(s)
Ifosfamide, carboplatin, and etoposide (ICE) regimen
Other Intervention Name(s)
Ifex®, Paraplatin ®, Toposar®, VePesid®, Etopophos®, VP-16, Etoposide phosphate
Intervention Description
Ifosfamide 2,500 mg/m2 given IV daily on day -8, -7, -6, -5, -4, and -3 prior to PBSCT. Ifosfamide 2,500 mg/m2 infused IV over 1 hour (hour 0-1) on days -8 to -3 for a total dose of 15,000 mg/m2. Mesna will be administered per BMT Standard of Care Guideline at a dose of 25% of the total Ifosfamide dose 30 minutes prior to and then 3, 6, and 9 hours after ifosfamide daily on days -8, -7, -6, -5, -4, and -3 prior to PBSCT for a total dose of 2500 mg/m2. Carboplatin at a dose of 250 mg/m2 will be given daily on days -8, -7, -6, -5, -4, and -3 prior to PBSCT for a total dose of 1500 mg/m2. VP-16 (etoposide) at a dose of 200 mg/m2 will be given IV on days -8, -7, -6, -5, -4 and -3. The total dose of VP-16 given prior to PBSCT will be 2,400 mg/m2. VP-16 will be given 200 mg/m2
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide, Thiotepa, Carboplatin (CTC) or STAMP V (CTC)
Other Intervention Name(s)
Cytoxan®, Neosar®, Paraplatin ®
Intervention Description
Cyclophosphamide will be given at a dose of 2000 mg/m2 in NS IV over one hour daily on days -4, -3, and -2 (total = 6000 mg/m2). Thiotepa will be given at a dose of 167 mg/m2 in NS IV over one hour daily on days -4, -3, -2 (total = 500 mg/m2) as the preparative regimen followed by PBSCT on day 0. Carboplatin will be given at a dose of 267 mg/m2 in D5W IV over one hour daily on days -4, -3, and -2. Mesna will be administered per BMT Standard of Care Guidelines at a dose of 25% of the total cyclophosphamide dose 30 minutes prior to and then 3, 6, and 9 hours after cyclophosphamide daily on days -4, -3, and -2 prior to PBSCT for a total of 2000mg/m2.
Intervention Type
Procedure
Intervention Name(s)
Leukapheresis
Intervention Description
Peripheral blood mononuclear cells (PBMC) will be collected by leukapheresis (for generation of ATC) prior to or post G-CSF (16 ug/kg/day) priming for collecting stem cells.
Intervention Type
Procedure
Intervention Name(s)
peripheral blood stem cell transplantation (PBSCT)
Intervention Description
Will be collected either before or after peripheral blood stem cell collection for stem cell transplant.
Primary Outcome Measure Information:
Title
Disease-free Survival
Time Frame
Length of time from day of transplant until recurrence or relapse.
Secondary Outcome Measure Information:
Title
Overall Survival
Time Frame
Length of time from day of transplant until death.

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Women with histologically documented metastatic carcinoma of the breast Bilateral disease allowed Concurrent intraductal or lobular carcinoma in situ allowed Measurable or evaluable recurrent metastatic disease (stage IV) documented by radiograph, CT scan, nuclear medicine scan, or physical exam Biopsy of recurrent site(s) recommended but not required Nonmeasurable disease allowed if tumor or metastatic disease has been previously removed or successfully treated 0 to 3+ HER2 amplification, as determined by FISH No clinical evidence of active brain metastases Patients with treated brain metastases (i.e., those who have received definitive radiation, chemotherapy, and/or underwent surgery) and are stable are eligible Hormone receptor status: Estrogen or progesterone receptor positive or negative PATIENT CHARACTERISTICS: Menopausal status not specified Karnofsky performance status 70-100% OR ECOG performance status 0-2 Life expectancy at least 3 months Granulocyte count at least 1,500/mm^3 Platelet count at least 50,000/mm^3 Hemoglobin greater than 8 g/dL Bilirubin less than 1.5 times normal AST, ALT, and alkaline phosphatase < 5 times upper normal Creatinine less than 1.8 mg/dL Creatinine clearance at least 60 mL/min BUN less than 1.5 times normal No myocardial infarction (MI) within the past year No history of MI (> 1 year ago) with current coronary symptoms requiring medication No current history of angina/coronary symptoms requiring medication No clinical evidence of congestive heart failure requiring medical management No significant congestive heart failure No other uncontrolled or significant cardiovascular disease Ejection fraction at least 45% at rest by MUGA Systolic BP < 130 mm Hg and diastolic BP < 80 mm Hg BP must be controlled to meet the standard by anti-hypertensive medications for at least 7 days prior to the first infusion PFT-FEV_1 at least 50% predicted DLCO2 at least 50% predicted FVC at least 50% predicted No other malignancy within the past 3 years No other serious medical or psychiatric illness that would preclude study participation HIV negative Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: See Disease Characteristics Prior chemotherapy regimens allowed, including prior treatment on protocol WSU-2006-130 Prior vaccine therapy on protocol WSU-2006-130 allowed More than 4 weeks to leukapheresis since prior hormonal therapy No radiation to the axial skeleton within 4 weeks of leukapheresis No concurrent hormonal therapy for breast cancer Hormones administered for non-disease-related condition (e.g. insulin for diabetes) allowed Concurrent steroids for adrenal failure, septic shock, or pulmonary toxicity allowed
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lawrence G. Lum, MD, DSc
Organizational Affiliation
Barbara Ann Karmanos Cancer Institute
Official's Role
Study Chair
Facility Information:
Facility Name
Barbara Ann Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201-1379
Country
United States

12. IPD Sharing Statement

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Chemotherapy Followed by Peripheral Stem Cell Transplantation Plus Biological Therapy in Treating Women With Stage IV Breast Cancer

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