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Vaccine Therapy in Treating Patients With Breast Cancer

Primary Purpose

Breast Cancer

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
GP2 peptide + GM-CSF vaccine
GM-CSF (sargramostim)
AE37 + GM-CSF vaccine
GM-CSF (sargramostim)
Sponsored by
San Antonio Military Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Breast Cancer focused on measuring stage I breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer, male breast cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS:

Inclusion criteria:

  1. Lymph node-positive breast cancer or high-risk lymph node-negative breast cancer. The latter is defined by any one of the following criteria:

    • T2 disease
    • Grade 3 disease
    • Lymphovascular invasion
    • Estrogen receptor- or progesterone receptor-negative disease
    • HER2/neu-expressing tumor (immunohistochemistry [IHC] 3+ and/or amplified fluorescence in situ hybridization [FISH] >2.2, or N0 (i+))
  2. HER2/neu-expressing tumor (IHC 1-3+ and or positive FISH >1.2)
  3. Completion of primary standard of care breast cancer therapies (i.e., surgery, chemotherapy, immunotherapy and radiation therapy as appropriate per standard of care for patients' specific cancer)
  4. Clinically cancer-free (no evidence of disease)
  5. Patients may be enrolled between 1-6 months from completion of standard primary breast cancer therapies
  6. Good performance status (as defined in Exclusion Criteria)
  7. Capable of informed consent

Exclusion criteria:

  1. HER2/neu-negative breast cancers (IHC 0)
  2. Clinical and/or radiographic evidence of residual or persistent breast cancer
  3. Receiving immunosuppressive therapy to include chemotherapy, steroids, or methotrexate
  4. In poor health (Karnofsky <60%, ECOG >/-2)
  5. Total bilirubin >1.8, creatinine >2, hemoglobin <10, platelets <50,000, WBC <2,000)
  6. Active interstitial lung disease; asthma requiring more than as needed bronchodilators for management; or other autoimmune lung disease
  7. Pregnancy (urine hCG)
  8. Breast feeding
  9. History of autoimmune disease
  10. Involved in other experimental protocols (except with permission of the other study PI)

PATIENT CHARACTERISTICS:

Inclusion criteria:

  • Female or male
  • Menopausal status not specified
  • Immunologically intact by recall anergy testing
  • Negative pregnancy test

Exclusion criteria:

  • Karnofsky 0-60% or ECOG ≥ 2
  • Total bilirubin > 1.8 g/dL
  • Creatinine > 2.0 g/dL
  • Hemoglobin < 10.0 g/dL
  • Platelet count < 50,000/mm³
  • WBC< 2,000/mm³
  • Active pulmonary disease requiring medication that includes multiple inhalers
  • Pregnancy
  • Breastfeeding
  • History of autoimmune disease

PRIOR CONCURRENT THERAPY:

Inclusion criteria:

  • See Disease Characteristics

Exclusion criteria:

  • Concurrent immunosuppressive therapy including chemotherapy, steroids, or methotrexate
  • Concurrent participation in another experimental treatment (except with permission of the other study investigator)

Sites / Locations

  • Sibley Memorial Hospital
  • University of Hawaii Cancer Center
  • MedStar Union Memorial Hospital
  • MedStar Good Samaritan Hospital Cancer Center
  • Walter Reed National Military Medical Center
  • Wake Forest University Comprehensive Cancer Center
  • Carl R. Darnall Army Medical Center
  • San Antonio Army Medical Center
  • University of Texas MD Anderson Cancer Center
  • STOH Clinical Research
  • Madigan Army Medical Center - Tacoma
  • Landstuhl Regional Medical Center
  • Saint Savas Cancer Hospital of Athens

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Active Comparator

Experimental

Active Comparator

Arm Label

Arm I

Arm II

Arm III

Arm IV

Arm Description

HLA-A2-positive patients receive GP2 peptide + GM-CSF vaccine intradermally (ID) every 3-4 weeks for a total of up to 6 inoculations.

HLA-A2-positive patients receive GM-CSF ID every 3-4 weeks for a total of up to 6 inoculations.

HLA-A2-negative patients receive AE37 peptide/GM-CSF vaccine ID every 3-4 weeks for a total of up to 6 inoculations.

HLA-A2-negative patients receive GM-CSF ID ID every 3-4 weeks for a total of up to 6 inoculations

Outcomes

Primary Outcome Measures

Disease recurrence
The following will be compared: disease recurrence rates between HLA-A2-negative patients receiving the AE37 + GM-CSF vaccine and HLA-A2-negative patients receiving GM-CSF alone disease recurrence rates between HLA-A2-positive patients receiving the GP2 + GM-CSF vaccine and HLA-A2-positive patients receiving GM-CSF alone disease recurrence rates between all four arms of the trial.

Secondary Outcome Measures

Safety
Inoculations will be immediately halted if any serious adverse reactions occur which, when based upon appropriate judgment of the PI, are determined to jeopardize the patient or require medical or surgical intervention. Any death or grade 4 adverse drug experience found to be directly related to the experimental vaccine will result in suspension of patient enrollment to the study.
Immune Response
Immune response will be measured by proliferation assays, dimer assays, and ELISPOT. Delayed type hypersensitivity reactions will be compared between the vaccinated group and GM-CSF-only group.

Full Information

First Posted
August 31, 2007
Last Updated
March 23, 2020
Sponsor
San Antonio Military Medical Center
Collaborators
NuGenerex Immuno-Oncology, Norwell, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT00524277
Brief Title
Vaccine Therapy in Treating Patients With Breast Cancer
Official Title
Phase II Trial of the HER2/Neu Peptide GP2 + GM-CSF Vaccine vs GM-CSF Alone in HLA-A2+ OR the Modified HER2/Neu Peptide AE37 + GM-CSF Vaccine vs GM-CSF Alone in HLA-A2- Node-Positive and High-Risk Node-Negative Breast Cancer Patients
Study Type
Interventional

2. Study Status

Record Verification Date
March 2020
Overall Recruitment Status
Completed
Study Start Date
January 2007 (undefined)
Primary Completion Date
December 31, 2014 (Actual)
Study Completion Date
March 31, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
San Antonio Military Medical Center
Collaborators
NuGenerex Immuno-Oncology, Norwell, Inc.

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Vaccines made from peptides may help the body build an effective immune response to kill tumor cells that express HER2/neu. Biological therapies, such as GM-CSF, may stimulate the immune system in different ways and stop tumor cells from growing. It is not yet known whether vaccine therapy is more effective than GM-CSF in treating breast cancer. PURPOSE: This randomized phase II trial is studying vaccine therapy to see how well it works compared with GM-CSF in treating patients with breast cancer.
Detailed Description
OBJECTIVES: To determine if the GP2 peptide/GM-CSF vaccine reduces the recurrence rate in HLA-A2-positive, HER2/neu-positive, node-positive, or high-risk node-negative breast cancer patients randomized to receive the vaccine versus the immunoadjuvant, sargramostim (GM-CSF), alone. To determine if the AE37 peptide/GM-CSF vaccine reduces the recurrence rate in HLA-A2-negative, HER2/neu-positive, node-positive or high-risk node-negative breast cancer patients randomized to receive the vaccine versus the immunoadjuvant, GM-CSF, alone. To monitor the invitro and invivo immunologic responses to the vaccines and correlate these responses with the clinical outcomes. To monitor for any unexpected toxicities with the vaccines. OUTLINE: This is a multicenter study. Patients are stratified according to nodal status. Patients are randomized to 1 of 4 treatment arms. Arm I: HLA-A2-positive patients receive GP2 peptide/GM-CSF vaccine intradermally (ID) every 3-4 weeks for a total of up to 6 inoculations. Arm II: HLA-A2-positive patients receive solely GM-CSF ID Arm III: HLA-A2-negative patients receive AE37 peptide/GM-CSF vaccine ID every 3-4 weeks for a total of up to 6 inoculations. Arm IV: HLA-A2-negative patients receive solely GM-CSF ID After completion of study therapy, patients are followed every 3 months for the first 24 months and then every 6 months for an additional 36 months. Booster inoculations are administered at 12, 18, 24, and 30 months from the date of patients' enrollment into the study. One booster inoculation is administered at each timepoint (+/- 2 weeks) and will be the same inoculation (vaccine or GM-CSF only) as what patients received during their regular inoculation series.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
stage I breast cancer, stage II breast cancer, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer, male breast cancer

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
456 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I
Arm Type
Experimental
Arm Description
HLA-A2-positive patients receive GP2 peptide + GM-CSF vaccine intradermally (ID) every 3-4 weeks for a total of up to 6 inoculations.
Arm Title
Arm II
Arm Type
Active Comparator
Arm Description
HLA-A2-positive patients receive GM-CSF ID every 3-4 weeks for a total of up to 6 inoculations.
Arm Title
Arm III
Arm Type
Experimental
Arm Description
HLA-A2-negative patients receive AE37 peptide/GM-CSF vaccine ID every 3-4 weeks for a total of up to 6 inoculations.
Arm Title
Arm IV
Arm Type
Active Comparator
Arm Description
HLA-A2-negative patients receive GM-CSF ID ID every 3-4 weeks for a total of up to 6 inoculations
Intervention Type
Biological
Intervention Name(s)
GP2 peptide + GM-CSF vaccine
Other Intervention Name(s)
GM-CSF (sargramostim)
Intervention Description
Given intradermally every 3-4 weeks for a total of up to 6 inoculations
Intervention Type
Biological
Intervention Name(s)
GM-CSF (sargramostim)
Intervention Description
GM-CSF given intradermally very 3-4 weeks for a total of up to 6 inoculations
Intervention Type
Biological
Intervention Name(s)
AE37 + GM-CSF vaccine
Other Intervention Name(s)
GM-CSF (sargramostim)
Intervention Description
Given intradermally every 3-4 weeks for a total of up to 6 inoculations
Intervention Type
Biological
Intervention Name(s)
GM-CSF (sargramostim)
Intervention Description
Given intradermally every 3-4 weeks for a total of up to 6 inoculations
Primary Outcome Measure Information:
Title
Disease recurrence
Description
The following will be compared: disease recurrence rates between HLA-A2-negative patients receiving the AE37 + GM-CSF vaccine and HLA-A2-negative patients receiving GM-CSF alone disease recurrence rates between HLA-A2-positive patients receiving the GP2 + GM-CSF vaccine and HLA-A2-positive patients receiving GM-CSF alone disease recurrence rates between all four arms of the trial.
Time Frame
Five years (from date of enrollment to the study through the end of the follow-up period)
Secondary Outcome Measure Information:
Title
Safety
Description
Inoculations will be immediately halted if any serious adverse reactions occur which, when based upon appropriate judgment of the PI, are determined to jeopardize the patient or require medical or surgical intervention. Any death or grade 4 adverse drug experience found to be directly related to the experimental vaccine will result in suspension of patient enrollment to the study.
Time Frame
Local and systemic reactions to each inoculation will be monitored every six months during the regular inoculation series and the booster series.
Title
Immune Response
Description
Immune response will be measured by proliferation assays, dimer assays, and ELISPOT. Delayed type hypersensitivity reactions will be compared between the vaccinated group and GM-CSF-only group.
Time Frame
Immune response will be measured after every monthly inoculation in the regular inoculation series and after each inoculation in the booster series

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Inclusion criteria: Lymph node-positive breast cancer or high-risk lymph node-negative breast cancer. The latter is defined by any one of the following criteria: T2 disease Grade 3 disease Lymphovascular invasion Estrogen receptor- or progesterone receptor-negative disease HER2/neu-expressing tumor (immunohistochemistry [IHC] 3+ and/or amplified fluorescence in situ hybridization [FISH] >2.2, or N0 (i+)) HER2/neu-expressing tumor (IHC 1-3+ and or positive FISH >1.2) Completion of primary standard of care breast cancer therapies (i.e., surgery, chemotherapy, immunotherapy and radiation therapy as appropriate per standard of care for patients' specific cancer) Clinically cancer-free (no evidence of disease) Patients may be enrolled between 1-6 months from completion of standard primary breast cancer therapies Good performance status (as defined in Exclusion Criteria) Capable of informed consent Exclusion criteria: HER2/neu-negative breast cancers (IHC 0) Clinical and/or radiographic evidence of residual or persistent breast cancer Receiving immunosuppressive therapy to include chemotherapy, steroids, or methotrexate In poor health (Karnofsky <60%, ECOG >/-2) Total bilirubin >1.8, creatinine >2, hemoglobin <10, platelets <50,000, WBC <2,000) Active interstitial lung disease; asthma requiring more than as needed bronchodilators for management; or other autoimmune lung disease Pregnancy (urine hCG) Breast feeding History of autoimmune disease Involved in other experimental protocols (except with permission of the other study PI) PATIENT CHARACTERISTICS: Inclusion criteria: Female or male Menopausal status not specified Immunologically intact by recall anergy testing Negative pregnancy test Exclusion criteria: Karnofsky 0-60% or ECOG ≥ 2 Total bilirubin > 1.8 g/dL Creatinine > 2.0 g/dL Hemoglobin < 10.0 g/dL Platelet count < 50,000/mm³ WBC< 2,000/mm³ Active pulmonary disease requiring medication that includes multiple inhalers Pregnancy Breastfeeding History of autoimmune disease PRIOR CONCURRENT THERAPY: Inclusion criteria: See Disease Characteristics Exclusion criteria: Concurrent immunosuppressive therapy including chemotherapy, steroids, or methotrexate Concurrent participation in another experimental treatment (except with permission of the other study investigator)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elizabeth A Mittendorf, MD, FACS
Organizational Affiliation
UT M.D. Anderson Cancer Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
George E Peoples, MD, FACS
Organizational Affiliation
Cancer Vaccine Development Program, Department of Surgery, Brooke Army Medical Center
Official's Role
Study Director
Facility Information:
Facility Name
Sibley Memorial Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20016
Country
United States
Facility Name
University of Hawaii Cancer Center
City
Honolulu
State/Province
Hawaii
ZIP/Postal Code
96813
Country
United States
Facility Name
MedStar Union Memorial Hospital
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21218
Country
United States
Facility Name
MedStar Good Samaritan Hospital Cancer Center
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21239
Country
United States
Facility Name
Walter Reed National Military Medical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20889
Country
United States
Facility Name
Wake Forest University Comprehensive Cancer Center
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157-1096
Country
United States
Facility Name
Carl R. Darnall Army Medical Center
City
Fort Hood
State/Province
Texas
ZIP/Postal Code
76544-4752
Country
United States
Facility Name
San Antonio Army Medical Center
City
Fort Sam Houston
State/Province
Texas
ZIP/Postal Code
78234-6200
Country
United States
Facility Name
University of Texas MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030-4009
Country
United States
Facility Name
STOH Clinical Research
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States
Facility Name
Madigan Army Medical Center - Tacoma
City
Tacoma
State/Province
Washington
ZIP/Postal Code
98431-5000
Country
United States
Facility Name
Landstuhl Regional Medical Center
City
Landstuhl
State/Province
Kirchberg
ZIP/Postal Code
66849
Country
Germany
Facility Name
Saint Savas Cancer Hospital of Athens
City
Athens
ZIP/Postal Code
11522
Country
Greece

12. IPD Sharing Statement

Citations:
PubMed Identifier
21692698
Citation
Mittendorf EA, Alatrash G, Xiao H, Clifton GT, Murray JL, Peoples GE. Breast cancer vaccines: ongoing National Cancer Institute-registered clinical trials. Expert Rev Vaccines. 2011 Jun;10(6):755-74. doi: 10.1586/erv.11.59.
Results Reference
background
PubMed Identifier
21895539
Citation
Sears AK, Perez SA, Clifton GT, Benavides LC, Gates JD, Clive KS, Holmes JP, Shumway NM, Van Echo DC, Carmichael MG, Ponniah S, Baxevanis CN, Mittendorf EA, Papamichail M, Peoples GE. AE37: a novel T-cell-eliciting vaccine for breast cancer. Expert Opin Biol Ther. 2011 Nov;11(11):1543-50. doi: 10.1517/14712598.2011.616889. Epub 2011 Sep 6.
Results Reference
result
PubMed Identifier
30025819
Citation
Jackson DO, Trappey FA, Clifton GT, Vreeland TJ, Peace KM, Hale DF, Litton JK, Murray JL, Perez SA, Papamichail M, Mittendorf EA, Peoples GE. Effects of HLA status and HER2 status on outcomes in breast cancer patients at risk for recurrence - Implications for vaccine trial design. Clin Immunol. 2018 Oct;195:28-35. doi: 10.1016/j.clim.2018.06.008. Epub 2018 Jul 17.
Results Reference
derived
Links:
URL
https://web.archive.org/web/20111026180718/http://cancer.gov/clinicaltrials/search/view?cdrid=562261&version=healthprofessional
Description
Clinical trial summary from the National Cancer Institute's PDQ® database

Learn more about this trial

Vaccine Therapy in Treating Patients With Breast Cancer

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