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Nelipepimut-S Plus GM-CSF Vaccine Therapy in Treating Patients With Breast Cancer

Primary Purpose

Breast Ductal Carcinoma In Situ

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Laboratory Biomarker Analysis
Nelipepimut-S Plus GM-CSF Vaccine
Sargramostim
Surgical Procedure
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Breast Ductal Carcinoma In Situ

Eligibility Criteria

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

Inclusion Criteria:

  • Participants must be pre- or post-menopausal
  • Participants must have a diagnosis of DCIS made by core needle biopsy
  • Participants must be human leukocyte antigen (HLA)-A2 positive
  • Eastern Cooperative Oncology Group (ECOG) performance status must be 0 or 1 (Karnofsky >= 60%)
  • Clinical chemistry less than 2 x normal upper limit of normal range
  • Platelets >= 100,000/mm^3
  • Hemoglobin >= 10 g/dL
  • Blood urea nitrogen < 2 x upper limit of normal (ULN)
  • Alkaline phosphatase < 2 x ULN
  • Lactate dehydrogenase < 2 x ULN
  • Creatinine < 2 x ULN
  • Bilirubin < 2 x ULN
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) < 2 x ULN
  • A normal ejection fraction, as defined by the participant's institution; only limited echocardiograms (ECHOs) will be used as cardiac evaluation; no other tests are allowed; ECHO is to be done only in HLA-A2 positive participants; if ECHO has been done within 30 days prior to randomization and results showing a normal ejection fraction have been obtained prior to randomization, an additional ECHO is not needed at baseline
  • Willingness to comply with all study interventions and follow-up procedures
  • The ability to understand and willingness to sign a written informed consent document

Exclusion Criteria:

  • Invasive breast cancer; areas of microinvasion or suspicious for microinvasion on the core biopsy is allowed
  • History of prior breast cancer treated within the past two years; patients completing all breast cancer-specific treatment over two years prior to the current diagnosis are eligible
  • History of prior ductal carcinoma in situ (DCIS) treated within the past two years; patients completing all treatment for a previous diagnosis of DCIS over two years prior to the current diagnosis are eligible
  • Prior lobular carcinoma in situ (LCIS) is allowed
  • Pregnant, unwilling to use adequate contraception during study treatment duration or breastfeeding; pregnant women will be excluded; all heterosexually active women who may become pregnant must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation OR be post-menopausal defined as any one of the following 1) prior hysterectomy, 2) absence of menstrual period for 1 year in the absence of prior chemotherapy or 3) absence of menstrual period for 2 years in women with a prior history of chemotherapy exposure who were pre-menopausal prior to chemotherapy; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately
  • Any autoimmune disease or other medical condition that, in the opinion of the investigator, would compromise the subject's safety
  • Immune deficiency diseases such as immunoglobulin deficiency or immunosuppressive therapy that might interfere with appropriate immune response
  • Known history of or known active infection with human immunodeficiency virus (HIV), hepatitis B or hepatitis C
  • Patients on chronic steroid therapy or other immunosuppressive therapy except for topical or inhaled steroids known to have low systemic absorption
  • Patients with a known hypersensitivity to GM-CSF, yeast-derived products, or any component of the GM-CSF product (e.g., mannitol)
  • Concurrent treatment with other investigational agent
  • History of non-breast malignancy within 5 years prior to randomization, except curatively treated superficial bladder cancer, carcinoma in situ of the cervix (stage 0-1), and basal cell or squamous cell carcinoma of the skin
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to NeuVax
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • No recent or planned immunotherapy

Sites / Locations

  • Dana-Farber Cancer Institute
  • NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
  • Thomas Jefferson University Hospital
  • M D Anderson Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Arm I (nelipepimut-S plus GM-CSF vaccine)

Arm II (sargramostim)

Arm Description

Patients receive nelipepimut-S plus GM-CSF vaccine ID on days 0 and 14 and then undergo surgery on day 28.

Patients receive sargramostim ID on days 0 and 14 and then undergo surgery on day 28.

Outcomes

Primary Outcome Measures

Mean Percent of Nelipepimut-S-specific Cytotoxic T Lymphocyte Response (E75)
Change from baseline in the Mean percent of Nelipepimut-S-specific cytotoxic T lymphocyte response one-month post-surgical resection. Wilcoxon rank sum test exact P-value was used.

Secondary Outcome Measures

Intra-tumoral Tumor-infiltrating Lymphocytes (iTILs) Within the Basement Membrane
Change from baseline in the iTILs at surgical resection. Wilcoxon rank sum test exact P-value was used.
Intra-tumoral Tumor-infiltrating Lymphocytes (iTILs)
Change from baseline in the iTILs at surgical resection. Wilcoxon rank sum test exact P-value was used.
Number of Participants With HER2 Expression in Biopsy and Resection Specimens
Difference in HER2 Expression in Biopsy and Resection Specimens. Differences were assessed using a Fisher's exact test.
Number of Adverse Events, Graded According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 4.03
The number of serious and non serious adverse events for both arms. Graded According to national Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 4.03.
Number of Participants With Presence of Ductal Carcinoma in Situ (DCIS)
Presence of DCIS with Invasive Cancer.

Full Information

First Posted
December 18, 2015
Last Updated
April 25, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02636582
Brief Title
Nelipepimut-S Plus GM-CSF Vaccine Therapy in Treating Patients With Breast Cancer
Official Title
VADIS Trial: Phase II Trial of Nelipeimut-S Peptide Vaccine in Women With DCIS of the Breast
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
June 14, 2016 (Actual)
Primary Completion Date
July 22, 2019 (Actual)
Study Completion Date
March 19, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase II trial studies how well nelipepimut-S plus GM-CSF vaccine therapy or sargramostim works in treating patients with breast cancer. Vaccines made from peptide or antigen and/or a person's white blood cells mixed with tumor proteins may help the body build an effective immune response to kill tumor cells that express breast cancer antigens. It is not yet known whether nelipepimut-S plus GM-CSF vaccine or sargramostim is more effective in treating patients with breast cancer.
Detailed Description
PRIMARY OBJECTIVE: I. Evaluate for nelipepimut-S-specific cytotoxic T lymphocyte (CTL; cluster of differentiation [CD]8+ T cell) response in patients receiving NeuVax (nelipepimut-S plus GM-CSF [sargramostim]) compared to patients receiving GM-CSF alone (control). SECONDARY OBJECTIVES: I. Toxicity profile and frequency of adverse events in women with ductal carcinoma in situ (DCIS) of the breast receiving nelipepimut-S vaccine as compared to women receiving GM-CSF alone. II. Presence of DCIS at resection. III. Difference in HER2 expression in the biopsy and the surgical specimen excised post-vaccination. IV. Histologic responses: IVa. Degree of lymphocyte infiltration determined on hematoxylin and eosin (H&E) stained slides and immune infiltration as determined by multiplex immunofluorescence staining for markers including but not limited to CD3, CD4 and CD8. IVb. Immune infiltrates in normal tissue maximally distant from the tumor (in mastectomy samples). OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive nelipepimut-S plus GM-CSF vaccine intradermally (ID) on days 0 and 14 and then undergo surgery on day 28. ARM II: Patients receive sargramostim ID on days 0 and 14 and then undergo surgery on day 28. After completion of study treatment, patients are followed up at 1 and 3-6 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Ductal Carcinoma In Situ

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Arm I (nelipepimut-S plus GM-CSF vaccine)
Arm Type
Experimental
Arm Description
Patients receive nelipepimut-S plus GM-CSF vaccine ID on days 0 and 14 and then undergo surgery on day 28.
Arm Title
Arm II (sargramostim)
Arm Type
Active Comparator
Arm Description
Patients receive sargramostim ID on days 0 and 14 and then undergo surgery on day 28.
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Intervention Type
Drug
Intervention Name(s)
Nelipepimut-S Plus GM-CSF Vaccine
Other Intervention Name(s)
E75 Plus GM-CSF, E75 Vaccine Plus GM-CSF, HLA A2/A3-Restricted HER-2/neu Peptide Vaccine Plus GM-CSF, Nelipepimut-S Plus Sargramostim, NeuVax Plus GM-CSF
Intervention Description
Given ID
Intervention Type
Biological
Intervention Name(s)
Sargramostim
Other Intervention Name(s)
23-L-Leucinecolony-Stimulating Factor 2, DRG-0012, Leukine, Prokine, rhu GM-CFS, Sagramostim, Sargramostatin
Intervention Description
Given ID
Intervention Type
Procedure
Intervention Name(s)
Surgical Procedure
Other Intervention Name(s)
Operation, Surgery, Surgical, Surgical Intervention, Surgical Interventions, Surgical Procedures, Type of Surgery
Intervention Description
Undergo surgery
Primary Outcome Measure Information:
Title
Mean Percent of Nelipepimut-S-specific Cytotoxic T Lymphocyte Response (E75)
Description
Change from baseline in the Mean percent of Nelipepimut-S-specific cytotoxic T lymphocyte response one-month post-surgical resection. Wilcoxon rank sum test exact P-value was used.
Time Frame
One-Month post-surgical resection from baseline
Secondary Outcome Measure Information:
Title
Intra-tumoral Tumor-infiltrating Lymphocytes (iTILs) Within the Basement Membrane
Description
Change from baseline in the iTILs at surgical resection. Wilcoxon rank sum test exact P-value was used.
Time Frame
Baseline to surgical resection, up to 5 weeks
Title
Intra-tumoral Tumor-infiltrating Lymphocytes (iTILs)
Description
Change from baseline in the iTILs at surgical resection. Wilcoxon rank sum test exact P-value was used.
Time Frame
Baseline to surgical resection, up to 5 weeks
Title
Number of Participants With HER2 Expression in Biopsy and Resection Specimens
Description
Difference in HER2 Expression in Biopsy and Resection Specimens. Differences were assessed using a Fisher's exact test.
Time Frame
Baseline to surgical resection, up to 5 weeks
Title
Number of Adverse Events, Graded According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 4.03
Description
The number of serious and non serious adverse events for both arms. Graded According to national Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 4.03.
Time Frame
3-6 months after surgery
Title
Number of Participants With Presence of Ductal Carcinoma in Situ (DCIS)
Description
Presence of DCIS with Invasive Cancer.
Time Frame
At resection
Other Pre-specified Outcome Measures:
Title
Immune Cell Analysis
Description
Will utilize tissue-based cyclic immunofluorescence (t-CyCIF), a novel, highly multiplexed imaging modality that follows the imaging of formalin-fixed, paraffin embedded (FFPE) tissue sections at subcellular resolution across 20-60 distinct antigen channels. 4-6 panels that will be used include both my not be limited to an already optimized immune panel.
Time Frame
up to 6 months after completion of the vaccination series timepoint
Title
Immune Infiltrates in Normal Tissue Maximally Distant From the Tumor (in Mastectomy Samples)
Description
In the mastectomy samples only will perform core needle biopsies of the normal tissue, maximally distant from the tumor (ex vivo after the mastectomy if performed and store for future studies of immune infiltrates.
Time Frame
Up to 6 months after completion of the vaccination series timepoint
Title
Toxicity Profile According to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 4.03)
Time Frame
up to 3 months after surgery
Title
Degree of Lymphocyte Infiltration
Description
We will define intra-tumoral TIL as those within the basement membrane. Stromal TIL will be defined as those in the periductal/lobular stroma including the intralobular stromal infiltrate. Cells in the interlobular stromal inflammatory infiltrate will be excluded. All mononuclear cells will be scored but polymorphonuclear leukocytes will be excluded. Intra-tumoral and stromal TILs will be scored as a continuous variable and the percentage of in the surgical specimen will be compared to that in the pre-vaccination diagnostic biopsy.
Time Frame
Up to 6 months after completion of the vaccination series timepoint

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must be pre- or post-menopausal Participants must have a diagnosis of DCIS made by core needle biopsy Participants must be human leukocyte antigen (HLA)-A2 positive Eastern Cooperative Oncology Group (ECOG) performance status must be 0 or 1 (Karnofsky >= 60%) Clinical chemistry less than 2 x normal upper limit of normal range Platelets >= 100,000/mm^3 Hemoglobin >= 10 g/dL Blood urea nitrogen < 2 x upper limit of normal (ULN) Alkaline phosphatase < 2 x ULN Lactate dehydrogenase < 2 x ULN Creatinine < 2 x ULN Bilirubin < 2 x ULN Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) < 2 x ULN A normal ejection fraction, as defined by the participant's institution; only limited echocardiograms (ECHOs) will be used as cardiac evaluation; no other tests are allowed; ECHO is to be done only in HLA-A2 positive participants; if ECHO has been done within 30 days prior to randomization and results showing a normal ejection fraction have been obtained prior to randomization, an additional ECHO is not needed at baseline Willingness to comply with all study interventions and follow-up procedures The ability to understand and willingness to sign a written informed consent document Exclusion Criteria: Invasive breast cancer; areas of microinvasion or suspicious for microinvasion on the core biopsy is allowed History of prior breast cancer treated within the past two years; patients completing all breast cancer-specific treatment over two years prior to the current diagnosis are eligible History of prior ductal carcinoma in situ (DCIS) treated within the past two years; patients completing all treatment for a previous diagnosis of DCIS over two years prior to the current diagnosis are eligible Prior lobular carcinoma in situ (LCIS) is allowed Pregnant, unwilling to use adequate contraception during study treatment duration or breastfeeding; pregnant women will be excluded; all heterosexually active women who may become pregnant must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation OR be post-menopausal defined as any one of the following 1) prior hysterectomy, 2) absence of menstrual period for 1 year in the absence of prior chemotherapy or 3) absence of menstrual period for 2 years in women with a prior history of chemotherapy exposure who were pre-menopausal prior to chemotherapy; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately Any autoimmune disease or other medical condition that, in the opinion of the investigator, would compromise the subject's safety Immune deficiency diseases such as immunoglobulin deficiency or immunosuppressive therapy that might interfere with appropriate immune response Known history of or known active infection with human immunodeficiency virus (HIV), hepatitis B or hepatitis C Patients on chronic steroid therapy or other immunosuppressive therapy except for topical or inhaled steroids known to have low systemic absorption Patients with a known hypersensitivity to GM-CSF, yeast-derived products, or any component of the GM-CSF product (e.g., mannitol) Concurrent treatment with other investigational agent History of non-breast malignancy within 5 years prior to randomization, except curatively treated superficial bladder cancer, carcinoma in situ of the cervix (stage 0-1), and basal cell or squamous cell carcinoma of the skin History of allergic reactions attributed to compounds of similar chemical or biologic composition to NeuVax Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements No recent or planned immunotherapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elizabeth A Mittendorf
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dana-Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10032
Country
United States
Facility Name
Thomas Jefferson University Hospital
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Links:
URL
http://www.mdanderson.org
Description
MD Anderson Cancer Center

Learn more about this trial

Nelipepimut-S Plus GM-CSF Vaccine Therapy in Treating Patients With Breast Cancer

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