search
Back to results

BATs in Patients With Breast Cancer and Leptomeningeal Metastases

Primary Purpose

Breast Cancer Female, Leptomeningeal Metastases

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
HER2 BATs
Sponsored by
University of Virginia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer Female focused on measuring Metastatic Breast Cancer, Adoptive Cell Therapy, Armed Activated T-cells, Bispecific Antibodies, Immunotherapy

Eligibility Criteria

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

Inclusion Criteria:

  1. Be willing and able to provide written informed consent for the trial.
  2. Participants must be female.
  3. Histologically confirmed breast cancer (any Her2, estrogen receptor (ER), or progesterone receptor (PR) expression) with leptomeningeal metastasis (LM) as determined by imaging and/or cerebrospinal fluid (CSF) cytology.
  4. 18 years of age or older.
  5. Women of reproductive potential must agree to use an effective method of contraception during therapy. Effective methods include intrauterine device (IUD), vasectomy of the male partner, diaphragm with spermicide, cervical cap with spermicide, contraceptive sponge, male or female condom, or hormonal contraceptive.
  6. Karnofsky Performance Status (KPS) of ≥60.
  7. Eligible for intraventricular (IVENT) catheter/reservoir placement as determined by neurosurgery.
  8. Demonstrate adequate organ function as defined below. All screening labs should be performed within 10 days of confirmation of eligibility.

Absolute lymphocyte count ≥ 500/mm3 Absolute neutrophil count ≥ 1000/mcL Platelets ≥ 100,000 / mnL Hemoglobin ≥ 8 g/dL BUN ≤ 1.5 x upper limit of normal (ULN) Serum creatinine within the normal limits OR measured or calculated creatinine clearance ≥ 60 mL/min 1.73m2 Serum total bilirubin ≤ 2 x ULN OR AST (SGOT) and ALT (SGPT) ≤ 5 x ULN Albumin ≥ 2.5 mg/dL

Exclusion Criteria:

  1. Current severe increased intracranial pressure with clinical or imaging findings suggestive of herniation, status epilepticus, or other serious complications requiring emergency or urgent intervention.
  2. Patients who cannot have MRI studies for any reason (intolerance, medical contraindication, etc.).
  3. Patients with a history of another malignancy within 1 year of study enrollment with the following exceptions: patients with history of ductal carcinoma in situ (DCIS), squamous cell skin cancers, or other in situ carcinomas are not excluded.
  4. Patients with unresolved autoimmune toxicity.
  5. Patients with a known disorder that increases the risk of bleeding (e.g., Hemophilia, von Willebrands disease, or clinically significant clotting factor deficiency).
  6. 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.
  7. Administration of any investigational agents, immunomodulating agents, radiation therapy or chemotherapy for MBC within the 7 days before the 80 mL blood draw to collect cells for study treatment.
  8. Has Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies) or known active Hepatitis B (e.g. HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected).
  9. Pregnancy or lactation at the time of registration.
  10. Psychiatric or addictive disorders or other conditions that in the opinion of the investigator would preclude the patient from complying with the study protocol.

Sites / Locations

  • University of Virginia

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Test dose then 8 doses HER2 Bi-armed activated T-cells (BATs)

Arm Description

Approximately 4 weeks following registration and blood collection, participants are given a test dose of HER2 BATs followed by 8 weekly infusions. Infusions are given intraventricularly.

Outcomes

Primary Outcome Measures

Types of adverse events (AEs)
Types of any adverse events or abnormalities of laboratory tests
Frequency of adverse events (AEs)
Frequency of any adverse events or abnormalities of laboratory tests
Severity of adverse events (AEs)
Severity of any adverse events or abnormalities of laboratory tests
Timing of onset of adverse events
Timing of onset of any adverse events or abnormalities of laboratory tests
Duration of adverse events
Duration of any adverse events or abnormalities of laboratory tests
Relationship to study therapy of any adverse events or abnormalities of laboratory tests as determined by CTCAE v5.0 will be assessed based on protocol-defined relationships of definitely, probably, possibly, unlikely and unrelated to study therapy.
Relationship to study therapy of any adverse events or abnormalities of laboratory tests
Number of participants achieving at least 80% of the planned HER2 BATs dose.
If at least 80% of the planned dose of cells cannot be produced for 3 consecutive participants at a designated dose level, that dose level will be considered not feasible.

Secondary Outcome Measures

Immune shift: in vitro cytotoxicity assays and/or IFN-y EliSpots against breast cancer cell lines
Immune shift induced by Her2 BATs as detected by in vitro cytotoxicity assays and/or IFN-γ EliSpots against breast cancer cell lines
Immune shift: Phenotyping of activating and regulatory immune cells
Immune shift induced by Her2 BATs as detected by phenotyping of activating and regulatory immune cells
Immune shift: Measurement of cytokine patterns
Immune shift induced by Her2 BATs as detected by measurement of cytokine patterns
Immune shift: Determination of anti-Her2 antibodies
Immune shift induced by Her2 BATs as detected by determination of anti-Her2 antibodies
Correlation of clinical and immune response characteristics to progression-free survival
Correlation individually and by heatmap analysis of imaging, pathology, clinical, and immune response characteristics to progression free survival (PFS)
Correlation of clinical and immune response characteristics to overall survival
Correlation individually and by heatmap analysis of imaging, pathology, clinical, and immune response characteristics to overall survival (OS).
Objective response rate (ORR)
Proportion of participants with complete or partial response according to brain and spine MRI
Progression-free survival (PFS)
Length of time from study participation initiation through disease progression for each participant
Overall survival (OS)
Length of time from study participation initiation through death or for 2 years following study treatment for each participant
MD Anderson Symptom Inventory for Spinal Tumors (MDASI - SP)
The MDASI- SP is a 24 item questionnaire that focuses on symptoms related to spinal tumors. For each potential symptom, there is an eleven-point scale where 0 is "Not Present" and 10 is "As Bad As You Can Imagine" so the minimum score would be 0 and the maximum score would be 240. For a subset of questions, the scale measures how much the symptoms interfered with other parts of life and the scale ranges from symptoms that "Did Not Interfere" (0) to those that "Interfered Completely" (10). Lower scores indicate fewer/less severe/less interfering symptoms and higher scores indicate more/more severe/more interfering symptoms.
MD Anderson Symptom Inventory for Brain Tumors (MDASI- BT)
The MDASI- BT is a 28 item questionnaire that focuses on symptoms related to brain tumors. For each potential symptom, there is an eleven-point scale where 0 is "Not Present" and 10 is "As Bad As You Can Imagine" so the minimum score would be 0 and the maximum score would be 280. For a subset of questions, the scale measures how much the symptoms interfered with other parts of life and the scale ranges from symptoms that "Did Not Interfere" (0) to those that "Interfered Completely" (10). Lower scores indicate fewer/less severe/less interfering symptoms and higher scores indicate more/more severe/more interfering symptoms.

Full Information

First Posted
August 22, 2018
Last Updated
December 15, 2022
Sponsor
University of Virginia
search

1. Study Identification

Unique Protocol Identification Number
NCT03661424
Brief Title
BATs in Patients With Breast Cancer and Leptomeningeal Metastases
Official Title
A Phase I Study of Anti-CD3 x Anti-Her2/Neu (Her2Bi) Armed Activated T Cells (ATC) in Patients With Breast Cancer Leptomeningeal Metastases
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Terminated
Why Stopped
slow study accrual, partially due to pandemic
Study Start Date
February 26, 2019 (Actual)
Primary Completion Date
December 14, 2021 (Actual)
Study Completion Date
December 14, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Virginia

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study uses bi-specific antibody (HER2Bi) armed activated T-cells (HER2 BATs) to target breast cancer cells that have metastasized to the membranes surrounding the brain and spinal cord. This is known as leptomeningeal metastases. Two doses will be evaluated in order to determine a safe dose. Study treatment includes a test dose of HER2 BATs followed by 8 weekly infusions of HER2 BATs at the assigned dose level. Before, during and after study treatment, participants will be monitored objectively by brain MRIs and clinically through physical and neurological exams, and blood and cerebrospinal fluid will be collected to evaluate immune responses.
Detailed Description
Once subjects are determined eligible, white blood cells (lymphocytes) are collected via leukapheresis procedure approximately 3 to 4 weeks prior to the first BATs infusion. The white blood cells, specifically T cells, are then mixed with two proteins in order to activate the cells to multiply. After approximately 14 days in culture, the activated T cells are coated with OKT3 and trastuzumab/Herceptin (HER2Bi), and washed to remove excess Herceptin in order to produce bispecific antibody armed T cells (BATs). Cells are then frozen and stored until scheduled to be infused. Up to 2 weeks following leukapheresis, participants will undergo surgery to place the catheter/reservoir into the lateral ventricle of the brain to allow intraventricular administration of HER2 BATs and a chemotherapy agent methotrexate. A few weeks later, participants will receive the intraventricular methotrexate in order to control disease while the BATs product is being manufactured. About 4-5 weeks following the leukapheresis and at least 7 days after receiving methotrexate, study treatment will begin with a test dose of HER2 BATs. If this dose is well tolerated by the participant, she will then receive 8 weekly doses of HER2 BATs at the assigned dose level.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer Female, Leptomeningeal Metastases
Keywords
Metastatic Breast Cancer, Adoptive Cell Therapy, Armed Activated T-cells, Bispecific Antibodies, Immunotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Test dose then 8 doses HER2 Bi-armed activated T-cells (BATs)
Arm Type
Experimental
Arm Description
Approximately 4 weeks following registration and blood collection, participants are given a test dose of HER2 BATs followed by 8 weekly infusions. Infusions are given intraventricularly.
Intervention Type
Drug
Intervention Name(s)
HER2 BATs
Intervention Description
A test dose (1 million cells) of HER2 BATs (at one of the two dose levels: 5 million cells or 10 million cells per infusion) followed by 8 weekly infusions of Her2 BATs delivered into the ventricle of the brain. Infusions are delivered weekly over 8 weeks with brain MRIs prior to first infusion and following the eighth infusion. Blood will be drawn for immune evaluation before during and after study treatment.
Primary Outcome Measure Information:
Title
Types of adverse events (AEs)
Description
Types of any adverse events or abnormalities of laboratory tests
Time Frame
For each participant, AEs will be collected from the time of the first protocol-related procedure through 30 days following last infusion of BATs. SAEs considered related to study treatment will also be collected following this period.
Title
Frequency of adverse events (AEs)
Description
Frequency of any adverse events or abnormalities of laboratory tests
Time Frame
For each participant, AEs will be collected from the time of the first protocol-related procedure through 30 days following last infusion of BATs. SAEs considered related to study treatment will also be collected following this period.
Title
Severity of adverse events (AEs)
Description
Severity of any adverse events or abnormalities of laboratory tests
Time Frame
For each participant, AEs will be collected from the time of the first protocol-related procedure through 30 days following last infusion of BATs. SAEs considered related to study treatment will also be collected following this period.
Title
Timing of onset of adverse events
Description
Timing of onset of any adverse events or abnormalities of laboratory tests
Time Frame
For each participant, AEs will be collected from the time of the first protocol-related procedure through 30 days following last infusion of BATs. SAEs considered related to study treatment will also be collected following this period.
Title
Duration of adverse events
Description
Duration of any adverse events or abnormalities of laboratory tests
Time Frame
For each participant, AEs will be collected from the time of the first protocol-related procedure through 30 days following last infusion of BATs. SAEs considered related to study treatment will also be collected following this period.
Title
Relationship to study therapy of any adverse events or abnormalities of laboratory tests as determined by CTCAE v5.0 will be assessed based on protocol-defined relationships of definitely, probably, possibly, unlikely and unrelated to study therapy.
Description
Relationship to study therapy of any adverse events or abnormalities of laboratory tests
Time Frame
For each participant, AEs will be collected from the time of the first protocol-related procedure through 30 days following last infusion of BATs. SAEs considered related to study treatment will also be collected following this period.
Title
Number of participants achieving at least 80% of the planned HER2 BATs dose.
Description
If at least 80% of the planned dose of cells cannot be produced for 3 consecutive participants at a designated dose level, that dose level will be considered not feasible.
Time Frame
An average of 4 weeks following blood draw to collect cells for HER2 BATs
Secondary Outcome Measure Information:
Title
Immune shift: in vitro cytotoxicity assays and/or IFN-y EliSpots against breast cancer cell lines
Description
Immune shift induced by Her2 BATs as detected by in vitro cytotoxicity assays and/or IFN-γ EliSpots against breast cancer cell lines
Time Frame
Blood for immune analysis collected prior to, during and following study treatment (tx) (up to 6 months following study tx).
Title
Immune shift: Phenotyping of activating and regulatory immune cells
Description
Immune shift induced by Her2 BATs as detected by phenotyping of activating and regulatory immune cells
Time Frame
Blood for immune analysis collected prior to, during and following study treatment (tx) (up to 6 months following study tx).
Title
Immune shift: Measurement of cytokine patterns
Description
Immune shift induced by Her2 BATs as detected by measurement of cytokine patterns
Time Frame
Blood for immune analysis collected prior to, during and following study treatment (tx) (up to 6 months following study tx).
Title
Immune shift: Determination of anti-Her2 antibodies
Description
Immune shift induced by Her2 BATs as detected by determination of anti-Her2 antibodies
Time Frame
Blood for immune analysis collected prior to, during and following study treatment (tx) (up to 6 months following study tx).
Title
Correlation of clinical and immune response characteristics to progression-free survival
Description
Correlation individually and by heatmap analysis of imaging, pathology, clinical, and immune response characteristics to progression free survival (PFS)
Time Frame
Blood collected prior to, during and following study treatment (tx) (up to 6 months following study tx). Clinical characteristics and imaging prior to and after study tx through 1st progression
Title
Correlation of clinical and immune response characteristics to overall survival
Description
Correlation individually and by heatmap analysis of imaging, pathology, clinical, and immune response characteristics to overall survival (OS).
Time Frame
Blood for immune analysis collected prior to, during and after study treatment (tx) (up to 6 months following study tx). Clinical characteristics and imaging prior to and after study tx through 1st progression
Title
Objective response rate (ORR)
Description
Proportion of participants with complete or partial response according to brain and spine MRI
Time Frame
Assessed on MRI studies done 9 weeks after first BATs infusion
Title
Progression-free survival (PFS)
Description
Length of time from study participation initiation through disease progression for each participant
Time Frame
From date of first BATs infusion (approximately 4 weeks following eligibility confirmation) until the date of confirmed progression, assessed up to 28 months
Title
Overall survival (OS)
Description
Length of time from study participation initiation through death or for 2 years following study treatment for each participant
Time Frame
Through each participant's death or for 2 years following study treatment
Title
MD Anderson Symptom Inventory for Spinal Tumors (MDASI - SP)
Description
The MDASI- SP is a 24 item questionnaire that focuses on symptoms related to spinal tumors. For each potential symptom, there is an eleven-point scale where 0 is "Not Present" and 10 is "As Bad As You Can Imagine" so the minimum score would be 0 and the maximum score would be 240. For a subset of questions, the scale measures how much the symptoms interfered with other parts of life and the scale ranges from symptoms that "Did Not Interfere" (0) to those that "Interfered Completely" (10). Lower scores indicate fewer/less severe/less interfering symptoms and higher scores indicate more/more severe/more interfering symptoms.
Time Frame
Prior to test dose of study treatment, prior to the 5th and 8th weekly infusions, and 30 days following last infusion
Title
MD Anderson Symptom Inventory for Brain Tumors (MDASI- BT)
Description
The MDASI- BT is a 28 item questionnaire that focuses on symptoms related to brain tumors. For each potential symptom, there is an eleven-point scale where 0 is "Not Present" and 10 is "As Bad As You Can Imagine" so the minimum score would be 0 and the maximum score would be 280. For a subset of questions, the scale measures how much the symptoms interfered with other parts of life and the scale ranges from symptoms that "Did Not Interfere" (0) to those that "Interfered Completely" (10). Lower scores indicate fewer/less severe/less interfering symptoms and higher scores indicate more/more severe/more interfering symptoms.
Time Frame
Prior to test dose of study treatment, prior to the 5th and 8th weekly infusions, and 30 days following last infusion

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Be willing and able to provide written informed consent for the trial. Participants must be female. Histologically confirmed breast cancer (any Her2, estrogen receptor (ER), or progesterone receptor (PR) expression) with leptomeningeal metastasis (LM) as determined by imaging and/or cerebrospinal fluid (CSF) cytology. 18 years of age or older. Women of reproductive potential must agree to use an effective method of contraception during therapy. Effective methods include intrauterine device (IUD), vasectomy of the male partner, diaphragm with spermicide, cervical cap with spermicide, contraceptive sponge, male or female condom, or hormonal contraceptive. Karnofsky Performance Status (KPS) of ≥60. Eligible for intraventricular (IVENT) catheter/reservoir placement as determined by neurosurgery. Demonstrate adequate organ function as defined below. All screening labs should be performed within 10 days of confirmation of eligibility. Absolute lymphocyte count ≥ 500/mm3 Absolute neutrophil count ≥ 1000/mcL Platelets ≥ 100,000 / mnL Hemoglobin ≥ 8 g/dL BUN ≤ 1.5 x upper limit of normal (ULN) Serum creatinine within the normal limits OR measured or calculated creatinine clearance ≥ 60 mL/min 1.73m2 Serum total bilirubin ≤ 2 x ULN OR AST (SGOT) and ALT (SGPT) ≤ 5 x ULN Albumin ≥ 2.5 mg/dL Exclusion Criteria: Current severe increased intracranial pressure with clinical or imaging findings suggestive of herniation, status epilepticus, or other serious complications requiring emergency or urgent intervention. Patients who cannot have MRI studies for any reason (intolerance, medical contraindication, etc.). Patients with a history of another malignancy within 1 year of study enrollment with the following exceptions: patients with history of ductal carcinoma in situ (DCIS), squamous cell skin cancers, or other in situ carcinomas are not excluded. Patients with unresolved autoimmune toxicity. Patients with a known disorder that increases the risk of bleeding (e.g., Hemophilia, von Willebrands disease, or clinically significant clotting factor deficiency). 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. Administration of any investigational agents, immunomodulating agents, radiation therapy or chemotherapy for MBC within the 7 days before the 80 mL blood draw to collect cells for study treatment. Has Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies) or known active Hepatitis B (e.g. HBsAg reactive) or Hepatitis C (e.g., HCV RNA [qualitative] is detected). Pregnancy or lactation at the time of registration. Psychiatric or addictive disorders or other conditions that in the opinion of the investigator would preclude the patient from complying with the study protocol.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Camilo Fadul, MD
Organizational Affiliation
University of Virginia
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Virginia
City
Charlottesville
State/Province
Virginia
ZIP/Postal Code
22908
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
25688159
Citation
Lum LG, Thakur A, Al-Kadhimi Z, Colvin GA, Cummings FJ, Legare RD, Dizon DS, Kouttab N, Maizel A, Colaiace W, Liu Q, Rathore R. Targeted T-cell Therapy in Stage IV Breast Cancer: A Phase I Clinical Trial. Clin Cancer Res. 2015 May 15;21(10):2305-14. doi: 10.1158/1078-0432.CCR-14-2280. Epub 2015 Feb 16.
Results Reference
background
PubMed Identifier
25802762
Citation
Vaishampayan U, Thakur A, Rathore R, Kouttab N, Lum LG. Phase I Study of Anti-CD3 x Anti-Her2 Bispecific Antibody in Metastatic Castrate Resistant Prostate Cancer Patients. Prostate Cancer. 2015;2015:285193. doi: 10.1155/2015/285193. Epub 2015 Feb 23.
Results Reference
background

Learn more about this trial

BATs in Patients With Breast Cancer and Leptomeningeal Metastases

We'll reach out to this number within 24 hrs