Treatment of Advanced or Metastatic Triple-negative Breast Cancer With Adoptive Therapy of PD1+ TILS (TILS001)

This is an interventional treatment trial for Metastatic Triple-Negative Breast Carcinoma focused on measuring TNBC, Breast Cancer, metastatic, triple negative Read More

Eligibility criteria for Part #1 (Molecular pre-screening: Determination of PD1 by mRNA analysis from an archival FFPE tumor sample):

Participants are eligible to be included in the study only if all of the following criteria apply:

1. Age ≥ 18 years. Enrollment of patients > 70 years of age is allowed after consultation and approval of the study medical monitor.
2. Estimated life expectancy of ≥6 months.
3. Histologically confirmed diagnosis of unresectable or metastatic breast cancer.
4. Histologically confirmed diagnosis of advanced triple-negative breast cancer (based on the most recently analyzed biopsy from locally recurrent or metastatic site, local laboratory) meeting the following criteria: HER2-negative in situ hibridation test or an immunohistochemistry (IHC) status of 0 or 1+, and ER and PgR expressions <10% as determined locally by IHC assay as per most recent ASCO/CAP guidelines.
5. Metastatic triple-negative breast cancer, being candidate to first-line taxane-based containg regimen. Biologic treatments (such as: atezolizumab and bevazicumab) are permitted as per standard criteria. Previous (neo)adjuvant taxanes are permitted (if completed ≥12 months before recurrence).
6. For patients included in the run-in safety phase, multiple lines of chemotherapy are permitted.

7. Patients must not have history of other malignancy within the past 3 years with the following exceptions:

   a. adequately treated non-melanoma skin cancer without evidence of disease at the time of enrollment b. adequately treated cervical carcinoma in situ without evidence of disease at the time of enrollment c. adequately treated breast d. prostatic intraepithelial neoplasia without evidence of prostate cancer at the time of enrollment e. adequately treated superficial or in-situ carcinoma of the bladder without evidence of disease at the time of enrollment.

8. Subject likely to be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures to the best of the subject and investigator's knowledge.
9. Absence of psychiatric or physiologic history, substance abuse, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule; those conditions should be discussed with the patient before registration in the trial.
10. Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
11. Pregnant or breast-feeding women will NOT be elegible.
12. Subject has known sensitivity to any of the products or components to be administered during dosing will NOT be eligible.
13. NOT having an immediate family member (eg, spouse, parent/legal guardian, sibling, or child) who is investigational site or sponsor staff directly involved in this trial, unless prospective institutional review board (IRB)/independent ethics committee (IEC) approval (by chair or designee) is given allowing exception to this criterion for a specific subject
14. Patients must NOT had undergone prior allogeneic hematopoietic stem cell transplantation
15. Patients with a history or evidence of symptomatic autoimmune will NOT be eligible: glomerulonephritis, vasculitis, or other symptomatic autoimmune disease, or active autoimmune disease or syndrome that has required systemic treatment in the past 2 years (ie, with use of disease modifying agents, corticosteroids or immunosuppressive drugs) except vitiligo or resolved childhood asthma/atopy. Replacement therapy (eg, thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
16. Absence of active bacillus tuberculosis history.
17. Absence of a known history of Human Immunodeficiency Virus (HIV). Note: No HIV testing is required.
18. Absence of a known history of Hepatitis B (defined as Hepatitis B surface antigen [HBsAg] reactive) or known active Hepatitis C virus (defined as HCV RNA is detected) infection. Note: no testing for Hepatitis B and Hepatitis C is required.

19. To be able to provide either a newly obtained tumor biopsy (preferred) or archival tumor tissue of a FFPE tumor block. The tumor tissue should be of good quality based on total and viable tumor content and must be evaluated centrally for gene expression analysis prior to enrollment in Part #2. Patients whose tumor tissue is NOT evaluable for PD1 expression central testing are not eligible.

    • Acceptable samples include core needle biopsies for deep tumor tissue or excisional, incisional, punch, or forceps biopsies for cutaneous, subcutaneous, or mucosal lesions or biopsies from bone metastases.
    • Fine needle aspiration, brushing, cell pellet from pleural effusion or lavage samples are not acceptable.

Eligibility criteria for Part #2 (Pre-Screening Phase: Selection, isolation and partial expansion of PD1+ TILs from a fresh tumor sample):

Participants are eligible to be included in the study only if all of the previous and the following criteria apply:

1. Patients will be elegible for Part #2 if they have a PD-1 mRNA expression above the 50th percentile (as described in L Paré et al; Annals of Oncol, 2018 Oct 1;29(10):2121-2128) in the FFPE tumor sample analysed in Part 1.
2. At least 1 resectable target lesion to generate TIL of a minimum 1.0 cm in diameter post- resection; surgical removal with minimal morbidity (defined as any procedure for which expected hospitalization is ≤3 days). Fine needle aspiration, brushing, cell pellet from pleural effusion, biopsies from lymph node are not acceptable, biopsies from bone metastases and lavage samples are not acceptable.
3. Patients should be candidate OR receiving a first line of treatment
4. Patients must NOT have clinically active cerebral metastases. Carcinomatous meningitis is no allowed regardless of clinical stability.

Eligibility criteria for Part #3 (Screening and treatment Phase: Complete expansion of PD1+TILs. Treatment of patients with PD1+ TILs infusion):

Participants are eligible to be included in the study only if all of the previous and the following criteria apply. For being included in this section, the following criteria must apply:

1. PD1+ TILs selection in Part #1 and successful partial expansion of tumor sample in Part #2
2. Resolution of all acute toxic effects of prior induction chemotherapy regimen to NCI CTCAE version 5.0 Grade ≤1 (except alopecia or other toxicities not considered a safety risk for the patient at investigator's discretion).
3. Patients must have received an acceptable, standard, chemotherapy containing taxane for the treatment of metastatic breast cancer prior to study enrollment. Eligible patients are expected to have completed 6 cycles of taxane chemotherapy. Patients are eligible if no evidence of disease progression by local assessment (i.e. CR, PR or SD) is observed. A minimum of 4 cycles of treatment are acceptable for patients experiencing significant toxicity associated with treatment as long as they are without evidence of disease progression (i.e. CR, PR or SD). The maximum number of cycles is 12. Patients can be included in Part#3 either immediately following completion of their induction therapy or after a gap of ≤12 weeks between their last infusion/dose of chemotherapy and the initiation of NMA-LD.

4. Adequate organ function determined within 28 days prior to enrollment, defined as follows:

   • Hematological
   • ANC ≥ 1.5 x 109/L
   • Platelet count ≥ 100 x 109/L
   • Hemoglobin ≥ 9 g/dL (without need for hematopoietic growth factor or transfusion support)
   • Renal
   • Serum creatinine ≤ 1.5 x upper limit of normal (ULN), OR 24-hour creatinine clearance ≥ 60 mL/min for subject with creatinine levels > 1.5 x ULN. (Note: Creatinine clearance need not be determined if the baseline serum creatinine is within normal limits. Creatinine clearance should be calculated per institutional standard).
   • Hepatic
   • Serum bilirubin ≤ 1.5 x ULN OR direct bilirubin ≤ ULN for a subject with total bilirubin level > 1.5 x ULN
   • Aspartate aminotransferase (AST) ≤ 2.5 x ULN OR ≤ 5 x ULN for subject with liver metastases.
   • Alanine aminotransferase (ALT) ≤ 2.5 x ULN OR ≤ 5 x ULN for subject with liver metastases.
   • Coagulation
   • International normalization ratio (INR) or prothrombin time (PT) ≤ 1.5 x ULN unless the subject is receiving anticoagulant therapy as long as PT and partial thromboplastin time (PTT)/activated PTT (aPTT) is within therapeutic range of intended use of anticoagulants

20. Female subject of childbearing potential must have a negative urine or serum pregnancy test within 72 hours prior to enrollment. If the urine pregnancy test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.

21. For patients ≥ 60 years or patients who have a history of ischemic heart disease, chest pain, or clinically significant atrial and/or ventricular arrhythmias, a cardiac stress tests must be performed showing normal LVEF, NYHA functional classification < class 1 and if any wall movement abnormalities, they must be reversible 22. Left ventricular ejection fraction (LVEF) ≥ 50% at baseline as determined by either ECHO or MUGA 23. Patients must have recovered from prior toxicities (i.e. ≥ grade 1) from prior therapies. Grade 2 for neuropathy is allowed.

24. Patients must not be currently receiving treatment with another investigational device or drug study. No other investigational procedures (of any kind) are permitted while participating in this study. Maintentance therapy with atezolizumab or bevacizumab is allowed.

25. Systemic steroid therapy is not permitted (patients who require replacement therapy for adrenal insufficiency may be enrolled if steroid treatment dose do not exceed 10 mg of prednisone or equivalent).

26. Patients with evidence of clinically significant immunosuppression will NOT be eligible such as the following:

1. diagnosis of immunodeficiency
2. concurrent opportunistic infection

27. Patients with evidence of (non-infectious) pneumonitis that required steroids or current pneumonitis will NOT be elegible.