A2-ESO-1 TCR-Engineered T Cells for Relapsed/Refractory Advanced or Metastatic NY-ESO-1 Overexpression Positive Triple Negative Breast Cancer
Triple Negative Breast Cancer
About this trial
This is an interventional treatment trial for Triple Negative Breast Cancer
Eligibility Criteria
Inclusion Criteria: Female aged >= 18 years Histologically confirmed advanced or metastatic TNBC that have relapsed on or are refractory to 2 or more lines of standard-of-care therapy including immune checkpoint inhibitors, chemotherapy, trastuzumab deruxtecan (TDX-d) and poly-ADP ribose polymerase (PARP) inhibitors if indicated, but less than 4 lines of total therapies. TNBC is defined as estrogen receptor (ER) and progesterone receptor negative (< 10% immunohistochemistry [IHC] staining) and HER2 negative (IHC 1+ or 0 AND/OR in situ hybridization negative based on: Single-probe average HER2 copy number < 4.0 signals/cell Dual-probe HER2/CEP17 ratio < 2.0 with an average HER2 copy number < 4.0 signals/cell) HLA-A2+ and tumoral overexpression of NY-ESO-1 (2 to 3+ IHC staining in > 50% of cells) Have measurable disease based on RECIST 1.1 Life expectancy >= 6 months Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 Hemoglobin >= 9.0 g/dL (transfusions permitted) Absolute neutrophil count (ANC) >= 1500/mm^3 Platelet count >= 100,000/mm^3 Creatinine (Cr) < 2 x upper limit of normal (ULN), and Cr clearance (CrCl) >= 50 mL/min by Cockcroft and Gault Alanine transaminase (ALT) and aspartate transaminase (AST) < 2 x ULN (Patients with liver metastases whose ALT/AST are < 5 x ULN are eligible for enrollment) Bilirubin < 2 x ULN White blood cell (WBC) count > 2500/uL and < 15000/uL Lymphocyte count >= 500/uL Cardiac ejection fraction >= 50% Negative serum pregnancy (human chorionic gonadotropin [beta-hCG]) test within 7 days of day 0 (leukapheresis) for women of childbearing potential (WOCBP). WOCBP must be willing to use a highly effective method of contraception for the course of the study through 90 days after A2-ESO-1 TCR-engineered T cell infusion Willing and able to provide written informed consent for the study Willing to provide biopsy tissues and blood samples as required by the study Exclusion Criteria: Radiation therapy, chemotherapy, or non-cytotoxic investigational agent within 2 weeks of day 0 (leukapheresis) Received cyclophosphamide within the past 4 months Evidence of New York Heart Association class III or greater cardiac disease History of myocardial infarction, stroke, ventricular arrhythmia, or symptomatic conduction abnormality within the past 12 months History of congenital QT prolongation Absolute QT interval of > 470 msec in the presence of > 4.0 mEq/L potassium and > 1.8 mg/dL magnesium Brain or leptomeningeal metastases Females who are pregnant or breastfeeding Hypersensitivity or intolerance to cyclophosphamide, fludarabine, or their components Alcoholic liver disease or other hepatic disease with the exception of liver metastases History of gastrointestinal bleeding, ulceration, or perforation Any severe and/or uncontrolled medical conditions or other conditions that could affect participation in the study, such as severely impaired lung function, any active (acute or chronic) or uncontrolled infection/disorders, and non-malignant medical illnesses that are uncontrolled or whose control may be jeopardized by the study treatment Current use of medications that interact with or compromise the immune system such as steroid doses > 10 mg/day prednisone or equivalent daily within 2 weeks before leukapheresis History of immunodeficiency disease or autoimmune disease Concurrent use of any complementary or alternative medicines Unwilling or unable to comply with the study protocol Prior major surgery that requires general anesthesia must be completed at least 4 weeks before leukapheresis and surgery that requires local anesthesia (except for study tissue sample collection) must be completed at least 2 weeks before leukapheresis
Sites / Locations
- USC / Norris Comprehensive Cancer Center
Arms of the Study
Arm 1
Experimental
Treatment (A2-ESO-1 TCR-T cells)
Patients undergo leukapheresis on day -28 then receive cyclophosphamide IV over 1 hour on days -7 and -6 followed by fludarabine IV over 30 minutes on days -5 to -1. Patients then receive A2-ESO-1 TCR-T cells IV over 30 minutes on day 0 followed by aldesleukin IV over 15 minutes on days 0 to 2. Patients also undergo blood sample collection and CT scans throughout the study. Additionally, patients may undergo a breast biopsy, a mammogram, breast MRI, and breast US at screening and follow up, and ECHO or MUGA at screening.