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"neoBREASTIM": Atezolizumab Plus RP1 Oncolytic Immunotherapy in the NeoAdjuvant Setting of Triple-Negative Breast Cancer (neoBREASTIM)

Primary Purpose

Triple Negative Breast Neoplasms

Status
Not yet recruiting
Phase
Phase 1
Locations
France
Study Type
Interventional
Intervention
Atezolizumab + RP1
Sponsored by
Institut Curie
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Triple Negative Breast Neoplasms focused on measuring Triple Negative Breast Cancer, Early-stage, Immunotherapy, Oncolytic virus

Eligibility Criteria

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

Inclusion Criteria: Female subject Age ≥ 18 years old. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) ≤ 1. Newly diagnosed Triple-Negative Breast Cancer (TNBC), defined as the absence of estrogen expression and progesterone expression, and of Human Epidermal growth factor Receptor 2 (HER2) overexpression, must be determined by local testing of a screening tumor sample as defined by American Society of Clinical Oncology/College of American Pathologists guidelines. TNBC defined as the following combined primary tumor (T), regional lymph node (N), and metastatic (M) American Joint Committee on Cancer staging criteria: cT ≥15 - ≤30 mm, N0, M0 according to Mammogram, breast Ultrasound and MRI, and PET-CT. In case of a difference in the measurement of the primary tumor among different imaging methods, the breast MRI measurement is the reference. Unicentric, unifocal and unilateral disease. Tumor-infiltrating lymphocytes (TILs) ≥ 30%, as defined by the International TILs Working Group 2014. ctDNA dosing at baseline. Agreement to provide tissue samples (tumor biopsy at screening and on-treatment), and at surgery for immune monitoring and translational research activities. Agreement to perform blood samples at screening, on-treatment, and at surgery for immune monitoring and translational research activities. Exclusion Criteria: Inflammatory breast cancer. Prior treatment with an oncolytic virus-based therapy. Patients with active significant herpetic infections or prior complications of Herpes Simplex Virus-1 (HSV-1) infection. Patients who require intermittent or chronic use of systemic (oral or IV) antivirals with known antiherpetic activity (e.g., acyclovir). Diagnosis of immunodeficiency. Has active autoimmune disease (e.g. inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, and multiple sclerosis, celiac disease, Wegener's granulomatosis) that has required systemic treatment in the past 3 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Prior systemic immunosuppressive medication (except physiologic corticosteroid replacement therapy) within 30 days of planned start of study therapy. Any live (attenuated) vaccine within 14 days of planned start of study therapy. Prior immunotherapy, including tumor vaccine, cytokine, anti-CTLA4, PD-1/PD-L1 blockade or similar agents, T cell receptor-based (TCR-based) or Chimeric Antigen Receptor-T (CAR-T) cell based adoptive cell therapy. Known history of, or any evidence of active, non-infectious pneumonitis.

Sites / Locations

  • Institut Curie

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Atezolizumab plus RP1 (Immulytic™) oncolytic immunotherapy

Arm Description

Atezolizumab IV q2w RP1 (Immulytic™) by imaging-guided intra-tumor (IT) route.

Outcomes

Primary Outcome Measures

Safety of the combination Atezolizumab plus RP1 oncolytic during the safety run-in phase
Incidence of combination Atezolizumab plus RP1 adverse events (AEs) graded according to NCI CTCAE v5.0 and nature and severity
Toxicity of the combination Atezolizumab plus RP1 oncolytic immunotherapy during the safety run-in phase.
Dose Limiting Toxicity (DLT) during the first cycle of treatment of the combination Atezolizumab plus RP1 oncolytic immunotherapy
Residual Cancer Burden (RCB) 0-1 during the phase II part
Rate of RCB 0-1 at time of surgery (in patients with no increase in ctDNA after cycle 3)

Secondary Outcome Measures

Response rate of RCB Score <= 1 at three cycles
Rate of RCB 0-1 after cycle 3 (in patients with no increase in ctDNA after cycle 3)
Safety and toxicity of the combination Atezolizumab plus RP1 oncolytic immunotherapy
Incidence, nature and severity of adverse events (AEs) graded according to NCI CTCAE v5.0 from the treatment start to the surgery
Invasive disease-free survival (iDFS)
iDFS will be measured using regular follow-up visits
Percentage of TILs
The percentage of TILs will be estimated and compared between RCB rates 0-1 versus 2-3
Pre-treatment expression of Programmed Death-Ligand 1 (PD-L1)
Expression of PD-L1 will be estimated and compared between RCB rates 0-1 versus 2-3
Correlation between RCB rates and response by Positron Emission Tomography-Scan (PET-CT) or breast MRI
To correlate the response by RCB rates with response by PET-CT or breast MRI will be studied
RCB rates and response
To correlate the response by breast MRI with RCB 0-1 rates,
Breast Conservation Surgery (BCS)
The rate of Breast Conservation Surgery (BCS) will be presented
Correlation between RCB rates and radiomics analyses
To correlate the RCB rates with response by radiomics analyses.

Full Information

First Posted
September 25, 2023
Last Updated
October 2, 2023
Sponsor
Institut Curie
Collaborators
Replimune Inc., Roche Pharma AG
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1. Study Identification

Unique Protocol Identification Number
NCT06067061
Brief Title
"neoBREASTIM": Atezolizumab Plus RP1 Oncolytic Immunotherapy in the NeoAdjuvant Setting of Triple-Negative Breast Cancer
Acronym
neoBREASTIM
Official Title
"neoBREASTIM": A Phase 2 Study of Atezolizumab Plus RP1 Oncolytic Immunotherapy in the NeoAdjuvant Setting of Triple-Negative Breast Cancer (TNBC)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 15, 2023 (Anticipated)
Primary Completion Date
February 15, 2026 (Anticipated)
Study Completion Date
February 15, 2031 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Institut Curie
Collaborators
Replimune Inc., Roche Pharma AG

4. Oversight

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

5. Study Description

Brief Summary
Neoadjuvant treatment is an important part of the treatment strategy for locally advanced TNBC having established a positive and significant correlation of pathologic Complete Response (pCR) with long-term clinical benefit such as Event-Free Survival (EFS) and Overall Survival (OS) as shown via large meta-analysis. Much effort has been made to identify novel agents and new drug combinations that can improve pCR rates in this specific clinical setting, which is the leading rationale to evaluate RP1 oncolytic immunotherapy in combination with Atezolizumab.
Detailed Description
The combination of RP1 plus Atezolizumab, while being expected to result in increased efficacy, is not expected to result in significant additional toxicity, as compared to either agent alone. Capitalizing on the strong prognostic and predictive value of the TIL infiltrate in early-stage TNBC and the capacity of circulating tumor DeoxyriboNucleic Acid (ctDNA) detection to predict response to immunotherapy and NeoAdjuvant Chemotherapy (NAC), neoBREASTIM - a single-arm phase 2 study - will evaluate a novel, biomarker-driven combination of Atezolizumab plus RP1 oncolytic immunotherapy in the neo-adjuvant setting of patients diagnosed with early-stage, TIL-high TNBC.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Triple Negative Breast Neoplasms
Keywords
Triple Negative Breast Cancer, Early-stage, Immunotherapy, Oncolytic virus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Model Description
An open-label, monocentric, single arm, phase II study with a safety run-in.
Masking
None (Open Label)
Allocation
N/A
Enrollment
51 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Atezolizumab plus RP1 (Immulytic™) oncolytic immunotherapy
Arm Type
Experimental
Arm Description
Atezolizumab IV q2w RP1 (Immulytic™) by imaging-guided intra-tumor (IT) route.
Intervention Type
Combination Product
Intervention Name(s)
Atezolizumab + RP1
Other Intervention Name(s)
Tecentriq®, Vusolimogene Oderparepvec
Intervention Description
Patients will be treated in a window period (ie 3 treatment cycles). After evaluation, patients that had no increase in ctDNA after 3 cycles (see Definition of ctDNA status) will continue on the same treatment (intratumoral injections of RP1 in combination with Atezolizumab) for a total of 10 treatment cycles prior to surgery.
Primary Outcome Measure Information:
Title
Safety of the combination Atezolizumab plus RP1 oncolytic during the safety run-in phase
Description
Incidence of combination Atezolizumab plus RP1 adverse events (AEs) graded according to NCI CTCAE v5.0 and nature and severity
Time Frame
9 months
Title
Toxicity of the combination Atezolizumab plus RP1 oncolytic immunotherapy during the safety run-in phase.
Description
Dose Limiting Toxicity (DLT) during the first cycle of treatment of the combination Atezolizumab plus RP1 oncolytic immunotherapy
Time Frame
9 months
Title
Residual Cancer Burden (RCB) 0-1 during the phase II part
Description
Rate of RCB 0-1 at time of surgery (in patients with no increase in ctDNA after cycle 3)
Time Frame
30 months
Secondary Outcome Measure Information:
Title
Response rate of RCB Score <= 1 at three cycles
Description
Rate of RCB 0-1 after cycle 3 (in patients with no increase in ctDNA after cycle 3)
Time Frame
26 months
Title
Safety and toxicity of the combination Atezolizumab plus RP1 oncolytic immunotherapy
Description
Incidence, nature and severity of adverse events (AEs) graded according to NCI CTCAE v5.0 from the treatment start to the surgery
Time Frame
60 months
Title
Invasive disease-free survival (iDFS)
Description
iDFS will be measured using regular follow-up visits
Time Frame
60 months
Title
Percentage of TILs
Description
The percentage of TILs will be estimated and compared between RCB rates 0-1 versus 2-3
Time Frame
30 months
Title
Pre-treatment expression of Programmed Death-Ligand 1 (PD-L1)
Description
Expression of PD-L1 will be estimated and compared between RCB rates 0-1 versus 2-3
Time Frame
30 months
Title
Correlation between RCB rates and response by Positron Emission Tomography-Scan (PET-CT) or breast MRI
Description
To correlate the response by RCB rates with response by PET-CT or breast MRI will be studied
Time Frame
60 months
Title
RCB rates and response
Description
To correlate the response by breast MRI with RCB 0-1 rates,
Time Frame
60 months
Title
Breast Conservation Surgery (BCS)
Description
The rate of Breast Conservation Surgery (BCS) will be presented
Time Frame
30 months
Title
Correlation between RCB rates and radiomics analyses
Description
To correlate the RCB rates with response by radiomics analyses.
Time Frame
30 months

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Female subject Age ≥ 18 years old. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) ≤ 1. Newly diagnosed Triple-Negative Breast Cancer (TNBC), defined as the absence of estrogen expression and progesterone expression, and of Human Epidermal growth factor Receptor 2 (HER2) overexpression, must be determined by local testing of a screening tumor sample as defined by American Society of Clinical Oncology/College of American Pathologists guidelines. TNBC defined as the following combined primary tumor (T), regional lymph node (N), and metastatic (M) American Joint Committee on Cancer staging criteria: cT ≥15 - ≤30 mm, N0, M0 according to Mammogram, breast Ultrasound and MRI, and PET-CT. In case of a difference in the measurement of the primary tumor among different imaging methods, the breast MRI measurement is the reference. Unicentric, unifocal and unilateral disease. Tumor-infiltrating lymphocytes (TILs) ≥ 30%, as defined by the International TILs Working Group 2014. ctDNA dosing at baseline. Agreement to provide tissue samples (tumor biopsy at screening and on-treatment), and at surgery for immune monitoring and translational research activities. Agreement to perform blood samples at screening, on-treatment, and at surgery for immune monitoring and translational research activities. Exclusion Criteria: Inflammatory breast cancer. Prior treatment with an oncolytic virus-based therapy. Patients with active significant herpetic infections or prior complications of Herpes Simplex Virus-1 (HSV-1) infection. Patients who require intermittent or chronic use of systemic (oral or IV) antivirals with known antiherpetic activity (e.g., acyclovir). Diagnosis of immunodeficiency. Has active autoimmune disease (e.g. inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, and multiple sclerosis, celiac disease, Wegener's granulomatosis) that has required systemic treatment in the past 3 years (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Prior systemic immunosuppressive medication (except physiologic corticosteroid replacement therapy) within 30 days of planned start of study therapy. Any live (attenuated) vaccine within 14 days of planned start of study therapy. Prior immunotherapy, including tumor vaccine, cytokine, anti-CTLA4, PD-1/PD-L1 blockade or similar agents, T cell receptor-based (TCR-based) or Chimeric Antigen Receptor-T (CAR-T) cell based adoptive cell therapy. Known history of, or any evidence of active, non-infectious pneumonitis.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Emanuela ROMANO, MD
Phone
+33172389335
Email
emanuela.romano@curie.fr
First Name & Middle Initial & Last Name or Official Title & Degree
Isabelle TURBIEZ
Phone
+33156245630
Email
drci.promotion@curie.fr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven Le Gouill, PhD
Organizational Affiliation
Institut Curie
Official's Role
Study Director
Facility Information:
Facility Name
Institut Curie
City
Paris
ZIP/Postal Code
75005
Country
France
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Emanuela Curie, MD
Phone
+33172389335
Email
emanuela.romano@curie.fr

12. IPD Sharing Statement

Learn more about this trial

"neoBREASTIM": Atezolizumab Plus RP1 Oncolytic Immunotherapy in the NeoAdjuvant Setting of Triple-Negative Breast Cancer

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