search
Back to results

Focused Ultrasound and Pembrolizumab in Metastatic Breast Cancer (Breast-48)

Primary Purpose

Breast Cancer

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Pembrolizumab
High-intensity focused ultrasound (HIFU)
Sponsored by
Patrick Dillon, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer focused on measuring breast cancer, pembrolizumab, focused ultrasound, immunotherapy

Eligibility Criteria

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

Inclusion Criteria (summary):

  • Histologically confirmed metastatic or unresectable breast cancer
  • Any receptor status (estrogen receptor, progesterone receptor, HER2 receptor). Patients who are HR+ should also no longer be candidates for hormonal-based therapy. Patients who are HER2+ should have progressed on or no longer be candidates for available HER2 directed therapy. Hormonal therapy must be stopped prior to day 1 of treatment.
  • Patients must have had at least one prior line of therapy for breast cancer in the metastatic setting.
  • Patients must have an accessible lesion in the breast/chest wall/axilla which has not been previously thermally ablated. Prior breast irradiation is acceptable if the lesion has recurred or grown following radiation.
  • Patients must agree to use an adequate method of contraception for the course of the study through 120 days after the last dose of study medication.
  • Patients must have at least one target lesion in breast/chest wall/axilla which is amenable to application of high intensity focused ultrasound:
  • Patients must be willing to provide tissue from a newly obtained core or excisional biopsy of a tumor lesion.
  • Performance status of 0 or 1 on the ECOG Performance Scale.
  • Adequate organ function

Exclusion Criteria (summary):

  • Patients currently participating and receiving study therapy or patients who have participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment.
  • Patients with a diagnosis of immunodeficiency, patients receiving systemic steroid therapy or, patients who have received any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment.
  • Patients with a known history of active Tuberculosis
  • Hypersensitivity to pembrolizumab or any of its excipients
  • Prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study Day 1. Patients who have not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier are excluded.
  • Prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1. Patients who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to a previously administered agent.
  • Known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer.
  • Known active central nervous system (CNS) metastases and/or carcinomatous meningitis.
  • Active autoimmune disease that has required systemic treatment in the past 2 years.
  • History of (non-infectious) pneumonitis that required steroids or current pneumonitis.
  • Active infection requiring systemic therapy.
  • Pregnancy
  • Prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent within the prior 24 weeks.
  • Known history of Human Immunodeficiency Virus (HIV)
  • Receipt of a live vaccine within 30 days of planned start of study therapy.
  • HIFU must not be applied to a breast with an implant. A region outside of the breast may be targeted as long as the targeted area is at least 10mm away from an implant.

Sites / Locations

  • University of Virginia

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Arm A: 1st dose of pembrolizumab after HIFU

Arm B: 1st dose of pembrolizumab before HIFU

Arm Description

Pembrolizumab (200 mg) administered intravenously, days 22, 43, 64, followed by day 1 of each ensuing 3 -week cycle. Focused ultrasound tumor ablation day 15. High-intensity focused ultrasound ablation will target 50% of the tumor, up to 3 cubic centimeters.

Pembrolizumab (200 mg) intravenously, days 1, 22, 43, 64, followed by day 1 of each ensuing 3 -week cycle. Focused ultrasound tumor ablation day 15. High-intensity focused ultrasound ablation will target 50% of the tumor, up to 3 cubic centimeters.

Outcomes

Primary Outcome Measures

Change in tumor infiltrating lymphocytes
Change in proportion of CD8+ tumor infiltrating lymphocytes (ration CD8+/CD4+) in the primary ablation zone

Secondary Outcome Measures

Adverse event profile of pembrolizumab and HIFU
Toxicities from the combination of pembrolizumab and HIFU

Full Information

First Posted
July 31, 2017
Last Updated
September 7, 2022
Sponsor
Patrick Dillon, MD
search

1. Study Identification

Unique Protocol Identification Number
NCT03237572
Brief Title
Focused Ultrasound and Pembrolizumab in Metastatic Breast Cancer
Acronym
Breast-48
Official Title
Focused Ultrasound Therapy to Augment Antigen Presentation and Immune-Specificity of Checkpoint Inhibitor Therapy With Pembrolizumab in Metastatic Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2022
Overall Recruitment Status
Terminated
Why Stopped
Low rate of enrollment
Study Start Date
September 25, 2017 (Actual)
Primary Completion Date
June 1, 2022 (Actual)
Study Completion Date
June 17, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Patrick Dillon, MD

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
Device Product Not Approved or Cleared by U.S. FDA
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This pilot study evaluates the use of high-intensity focused ultrasound (HIFU) combined with pembrolizumab in patients with metastatic breast cancer. One-half of participants will be randomized to receive the first dose of pembrolizumab after HIFU and one-half of participants will be randomized to receive their first dose of pembrolizumab before HIFU.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
breast cancer, pembrolizumab, focused ultrasound, immunotherapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Model Description
Pilot, 2-arm randomized study
Masking
None (Open Label)
Allocation
Randomized
Enrollment
13 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A: 1st dose of pembrolizumab after HIFU
Arm Type
Experimental
Arm Description
Pembrolizumab (200 mg) administered intravenously, days 22, 43, 64, followed by day 1 of each ensuing 3 -week cycle. Focused ultrasound tumor ablation day 15. High-intensity focused ultrasound ablation will target 50% of the tumor, up to 3 cubic centimeters.
Arm Title
Arm B: 1st dose of pembrolizumab before HIFU
Arm Type
Experimental
Arm Description
Pembrolizumab (200 mg) intravenously, days 1, 22, 43, 64, followed by day 1 of each ensuing 3 -week cycle. Focused ultrasound tumor ablation day 15. High-intensity focused ultrasound ablation will target 50% of the tumor, up to 3 cubic centimeters.
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
Keytruda
Intervention Description
Pembrolizumab (200 mg)
Intervention Type
Device
Intervention Name(s)
High-intensity focused ultrasound (HIFU)
Intervention Description
Ablation will target 50% of the tumor, up to 3 cubic centimeters
Primary Outcome Measure Information:
Title
Change in tumor infiltrating lymphocytes
Description
Change in proportion of CD8+ tumor infiltrating lymphocytes (ration CD8+/CD4+) in the primary ablation zone
Time Frame
baseline and week 4
Secondary Outcome Measure Information:
Title
Adverse event profile of pembrolizumab and HIFU
Description
Toxicities from the combination of pembrolizumab and HIFU
Time Frame
From date of randomization through 30 days following cessation of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria (summary): Histologically confirmed metastatic or unresectable breast cancer Any receptor status (estrogen receptor, progesterone receptor, HER2 receptor). Patients who are HR+ should also no longer be candidates for hormonal-based therapy. Patients who are HER2+ should have progressed on or no longer be candidates for available HER2 directed therapy. Hormonal therapy must be stopped prior to day 1 of treatment. Patients must have had at least one prior line of therapy for breast cancer in the metastatic setting. Patients must have an accessible lesion in the breast/chest wall/axilla which has not been previously thermally ablated. Prior breast irradiation is acceptable if the lesion has recurred or grown following radiation. Patients must agree to use an adequate method of contraception for the course of the study through 120 days after the last dose of study medication. Patients must have at least one target lesion in breast/chest wall/axilla which is amenable to application of high intensity focused ultrasound: Patients must be willing to provide tissue from a newly obtained core or excisional biopsy of a tumor lesion. Performance status of 0 or 1 on the ECOG Performance Scale. Adequate organ function Exclusion Criteria (summary): Patients currently participating and receiving study therapy or patients who have participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks of the first dose of treatment. Patients with a diagnosis of immunodeficiency, patients receiving systemic steroid therapy or, patients who have received any other form of immunosuppressive therapy within 7 days prior to the first dose of trial treatment. Patients with a known history of active Tuberculosis Hypersensitivity to pembrolizumab or any of its excipients Prior anti-cancer monoclonal antibody (mAb) within 4 weeks prior to study Day 1. Patients who have not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to agents administered more than 4 weeks earlier are excluded. Prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to study Day 1. Patients who has not recovered (i.e., ≤ Grade 1 or at baseline) from adverse events due to a previously administered agent. Known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer. Known active central nervous system (CNS) metastases and/or carcinomatous meningitis. Active autoimmune disease that has required systemic treatment in the past 2 years. History of (non-infectious) pneumonitis that required steroids or current pneumonitis. Active infection requiring systemic therapy. Pregnancy Prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent within the prior 24 weeks. Known history of Human Immunodeficiency Virus (HIV) Receipt of a live vaccine within 30 days of planned start of study therapy. HIFU must not be applied to a breast with an implant. A region outside of the breast may be targeted as long as the targeted area is at least 10mm away from an implant.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Patrick Dillon, 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

Citations:
PubMed Identifier
32819975
Citation
Sheybani ND, Witter AR, Thim EA, Yagita H, Bullock TNJ, Price RJ. Combination of thermally ablative focused ultrasound with gemcitabine controls breast cancer via adaptive immunity. J Immunother Cancer. 2020 Aug;8(2):e001008. doi: 10.1136/jitc-2020-001008.
Results Reference
derived

Learn more about this trial

Focused Ultrasound and Pembrolizumab in Metastatic Breast Cancer

We'll reach out to this number within 24 hrs