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INVINCIBLE TRIAL: Intratumoral INT230-6 in Breast Cancer

Primary Purpose

Breast Cancer

Status
Recruiting
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
INT230-6
Saline injection
Sponsored by
Ottawa Hospital Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer focused on measuring window of opportunity, intratumoral, Ki67, complete pathologic response (PCR), immune activation, INT230-6, cisplatin, vinblastine, cell cycle arrest

Eligibility Criteria

undefined - undefined (Child, Adult, Older Adult)FemaleAccepts Healthy Volunteers

Inclusion Criteria:

  1. Female patients with newly diagnosed histologically confirmed primary invasive breast cancer currently not undergoing any treatment while awaiting surgery.
  2. Patients with early, operable stage I to II breast cancer amendable for complete surgical resection as assessed by treating surgical oncologist.
  3. Tumors must be clinically palpable by surgeon. Part I: ≥ 1.0 cm by palpation or on imaging. Part II: ≥ 1.5 cm by palpation or on imaging.
  4. Histologic Bloom Richardson grade ≥2.

4. Invasive ductal or lobular carcinoma, invasive carcinoma Not Otherwise Specified (NOS).

5. ECOG PS 0-2 (Appendix A). 6. The participant (or legally acceptable representative if applicable) is able to provide written informed consent for the study.

Exclusion Criteria:

  1. Locally advanced or metastatic breast cancer.
  2. Prior therapy with chemotherapy or planned neoadjuvant chemotherapy.
  3. Pre-dominant histology other than invasive ductal or lobular carcinoma or invasive carcinoma NOS.
  4. Patients with an active infection.
  5. Absolute Neutrophil Count < 1.5 x 10^9/L.
  6. Patients with pre-existing renal impairment, Creatinine clearance calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation of less than 50 mL/min/1.73m2.
  7. Any serious known immediate or delayed hypersensitivity reaction(s) to vinblastine or cisplatin or idiosyncrasy to drugs chemically related to the investigational drugs.
  8. Known allergic reaction to local anesthetic (Xylocaine, Marcaine).
  9. Concurrent medical condition requiring the use of immunosuppressive medications, or systemic corticosteroids at doses of greater than 10 mg Prednisone-equivalent Topical steroids and other localized corticosteroids are permitted. Use of steroids as prophylactic treatment for subjects with contrast allergies to diagnostic imaging contrast dyes will be permitted.
  10. Concurrent use of a prohibited medication or planned use of any forbidden medications during treatment with INT230-6, or within 4 weeks prior to study drug administration, which include chemotherapy, immunotherapy (tumor vaccine, cytokine, or growth factor given to control the cancer: systemic or intratumoral), other biologic therapy, investigational therapy, or hormonal therapy, cisplatin containing agents, and vinblastine containing agents while on treatment in this study. Other prohibited concomitant medications that will interact with vinblastine and cisplatin include mitomycin, phenytoin, CYP3A4 inhibitors (ketoconazole, voriconazole, clarithromycin, erythromycin), nephrotoxic drugs (aminoglycosides, amphotericin), or pure pyridoxine (pyridoxine contained in multivitamin is permitted). Use of other investigational drugs (drugs not marketed for any indication) within 4 weeks prior to study drug administration not permitted.
  11. Pregnancy if patient is of childbearing age) or breast feeding.
  12. Subjects with signs/symptoms suggestive of COVID-19 or known COVID-19 positive contacts in the past 14 days would be tested as per local Public Health and/or Institutional Guidelines. If patients are COVID-19 positive at the time of screening, they would be excluded from the trial.
  13. Any underlying medical condition that, in the Principal Investigator's opinion, will make the administration of study drug hazardous or obscure the interpretation of toxicity determination or adverse events, or renders the patient ineligible to be on study.

Sites / Locations

  • The Ottawa Hospital Research Institute and Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

INT230-6 Treated Arm

Control Arm

Arm Description

Part I: Patients will receive up to 3 doses of INT230-6 injected weekly prior to breast surgery Part II: Patients will receive up to 2 intratumoral doses of INT230-6 (over a 15-day period) prior to breast surgery

Part I: No intervention while awaiting surgery Part II: Placebo saline injection

Outcomes

Primary Outcome Measures

The proportion of patients achieving a CCCA defined as a reduction in the proportion of cells staining positive for Ki67 as assessed by immunohistochemistry to less than a natural logarithm, or ≤2.7%, at the post-treatment specimen.
Tumor's viable plus necrotic tissue, at the post-treatment specimen.

Secondary Outcome Measures

The proportion of patients that achieved a complete pathologic response on surgical pathology as measured by the residual cancer burden index
Assessed by the local pathologist at the time of definitive surgery in subjects with breast cancer
Immunohistochemical and gene expression markers of necrosis, apoptosis and tumor proliferation pathways.
Comparison of pre (diagnostic biopsy) and post treatment (surgical resection) samples
Markers of immunomodulation including macrophages, NK, DC, CD4 T-cells, CD8 T-cells, regulatory T-cells.
Comparison of pre (diagnostic biopsy) and post treatment (surgical resection) samples
Adverse effects of INT230-6 injected to breast cancers in healthy patients prior to surgery.
overall safety of INT230-6 injected prior to surgery

Full Information

First Posted
January 25, 2021
Last Updated
November 9, 2021
Sponsor
Ottawa Hospital Research Institute
Collaborators
Intensity Therapeutics, Inc., Ontario Institute for Cancer Research
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1. Study Identification

Unique Protocol Identification Number
NCT04781725
Brief Title
INVINCIBLE TRIAL: Intratumoral INT230-6 in Breast Cancer
Official Title
A Phase II Randomized Window of Opportunity Trial Evaluating Clinical and Biological Effects of Intratumoral INT230-6 in Early Stage Breast Cancer: The INVINCIBLE Trial
Study Type
Interventional

2. Study Status

Record Verification Date
November 2021
Overall Recruitment Status
Recruiting
Study Start Date
March 25, 2021 (Actual)
Primary Completion Date
March 1, 2022 (Anticipated)
Study Completion Date
March 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ottawa Hospital Research Institute
Collaborators
Intensity Therapeutics, Inc., Ontario Institute for Cancer Research

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase II, randomized, multi-center, parallel design, window of opportunity trial evaluating intratumoral INT230-6 in up to 90 patients with early stage breast cancer. In a 2:1 randomization, patients on the treatment arm will receive intratumoral INT230-6 injections prior to breast surgery.
Detailed Description
The study comprises 2 consecutive parts. The first part will be to test safety and feasibility of the dosing procedures. Results from Part I of the study will standardise the optimal dose and frequency of INT230-6 for participants in Part II. Part I: Open-label 2:1 randomized study of up to 30 patients. Treatment arm patients will be given up to 3 doses of INT230-6 injected weekly prior to breast surgery, at a dose based on longest diameter. The control arm patients receive no treatment. Part II: Double-blind, 2:1 randomized study of up to an additional 60 patients. The placebo arm includes a saline injection of similar dose and frequency as the treatment arm (up to 2 doses of INT230-6/saline injected weekly prior to breast surgery).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer
Keywords
window of opportunity, intratumoral, Ki67, complete pathologic response (PCR), immune activation, INT230-6, cisplatin, vinblastine, cell cycle arrest

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
90 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
INT230-6 Treated Arm
Arm Type
Experimental
Arm Description
Part I: Patients will receive up to 3 doses of INT230-6 injected weekly prior to breast surgery Part II: Patients will receive up to 2 intratumoral doses of INT230-6 (over a 15-day period) prior to breast surgery
Arm Title
Control Arm
Arm Type
Placebo Comparator
Arm Description
Part I: No intervention while awaiting surgery Part II: Placebo saline injection
Intervention Type
Drug
Intervention Name(s)
INT230-6
Other Intervention Name(s)
Cisplatin, Vinblastine, 2-hydroxybenzoylaminooctanoate (SAHO)
Intervention Description
INT230-6 is a formulation of two well known chemotherapeutic agents, cisplatin (0.5mg/mL) and vinblastine sulfate (0.1mg/mL), combined with 2-hydroxybenzoylaminooctanoate (also known as SHAO-FA or SHAO as a sodium salt at 10mg/mL).
Intervention Type
Other
Intervention Name(s)
Saline injection
Intervention Description
Standard 0.9 % NaCl Normal Saline
Primary Outcome Measure Information:
Title
The proportion of patients achieving a CCCA defined as a reduction in the proportion of cells staining positive for Ki67 as assessed by immunohistochemistry to less than a natural logarithm, or ≤2.7%, at the post-treatment specimen.
Description
Tumor's viable plus necrotic tissue, at the post-treatment specimen.
Time Frame
presurgical window (period from diagnosis to surgery window of 3-6 weeks)
Secondary Outcome Measure Information:
Title
The proportion of patients that achieved a complete pathologic response on surgical pathology as measured by the residual cancer burden index
Description
Assessed by the local pathologist at the time of definitive surgery in subjects with breast cancer
Time Frame
presurgical window (period from diagnosis to surgery of 3-6 weeks)
Title
Immunohistochemical and gene expression markers of necrosis, apoptosis and tumor proliferation pathways.
Description
Comparison of pre (diagnostic biopsy) and post treatment (surgical resection) samples
Time Frame
presurgical window (period from diagnosis to surgery of 3-6 weeks)
Title
Markers of immunomodulation including macrophages, NK, DC, CD4 T-cells, CD8 T-cells, regulatory T-cells.
Description
Comparison of pre (diagnostic biopsy) and post treatment (surgical resection) samples
Time Frame
presurgical window (period from diagnosis to surgery of 3-6 weeks)
Title
Adverse effects of INT230-6 injected to breast cancers in healthy patients prior to surgery.
Description
overall safety of INT230-6 injected prior to surgery
Time Frame
presurgical window (period from diagnosis to surgery of 3-6 weeks)

10. Eligibility

Sex
Female
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Female patients with newly diagnosed histologically confirmed primary invasive breast cancer currently not undergoing any treatment while awaiting surgery. Patients with early, operable stage I to II breast cancer amendable for complete surgical resection as assessed by treating surgical oncologist. Tumors must be clinically palpable by surgeon. Part I: ≥ 1.0 cm by palpation or on imaging. Part II: ≥ 1.5 cm by palpation or on imaging. Histologic Bloom Richardson grade ≥2. 4. Invasive ductal or lobular carcinoma, invasive carcinoma Not Otherwise Specified (NOS). 5. ECOG PS 0-2 (Appendix A). 6. The participant (or legally acceptable representative if applicable) is able to provide written informed consent for the study. Exclusion Criteria: Locally advanced or metastatic breast cancer. Prior therapy with chemotherapy or planned neoadjuvant chemotherapy. Pre-dominant histology other than invasive ductal or lobular carcinoma or invasive carcinoma NOS. Patients with an active infection. Absolute Neutrophil Count < 1.5 x 10^9/L. Patients with pre-existing renal impairment, Creatinine clearance calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation of less than 50 mL/min/1.73m2. Any serious known immediate or delayed hypersensitivity reaction(s) to vinblastine or cisplatin or idiosyncrasy to drugs chemically related to the investigational drugs. Known allergic reaction to local anesthetic (Xylocaine, Marcaine). Concurrent medical condition requiring the use of immunosuppressive medications, or systemic corticosteroids at doses of greater than 10 mg Prednisone-equivalent Topical steroids and other localized corticosteroids are permitted. Use of steroids as prophylactic treatment for subjects with contrast allergies to diagnostic imaging contrast dyes will be permitted. Concurrent use of a prohibited medication or planned use of any forbidden medications during treatment with INT230-6, or within 4 weeks prior to study drug administration, which include chemotherapy, immunotherapy (tumor vaccine, cytokine, or growth factor given to control the cancer: systemic or intratumoral), other biologic therapy, investigational therapy, or hormonal therapy, cisplatin containing agents, and vinblastine containing agents while on treatment in this study. Other prohibited concomitant medications that will interact with vinblastine and cisplatin include mitomycin, phenytoin, CYP3A4 inhibitors (ketoconazole, voriconazole, clarithromycin, erythromycin), nephrotoxic drugs (aminoglycosides, amphotericin), or pure pyridoxine (pyridoxine contained in multivitamin is permitted). Use of other investigational drugs (drugs not marketed for any indication) within 4 weeks prior to study drug administration not permitted. Pregnancy if patient is of childbearing age) or breast feeding. Subjects with signs/symptoms suggestive of COVID-19 or known COVID-19 positive contacts in the past 14 days would be tested as per local Public Health and/or Institutional Guidelines. If patients are COVID-19 positive at the time of screening, they would be excluded from the trial. Any underlying medical condition that, in the Principal Investigator's opinion, will make the administration of study drug hazardous or obscure the interpretation of toxicity determination or adverse events, or renders the patient ineligible to be on study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Angel Arnaout, MD
Phone
6137985555
Email
anarnaout@toh.on.ca
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Angel Arnaout, MD
Organizational Affiliation
Ottawa Hospital Research Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Arif Awan, MD
Organizational Affiliation
Ottawa Hospital Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Ottawa Hospital Research Institute and Cancer Center
City
Ottawa
State/Province
Ontario
ZIP/Postal Code
K1Y 4E9
Country
Canada
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Angel Arnaout, MD
Phone
613-798-5555
Ext
79622
Email
aarnaout@toh.on.ca

12. IPD Sharing Statement

Plan to Share IPD
No

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INVINCIBLE TRIAL: Intratumoral INT230-6 in Breast Cancer

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