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STEMVAC in Patients With Early Stage Triple Negative Breast Cancer

Primary Purpose

Anatomic Stage IB Breast Cancer AJCC v8, Anatomic Stage II Breast Cancer AJCC v8, Anatomic Stage IIA Breast Cancer AJCC v8

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
CD105/Yb-1/SOX2/CDH3/MDM2-polyepitope Plasmid DNA Vaccine
Sargramostim
Sponsored by
University of Washington
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Anatomic Stage IB Breast Cancer AJCC v8

Eligibility Criteria

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

Inclusion Criteria:

  • Participants with triple negative breast cancer, stages IB, II or III. Estrogen receptor (ER)-negative and progesterone receptor (PR)-negative is defined as breast cancer with less than 1% of ER or PR expression. HER2 negative is defined as:

    • 0-1+ HER2 expression by immunohistochemistry (IHC) OR
    • Fluorescence in situ hybridization (FISH) negative OR
    • HER2 2+ and FISH negative
  • Participants must have completed standard of care systemic therapy (including immune modulating agents) and radiotherapy if used between 28 and 365 days prior to enrollment

    * Note: Treatment with a bisphosphonate or denosumab to prevent bone loss is not considered to be systemic therapy for breast cancer and its use within the 28 day pre-enrollment period or while on study is not exclusionary

  • Participants must agree to avoid systemic steroids for the duration of the treatment period and until completion of the 1 month post 2nd booster vaccine visit (end of treatment)
  • Participants must be at least 18 years of age
  • Participants must have Eastern Cooperative Oncology Group (ECOG) performance status score of =< 1
  • White blood cell (WBC) >= 3000/mm^3 (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • Lymphocyte count >= 800/mm^3 (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • Platelet count >= 100,000/mm^3 (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • Hemoglobin (Hgb) >= 10 mg/dl (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • Serum creatinine =< 1.2 mg/dl OR creatinine clearance > 60 ml/min (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • Total bilirubin =< 1.5 X upper limit of institutional normal (ULN) (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • AST (aspartate aminotransferase)/serum glutamic-oxaloacetic transaminase (SGOT) =< 1.5 X upper limit of institutional normal (ULN) (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment)
  • Must have recovered from major infections and/or surgical procedures, and in the opinion of the investigator, not have any significant active concurrent medical illnesses precluding protocol treatment
  • The effects of STEMVAC on the developing human fetus are unknown. For this reason,

    • Female participant agrees to use adequate contraception (examples include: estrogen and/or progestogen containing hormonal contraception, barrier method (condom, cervical cap) or abstinence) while on the study and until 1 month after the 2nd booster vaccination when/if engaging in sex that could lead to pregnancy. Exceptions: Females who have had a hysterectomy, tubal ligation or bilateral oophorectomy OR meet one of the following criteria for postmenopausal: Age > 60 or age < 60 with >= 12 months amenorrhea and follicle-stimulating hormone (FSH) within the testing facility's postmenopausal range
    • Female participant agrees to inform her study physician immediately should she become pregnant or suspect she is pregnant while participating in this study
    • Male participants who are having sex that can lead to pregnancy must use an acceptable form of contraception (vasectomy with the absence of sperm, sexual abstinence, condoms) throughout the course of the study
  • Patients must be willing to not undergo major elective surgical procedures with general anesthesia or conscious sedation through the end of treatment visit. (Note: port removal is allowable)
  • Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Contraindication or known hypersensitivity to receiving sargramostim (rhuGM-CSF) or other yeast based products
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to STEMVAC
  • Participants receiving any other investigational agents or enrolled in any other treatment study
  • Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is prohibited during the treatment period of the study, except when taken as low-dose (81 mg) aspirin therapy. Prohibited chronic use is defined as daily use for more than 7 days
  • Participants with any clinically significant autoimmune disease uncontrolled with treatment
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Pregnant and breastfeeding women are excluded from this study
  • Known history of human immunodeficiency virus (HIV) infection, hepatitis B, or hepatitis C

    * Note: These individuals are excluded in order to avoid confounding an existing condition with an immune response to STEMVAC

  • Has > Common Terminology Criteria for Adverse Events (CTCAE) grade 1 (mild) residual toxicity from prior breast cancer treatment

Sites / Locations

  • Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsRecruiting
  • Fred Hutch/University of Washington Cancer ConsortiumRecruiting
  • University of Wisconsin Carbone Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Prevention (STEMVAC vaccine, sargramostim)

Arm Description

Patients receive STEMVAC vaccine with sargramostim ID every month for 3 months in the absence of disease progression or unacceptable toxicity. Patients then receive STEMVAC vaccine with sargramostim ID booster injections 3 months after the 3rd vaccination and 6 months after the 1st booster vaccination.

Outcomes

Primary Outcome Measures

Cellular immune response: incidence
Defined by the incidence of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT).
Cellular immune response: incidence
Defined by the incidence of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT).
Cellular immune response: magnitude
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Cellular immune response: magnitude
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Cellular immune response: magnitude
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Cellular immune response: magnitude
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.

Secondary Outcome Measures

Kinetics of the magnitude of antigen specific IFN-gamma ELISPOT counts
Will be assessed over time from pre to post immunization to determine if pre-existent immunity affects magnitude of response.
Incidence of adverse events
Safety and systemic toxicity will be determined by chemical and clinical parameters evaluated at various time points. Toxicity grading will be evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 5.0 and monitoring of adverse events will be done per Food and Drug Administration and NCI guidelines.
Activation status and repertoire diversity of peripheral blood T-cells
The peripheral T cell repertoire diversity will be determined by high-throughput deoxyribonucleic acid (DNA) sequencing of the recombined V(D)J region of the T cell receptor beta-chain (TCRB) using the immunoSEQ platform (Adaptive Biotechnologies) on antigen-specific T-cells from a short-term in vitro culture. The activation, exhaustion and memory status of the peripheral T cells will be determined by flow cytometry using fluorochrome linked antibodies to PD-1, CD4, CD3, LAG3, CD137, CD8, KLGR1, CD44, CD69, CD62L and OX40. Transcription factors for Th1 (Tbet), Th2 (GATA3) and Treg (FOXP3) will also be evaluated. All results will be summarized using simple descriptive statistics.
Relapse free survival (RFS)
Will explore if adjuvant vaccination with STEMVAC improves relapse free survival as compared to historical controls. Local and distant recurrence at year 5 will be reported as proportion with confidence intervals, and RFS will be estimated using Kaplan-Meier method with the 5-year RFS rate estimated from the Kaplan-Meier estimate of the survival distribution along with a 95% confidence interval. Comparison of the local and distant recurrence and 5-year RFS against the historical control will be based on a binomial test.

Full Information

First Posted
June 30, 2022
Last Updated
September 11, 2023
Sponsor
University of Washington
Collaborators
National Cancer Institute (NCI), University of Wisconsin, Madison
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1. Study Identification

Unique Protocol Identification Number
NCT05455658
Brief Title
STEMVAC in Patients With Early Stage Triple Negative Breast Cancer
Official Title
A Phase II Trial of The Immunogenicity of a DNA Plasmid Based Vaccine (STEMVAC) Encoding Th1 Selective Epitopes From Five Antigens Associated With Breast Cancer Stem Cells (MDM2, YB1, SOX2, CDC25B, CD105) in Participants With Early Stage Triple Negative Breast Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 17, 2022 (Actual)
Primary Completion Date
April 30, 2024 (Anticipated)
Study Completion Date
April 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Washington
Collaborators
National Cancer Institute (NCI), University of Wisconsin, Madison

4. Oversight

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

5. Study Description

Brief Summary
This phase II trial studies the effect of DNA plasmid based vaccine (STEMVAC) in treating patients with patients with stage IB-III triple negative breast cancer. STEMVAC may wake up the immune system in patients who have had a diagnosis of triple negative breast cancer and have been treated. STEMVAC targets proteins that are expressed on breast cancer cells and works by boosting the immune system to recognize and destroy the invader cancer cell proteins that are causing the disease. The purpose of this trial is to test the immune system's response to STEMVAC.
Detailed Description
OUTLINE: Patients receive STEMVAC vaccine with sargramostim intradermally (ID) every month for 3 months in the absence of disease progression or unacceptable toxicity. Patients then receive STEMVAC vaccine with sargramostim ID booster injections 3 months after the 3rd vaccination and 6 months after the 1st booster vaccination. After completion of study treatment, patients are followed up at 28 days, and then annually for 5 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anatomic Stage IB Breast Cancer AJCC v8, Anatomic Stage II Breast Cancer AJCC v8, Anatomic Stage IIA Breast Cancer AJCC v8, Anatomic Stage IIB Breast Cancer AJCC v8, Anatomic Stage III Breast Cancer AJCC v8, Anatomic Stage IIIA Breast Cancer AJCC v8, Anatomic Stage IIIB Breast Cancer AJCC v8, Anatomic Stage IIIC Breast Cancer AJCC v8, Prognostic Stage IB Breast Cancer AJCC v8, Prognostic Stage II Breast Cancer AJCC v8, Prognostic Stage IIA Breast Cancer AJCC v8, Prognostic Stage IIB Breast Cancer AJCC v8, Prognostic Stage III Breast Cancer AJCC v8, Prognostic Stage IIIA Breast Cancer AJCC v8, Prognostic Stage IIIB Breast Cancer AJCC v8, Prognostic Stage IIIC Breast Cancer AJCC v8, Triple-Negative Breast Carcinoma

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
33 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Prevention (STEMVAC vaccine, sargramostim)
Arm Type
Experimental
Arm Description
Patients receive STEMVAC vaccine with sargramostim ID every month for 3 months in the absence of disease progression or unacceptable toxicity. Patients then receive STEMVAC vaccine with sargramostim ID booster injections 3 months after the 3rd vaccination and 6 months after the 1st booster vaccination.
Intervention Type
Biological
Intervention Name(s)
CD105/Yb-1/SOX2/CDH3/MDM2-polyepitope Plasmid DNA Vaccine
Other Intervention Name(s)
CD105/Yb-1/SOX2/CDH3/MDM2 Plasmid Vaccine, STEMVAC, STEMVAC Th1 Polyepitope Plasmid-based Vaccine
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
Sargramostim
Other Intervention Name(s)
123774-72-1, 23-L-Leucinecolony-Stimulating Factor 2, DRG-0012, Leukine, Prokine, rhu GM-CFS, Sagramostim, Sargramostatin
Intervention Description
Given ID
Primary Outcome Measure Information:
Title
Cellular immune response: incidence
Description
Defined by the incidence of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT).
Time Frame
At 1 month after 3rd vaccination
Title
Cellular immune response: incidence
Description
Defined by the incidence of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT).
Time Frame
At 10 months after 3rd vaccination
Title
Cellular immune response: magnitude
Description
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Time Frame
At 1 month after 3rd vaccination
Title
Cellular immune response: magnitude
Description
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Time Frame
At 3 months after 3rd vaccination
Title
Cellular immune response: magnitude
Description
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Time Frame
At 9 months after 3rd vaccination
Title
Cellular immune response: magnitude
Description
Defined by the magnitude of development of the Th1 (IFN-gamma [g]) antigen specific immune response against STEMVAC antigens using enzyme-linked immunosorbent spot assay (ELISPOT). The magnitude of immune response is defined as the sum of the corrected spots/well values calculated at each time point.
Time Frame
At 10 months after 3rd vaccination
Secondary Outcome Measure Information:
Title
Kinetics of the magnitude of antigen specific IFN-gamma ELISPOT counts
Description
Will be assessed over time from pre to post immunization to determine if pre-existent immunity affects magnitude of response.
Time Frame
13 months
Title
Incidence of adverse events
Description
Safety and systemic toxicity will be determined by chemical and clinical parameters evaluated at various time points. Toxicity grading will be evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 5.0 and monitoring of adverse events will be done per Food and Drug Administration and NCI guidelines.
Time Frame
1 month after last booster vaccine
Title
Activation status and repertoire diversity of peripheral blood T-cells
Description
The peripheral T cell repertoire diversity will be determined by high-throughput deoxyribonucleic acid (DNA) sequencing of the recombined V(D)J region of the T cell receptor beta-chain (TCRB) using the immunoSEQ platform (Adaptive Biotechnologies) on antigen-specific T-cells from a short-term in vitro culture. The activation, exhaustion and memory status of the peripheral T cells will be determined by flow cytometry using fluorochrome linked antibodies to PD-1, CD4, CD3, LAG3, CD137, CD8, KLGR1, CD44, CD69, CD62L and OX40. Transcription factors for Th1 (Tbet), Th2 (GATA3) and Treg (FOXP3) will also be evaluated. All results will be summarized using simple descriptive statistics.
Time Frame
Prior to and after STEMVAC vaccination
Title
Relapse free survival (RFS)
Description
Will explore if adjuvant vaccination with STEMVAC improves relapse free survival as compared to historical controls. Local and distant recurrence at year 5 will be reported as proportion with confidence intervals, and RFS will be estimated using Kaplan-Meier method with the 5-year RFS rate estimated from the Kaplan-Meier estimate of the survival distribution along with a 95% confidence interval. Comparison of the local and distant recurrence and 5-year RFS against the historical control will be based on a binomial test.
Time Frame
Up to 5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants with triple negative breast cancer, stages IB, II or III. Estrogen receptor (ER)-negative and progesterone receptor (PR)-negative is defined as breast cancer with less than 1% of ER or PR expression. HER2 negative is defined as: 0-1+ HER2 expression by immunohistochemistry (IHC) OR Fluorescence in situ hybridization (FISH) negative OR HER2 2+ and FISH negative Participants must have completed standard of care systemic therapy (including immune modulating agents) and radiotherapy if used between 28 and 365 days prior to enrollment * Note: Treatment with a bisphosphonate or denosumab to prevent bone loss is not considered to be systemic therapy for breast cancer and its use within the 28 day pre-enrollment period or while on study is not exclusionary Participants must agree to avoid systemic steroids for the duration of the treatment period and until completion of the 1 month post 2nd booster vaccine visit (end of treatment) Participants must be at least 18 years of age Participants must have Eastern Cooperative Oncology Group (ECOG) performance status score of =< 1 White blood cell (WBC) >= 3000/mm^3 (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) Lymphocyte count >= 800/mm^3 (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) Platelet count >= 100,000/mm^3 (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) Hemoglobin (Hgb) >= 10 mg/dl (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) Serum creatinine =< 1.2 mg/dl OR creatinine clearance > 60 ml/min (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) Total bilirubin =< 1.5 X upper limit of institutional normal (ULN) (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) AST (aspartate aminotransferase)/serum glutamic-oxaloacetic transaminase (SGOT) =< 1.5 X upper limit of institutional normal (ULN) (within 60 days of enrollment and at least 28 days post standard of care [SOC] treatment) Must have recovered from major infections and/or surgical procedures, and in the opinion of the investigator, not have any significant active concurrent medical illnesses precluding protocol treatment The effects of STEMVAC on the developing human fetus are unknown. For this reason, Female participant agrees to use adequate contraception (examples include: estrogen and/or progestogen containing hormonal contraception, barrier method (condom, cervical cap) or abstinence) while on the study and until 1 month after the 2nd booster vaccination when/if engaging in sex that could lead to pregnancy. Exceptions: Females who have had a hysterectomy, tubal ligation or bilateral oophorectomy OR meet one of the following criteria for postmenopausal: Age > 60 or age < 60 with >= 12 months amenorrhea and follicle-stimulating hormone (FSH) within the testing facility's postmenopausal range Female participant agrees to inform her study physician immediately should she become pregnant or suspect she is pregnant while participating in this study Male participants who are having sex that can lead to pregnancy must use an acceptable form of contraception (vasectomy with the absence of sperm, sexual abstinence, condoms) throughout the course of the study Patients must be willing to not undergo major elective surgical procedures with general anesthesia or conscious sedation through the end of treatment visit. (Note: port removal is allowable) Ability to understand and the willingness to sign a written informed consent document Exclusion Criteria: Contraindication or known hypersensitivity to receiving sargramostim (rhuGM-CSF) or other yeast based products History of allergic reactions attributed to compounds of similar chemical or biologic composition to STEMVAC Participants receiving any other investigational agents or enrolled in any other treatment study Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is prohibited during the treatment period of the study, except when taken as low-dose (81 mg) aspirin therapy. Prohibited chronic use is defined as daily use for more than 7 days Participants with any clinically significant autoimmune disease uncontrolled with treatment Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements Pregnant and breastfeeding women are excluded from this study Known history of human immunodeficiency virus (HIV) infection, hepatitis B, or hepatitis C * Note: These individuals are excluded in order to avoid confounding an existing condition with an immune response to STEMVAC Has > Common Terminology Criteria for Adverse Events (CTCAE) grade 1 (mild) residual toxicity from prior breast cancer treatment
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kim Mast
Phone
608-263-8606
Email
mast2@wisc.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Jennifer Childs, MPH
Phone
206-616-2305
Email
childj@uw.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mary Disis, MD
Organizational Affiliation
Fred Hutch/University of Washington Cancer Consortium
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Howard Bailey, MD
Organizational Affiliation
University of Wisconsin, Madison
Official's Role
Study Director
Facility Information:
Facility Name
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hopkins Breast Trials
Phone
410-614-1361
Email
HopkinsBreastTrials@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Cesar Santa-Maria, MD
Facility Name
Fred Hutch/University of Washington Cancer Consortium
City
Seattle
State/Province
Washington
ZIP/Postal Code
98109
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kris Kauno
Phone
206-543-3829
Email
cvitrial@medicine.washington.edu
First Name & Middle Initial & Last Name & Degree
Mary Disis, MD
Facility Name
University of Wisconsin Carbone Cancer Center
City
Madison
State/Province
Wisconsin
ZIP/Postal Code
53792
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Kim Mast
Phone
608-263-8606
Email
mast2@wisc.edu
First Name & Middle Initial & Last Name & Degree
Howard Bailey, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

STEMVAC in Patients With Early Stage Triple Negative Breast Cancer

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