Clinical Trials /

Pembrolizumab in High-risk Ductal Carcinoma in Situ (DCIS)

NCT02872025

Description:

This is a pilot study to investigate the change in the immune microenvironment of high risk ductal carcinoma in situ (DCIS) after short term exposure to pembrolizumab.

Related Conditions:
  • Ductal Carcinoma In Situ
Recruiting Status:

Recruiting

Phase:

Early Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Pembrolizumab in High-risk Ductal Carcinoma in Situ (DCIS)
  • Official Title: Testing the Ability of Pembrolizumab and mRNA 2752 to Alter the Tumor Immune MicroEnvionment (TIME) of High Risk DCIS

Clinical Trial IDs

  • ORG STUDY ID: 16704
  • SECONDARY ID: NCI-2017-01320
  • NCT ID: NCT02872025

Conditions

  • Carcinoma, Intraductal, Noninfiltrating

Interventions

DrugSynonymsArms
PembrolizumabKeytruda, MK-3475Pembrolizumab intralesional (IL) x 2 doses + intralesional mRNA 2752 x 2-4 doses (Expansion Phase)
Intralesional mRNA 2752mRNA 2752Pembrolizumab intralesional (IL) x 2 doses + intralesional mRNA 2752 x 2-4 doses (Expansion Phase)

Purpose

This is a pilot study to investigate the change in the immune microenvironment of high risk ductal carcinoma in situ (DCIS) after short term exposure to pembrolizumab.

Detailed Description

      This study will include 3 dose cohorts using a 3+3 cohort dose escalation design followed by
      a 4th cohort (the dose expansion phase) at the maximum tolerated dose. Unless a dose limiting
      toxicity (DLT), defined any grade 3 or 4 toxicity, is observed requiring expansion of a
      cohort or a subject withdraws, 3 subjects will be enrolled into each cohort in the dose
      escalation phase. Subjects, upon diagnosis with high risk DCIS, will be offered 2 doses of
      pembrolizumab injected intralesionally (IL) 3 weeks apart (+/- 1 week) with surgery 3 weeks
      (+/- 2 weeks) after the 2nd dose. The subject will then undergo the surgical treatment as
      determined by the surgeon and the subject (partial mastectomy or mastectomy). The primary
      objective of this phase of the study will be safety and feasibility of intralesional
      injection of pembrolizumab.

      The maximum tolerated dose will be used in the expansion phase. The expansion cohort will
      have a target enrollment of 30 subjects enrolled to either the control group or the treatment
      group. The treatment group will consist of 20 subjects who agree to receive the treatment.
      The control group will consist of 10 eligible subjects who decline treatment and agree to
      tissue collection and to the use of tissue for research purposes. The control group will
      proceed to surgery alone within a 4 month timeframe following the diagnosis of high risk
      DCIS. The treatment group will receive 4 doses of intralesional pembrolizumab monotherapy 3
      weeks apart (+/- 1 week) prior to surgery (first 5 patients enrolled) but will now receive 2
      doses of intralesional pembrolizumab and intralesional mRNA 2752 3 weeks apart (+/- 1 week)
      prior to surgery. All subjects in the expansion cohort will also undergo a baseline MRI at
      diagnosis and undergo a 2nd MRI prior to surgery. Baseline and pre-surgical MRI images will
      be evaluated for changes in tumor volume.

      Note: The last patient finished the escalation phase on 08/14/2018, and the study is
      currently in the expansion phase.
    

Trial Arms

NameTypeDescriptionInterventions
Pembrolizumab intralesionally (IL) x 2 doses (Escalation Phase)ExperimentalSubjects, upon diagnosis with high risk DCIS, will be offered 2 doses of pembrolizumab injected intralesionally (IL) 3 weeks apart (+/- 1 week) with surgery 3 weeks (+/- 2 weeks) after the 2nd dose. The subject will then undergo the surgical treatment as determined by the surgeon and the subject (partial mastectomy or mastectomy).
  • Pembrolizumab
Pembrolizumab intralesionally (IL) x 4 doses (Expansion Phase)ExperimentalSubjects, upon diagnosis with high risk DCIS, will be offered 4 doses of pembrolizumab injected intralesionally (IL) 3 weeks apart (+/- 1 week) with surgery 3 weeks (+/- 2 weeks) after the 4th dose. The subject will then undergo the surgical treatment as determined by the surgeon and the subject (partial mastectomy or mastectomy).
  • Pembrolizumab
Pembrolizumab intralesional (IL) x 2 doses + intralesional mRNA 2752 x 2-4 doses (Expansion Phase)ExperimentalSubjects, upon diagnosis with high risk DCIS, will be offered 2 doses of pembrolizumab and intralesional mRNA 2752 injected intralesionally (IL) 3 weeks apart (+/- 1 week) with surgery 3 weeks (+/- 2 weeks) after the 2nd dose. The subject will then undergo the surgical treatment as determined by the surgeon and the subject (partial mastectomy or mastectomy).
  • Pembrolizumab
  • Intralesional mRNA 2752
No active treatmentNo InterventionThe control group will proceed to surgery alone within a 4 month timeframe following the diagnosis of high risk DCIS.

    Eligibility Criteria

            Inclusion Criteria:
    
              1. Plan on having surgical treatment to remove the lesion
    
              2. Have at least 2 of the following high risk features associated with her DCIS -
                 high-grade (grade II-III), palpable mass, hormone receptor negative (less than 1%),
                 Her2 positive, young age (less than 45 years old), and large size (greater than 5 cm)
    
              3. Patients with a history of tamoxifen and/or aromatase inhibitor use for treatment or
                 prevention are eligible but should discontinue these medications at least 2 weeks
                 prior to starting this trial
    
              4. Be willing and able to provide written informed consent/assent for the trial.
    
              5. Be >=18 years of age on day of signing informed consent.
    
              6. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1
    
              7. Demonstrate adequate organ function:
    
                   -  All screening labs should be performed within 10 days of treatment initiation.
    
                   -  Hematological Absolute Neutrophil Count (ANC) >=1,500/microliter (mcL) Platelets
                      >=100,000/mcL Hemoglobin >=9 g/dL or >=5.6 mmol/L without transfusion or
                      erythropoietin (EPO) dependency (within 7 days of assessment)
    
                   -  Renal Serum creatinine <=1.5 X upper limit of normal (ULN) OR Measured or
                      calculated creatinine clearance (GFR can also be used in place of creatinine or
                      CrCl) >=60 mL/min for subject with creatinine levels > 1.5 X institutional ULN
    
                   -  Hepatic Serum total bilirubin <=1.5 x ULN OR Direct bilirubin <= ULN for subjects
                      with total bilirubin levels > 1.5 ULN aspartate aminotransferase (AST) / serum
                      glutamic-oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT) /
                      serum glutamic-pyruvic transaminase (SGPT) <= 2.5 X ULN Albumin >=2.5mg/dL
    
                   -  Coagulation International Normalized Ratio (INR) or Prothrombin Time (PT) <=1.5 X
                      ULN unless subject is receiving anticoagulant therapy as long as PT or PTT is
                      within therapeutic range of intended use of anticoagulants Activated Partial
                      Thromboplastin Time (aPTT) <=1.5 X ULN unless subject is receiving anticoagulant
                      therapy as long as PT or PTT is within therapeutic range of intended use of
                      anticoagulants
    
                   -  Female subjects of childbearing potential should have a negative urine or serum
                      pregnancy within 72 hours prior to receiving the first dose of study medication.
                      If the urine test is positive or cannot be confirmed as negative, a serum
                      pregnancy test will be required.
    
                   -  Female subjects of childbearing potential should be willing to use 2 methods of
                      birth control or be surgically sterile, or abstain from heterosexual activity for
                      the course of the study through 120 days after the last dose of study medication
                      (Reference Section 5.7.2). Subjects of childbearing potential are those who have
                      not been surgically sterilized or have not been free from menses for > 1 year.
    
              8. A female participant is eligible to participate if she is not pregnant, not
                 breastfeeding, and at least one of the following conditions applies:
    
                   1. Not a woman of childbearing potential (WOCBP) OR
    
                   2. A WOCBP who agrees to follow the contraceptive guidance during the treatment
                      period and for at least 90 days corresponding to time needed to eliminate any
                      study treatment plus 30 days (a menstruation cycle) after the last dose of study
                      treatment.
    
              9. A male participant must agree to use a contraception during the treatment period and
                 for at least 90 days corresponding to time needed to eliminate any study treatment
                 plus an additional 120 days (a spermatogenesis cycle) after the last dose of study
                 treatment and refrain from donating sperm during this period.
    
            Exclusion Criteria:
    
              1. Is currently participating and receiving study therapy or has 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.
    
              2. Has a diagnosis of immunodeficiency or is receiving systemic steroid therapy or any
                 other form of immunosuppressive therapy within 7 days prior to the first dose of trial
                 treatment.
    
              3. Is not interested in surgical treatment of her DCIS
    
              4. Has invasive breast cancer. This does not include microinvasion.
    
              5. Has a known history of active Bacillus Tuberculosis (TB)
    
              6. Hypersensitivity to pembrolizumab or any of its excipients.
    
              7. Has a 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.
    
              8. Has active autoimmune disease that has required systemic treatment in the past 2 years
                 (i.e. with use of disease modifying agents, corticosteroids or immunosuppressive
                 drugs). Replacement therapy (e.g.,, thyroxine, insulin, or physiologic corticosteroid
                 replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a
                 form of systemic treatment.
    
              9. Has a history of (non-infectious) pneumonitis that required steroids or has current
                 pneumonitis.
    
             10. Has a history or current evidence of any condition, therapy, or laboratory abnormality
                 that might confound the results of the trial, interfere with the subject's
                 participation for the full duration of the trial, or is not in the best interest of
                 the subject to participate, in the opinion of the treating investigator.
    
             11. Has known psychiatric or substance abuse disorders that would interfere with
                 cooperation with the requirements of the trial.
    
             12. Is pregnant or breastfeeding, or expecting to conceive or father children within the
                 projected duration of the trial, starting with the pre-screening or screening visit
                 through 120 days after the last dose of trial treatment.
    
             13. Has a known history of Human Immunodeficiency Virus (HIV) (HIV 1/2 antibodies).
    
             14. Has a known history of Hepatitis B (defined as Hepatitis B surface antigen (HBsAg)
                 reactive) or known active Hepatitis C virus (HCV) (defined as HCV RNA [qualitative] is
                 detected) infection. Note: no testing for Hepatitis B and Hepatitis C is required
                 unless mandated by local health authority.
    
             15. Has received a live vaccine within 30 days prior to the first dose of study drug.
                 Examples of live vaccines include, but are not limited to, the following: measles,
                 mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus
                 Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection
                 are generally killed virus vaccines and are allowed; however, intranasal influenza
                 vaccines (eg, FluMist®) are live attenuated vaccines and are not allowed.
          
    Maximum Eligible Age:N/A
    Minimum Eligible Age:18 Years
    Eligible Gender:Female
    Healthy Volunteers:No

    Primary Outcome Measures

    Measure:Maximum tolerated dose (MTD)
    Time Frame:18 months
    Safety Issue:
    Description:To determine the maximum tolerated dose (MTD), and recommended dose for subsequent expansion cohort, of intralesionally administered pembrolizumab in patients with ductal carcinoma in situ (DCIS) of the breast.

    Details

    Phase:Early Phase 1
    Primary Purpose:Interventional
    Overall Status:Recruiting
    Lead Sponsor:Laura Esserman

    Last Updated

    January 29, 2021