Clinical Trials /

Effects of MK-3475 (Pembrolizumab) on the Breast Tumor Microenvironment in Triple Negative Breast Cancer

NCT02977468

Description:

Assess response to pembrolizumab in both primary tumor, normal breast stroma, circulating lymphocytes and serum exosomes in treatment naive triple negative breast cancer (TNBC) patients. Assess for change in tumor-infiltrating lymphocytes (TILS) both stromal (sTILS) and intraepithelial (iTILS) in newly diagnosed early stage TNBC patients treated with two doses of MK-3475 prior to lumpectomy.

Related Conditions:
  • Invasive Breast Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Effects of MK-3475 (Pembrolizumab) on the Breast Tumor Microenvironment in Triple Negative Breast Cancer
  • Official Title: Effects of MK-3475 (Pembrolizumab) on the Breast Tumor Microenvironment in Triple Negative Breast Cancer With and Without Intra-operative RT: a Window of Opportunity Study

Clinical Trial IDs

  • ORG STUDY ID: AAAQ7863
  • NCT ID: NCT02977468

Conditions

  • Triple Negative Breast Cancer

Interventions

DrugSynonymsArms
Merck 3475 PembrolizumabKeytruda, SCH-900475, MK-3475Single Arm open label

Purpose

Assess response to pembrolizumab in both primary tumor, normal breast stroma, circulating lymphocytes and serum exosomes in treatment naive triple negative breast cancer (TNBC) patients. Assess for change in tumor-infiltrating lymphocytes (TILS) both stromal (sTILS) and intraepithelial (iTILS) in newly diagnosed early stage TNBC patients treated with two doses of MK-3475 prior to lumpectomy.

Detailed Description

      This is an open-label, single-arm, single institution pre-operative "window of opportunity
      study" of pembrolizumab in subjects with newly diagnosed triple-negative, < 3 cm, node
      negative breast cancer. Subjects may not have received any prior neo/adjuvant chemotherapy,
      definitive surgery or radiation treatment prior to enrollment.

      The goal of this project is to determine if immune modulation through treatment with MK-3475
      (Pembrolizumab) in triple negative breast cancer (TNBC) patients will alter expression of
      immune tolerant markers [including PD-L1], within the primary tumor. Investigators hope to
      determine if MK-3475 exposure will change the molecular signature of breast stroma from
      "normal" adjacent breast tissue (non-tumor tissue) obtained prospectively at the time of
      breast conserving surgery (BCS) in TNBC patients. Finally, investigators will investigate how
      pembrolizumab alters breast stromal response to high dose radiation delivered by
      intraoperative radiation therapy (IORT).
    

Trial Arms

NameTypeDescriptionInterventions
Single Arm open labelExperimentalParticipants receive 'Merck 3475 Pembrolizumab' by vein one to two times before Intraoperative radiation therapy (IORT). The Intrabeam® Photon Radiosurgery System is a miniature electron beam-driven X-ray source which provides a point source of low energy X-rays (50 kV maximum) at the tip of a 3.2 mm diameter tube. The radiation source can be inserted into the area of interest immediately after excision of the tumor and switched on for 20-35 minutes to provide intraoperative radiotherapy accurately targeted to the tissues that are at the highest risk of local recurrence. The dosimetric characteristics and early clinical applications of this device have been well studied and this is the device which was utilized in the international TARGIT trial.
  • Merck 3475 Pembrolizumab

Eligibility Criteria

        Inclusion Criteria:

          1. Be willing and able to provide written informed consent/assent for the trial.

          2. Be > or = 21 years of age on day of signing informed consent.

          3. Histologically proven invasive breast carcinoma with triple negative receptor status
             (Estrogen receptor, Progesterone receptor and HER2 negative by IHC and FISH). Patients
             who are weekly positive for the estrogen or progesterone receptor (i.e., < or = 10%)
             are eligible.

          4. Clinically ≤ 3 cm unifocal lesion by imaging or physical examination.

          5. Clinically node negative, no evidence of metastatic disease.

          6. No prior anti-cancer therapy including investigational agents, radiation therapy, or
             breast resection within 6 months of study entry.

          7. Breast size B cup or larger, to allow for IORT procedure.

          8. Have a performance status of 0 or 1 on the ECOG Performance Scale.

          9. Demonstrate adequate organ function.

         10. Female subject 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.

         11. Female subjects of childbearing potential must be willing to use an adequate method of
             contraception for the course of the study through 120 days after the last dose of
             study medication.

        Exclusion Criteria:

          1. Multifocal disease within the breast.

          2. Has primary lesion > 3 cm in size radiographically or by physical examination.
             Pathologically proven nodal disease at diagnosis is not allowed.

          3. Has metastatic disease.

          4. Has a known additional malignancy that is progressing or requires active treatment in
             the last 5 years. Exceptions include basal cell carcinoma of the skin, squamous cell
             carcinoma of the skin, DCIS of the breast, or in situ cervical cancer that has
             undergone potentially curative therapy.

          5. Patients for whom radiotherapy for breast cancer is contraindicated because of medical
             reasons (e.g., connective tissue disorder or prior ipsilateral breast radiation).

          6. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy
             (in dosing exceeding 10mg daily of prednisone equivalent) or any other form of
             immunosuppressive therapy within 7 days prior to the first dose of trial treatment.

          7. Has a known history of active TB (Bacillus Tuberculosis).

          8. Has severe hypersensitivity (≥ Grade 3) to pembrolizumab or any of its excipients.

          9. 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.

         10. Has a history of (non-infectious) pneumonitis that required steroids or current
             pneumonitis.

         11. Has an active infection requiring systemic therapy.

         12. Has a history or current evidence of any condition, therapy, or laboratory abnormality
             that might confound the results of the study, interfere with the subject's
             participation for the full duration of the study, or is not in the best interest of
             the subject to participate, in the opinion of the treating investigator.

         13. Has known psychiatric or substance abuse disorders that would interfere with
             cooperation with the requirements of the trial.

         14. Is pregnant or breastfeeding, or expected to conceive children within the projected
             duration of the study, starting with the screening visit through 120 days after the
             last dose of trial treatment.

             The effects of MK-3745 on the developing human fetus are unknown. For this reason and
             because monoclonal antibody neoplastic agents are known to be teratogenic, women of
             child-bearing potential must agree to use adequate contraception (hormonal or barrier
             method of birth control; abstinence) prior to study entry and for the duration of
             study participation. Should a woman become pregnant or suspect she is pregnant while
             she is participating in this study, she should inform her treating physician
             immediately.

         15. Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with
             an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4,
             OX-40, CD137).

         16. Has known active Hepatitis B (e.g., HBsAg reactive) or Hepatitis C (e.g., HCV RNA
             [qualitative] is detected).

         17. Has received a live vaccine within 30 days of planned start of study therapy.

         18. Has a medical history of allogenic stem cell transplant

         19. Has received a solid organ transplant
      
Maximum Eligible Age:80 Years
Minimum Eligible Age:21 Years
Eligible Gender:Female
Healthy Volunteers:No

Primary Outcome Measures

Measure:Number of subjects with significant mean percent change in TILs
Time Frame:3 months
Safety Issue:
Description:This outcome measure is designed to determine if immune modulation therapy with MK-3475 will increase TILs in newly diagnosed TNBC tumors. The mean percent change in TILS in tumor tissue from initial core biopsy samples will be compared with pathology samples from definitive surgery after two cycles of MK-3475.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Eileen Connolly

Trial Keywords

  • triple negative breast cancer
  • Pembrolizumab
  • IORT
  • tumor microenvironment

Last Updated

August 23, 2021