Clinical Trials /

CMP-001 and Pre-operative Stereotactic Body Radiation Therapy (SBRT) in Early Stage Triple Negative Breast Cancer (TNBC)

NCT04807192

Description:

This is an open-label, randomized, window-of-opportunity phase 2 clinical study evaluating the biological activity of preoperative Stereotactic Body RadioTherapy (SBRT) alone (Arm 1), and combined with subcutaneous (SC) followed by intra-tumoral (IT) administrations of CMP-001 (Arm 2), in subjects with early stage TNBC. Safety and efficacy of the treatments are also examined. The main hypothesis that the study treatment induces an increase in stromal tumor infiltrating lymphocytes (sTILs) will be explored in each arm separately. The study is designed as a randomized selection study, with randomization used to address patient selection bias while each arm is run as an independent study. No formal statistical comparison between the two arms is planned. 40 patients will be equally (1:1) randomized in this study (20 per arm).

Related Conditions:
  • Breast Carcinoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: CMP-001 and Pre-operative Stereotactic Body Radiation Therapy (SBRT) in Early Stage Triple Negative Breast Cancer (TNBC)
  • Official Title: CMP-001 in Combination With Pre-Operative Stereotactic Body Radiation Therapy in Patients With Early Stage Triple Negative Breast Cancer: An Open-Label, Window of Opportunity, Randomized Phase 2 Clinical Study

Clinical Trial IDs

  • ORG STUDY ID: CHUV-DO-0009-CyberImmunoBreast
  • NCT ID: NCT04807192

Conditions

  • Triple Negative Breast Cancer

Interventions

DrugSynonymsArms
CMP-001Arm 2: CMP-001 + SBRT

Purpose

This is an open-label, randomized, window-of-opportunity phase 2 clinical study evaluating the biological activity of preoperative Stereotactic Body RadioTherapy (SBRT) alone (Arm 1), and combined with subcutaneous (SC) followed by intra-tumoral (IT) administrations of CMP-001 (Arm 2), in subjects with early stage TNBC. Safety and efficacy of the treatments are also examined. The main hypothesis that the study treatment induces an increase in stromal tumor infiltrating lymphocytes (sTILs) will be explored in each arm separately. The study is designed as a randomized selection study, with randomization used to address patient selection bias while each arm is run as an independent study. No formal statistical comparison between the two arms is planned. 40 patients will be equally (1:1) randomized in this study (20 per arm).

Detailed Description

      This is a Phase 2, proof of principle study that explores the therapeutic window between
      diagnosis and surgery in patients with early stage invasive TNBC not being candidates for
      neo-adjuvant chemotherapy.

      The presence of tumor infiltrating lymphocytes (TILs) within the tumors of patients with
      early invasive TNBC has been associated with improved prognosis. The hypothesis of this study
      is that pre-operative SBRT with or without CpG (CMP-001), a toll-like receptor (TLR) 9
      agonist will induce an increase in sTILs in the tumor in patients with early invasive TNBC,
      which theoretically should improve those patients' prognosis.

      There is growing evidence indicating that radiotherapy (RT) induces massive release of
      tumor-associated antigens (TAAs) during cancer cell death. RT enhances tumor immunogenicity
      and increases the presence of effector immune cells to the tumor site. It increases
      availability of tumor antigens and promotes antigen capture, cell migration to the lymph
      nodes, polarization towards a tolerogenic or immunogenic phenotype or migration of
      lymphocytes into the tumor. Doses of around 8 Gy induce more important immune infiltration.

      SBRT is a precise technique of irradiation within the tumor permitting high dose delivery in
      a safe manner with tight margins. In our study, the irradiated tissue will then be removed by
      surgery, allowing for standard of care irradiation to be administered postoperatively.
      However, the preoperative SBRT on the tumor might increase intratumoral or stromal TILs'
      presence.

      CMP-001 has already been shown to increase CD8+ T cell intratumoral infiltration in early
      clinical data, and ongoing data of a phase Ib clinical trial combining intratumoral (IT)
      injections of CMP-001 (3-10 mg) in melanoma lesions with Pembrolizumab show rapid abscopal
      responses in other skin lesions after 3 injections. The combination of IT CMP-001 and SBRT,
      through increased TAA release and immunologic enhancement due to the TLR9 agonist, might
      ultimately result in a clinically meaningful " in-situ vaccination " effect through
      enhancement of the host's antitumor immunity, promoting immune eradication of micrometastatic
      disease. The TNBC population is prone to micrometastatic disease, even at early stages;
      therefore any of these experimental treatments might result in increased TILs' infiltration,
      which theoretically would bring potential benefits in distant control of the disease and
      overall survival improvements.
    

Trial Arms

NameTypeDescriptionInterventions
Arm 1: SBRTExperimental
    Arm 2: CMP-001 + SBRTExperimental
    • CMP-001

    Eligibility Criteria

            Inclusion Criteria:
    
              1. Signed study Informed Consent Form prior to the initiation of any study procedures
    
              2. Women age ≥18 years
    
              3. Histologically confirmed diagnosis of triple negative breast cancer (TNBC) of early
                 stage (cT1-2, at least 5 mm, cN0-1 cM0) determined according to immunohistochemistry
                 (IHC)/ fluorescence in situ hybridization (FISH) and current American Society of
                 Clinical Oncology (ASCO) guidelines. TNBC subtype is defined as:
    
                   -  Estrogen receptor (ER) <10%
    
                   -  Progesterone receptor (PR) <10%
    
                   -  Human epidermal growth factor receptor 2 (HER2) negative (not eligible for
                      anti-HER2 therapy) defined as:
    
                        -  IHC 0, 1+ without ISH or
    
                        -  IHC 2+ and ISH non-amplified with ratio less than 2.0 and if reported,
                           average HER2 copy number < 6 signals/cells or
    
                        -  ISH non-amplified with ratio less than 2.0 and if reported, average HER2
                           copy number < 6 signals/cells (without IHC)
    
              4. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1.
    
              5. Women with bilateral breast TNBC can be acceptable if both sides are TNBC (treatment
                 is allowed to be administered to one breast only).
    
              6. Capable of understanding and complying with protocol requirements
    
              7. A planned breast surgery (Breast conserving surgery [BCS] or mastectomy).
    
              8. No planned neoadjuvant chemotherapy/endocrine therapy or other anticancer therapy
    
              9. Presence of measurable disease in the breast, defined as a lesion that can be
                 accurately measured in at least one dimension with conventional techniques (Magnetic
                 resonance imaging [MRI] and/or ultrasound)
    
             10. Primary tumor accessible to injections and biopsy. Multifocal and multicentric disease
                 is allowed and the most accessible lesion will be injected. The lesion to be injected
                 should be confined in a single irradiation volume that does not result in more than
                 30% of the whole breast.
    
             11. The injected tumor should be located at least 5 mm from the skin or pectoral muscle
    
             12. Most recent laboratory values (within 28 days prior to randomization) meet the
                 following standards:
    
                   1. Bone marrow function:
    
                        -  neutrophil count ≥1.5 G/L
    
                        -  hemoglobin ≥ 90 g/L
    
                        -  platelet count ≥ 100 G/L
    
                   2. Liver function:
    
                        -  total bilirubin within normal ranges of each institution (except patients
                           with Gilbert's syndrome who must have total bilirubin < 3.0 mg/dL)
    
                        -  aspartate aminotransferase (AST) ≤ 2.5 times the ULN range.
    
                        -  alanine aminotransferase (ALT) ≤ 2.5 times the ULN range
    
                   3. Renal function: estimated glomerular filtration rate (eGFR) ≥ 40 ml/min/1.73 m2
                      (according to Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]
                      formula)
    
             13. For women of childbearing potential (WOCBP):
    
                   1. Agreement to use an acceptable method of effective contraception from screening
                      until 30 days after last study treatment (RT and CMP-001).
    
                   2. WOCBP must have a negative urine/blood pregnancy test within 7 days before
                      registration and prior to the first study treatment. A positive urine test must
                      be confirmed by a serum pregnancy test.
    
            Exclusion Criteria:
    
            Subjects presenting with any of the following do not qualify for entry into the study:
    
              1. Breast-feeding women (absence of pregnancy should be confirmed by a negative pregnancy
                 test within 7 days of randomization, a positive urine pregnancy test should be
                 confirmed by a serum β-Human chorionic gonadotropin [β-HCG] test)
    
                 Medical history and concurrent diseases:
    
              2. History of malignancy other than TNBC within 5 years prior to screening, with the
                 exception of malignancies with a negligible risk of metastasis or death (e.g., 5-year
                 OS rate >90%), such as adequately treated carcinoma of the cervix in situ,
                 non-melanoma skin carcinoma, ductal carcinoma in situ, or Stage I uterine cancer
    
              3. Known infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or
                 hepatitis C virus (HCV)
    
              4. Developed autoimmune disorders of Grade 4 while on prior immunotherapy. Subjects who
                 developed autoimmune disorders of Grade ≤ 3 may enroll if the disorder has resolved to
                 Grade ≤ 1 and the subject has been off systemic steroids for at least 2 weeks.
    
              5. Any concurrent uncontrolled illness, including mental illness or substance abuse,
                 which in the opinion of the Investigator, would make the subject unable to cooperate
                 and participate in the trial
    
              6. Severe uncontrolled cardiac disease within 6 months of Screening, including but not
                 limited to uncontrolled hypertension; unstable angina; myocardial infarction (MI) or
                 cerebrovascular accident (CVA)
    
              7. Active, known, or suspected autoimmune disease:
    
                   -  Participants with well controlled asthma and/or mild allergic rhinitis (seasonal
                      allergies) are eligible
    
                   -  Participants with the following disease conditions are also eligible:
    
                        -  Vitiligo
    
                        -  Type 1 diabetes mellitus
    
                        -  Residual hypothyroidism due to autoimmune condition only requiring hormone
                           replacement
    
                        -  Psoriasis not requiring systemic treatment conditions not expected to recur
                           in the absence of an external trigger are permitted to enroll
    
              8. History of allergic reactions attributed to compounds of similar chemical or biologic
                 composition to CMP-001
    
              9. Any history of adrenal deficiency
    
                 Prohibited treatments and/or therapies:
    
             10. Any prior ipsilateral breast irradiation.
    
             11. Received investigational therapy with another drug or biologic within 28 days prior to
                 randomization.
    
             12. Require systemic pharmacologic doses of corticosteroids at or above the equivalent of
                 10 mg/day prednisone; replacement doses, topical, ophthalmologic and inhalational
                 steroids are permitted. Subjects who are currently receiving steroids at a dose of <
                 10 mg/d do not need to discontinue steroids prior to randomization.
    
             13. Requires prohibited treatment (i.e., non-protocol specified anticancer
                 pharmacotherapy, surgery or conventional radiotherapy for treatment of malignant
                 tumor).
    
             14. For arm 2: Requires concomitant treatment with warfarin. Other anticoagulants (ie, low
                 molecular weight heparins, non-steroidal anti-inflammatory drugs) are allowed as long
                 as the institutional guidelines requiring their withholding for interventional
                 radiology procedures can be followed.
    
             15. Administration of a live, attenuated vaccine within 2 weeks before randomization.
          
    Maximum Eligible Age:N/A
    Minimum Eligible Age:18 Years
    Eligible Gender:Female
    Healthy Volunteers:No

    Primary Outcome Measures

    Measure:To assess and describe independently in each arm the biological activity (increase in sTILs) of CMP-001 combined with SBRT and of SBRT alone in patients with early stage TNBC in a preoperative setting
    Time Frame:Evaluated between baseline and surgery (up to 7 weeks)
    Safety Issue:
    Description:A 10% increase in the presence of TILs (between baseline and surgery) is the defined threshold for efficacy. Percentage of sTILs will be quantified using hematoxylin and eosin (H&E) staining and immunohistochemistry (IHC) as per current consensus.

    Secondary Outcome Measures

    Measure:Toxicity of CMP-001 combined with SBRT and of SBRT alone
    Time Frame:(S)AEs collected continuously from the time of informed consent signature until end of treatment visit, which correspond to Day 51 to 60.
    Safety Issue:
    Description:Assessement of the incidence and severity of AEs and SAEs
    Measure:Tumor response: pCR and pPR
    Time Frame:evaluation at surgery (between day 21 and day 30 post-SBRT) or change from baseline to surgery (up to 7 weeks)
    Safety Issue:
    Description:Percentage of patients with a pathological complete response (pCR) and pathological Partial Response (pPR) at surgery in the breast tumoral lesion(s) (lymph node tumoral lesion(s) not included)
    Measure:Tumor response: minimal residual cancer
    Time Frame:evaluation at surgery (between day 21 and day 30 post-SBRT) or change from baseline to surgery (up to 7 weeks)
    Safety Issue:
    Description:Percentage of patients with minimal residual cancer as assessed by the residual cancer burden index (RCB) at surgery in the breast tumoral lesion(s) (lymph node tumoral lesion(s) not included)
    Measure:Tumor response: Ki-67
    Time Frame:evaluation at surgery (between day 21 and day 30 post-SBRT) or change from baseline to surgery (up to 7 weeks)
    Safety Issue:
    Description:Mean change of proliferation index Ki-67 from baseline at surgery.
    Measure:Tumor response: change in tumor characteristics
    Time Frame:evaluation at surgery (between day 21 and day 30 post-SBRT) or change from baseline to surgery (up to 7 weeks)
    Safety Issue:
    Description:Mean change in tumor characteristics and peritumoral tissues as assessed by breast MRI and/or ultrasound (US) from baseline at surgery. Data will also be compared to previously reported findings.
    Measure:Time-to-event (TTE)
    Time Frame:time from the date of randomization to the date of earliest objective tumor recurrence (up to 2 years from randomization)
    Safety Issue:
    Description:defined as time from the date of randomization to the date of earliest objective tumor recurrence, including progression that precludes surgery, or local or distant disease recurrence (deaths are censored)
    Measure:Event-free survival (EFS) rate
    Time Frame:at 24 months
    Safety Issue:
    Description:EFS rate is defined as the percentage of patients who are alive and without event (protocol-defined progression prior to surgery; local, regional, or distant recurrence of breast cancer following curative surgery; a new breast cancer; another new onset malignancy; or death as a result of any cause) at month 24, per the Kaplan-Meier estimate of recurrence-free survival at 24 months.
    Measure:Distant disease-free survival (DDFS) rate
    Time Frame:at 24 months
    Safety Issue:
    Description:DDFS rate is defined as the percentage of patients without objective distant tumor recurrence (outside of the ipsilateral locoregional region) at month 24, per the Kaplan-Meier estimate of distant tumor recurrence-free survival at 24 months.
    Measure:Overall survival (OS) rate
    Time Frame:at 24 months
    Safety Issue:
    Description:OS rate is defined as the percentage of patients who are alive at month 24, per the Kaplan-Meier estimate of overall survival at 24 months (as event is considered the death from any cause).
    Measure:Biological activity (difference between the 2 arms)
    Time Frame:Evaluated between baseline and surgery for both arms (up to 7 weeks)
    Safety Issue:
    Description:sTILs increase will be compared between the two arms

    Details

    Phase:Phase 2
    Primary Purpose:Interventional
    Overall Status:Recruiting
    Lead Sponsor:Centre Hospitalier Universitaire Vaudois

    Last Updated

    July 9, 2021