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Study of Combination Immunotherapy for the Generation of HER-2/Neu Specific Cytotoxic T Cells

2014-07-23 21:48:12 | BioPortfolio

Summary

This will be a single arm phase I-II single institution clinical trial in patients with HER2 overexpressing Stage IV breast and ovarian cancer who are on maintenance trastuzumab alone after being treated with chemotherapy and trastuzumab or trastuzumab alone to NED or stable disease. Patients will receive a monthly vaccination for 6 months with a HER2 CTL peptide-based vaccine.

Description

Study Population:

Patients with HER2 overexpressing Stage IV breast cancer who are on maintenance trastuzumab alone after being treated with chemotherapy and trastuzumab until there is no evidence of disease (NED) or stable disease. Stage IV HER2 overexpressing ovarian cancer patients who are on maintenance trastuzumab alone or after being treated with chemotherapy and trastuzumab until there is no evidence of disease (NED) or stable disease.

Patients must be HLA-A2.

Rationale:

Data from tumor vaccine studies now indicate there might be survival advantages for patients who have received tumor-antigen specific vaccinations. Our group has demonstrated a potential survival advantage for patients with advanced stage HER2 overexpressing breast cancer immunized with a HER2 peptide based vaccine after being treated to maximal response or complete remission with standard therapy. Recent studies have demonstrated that "sensitization" of HER2 overexpressing tumor cells with trastuzumab, in vitro, will enhance the function of CTL specific for HER2. Theoretically, the mechanism of trastuzumab's enhancement of a HER2 specific CTL response might be the internalization of the HER2 receptor, degradation of the HER2 protein, and increased MHC-peptide presentation with a resultant increase in CD8+ HER2 specific CTL function. Thus, combination of trastuzumab with HER2 peptide based vaccine designed to elicit CTL in the context of HLA-A2 may even further enhance the generation of a HER2 specific CTL response and potentially translate into improved survival for advanced stage breast and ovarian cancer patients when used in the adjuvant setting.

This proposal outlines a clinical trial designed to utilize the potential synergistic effect between trastuzumab and a HER2 CTL generating peptide based vaccine (HER2 CTL vaccine) in order to increase CTL precursor frequencies that target HER2 specific epitopes. Patients will be treated to NED or stable disease with chemotherapy and trastuzumab or trastuzumab alone and while on maintenance trastuzumab receive vaccinations with a HER2 CTL vaccine.

Objectives

Primary:

1. To evaluate the safety of administering a HER2 CTL peptide-based vaccine to Stage IV breast and ovarian cancer patients receiving maintenance trastuzumab.

2. To quantify and characterize antigen specific T cells directed against HER2 in PBMC of patients after vaccination with a HER CTL peptide-based vaccine administered while receiving maintenance trastuzumab.

Secondary:

1. To evaluate overall survival (OS) in Stage IV breast cancer patients who complete a vaccination series with a HER2 CTL peptide-based vaccine while receiving maintenance trastuzumab.

Study Design:

This will be a single arm phase I-II single institution clinical trial in patients with HER2 overexpressing Stage IV breast and ovarian cancer who are on maintenance trastuzumab alone after being treated with chemotherapy and trastuzumab or trastuzumab alone to NED or stable disease. Patients will receive a monthly vaccination for 6 months with a HER2 CTL peptide-based vaccine.

Number of Patients:

Twenty subjects will be enrolled. This will provide statistically adequate numbers of subjects for gathering (1) safety data and (2) immunologic response data.

Outcome Measures

Primary Endpoints:

1. Safety will be assessed using NCI common toxicity criteria.

2. Immune response will be defined by cytokine flow cytometry (CFC). Specifically, a positive immune response will be defined as a post-vaccination HER2 antigen specific CD8 or CD4 precursor frequency measured by CFC of less than 1:20,000. For subjects who have measurable precursors by CFC at baseline, a positive response will be defined as a 2-fold increase in either T cell subset after vaccination.

HLA-A2 MHC tetramer analysis will be used to demonstrate the specificity of the T cells for the HER2 HLA-A2 defined epitopes. IFN-gamma secreting PBMC precursor frequency will also be measured by ELIspot in order to determine the development of lower precursor frequencies not detected by CFC. ELIspot measurements will not define response.

Secondary Endpoints:

1. Overall survival for all patients will be followed. Survival for the Stage IV breast cancer patients will be compared to historical control. This study will not enroll sufficient numbers of subjects to give statistical power to this endpoint. However, a large difference observed between the treatment group and historical control would give additional impetus for a phase II study of efficacy. Although the study will enroll both breast and ovarian cancer patients, from our extensive experience in combined breast and ovarian cancer vaccine studies for HER2, we anticipate approximately 80% of the subjects enrolled will be Stage IV breast cancer patients.

Study Design

Allocation: Non-Randomized, Control: Uncontrolled, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Conditions

Breast Cancer

Intervention

HER2 CTL vaccine (plus trastuzumab)

Location

University of Washington
Seattle
Washington
United States
98109

Status

Active, not recruiting

Source

University of Washington

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-07-23T21:48:12-0400

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A humanized monoclonal antibody against the ERBB-2 RECEPTOR (HER2). As an ANTINEOPLASTIC AGENT, it is used to treat BREAST CANCER where HER2 is overexpressed.

Abnormal accumulation of lymph in the arm, shoulder and breast area associated with surgical or radiation breast cancer treatments (e.g., MASTECTOMY).

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A deoxycytidine derivative and fluorouracil PRODRUG that is used as an ANTINEOPLASTIC ANTIMETABOLITE in the treatment of COLON CANCER; BREAST CANCER and GASTRIC CANCER.

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