Immunotherapy + Chemotherapy for Triple Negative Breast Cancer

Recruiting in Palo Alto (17 mi)

+5 other locations

Overseen by Sangeetha Reddy, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Recruiting

Sponsor: University of Texas Southwestern Medical Center

Must not be taking: Immunosuppressants, Corticosteroids, Anthracyclines, others

Disqualifiers: Autoimmune disease, Cardiovascular disease, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial tests a new combination of two immune-boosting drugs and a chemotherapy drug in patients with hard-to-treat breast cancer. The goal is to see if this combination is safe and effective at controlling the cancer.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. However, certain treatments like immunotherapy, chemotherapy, and some other medications must be stopped for a specific period before starting the trial. It's best to discuss your current medications with the trial team to get specific guidance.

What data supports the effectiveness of the drug CDX-1140, Agonist Anti-CD40 CDX-1140, CDX-301, CDX-301, PLD Chemotherapy, Pegylated Liposomal Doxorubicin, Doxil, Caelyx for Triple Negative Breast Cancer?

Research shows that pegylated liposomal doxorubicin (PLD) is effective for metastatic breast cancer with less toxicity than traditional chemotherapy. Additionally, combining chemotherapy with immune checkpoint inhibitors has shown promise in improving cancer treatment outcomes, as seen in studies with similar drugs. ^{1 2 3 4 5}

Is the combination of immunotherapy and chemotherapy safe for treating triple negative breast cancer?

The combination of pegylated liposomal doxorubicin (Caelyx) and paclitaxel has been studied in patients with advanced breast cancer and other solid tumors, showing moderate toxicity with some serious side effects like neutropenia (low white blood cell count) and diarrhea. However, it generally has an acceptable safety profile with minimal heart-related side effects. ^{6 7 8 9 10}

How is the treatment with CDX-1140, CDX-301, and PLD chemotherapy different for triple-negative breast cancer?

This treatment is unique because it combines immunotherapy (CDX-1140 and CDX-301) with chemotherapy (PLD), aiming to enhance the immune system's response to cancer cells, which is particularly important for triple-negative breast cancer that often has 'cold' tumors with low immune activity. ^{1 2 3 4 11}

Research Team

Sangeetha Reddy, MD

Principal Investigator

UT Southwestern Medical Center

Eligibility Criteria

This trial is for adults with metastatic triple negative breast cancer who have a life expectancy of at least 12 weeks. They should be in their first to third line of treatment and may have had up to two prior regimens. Participants must not be pregnant, agree to use contraception, and cannot have certain health conditions or treatments that would conflict with the trial.

Inclusion Criteria

My cancer has worsened despite treatment, or I had to stop treatment due to side effects.

I have at least one cancer lesion that can be measured over time.

I agree to have biopsies before and during treatment, from areas that haven't been irradiated and are safe to biopsy.

Exclusion Criteria

Any other acute or chronic medical or psychiatric condition or laboratory abnormality that could increase the risk associated with trial participation or trial drug administration or could interfere with the interpretation of trial results and, in the judgment of the investigator, would make the patient inappropriate for entry into the trial.

I do not have serious heart problems or recent major heart events.

I haven't taken any kinase inhibitors in the last 2 weeks.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive CDX-301, CDX-1140, and PLD chemotherapy in cycles. CDX-301 is administered daily for 5 days in cycles 1 and 2, CDX-1140 is administered once per cycle for up to 24 months, and PLD is administered once per cycle until toxicity or progression.

Up to 24 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, including assessment of overall response rate and progression-free survival.

12 months

Extension

Participants may continue to receive treatment until disease progression or unacceptable toxicity.

Treatment Details

Interventions

• CDX-1140 (CD40 Agonist)
• CDX-301 (Flt3 Ligand)
• PLD Chemotherapy (Immunotherapy)

Trial Overview The study tests if combining immunotherapy drugs CDX-301 and CDX-1140 with standard chemotherapy PLD is safe and effective against this type of breast cancer. It aims to find the right dose and schedule for these drugs while also observing how they affect the body's immune response to cancer.

Participant Groups

Group I: Cohort C Experimental Treatment 3 Interventions

PLD chemotherapy will be administered 40 mg/m2 as intravenous injection once per cycle until toxicity or progression. CDX-1140 will be administered 1.5mg/kg as intravenous injection once per cycle starting on cycle 2 until toxicity or progression for up to 24 months. CDX-301 will be administered 75µg/kg as subcutaneous injection daily x 5 days cycles 2 and 3 only.

Group II: Cohort A Experimental Treatment 3 Interventions

PLD chemotherapy will be administered 40 mg/m2 as intravenous injection once per cycle until toxicity or progression. CDX-1140 will be administered 1.5mg/kg as intravenous injection once per cycle until toxicity or progression for up to 24 months. CDX-301 will be administered 75µg/kg as subcutaneous injection daily x 5 days cycles 1 and 2 only.

Who Is Running the Clinical Trial?

University of Texas Southwestern Medical Center

Lead Sponsor

Trials

1,102

Recruited

1,077,000+

Daniel K. Podolsky

University of Texas Southwestern Medical Center

Chief Executive Officer since 2008

MD from Harvard Medical School

Robert L. Bass

University of Texas Southwestern Medical Center

Chief Medical Officer since 2019

MD from University of Texas Southwestern Medical School

Celldex Therapeutics

Industry Sponsor

Trials

66

Recruited

5,900+

Anthony S. Marucci

Celldex Therapeutics

Chief Executive Officer since 2008

MBA from Columbia University, MHL from Brown University

Diane C. Young

Celldex Therapeutics

Chief Medical Officer since 2019

MD from Harvard Medical School, AB in Biochemical Sciences from Harvard University

Gateway for Cancer Research

Collaborator

Trials

47

Recruited

2,500+

Findings from Research

In a study of 162 patients with stages I-III Triple-negative breast cancer (TNBC), pegylated liposomal doxorubicin (PLD) showed similar overall survival (OS) and relapse-free survival (RFS) rates compared to conventional chemotherapy, indicating its efficacy as an alternative treatment.

PLD-based chemotherapy resulted in a lower incidence of severe neutropenia (25% vs. 41.6%) but a higher incidence of hand-foot syndrome (16.3% vs. 4.4%), suggesting a different safety profile compared to traditional anthracycline treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of pegylated liposomal doxorubicin-based adjuvant chemotherapy in patients with stage I-III triple-negative breast cancer. Lien, MY., Liu, LC., Wang, HC., et al.[2018]

The combination of doxorubicin (DOX) with ginsenoside Rg3-loaded nanoparticles significantly enhanced immunogenic cell death (ICD) in triple-negative breast cancer (TNBC), leading to a stronger immune response compared to DOX alone.

Using a thermo-sensitive hydrogel to co-deliver DOX and Rg3-PNPs, along with PD-L1 immunotherapy, effectively transformed nonimmunogenic tumors into immunogenic ones, resulting in substantial antitumor effects and improved recruitment of memory T cells.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ginsenoside Rg3 nanoparticles with permeation enhancing based chitosan derivatives were encapsulated with doxorubicin by thermosensitive hydrogel and anti-cancer evaluation of peritumoral hydrogel injection combined with PD-L1 antibody. Wu, H., Wei, G., Luo, L., et al.[2022]

The ALICE trial demonstrated that adding atezolizumab (an anti-PD-L1 immune checkpoint inhibitor) to chemotherapy improved progression-free survival in patients with metastatic triple-negative breast cancer, with a median of 4.3 months compared to 3.5 months for those receiving placebo.

The treatment was generally well-tolerated, with 18% of patients in the atezo-chemo group experiencing adverse events leading to drug discontinuation, compared to 7% in the placebo group, suggesting that atezolizumab can be safely combined with chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Atezolizumab plus anthracycline-based chemotherapy in metastatic triple-negative breast cancer: the randomized, double-blind phase 2b ALICE trial. Røssevold, AH., Andresen, NK., Bjerre, CA., et al.[2023]

The study developed doxorubicin-loaded platelet decoys (PD@Dox) that not only deliver chemotherapy but also induce immunogenic cell death (ICD) in triple-negative breast cancer (TNBC), enhancing the immune response against tumors.

Combining PD@Dox with PD-1 antibody therapy significantly improved treatment efficacy by blocking tumor immune escape and activating T cells, suggesting a promising new approach for TNBC therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Doxorubicin-Loaded Platelet Decoys for Enhanced Chemoimmunotherapy Against Triple-Negative Breast Cancer in Mice Model. Dong, H., Gao, M., Lu, L., et al.[2023]

Stealth liposomal doxorubicin (Caelyx, Doxil) shows promise as a treatment for breast cancer, leveraging its unique liposomal formulation to improve drug delivery and efficacy.

The liposomal encapsulation of doxorubicin significantly alters its pharmacokinetics and reduces toxicity compared to traditional non-liposomal doxorubicin, making it a safer option for patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caelyx (stealth liposomal doxorubicin) in the treatment of advanced breast cancer. Ranson, MR., Cheeseman, S., White, S., et al.[2019]

In a phase I study involving 26 patients with advanced solid tumors, the combination of pegylated liposomal doxorubicin (Caelyx) and paclitaxel was found to be feasible, with a maximum tolerated dose established at 15 mg/m2 for Caelyx and 115 mg/m2 for paclitaxel, administered every two weeks.

The treatment regimen showed acceptable toxicity levels, with mild hematologic side effects and no significant cardiotoxicity, while achieving a complete response in one patient and partial responses in four, particularly among breast cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase I study of paclitaxel (taxol) and pegylated liposomal doxorubicin (caelyx) administered every 2 weeks in patients with advanced solid tumors. Mavroudis, D., Kouroussis, Ch., Kakolyris, S., et al.[2018]

The maximum tolerated dose (MTD) for pegylated liposomal doxorubicin was determined to be 10 mg/m² per week when combined with paclitaxel at 80 mg/m² per week, based on a study involving 19 patients with advanced solid tumors.

The treatment was generally well tolerated, with manageable dose-limiting toxicities including grade 3 neutropenia and diarrhea, and no significant cardiac toxicity observed, suggesting it is safe for further evaluation in sensitive tumor types.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase I study of weekly paclitaxel and liposomal doxorubicin in patients with advanced solid tumours. Androulakis, N., Kouroussis, C., Mavroudis, D., et al.[2019]

In a study of 42 patients receiving cumulative doses of pegylated liposomal doxorubicin (doxil) exceeding 500 mg/m2, none developed clinical congestive heart failure, indicating a favorable safety profile for higher doses compared to traditional doxorubicin.

While five patients experienced a drop in left ventricular ejection fraction (LVEF), the overall risk of cardiomyopathy appears significantly lower with doxil, even in patients previously treated with doxorubicin, suggesting that doxil may be a safer option for patients with solid tumors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pegylated liposomal doxorubicin (doxil): reduced clinical cardiotoxicity in patients reaching or exceeding cumulative doses of 500 mg/m2. Safra, T., Muggia, F., Jeffers, S., et al.[2022]

In a phase II study involving 34 patients with metastatic breast cancer, the combination of paclitaxel and liposomal doxorubicin was effective in 73% of patients, showing a high response rate with 7 complete and 18 partial responses.

The treatment had a moderate toxicity profile, with only a small number of severe side effects reported, including 2 toxic deaths (6%), indicating that while effective, careful monitoring for serious adverse effects is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

First line therapy with paclitaxel (Taxol) and pegylated liposomal doxorubicin (Caelyx) in patients with metastatic breast cancer: a multicentre phase II study. Vorobiof, DA., Rapoport, BL., Chasen, MR., et al.[2015]

In a study of 27 metastatic breast cancer patients treated with pegylated liposomal doxorubicin (PLD) and vinorelbine, there were no treatment interruptions or cardiac toxicity, highlighting the cardiac safety of PLD compared to traditional doxorubicin.

The combination treatment showed a median progression-free survival of 5.3 months and an overall clinical benefit rate of 55.5%, indicating its efficacy in patients previously treated with anthracycline-based chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pegylated liposomal doxorubicin (Caelyx®) and oral vinorelbine in first-line metastatic breast cancer patients previously treated with anthracyclines. Livi, L., Meattini, I., Scotti, V., et al.[2018]

Triple-negative breast cancer is a diverse and aggressive type of cancer, and while molecular characterization isn't standard practice, it can help in understanding the disease better and predicting outcomes.

Recent advances in treatment options include neoadjuvant platinum-based chemotherapy and targeted therapies for patients with BRCA mutations, which may improve outcomes in various stages of the disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advances in the systemic treatment of triple-negative breast cancer. Lebert, JM., Lester, R., Powell, E., et al.[2023]

References

1. Greece pubmed.ncbi.nlm.nih.gov

Safety and efficacy of pegylated liposomal doxorubicin-based adjuvant chemotherapy in patients with stage I-III triple-negative breast cancer. [2018]

2. England pubmed.ncbi.nlm.nih.gov

Ginsenoside Rg3 nanoparticles with permeation enhancing based chitosan derivatives were encapsulated with doxorubicin by thermosensitive hydrogel and anti-cancer evaluation of peritumoral hydrogel injection combined with PD-L1 antibody. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Atezolizumab plus anthracycline-based chemotherapy in metastatic triple-negative breast cancer: the randomized, double-blind phase 2b ALICE trial. [2023]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Doxorubicin-Loaded Platelet Decoys for Enhanced Chemoimmunotherapy Against Triple-Negative Breast Cancer in Mice Model. [2023]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Caelyx (stealth liposomal doxorubicin) in the treatment of advanced breast cancer. [2019]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Phase I study of paclitaxel (taxol) and pegylated liposomal doxorubicin (caelyx) administered every 2 weeks in patients with advanced solid tumors. [2018]

7. England pubmed.ncbi.nlm.nih.gov

Phase I study of weekly paclitaxel and liposomal doxorubicin in patients with advanced solid tumours. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Pegylated liposomal doxorubicin (doxil): reduced clinical cardiotoxicity in patients reaching or exceeding cumulative doses of 500 mg/m2. [2022]

9. Netherlands pubmed.ncbi.nlm.nih.gov

First line therapy with paclitaxel (Taxol) and pegylated liposomal doxorubicin (Caelyx) in patients with metastatic breast cancer: a multicentre phase II study. [2015]

10. England pubmed.ncbi.nlm.nih.gov

Pegylated liposomal doxorubicin (Caelyx®) and oral vinorelbine in first-line metastatic breast cancer patients previously treated with anthracyclines. [2018]

11. Switzerland pubmed.ncbi.nlm.nih.gov

Advances in the systemic treatment of triple-negative breast cancer. [2023]