Trial Title:
Phase I Study of Autologous Tumor-Draining Lymph Node-Derived Lymphocytes as Neoadjuvant Therapy for HER2-Negative Breast Cancer
NCT ID:
NCT06121570
Condition:
Breast Neoplasms
Conditions: Official terms:
Breast Neoplasms
Paclitaxel
Cyclophosphamide
Doxorubicin
Fludarabine
Interleukin-2
Epirubicin
Conditions: Keywords:
HER2-Negative
Neoadjuvant Chemotherapy
Lymph Node
Lymphocytes
Adoptive Cell Therapy
Doxorubicin
Epirubicin
Cyclophosphamide
Nab-paclitaxel
Study type:
Interventional
Study phase:
Phase 1
Overall status:
Recruiting
Study design:
Allocation:
N/A
Intervention model:
Single Group Assignment
Primary purpose:
Treatment
Masking:
None (Open Label)
Intervention:
Intervention type:
Procedure
Intervention name:
Sentinel Lymph Node Biopsy (SLNB)
Description:
A sample of the participant's tumor-draining lymph nodes will be collected and sent to
the biotherapy center for LNL isolation and expansion.
Arm group label:
Chemotherapy + LNL treatment
Other name:
SLNB
Intervention type:
Drug
Intervention name:
Doxorubicin
Description:
Doxorubicin will be administered at 60 mg/m^2 IV on Day 1 of Cycles 1-2 of the
neoadjuvant chemotherapy of the study.
Arm group label:
Chemotherapy + LNL treatment
Intervention type:
Drug
Intervention name:
Epirubicin
Description:
Epirubicin will be administered at 100 mg/m^2 IV on Day 1 of Cycles 1-2 of the
neoadjuvant chemotherapy of the study.
Arm group label:
Chemotherapy + LNL treatment
Intervention type:
Drug
Intervention name:
Cyclophosphamide
Description:
Cyclophosphamide will be administered at 600 mg/m^2 IV on Day 1 of Cycles 1-2 of the
neoadjuvant chemotherapy of the study.
Arm group label:
Chemotherapy + LNL treatment
Intervention type:
Drug
Intervention name:
Cyclophosphamide
Description:
Cyclophosphamide will be administered at 500 mg/m^2 IV daily for three days.
Cyclophosphamide will be initiated five days prior to the anticipated LNL transfer, and
the precise timing will depend on the rate of in vitro LNL growth.
Arm group label:
Chemotherapy + LNL treatment
Intervention type:
Drug
Intervention name:
Fludarabine
Description:
Fludarabine will be administered at 30 mg/m^2 IV daily for three days. Fludarabine will
be initiated five days prior to the anticipated LNL transfer, and the precise timing will
depend on the rate of in vitro LNL growth.
Arm group label:
Chemotherapy + LNL treatment
Intervention type:
Biological
Intervention name:
Tumor-draining lymph node-derived lymphocyte (LNL)
Description:
Participants receive single infusion of LNL at the recommended phase 2 dose (RP2D).
Arm group label:
Chemotherapy + LNL treatment
Other name:
LNL
Intervention type:
Biological
Intervention name:
Interleukin-2
Description:
Eight to twelve hours after completing the LNL infusion, all participants will receive
intermediate-dose decrescendo IL-2 IV.
Arm group label:
Chemotherapy + LNL treatment
Other name:
IL-2
Intervention type:
Drug
Intervention name:
Nab-paclitaxel
Description:
Nab-paclitaxel will be administered at 260 mg/m^2 IV on Day 1 of Cycles 3-6 of the
neoadjuvant chemotherapy of the study.
Arm group label:
Chemotherapy + LNL treatment
Summary:
RATIONALE: Patients with HER2-negative breast cancer not responding to initial
neoadjuvant chemotherapy might have lower chances for a pathologic complete response
(pCR) at definitive surgery, indicating worse prognosis. Adoptive cell therapy has
demonstrated efficacy in advanced breast cancer, but whether the addition of adoptive
cell therapy to neoadjuvant chemotherapy could increase the pCR rate remains unclear.
Tumor-draining lymph node-derived lymphocytes (LNLs) that have abundant tumor-reactive T
cells, but not exhausted T cells, are easy to produce. It is not yet known whether LNL
treatment is safe and effective in patients with HER2-negative breast cancer not
responding to neoadjuvant chemotherapy.
PURPOSE: This phase I trial is mainly to investigate the safety of autologous LNL in
patients with HER2-negative breast cancer not responding to neoadjuvant chemotherapy.
Criteria for eligibility:
Criteria:
Inclusion Criteria:
In order to be eligible for participation in this trial, the participant must:
1. Have signed the informed consent to study participation.
2. Be a female subject and aged between 18 and 70 years.
3. Provide a core needle biopsy which is histologically confirmed as invasive breast
cancer. Excisional biopsy or surgical biopsy is not allowed.
4. Have received two cycles of doxorubicin or epirubicin, plus cyclophosphamide, and
had stable disease (SD) confirmed by breast MRI.
5. Have breast cancer defined as the following combined primary tumor (T), regional
lymph node (N), and distant metastasis (M) staging per AJCC for breast cancer
staging criteria version 8 based on breast MRI assessment before receiving
neoadjuvant chemotherapy:
The minimum size of the primary tumor was 1 cm in largest diameter by breast MRI,
N0-3, M0.
6. Have HER2-negative breast cancer, defined as 0-1+ by immunohistochemistry or 2+ by
immunohistochemistry without HER2 amplification by FISH.
7. Have known hormone receptor status (estrogen receptor [ER], progesterone receptor
[PgR]), Ki67 value and, if institutional standard permits, known tumor grade.
8. Have not received prior therapies for breast cancer, including but not limited to,
chemotherapy (except two cycles of doxorubicin or epirubicin, plus
cyclophosphamide), radiotherapy, hormonal therapy, targeted therapy, biological
therapy, immunotherapy and surgery.
9. Have accessible tumor-draining lymph nodes by surgery to grow LNL. Participants have
not received sentinel lymph node biopsy (SLNB) and ipsilateral axillary lymph node
dissection (ALND) for the breast cancer lesion.
10. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
11. Demonstrate adequate normal organ function:
NOTE: Blood component or cytokine therapy is not allowed within 14 days before
surgery.
1. Routine blood test:
- Absolute neutrophil count (ANC) ≥1.5×10^9/L
- Lymphocyte count (LC) >0.5×10^9/L
- Platelets (PLT) ≥100×10^9/L
- Hemoglobin (Hb) ≥90 g/L
2. Liver function test:
- AST and ALT ≤2.5×ULN (≤5×ULN for participants with liver metastases)
- ALP ≤2.5×ULN (≤5×ULN for participants with liver or bone metastases)
- Total bilirubin ≤1.5×ULN (≤3.0 mg/dL for participants with Gilbert's
syndrome)
3. Renal function test:
• Calculated creatinine clearance (CrCL) ≥45 mL/min OR creatinine ≤1.5×ULN
4. Coagulation function test:
- APTT ≤1.5×ULN
- INR or PT ≤1.5×ULN
5. Doppler echocardiography:
• Left ventricular ejection fraction (LVEF) ≥50%
6. Pulmonary function test:
- FEV1 ≥60%
12. Female participants of childbearing potential must be willing to use an adequate
method of contraception for the course of the study through one year (or longer as
specified by local institutional guidelines) after the last dose of study treatment.
Female subjects of childbearing potential must have a negative serum pregnancy test
within 7 days prior to LNL infusion.
13. Have recovered from prior therapy-related adverse events to Grade≤1 per CTCAE
version 5.0 criteria or met the criteria of normal organ function specified above
prior to the surgery for obtaining the lymph nodes, except for second-degree
peripheral nerve injury, alopecia, leukoderma, hypothyroidism controlled by thyroid
hormone replacement therapy, type 1 diabetes controlled by insulin therapy, and
other irreversible toxic events that would not be exacerbated by LNL infusion as
judged by the investigator (e.g., hearing loss).
Exclusion Criteria:
The participant must be excluded from participating in this trial if the participant:
1. Has metastatic breast cancer.
2. Has a known additional malignancy that is progressing or requires active treatment
within the last 5 years. Exceptions include basal or squamous cell carcinoma of the
skin, and thyroid cancer that has undergone potentially curative therapy or in situ
cervical cancer.
3. Has a known history of cardiovascular disease, including but not limited to, (1)
congestive heart failure (New York Heart Association [NYHA] functional
classification Class > 2), (2) unstable angina pectoris, (3) myocardial infarction
in the past 3 months, (4) supraventricular arrhythmia or ventricular arrhythmia that
requires treatments.
4. Has interstitial pneumonia or active pneumonia that has clinical implications, or
other respiratory diseases that seriously affect pulmonary function.
5. Has an active infection requiring systemic therapy or has an unexplained fever of
>38.5℃ except fevers caused by cancer.
6. Has arterial and/or venous thrombotic events in the past 5 months, e.g.,
cerebrovascular accident, deep vein thrombosis or pulmonary embolism.
7. Has a known psychiatric, alcohol abuse or substance abuse disorders.
8. Is pregnant or breastfeeding.
9. Has an active autoimmune disease, a history of autoimmune disease, or autoimmune
disease that has required systemic treatment (e.g., with use of prednisone at a dose
of >10 mg per day or other corticosteroids at an equivalent dose). Replacement
therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy
for adrenal or pituitary insufficiency) is allowed.
10. Has a history of congenital immunodeficiency or acquired immunodeficiency (e.g.,
positive serology test for HIV).
11. Has tuberculosis in the past one year, or has a history of active tuberculosis more
than one year but did not receive regular treatments.
12. Has known active hepatitis B or hepatitis C. Participants that are hepatitis B
surface antigen (HBsAg) or hepatitis B core antigen (HBcAg) positive may participate
provided that the HBV DNA level is normal. Participants that are hepatitis C
antibody positive may participate provided that the HCV DNA level is normal.
Carriers of HBV or HCV must receive anti-virus therapy, and take regular DNA copy
number tests during this trial.
13. Has received a live vaccine within 4 weeks prior to enrollment, or plans to receive
a live vaccine during this trial.
14. Has a history of allogeneic bone marrow or organ transplant.
15. Has received the study-related drugs including anthracycline, cyclophosphamide,
taxane, fludarabine, interleukin-2, except two-cycle neoadjuvant chemotherapy of
doxorubicin or epirubicin, plus cyclophosphamide.
16. Has a history of hypersensitivity or allergy to the drugs in this study and any of
their components including but not limited to, LNL, doxorubicin/epirubicin,
cyclophosphamide, nab-paclitaxel, fludarabine, interleukin-2, dimethyl sulphoxide
(DMSO), human serum albumin (HSA), dextran-40 and antibiotics (β-lactam antibiotics,
gentamicin).
17. Has contraindication for use of IL-2, including but not limited to, refractory or
intractable epilepsy, and active gastrointestinal bleeding.
18. Has a history of Grade≥2 neuropathy.
19. Has received long half-life angiogenesis inhibitors within four weeks prior to
enrollment, e.g., bevacizumab.
20. Is receiving any medication prohibited in combination with study treatments as
described in the respective product labels, unless medication was stopped within 7
days prior to enrollment.
21. Has a history or current evidence of any condition, therapy, or laboratory
abnormality that might confound the results of the study, interfere with
participation for the full duration of the study, or render study participation not
compatible with the participant's best interest, in the opinion of the investigator.
Gender:
Female
Minimum age:
18 Years
Maximum age:
70 Years
Healthy volunteers:
No
Locations:
Facility:
Name:
Sun Yat-sen Memorial Hospital, Sun Yat-sen University
Address:
City:
Guangzhou
Zip:
510120
Country:
China
Status:
Recruiting
Contact:
Last name:
Shicheng Su, M.D., Ph.D.
Phone:
+86 13632394954
Email:
lnl_trial@126.com
Contact backup:
Last name:
Erwei Song, M.D., Ph.D.
Phone:
+86 13719237746
Email:
lnl_trial@126.com
Start date:
November 1, 2023
Completion date:
August 31, 2031
Lead sponsor:
Agency:
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Agency class:
Other
Source:
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
Record processing date:
ClinicalTrials.gov processed this data on November 12, 2024
Source: ClinicalTrials.gov page:
https://clinicaltrials.gov/ct2/show/NCT06121570
