To determine whether short-term pre-operative nivolumab either as monotherapy or in combination with low dose doxorubicin or novel IO combinations can induce immune activation in early BC.
The investigators aim to test the activity of nivolumab monotherapy in primary breast tumors in a pre-operative window of opportunity trial. As the data of the investigators generated in the TONIC trial (metastatic TNBC) indicate that low dose doxorubicin may 'prime' the tumor microenvironment (TME) resulting in higher response rates on nivolumab, in addition, cohorts for treatment with nivolumab plus low dose doxorubicin will be opened. Given the emerging data on other immunomodulatory strategies, this platform study allows opening additional cohorts for promising novel immune-oncology (IO) drugs for which a strong efficacy signal has been seen without drug safety issues. The investigators will study the TME and systemic host factors with specific emphasis on immunosuppressive processes that can potentially be targeted by novel IO agents to further optimize BC immunotherapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
80
2 courses 240 mg flat dose
single dose ipilimumab (1mg/kg) at day 1
two courses ipilimumab (1mg/kg) at day 1 and 21
NKI-AVL
Amsterdam, Netherlands
RECRUITINGPathological complete response rate per cohort,
number of patients with no residual invasively growing tumor cells detected by microscopic examination in breast and axilla
Time frame: up to 3 weeks after surgery, an average of 6 months
Incidence of Treatment-Emergent Adverse Events according to NCI Common Toxicity Criteria version 5.0
Adverse events in all regimens will be graded according to NCI Common Toxicity Criteria version 5.0.
Time frame: up to 3 weeks after surgery, an average of 6 months
Radiological response rate
The percentage of patients having a complete response, partial response or stable disease per cohort assessed by MRI
Time frame: At 4 weeks
Immune activation after pre-operative nivolumab, either as monotherapy or in combination with ipilimumab or relatlimab or novel IO combinations.
Immune activation is defined as either a 2-fold increase in tumor-associated CD8 after pre-operative immunotherapy; and/or a 2-fold increase expression of genes induced by IFNy (determined using mRNA expression levels)
Time frame: within 6 months after surgery
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