This clinical trial will assess the safety and early efficacy of Hydroxychloroquine or Avelumab, with or without Palbociclib, in early-stage ER+ breast cancer patients who are found to harbor disseminated tumor cells (DTCs) in the bone marrow after definitive surgery and standard adjuvant therapy.
The overarching goal of this clinical trial is to reduce the incidence of incurable recurrent metastatic breast cancer by targeting the precursors of these recurrences, bone marrow disseminated tumor cells (DTCs) present after definitive treatment. This trial targets unique mechanisms by which DTCs maintain a dormant phenotype (autophagy) and by which they escape dormancy (upregulation of the cyclin-dependent kinase4/6 (CDK4/6) pathway and microenvironmental factors such as immune evasion). The selection of these agents is based upon strong preclinical data demonstrating the relevance of autophagy (inhibited by HCQ), the CDK4/6 pathway (inhibited by palbociclib) and the programmed cell death-1 (PD-1)/Programmed death-ligand 1 (PD-L1) immune checkpoint pathway (blocked by avelumab) as critical mechanisms of cellular and immunological tumor dormancy. The phase II trial is designed to provide "proof of concept" and estimates of effect of various combinations and durations of these therapies on bone marrow DTCs as a surrogate for ultimate reduction in recurrence. The correlative science aims will provide additional insight into the relationship between the primary tumor and both the biology of DTCs and host immune surveillance for target validation and development, as well as evaluate the role of additional biomarkers both in the bone marrow (with a novel flow-based assay), and in the peripheral circulation (including both circulating tumor cells and cell-free DNA), to identify patients with minimal residual disease (MRD) and targets for intervention and measurement of DTC response.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
96
600 mg tablets twice daily D1-28 of each 28-day cycle
10 mg/kg, IV, D1 and D15 of each 28-day cycle
125 mg capsule daily, by mouth on D1-21 concurrently with Avelumab. Or 75 mg capsule daily, by mouth on D1-28 concurrently with HCQ.
Georgetown University
Washington D.C., District of Columbia, United States
RECRUITINGUniversity of Chicago
Chicago, Illinois, United States
RECRUITINGIndiana University
Indianapolis, Indiana, United States
Determine the efficacy of HCQ or Avelumab, alone or in combination with Palbociclib, in eradicating DTCs
Endpoint: Proportion of subjects in each treatment arm with clearance of DTCs at the end of 6 cycles of therapy.
Time frame: Efficacy is assessed at the end of Cycle 6 (each cycle is 28 days).
Determine the safety and tolerability of HCQ or Avelumab, alone or in combination with Palbociclib, in this Phase II study: adverse events
Endpoint: Occurrence of an adverse event on treatment by NCI CTCAE v5 criteria.
Time frame: Toxicity is assessed from the first dose of study treatment through 30 days after the last dose of study treatment
Estimate the risk of recurrence after treatment with Palbociclib, Avelumab and HCQ, alone or in combination
Endpoint: 3-year recurrence free survival (RFS)
Time frame: Recurrence free survival (RFS) will be assessed 3 years after the completion of study treatment
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Dana-Farber Cancer Institute
Boston, Massachusetts, United States
RECRUITINGUniversity of Pennsylvania
Philadelphia, Pennsylvania, United States
RECRUITINGVanderbilt University
Nashville, Tennessee, United States
RECRUITINGUniversity of Washington
Seattle, Washington, United States
RECRUITING