This phase II trial studies how well a cancer vaccine called STEMVAC works in combination with chemotherapy in treating patients with PD-L1 negative, triple-negative breast cancer that has spread from where it first started (primary site) to other places in the body (metastatic). STEMVAC is designed to target proteins that are expressed on breast cancer stem cells, and it is believed to work by boosting the immune system to recognize and destroy the invader tumor cells that are causing the disease. The allowable combination chemotherapy includes: (1) Paclitaxel is in a class of chemotherapy medications called antimicrotubule agents. It stops tumor cells from growing and dividing and may kill them. (2) Docetaxel is in a class of chemotherapy medications called taxanes. It stops tumor cells from growing and dividing and may kill them. (3) Cisplatin is in a class of chemotherapy medications known as platinum-containing compounds. It works by killing, stopping or slowing the growth of tumor cells. (4) Carboplatin is in a class of chemotherapy medications known as platinum-containing compounds. It works in a way similar to the anticancer drug cisplatin but may be better tolerated than cisplatin. Carboplatin works by killing, stopping or slowing the growth of tumor cells. (5) Doxorubicin is in a class of chemotherapy medications called anthracyclines. Doxorubicin damages the cell's deoxyribonucleic acid (DNA) and may kill tumor cells. It also blocks a certain enzyme needed for cell division and DNA repair. (6) Liposomal doxorubicin is a form of the anticancer drug doxorubicin that is contained inside very tiny, fat-like particles. Liposomal doxorubicin may have fewer side effects and work better than other forms of the drug. (7) Eribulin is in a class of chemotherapy medications called microtubule dynamics inhibitors. It works by stopping the growth and spread of tumor cells. Giving STEMVAC in combination with chemotherapy may be an effective treatment for PD-L1 negative metastatic triple-negative breast cancer.
OUTLINE: Patients receive one of the following chemotherapy regimens, per the treating physician's discretion, in the absence of disease progression or unacceptable toxicity: 1) Paclitaxel every 21 days; paclitaxel on days 1, 8, and 15 every 28 days; paclitaxel on days 1 and 8 every 21 days; or docetaxel every 21 days; 2) Carboplatin every 21 days; carboplatin every 28 days; carboplatin on days 1 and 8 every 21 days; or cisplatin every 21 days; 3) Doxorubicin every 21 days; or liposomal doxorubicin every 28 days; OR 4) Eribulin on days 1 and 8 every 21 days. Patients receive 3 priming doses of STEMVAC with sargramostim intradermally (ID) every 21-28 days (7-10 days after each chemotherapy administration or during the off week of weekly chemotherapy), 2 booster STEMVAC/sargramostim doses at 4 and 7 months after 3rd priming dose, and then every 6 months in the absence of disease progression or unacceptable toxicity. Patients also undergo computed tomography (CT) or ultrasound-guided biopsy, for research purposes, on study, as well as CT or positron emission tomography (PET) scans and blood sample collection throughout the study. In addition, patients may also undergo CT or ultrasound-guided biopsy, for research purposes, during screening. After completion of study treatment, patients are followed up at 21 or 28 days and then every 6 months for 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Given ID
Given cisplatin
Undergo CT scans
Undergo CT-guided biopsy
Given docetaxel
Given doxorubicin
Given eribulin
Given paclitaxel
Given liposomal doxorubicin
Given ID
Undergo ultrasound-guided biopsy
Undergo blood sample collection
Given carboplatin
Undergo PET scan
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Progression-free survival (PFS)
Assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1/Positron Emission Tomography (PET) Response Criteria in Solid Tumors (PERCIST). Kaplan-Meier method will be used to estimate PFS and the rates at specified time point (e.g., 6 or 12 months) will be calculated and the 95% confidence intervals will be provided.
Time frame: From the start of treatment to the worsening of cancer or death whichever occurs first, assessed up to 3 years after completion of study treatment
Overall survival (OS)
Kaplan-Meier method will be used to estimate OS and the rates at specified time point (e.g., 6 or 12 months) will be calculated and the 95% confidence intervals will be provided.
Time frame: Up to 3 years after completion of study treatment
Incidence of adverse events
Will be determined by chemical and clinical parameters evaluated at various time points. Toxicity grading will be evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 6.0 and monitoring of adverse events will be done per Food and Drug Administration and NCI guidelines. Descriptive statistics will be provided on the key demographic and clinical variables, such as mean, standard deviation, and range for continuous variables, and percent and number for categorical variables, such as toxicity grades.
Time frame: Up to 21 or 28 days after completion of study treatment
Immunogenicity of CD105/Yb-1/SOX2/CDH3/MDM2-polyepitope plasmid deoxyribonucleic acid vaccine (STEMVAC)
Defined as the sum of the interferon gamma enzyme-linked immunosorbent spot of all STEMVAC antigens on blood samples collected pre-vaccine as compared to 1-month post dose #3 of the STEMVAC vaccine and again after 2 booster doses of STEMVAC vaccine. Both incidence and magnitude will be assessed. Will generate boxplots for its measurements at different timepoints (pre-vaccine, 1 month after vaccine 3, and at each booster) and spaghetti plots to show the changes over time. To make the full use of longitudinal data, will use a weighted generalized estimating equation approach to assess the association between the longitudinal measures over time and a covariate of interest.
Time frame: Baseline up to 7 months after STEMVAC priming dose #3
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