The goal of this clinical trial is to study the safety, feasibility, histologic and immunological effects of Mitazalimab, a CD40 agonistic antibody, when administered either alone or in combination with PD-1 inhibition prior to surgical resection. The investigator hypothesizes that preoperative administration of CD40 agonist with or without PD-1 inhibitor intratumorally will demonstrate an acceptable safety profile, will not result in an unplanned delay in surgery, and will lead to increased immune activation. Subjects will receive a single intratumoral dose of CD40 agonist with or without PD-1 inhibitor 7 or more days prior to surgery and will be followed for safety, feasibility, immune, and pathologic responses.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
32
Intratumoral agonistic CD40
Checkpoint inhibitor
Occurrence of Grade 3 or higher adverse events as assessed by CTCAE v5.0
Type and severity of adverse events
Time frame: Within 30 days of treatment
Feasibility of CD40 agonist (Mitazalimab) with/without PD-1 inhibitor (Nivolumab) prior to surgery
Number of successful surgical resection without unanticipated delay in surgery \> 14 days after planned surgical date due to treatment-related issues
Time frame: 14 days after planned surgical date
Tumor response rate
Rate of tumors with response (Residual Cancer Burden 0-II)
Time frame: 2 weeks after surgery
Recurrence of disease
Occurrence of a breast cancer recurrence
Time frame: up to 5 years post surgery
Event-free survival
Length of time between time of surgery and a breast cancer recurrence or death
Time frame: up to 5 years post surgery
immunologic effects of CD40 agonist (Mitazalimab) with/without PD-1 inhibitor (Nivolumab)
Immunophenotyping of PBMCs pre- and post-treatment
Time frame: Prior to treatment and up to 30 days post surgery
Number of participants with change in serum cytokine levels pre- and post-treatment
Serum cytokine measurement
Time frame: Prior to treatment and up to 30 days post surgery
Number of participants with changes in tumor immune cell number pre- and post-treatment
10x genomics platform will be used to evaluate for changes in tumor immune cell number pre- and post-treatment
Time frame: Prior to treatment and up to 30 days post surgery
Number of participants with changes in TCR repertoire in peripheral blood pre- and post-treatment
Comparison of TCR repertoire in peripheral blood via TCR sequencing pre- and post-treatment
Time frame: Prior to treatment and up to 30 days post surgery
Number of participants with changes in TCR repertoire in tumor pre- and post-treatment
Comparison of TCR repertoire in tumor via TCR sequencing pre- and post-treatment
Time frame: Prior to treatment and up to 30 days post surgery
Number of patients with FDG PET/CT response or flair after treatment
Change in FDG activity in tumor and/or lymph nodes between baseline (PET0) and post-treatment (PET1) FDG PET/CT scans.
Time frame: between baseline and 1 week post-treatment
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