Combination of Chemotherapy With Taxol, Adriamycin, and Cytoxan (TAC), Multiple Infusions of Activated T Cells (ATC), Interleukin-2 (IL-2) and GM-CSF for High Risk Breast Cancer With and Without Her2/Neu Overexpression. (Phase I/II)
18 Years
N/A
Female
Breast Cancer
Trial Information
Combination of Chemotherapy With Taxol, Adriamycin, and Cytoxan (TAC), Multiple Infusions of Activated T Cells (ATC), Interleukin-2 (IL-2) and GM-CSF for High Risk Breast Cancer With and Without Her2/Neu Overexpression. (Phase I/II)
OBJECTIVES:
- Determine the toxic effects of sequential paclitaxel (or other taxane), doxorubicin,
and cyclophosphamide followed by immunotherapy with activated T cells, interleukin-2,
and sargramostim (GM-CSF) in patients with high-risk stage II or III breast cancer.
- Determine the disease-free survival and overall survival of patients treated with this
regimen.
- Determine the immune function of patients treated with this regimen.
OUTLINE: Patients are stratified according to number of positive lymph nodes (less than 4
nodes vs 4-9 nodes vs 10 or more nodes), type of taxane chemotherapy during study
(paclitaxel vs other taxane), and prior treatment with 2 of 3 study chemotherapy agents (yes
vs no).
Patients receive doxorubicin IV on day 1 and filgrastim (G-CSF) on days 3-10 of 3
consecutive 14-day courses. Patients then receive paclitaxel or another taxane IV on day 1
and G-CSF on days 3-10 of 3 consecutive 14-day courses. Patients then receive
cyclophosphamide IV on day 1 and G-CSF on days 3-10 of 3 consecutive 14-day courses.
Patients who enroll after previously receiving 2 of these 3 chemotherapy drugs may receive
the third. Treatment continues in the absence of disease progression or unacceptable
toxicity.
After recovery from chemotherapy, patients undergo peripheral blood mononuclear cell (PBMC)
collection. The PBMC are treated ex vivo with monoclonal antibody OKT3 to form activated T
cells (ATC). The ATC are expanded for up to 14 days in interleukin-2 (IL-2).
At 3-4 weeks after PBMC collection, patients receive ATC IV over 15-30 minutes weekly for 8
weeks. Patients also receive IL-2 subcutaneously (SC) daily and sargramostim (GM-CSF) SC
twice weekly beginning 3 days before the first ATC infusion and continuing until 7 days
after completion of ATC therapy.
Patients are followed every 3 months for 1 year and then annually thereafter.
PROJECTED ACCRUAL: A total of 40-60 patients will be accrued for this study within 4-5
years.
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed stage II or III adenocarcinoma of the breast
- High-risk disease
- At least 4 positive lymph nodes
- Fewer than 4 positive lymph nodes considered high-risk if one of the following
is present:
- HER2/neu-positive disease
- Enlarged axillary nodes
- Extra capsular extension of tumor from lymph node
- Dermal lymphatic invasion
- Vascular invasion
- Bilateral disease
- Familial breast cancer
- T4 locally advanced disease
- Clinically chemosensitive to prior paclitaxel (or other taxane), doxorubicin, and
cyclophosphamide
- No relapse after chemotherapy
- No clinical evidence of brain metastases
- Hormone receptor status:
- Estrogen and progesterone receptor status known
PATIENT CHARACTERISTICS:
Age:
- 18 and over
Sex:
- Female
Menopausal status:
- Not specified
Performance status:
- Karnofsky 70-100% OR
- ECOG 0-2
Life expectancy:
- At least 3 months
Hematopoietic:
- Granulocyte count at least 1,500/mm^3
- Platelet count at least 50,000/mm^3
- Hemoglobin greater than 8 g/dL
Hepatic:
- Bilirubin less than 1.5 times normal
- SGOT less than 1.5 times normal
Renal
- Creatinine less than 1.8 mg/dL
- Creatinine clearance at least 60 mL/min
- BUN less than 1.5 times normal
Cardiovascular:
- Ejection fraction at least 45% by MUGA
- No uncontrolled or significant cardiovascular disease
- No myocardial infarction within the past year
- No significant congestive heart failure
Pulmonary:
- FEV_1 at least 60% predicted
- DLCO at least 60% predicted
- FVC at least 60% predicted
Other:
- No other malignancy except curatively treated squamous cell carcinoma in situ of the
cervix or basal cell skin cancer
- No other serious medical or psychiatric illness that would preclude study
participation
- HIV negative
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
- Not specified
Chemotherapy:
- See Disease Characteristics
- Prior standard chemotherapy with anthracyclines or combination chemotherapy involving
a combination of taxanes, doxorubicin, and/or cyclophosphamide allowed
Endocrine therapy:
- No concurrent hormonal therapy for breast cancer
- Concurrent hormonal therapy for nondisease-related conditions (e.g., insulin for
diabetes) allowed
- Concurrent steroids for adrenal failure, septic shock, or pulmonary toxicity allowed
Radiotherapy:
- Not specified
Surgery:
- Prior complete resection of tumor allowed
Other:
- Prior successful neoadjuvant therapy allowed
Type of Study:
Interventional
Study Design:
Primary Purpose: Treatment
Outcome Measure:
Toxicity
Safety Issue:
Yes
Principal Investigator
Lawrence G. Lum, MD, DSc
Investigator Role:
Study Chair
Investigator Affiliation:
Roger Williams Medical Center
Authority:
United States: Federal Government
Study ID:
CDR0000068797
NCT ID:
NCT00022230
Start Date:
January 2000
Completion Date:
January 2007
Related Keywords:
- Breast Cancer
- stage II breast cancer
- stage IIIA breast cancer
- stage IIIB breast cancer
- stage IIIC breast cancer
- Breast Neoplasms
Name | Location |
|---|---|
| Roger Williams Medical Center | Providence, Rhode Island 02908-4735 |
