Study Stopped
Drug provider decided not to move forward with the study.
MCS110 Combined With Neoadjuvant Doxorubicin, Cyclophosphamide, and Weekly Paclitaxel in Patients With Hormone-Receptor Positive and HER2- Breast Cancer
Phase I Study of MCS110 Combined With Neoadjuvant Dose-Dense Doxorubicin, Cyclophosphamide, and Weekly Paclitaxel in Patients With Hormone-Receptor Positive and HER2- Breast Cancer
2 other identifiers
interventional
N/A
0 countries
N/A
Brief Summary
In patients with locally advanced hormone receptor positive (HR+)/HER2- breast cancer, neoadjuvant chemotherapy produces a pathologic complete response rate (pCR) of only 9-15%, and late recurrences often occur despite neoadjuvant chemotherapy. Therefore, there is an unmet clinical need to improve the outcomes of these patients. Tumor-associated macrophages (TAM) infiltration leads to poor outcomes in breast cancer patients by promoting angiogenesis, activating epithelial-mesenchymal transition, degrading the extracellular matrix, and suppressing the anti-tumor immune response. Pre-clinical studies, as summarized above, have shown that the breast cancer immune microenvironment may be reprogrammed by targeting colony-stimulating factor-1 (CSF-1) to decrease TAM infiltration and increase CD8+ TIL infiltration, in order to foster antitumor immunity and improve response to therapy. Here, the investigators propose a phase I dose-escalation study in patients with locally advanced HR+/HER2- breast cancer to determine the feasibility of adding MCS110, a CSF-1 inhibitor, to the standard neoadjuvant chemotherapy regimen of dose-dense doxorubicin, cyclophosphamide followed by paclitaxel. The investigators will also include a dose expansion cohort for preliminary efficacy analysis and correlative studies. The investigators propose that if they can decrease the TAM-induced immunosuppression and TAM-induced chemoresistance observed in breast cancer patients, then the patients' own immune system could find and destroy the dormant and resistant tumor cells, and combined with enhanced chemotherapy efficacy, the investigators will see durable remissions and long term cures.
Trial Health
Trial Health Score
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Started Sep 2018
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Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
September 14, 2017
CompletedFirst Posted
Study publicly available on registry
September 18, 2017
CompletedStudy Start
First participant enrolled
September 30, 2018
CompletedPrimary Completion
Last participant's last visit for primary outcome
October 31, 2019
CompletedStudy Completion
Last participant's last visit for all outcomes
February 28, 2021
CompletedAugust 16, 2018
August 1, 2018
1.1 years
September 14, 2017
August 14, 2018
Conditions
Outcome Measures
Primary Outcomes (1)
Maximum tolerated dose (MTD) of regimen
* The maximum tolerated dose (MTD) is defined as the dose level at which \<1 patients of a cohort (of 3 to 6 patients) experience dose-limiting toxicity during the first cycle. * A dose-limiting toxicity (DLT) is defined as an adverse event or abnormal laboratory value of CTCAE Grade ≥ 3 assessed as unrelated to disease, disease progression, intercurrent illness, or concomitant medications that occurs within the first cycle of treatment with the combination treatment and meets any of the criteria outlined.
Completion of cycle 1 (28 days) for all patients
Secondary Outcomes (4)
Safety and tolerability of regimen as measured by grade and number of adverse events experienced per participant
30 days after completion of treatment (approximately 24 weeks)
Pathologic complete response-rate (pCR)
At the time of surgery (approximately 20 weeks)
Residual invasive tumor size (RITS)
At the time of surgery (approximately 20 weeks)
Number of positive axillary lymph nodes
At the time of surgery (approximately 20 weeks)
Study Arms (3)
Dose Level 1:MCS110/Doxorubicin/Cyclophosphamide/Paclitaxel
EXPERIMENTAL* MCS110 will be administered intravenously over 60 minutes (up to 120 minutes permitted) on a 28-day cycle. The dose of MCS110 given will depend on the dose level to which a given patient is enrolled. * The standard neoadjuvant chemotherapy regimen of dose-dense doxorubicin/ cyclophosphamide followed by weekly paclitaxel consists of: * doxorubicin 60 mg/m\^2 IV Q2W during Weeks 1 through 8 (total of 4 doses) * cyclophosphamide 600 mg/m\^2 Q2W during Weeks 1 through 8 (total of 4 doses) * paclitaxel 80 mg/m\^2 IV QW during Weeks 9 through 20 (total of 12 doses) * Surgery will be performed approximately 4-6 weeks after the end of the last cycle of treatment (Week 20-22). It is outside the scope of this study as part of each patient's standard of care. Both types of surgery (lumpectomy or mastectomy) are allowed. The decision on surgical approach and timing will be at the discretion of the treating surgeon.
Dose Level 2:MCS110/Doxorubicin/Cyclophosphamide/Paclitaxel
EXPERIMENTAL* MCS110 will be administered intravenously over 60 minutes (up to 120 minutes permitted) on a 28-day cycle. The dose of MCS110 given will depend on the dose level to which a given patient is enrolled. * The standard neoadjuvant chemotherapy regimen of dose-dense doxorubicin/ cyclophosphamide followed by weekly paclitaxel consists of: * doxorubicin 60 mg/m\^2 IV Q2W during Weeks 1 through 8 (total of 4 doses) * cyclophosphamide 600 mg/m\^2 Q2W during Weeks 1 through 8 (total of 4 doses) * paclitaxel 80 mg/m\^2 IV QW during Weeks 9 through 20 (total of 12 doses) * Surgery will be performed approximately 4-6 weeks after the end of the last cycle of treatment (Week 20-22). It is outside the scope of this study as part of each patient's standard of care. Both types of surgery (lumpectomy or mastectomy) are allowed. The decision on surgical approach and timing will be at the discretion of the treating surgeon.
Dose Expansion:MCS110/Doxorubicin/Cyclophosphamide/Paclitaxel
EXPERIMENTAL* MCS110 will be administered intravenously over 60 minutes (up to 120 minutes permitted) on a 28-day cycle. The dose of MCS110 given will depend on the dose level to which a given patient is enrolled. * The standard neoadjuvant chemotherapy regimen of dose-dense doxorubicin/ cyclophosphamide followed by weekly paclitaxel consists of: * doxorubicin 60 mg/m\^2 IV Q2W during Weeks 1 through 8 (total of 4 doses) * cyclophosphamide 600 mg/m\^2 Q2W during Weeks 1 through 8 (total of 4 doses) * paclitaxel 80 mg/m\^2 IV QW during Weeks 9 through 20 (total of 12 doses) * Surgery will be performed approximately 4-6 weeks after the end of the last cycle of treatment (Week 20-22). It is outside the scope of this study as part of each patient's standard of care. Both types of surgery (lumpectomy or mastectomy) are allowed. The decision on surgical approach and timing will be at the discretion of the treating surgeon.
Interventions
-MCS110 is an IgG1/κ humanized monoclonal antibody directed against human macrophage colony stimulating factor
-Standard of care
-Standard of care
-Standard of care
-Time of enrollment and at time of surgery
-Time of enrollment and at time of surgery
-Time of enrollment and at time of surgery
Eligibility Criteria
You may qualify if:
- Histologically or cytologically confirmed ER+ HER2- breast cancer. ER-positivity is to follow local guidelines. If IHC HER2 is 2+, a negative FISH test is required.
- Clinical stage II or stage III (by AJCC 7th edition) breast cancer eligible for neoadjuvant chemotherapy with complete surgical excision of the breast cancer after neoadjuvant therapy as the treatment goal.
- Clinically positive axillary lymph nodes.
- At least 18 years of age.
- Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
- Normal bone marrow and organ function as defined below:
- Absolute neutrophil count ≥ 1,500/mcL
- Platelets ≥ 100,000/mcL
- Hemoglobin ≥ 9.0 g/dL
- Total bilirubin ≤ 1.5 x institutional upper limit of normal (IULN)
- AST(SGOT)/ALT(SGPT) ≤ 3.0 x IULN
- Creatinine ≤ 1.5 x IULN
- PT/INR ≤ 1.5 x IULN (for participants on anticoagulation therapy, ≤ 1.5 x baseline value)
- aPTT ≤ 1.5 x IULN (for participants on anticoagulation therapy, ≤ 1.5 x baseline value)
- Adequate cardiac function as defined below:
- +4 more criteria
You may not qualify if:
- Presence of metastatic disease.
- Therapy for underlying malignancy within 2 weeks prior to start of study treatment.
- A history of other malignancy ≤ 3 years previous with the exception of basal cell or squamous cell carcinoma of the skin which were treated with local resection only or carcinoma in situ of the cervix.
- Bilateral or inflammatory breast cancer.
- Currently receiving any other investigational agents.
- Receiving immunosuppressive agents or \> 10 mg daily prednisone or equivalent of corticosteroids.
- A history of allergic reactions attributed to compounds of similar chemical or biologic composition to MCS110, doxorubicin, cyclophosphamide, paclitaxel, or other agents used in the study.
- Known hypersensitivity to monoclonal antibodies.
- Personal or family history of long QT syndrome.
- Evidence of retinal pathology on ophthalmologic examination that is considered a risk factor for neurosensory retinal detachment / central serous chorioretinopathy (CSCR), retinal vein occlusion (RVO), or neovascular macular degeneration.
- Diagnosis of any type of muscle disease that may result in CK elevation.
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia. Clinically significant cardiovascular disease within 6 months of screening.
- Presence of any Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or greater toxicity.
- Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry.
- Known history of human immunodeficiency virus or infection with hepatitis requiring antiviral therapy.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- Washington University School of Medicinelead
- Novartis Pharmaceuticalscollaborator
Related Links
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Leonel Hernandez-Aya, M.D.
Washington University School of Medicine
Study Design
- Study Type
- interventional
- Phase
- phase 1
- Allocation
- NON RANDOMIZED
- Masking
- NONE
- Purpose
- TREATMENT
- Intervention Model
- SEQUENTIAL
- Sponsor Type
- OTHER
- Responsible Party
- SPONSOR
Study Record Dates
First Submitted
September 14, 2017
First Posted
September 18, 2017
Study Start
September 30, 2018
Primary Completion
October 31, 2019
Study Completion
February 28, 2021
Last Updated
August 16, 2018
Record last verified: 2018-08
Data Sharing
- IPD Sharing
- Will not share