Adjuvant Therapy With an Alpha-lactalbumin Vaccine in Triple-Negative Breast Cancer

NCT04674306 | Active Not Recruiting Early Phase 1 DMC FDA Drug

• 3 other identifiers: CASE6119W81XWH-17-1-0593W81XWH-17-1-0592
• Study Type: interventional
• Target: 35
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to determine the safety as well as the most effective dose of the alpha-lactalbumin vaccine (aLA breast cancer vaccine) to treat patients with non-metastatic triple negative breast cancer, participants who are of cancer-free but may be at risk for triple-negative breast cancer, and for participants who are receiving adjuvant pembrolizumab following initial triple negative breast cancer treatment.

Conditions

Pathologic Stage IIA-IIIC Triple-Negative Breast Cancer; TNBC - Triple-Negative Breast Cancer; Residual Disease

Outcome Measures

Primary Outcomes (3)

• Treatment Cohort MTD of α-lactalbumin vaccine

  MTD of an α-lactalbumin vaccine in participants with operable triple-negative breast cancer

  Day 84

• Preventative Cohort MTD of α-lactalbumin vaccine

  MTD of an α-lactalbumin vaccine in participants at risk for TNBC who are scheduled for prophylactic double mastectomy.

  Day 84

• Pembrolizumab Cohort of α-lactalbumin vaccine

  MTD of an α-lactalbumin vaccine in participants who are receiving adjuvant pembrolizumab following initial TNBC treatment.

  Day 84

Secondary Outcomes (3)

• Treatment Cohort Lowest Immunologic Dose (LID) of α-lactalbumin vaccine

  Day 84

• Preventative Cohort Lowest Immunologic Dose (LID) of α-lactalbumin vaccine

  Day 84

• Pembrolizuman Cohort Lowest Immunologic Dose (LID) of α-lactalbumin vaccine

  Day 84

Study Arms (3)

Treatment α-lactalbumin and zymosan

EXPERIMENTAL

Participants diagnosed with triple negative breast cancer will be treated with successively higher doses of α-lactalbumin and zymosan in a 3 + 3 trial design. Treatment will involve 3 vaccinations every 2 weeks. Participants will be enrolled into 1 of 5 different dose levels each comprised of cohorts of 1-6 participants until the MTD has been identified (intra-patient dose escalation not permitted), after which the MTD will be expanded to 6 participants. Successively lower doses will be expanded to 6 participants until the lowest DL associated with immune response has been expanded. DL1: 10 mcg a-lactalbumin + 10 mcg Zymosan Original DL2:100 mcg a-lactalbumin + 100 mcg Zyomsan DL2: 100 mcg a-lactalbumin + 10 mcg Zyomsan DL3: 500 mcg a-lactalbumin + 10 mcg Zymosan DL1b: 50 mcg a-lactalbumin + 10 mcg Zymosan DL1e: 10 mcg a-lactalbumin + 20 mcg Zymosan DL1f: 20 mcg a-lactalbumin + 10 mcg Zymosan DL1g: 20 mcg a-lactalbumin + 10 mcg Zymosan (if DL1e is too toxic)

Biological: α-lactalbumin vaccine; Biological: Zymosan

Preventitive a-lactalbumin and zymosan

EXPERIMENTAL

Participants with a genetic risk for developing TNBC who plan to undergo prophylactic mastectomy will be treated with α-lactalbumin and zymosan at doses based on the TNBC cohort. Treatment will involve 3 vaccinations every 2 weeks. Participants enrolled in the prevention cohort will be enrolled at the dose level being used in the TNBC cohort if no DLTs above Grade 1 have been observed. If the TNBC cohort proceeds to the next dose level before another prevention cohort patient is enrolled, the next prevention patient will be enrolled on the next dose level along with the TNBC cohort. DL1: 10 mcg a-lactalbumin + 10 mcg Zymosan Original DL2:100 mcg a-lactalbumin + 100 mcg Zyomsan DL2: 100 mcg a-lactalbumin + 10 mcg Zyomsan DL3: 500 mcg a-lactalbumin + 10 mcg Zymosan DL1b: 50 mcg a-lactalbumin + 10 mcg Zymosan DL1e: 10 mcg a-lactalbumin + 20 mcg Zymosan DL1f: 20 mcg a-lactalbumin + 10 mcg Zymosan DL1g: 20 mcg a-lactalbumin + 10 mcg Zymosan (if DL1e is too toxic)

Biological: α-lactalbumin vaccine; Biological: Zymosan

Standard of Care with a-lactalbumin and zymosan

EXPERIMENTAL

Participants undergoing chemo-immunotherapy for operable triple-negative breast cancer will be treated with α-lactalbumin concurrently with standard of care adjuvant pembrolizumab after having completed all pre- and postoperative chemotherapy and radiation therapy, with the exception of Xeloda/capecitabine at provider discretion. Treatment will involve 3 vaccinations every 2 weeks. Participants enrolled in the Pembrolizumab cohort will be enrolled at the proper Optimal Immunologic Dose as defined by the TNBC and preventative cohorts and based on information available at the time of study entry. DL1: 10 mcg a-lactalbumin + 10 mcg Zymosan Original DL2:100 mcg a-lactalbumin + 100 mcg Zyomsan DL2: 100 mcg a-lactalbumin + 10 mcg Zyomsan DL3: 500 mcg a-lactalbumin + 10 mcg Zymosan DL1b: 50 mcg a-lactalbumin + 10 mcg Zymosan DL1e: 10 mcg a-lactalbumin + 20 mcg Zymosan DL1f: 20 mcg a-lactalbumin + 10 mcg Zymosan DL1g: 20 mcg a-lactalbumin + 10 mcg Zymosan (if DL1e is too toxic)

Biological: α-lactalbumin vaccine; Biological: Zymosan

Interventions

α-lactalbumin vaccine BIOLOGICAL

α-lactalbumin vaccine will be administered subcutaneously in rotating sites (vaccine will not be administered in the arms of any participant, due to likelihood of prior bilateral mastectomy). DL1: 10 mcg DL Original 2: 100 mcg DL2: 100 mcg DL3: 500 mcg D1b: 50 mcg D1e: 10 mcg D1f: 20 mcg D1g: 20 mcg (D1g will only be utilized if D1c is deemed too toxic)

Also known as: α-lactalbumin protein

Preventitive a-lactalbumin and zymosan; Standard of Care with a-lactalbumin and zymosan; Treatment α-lactalbumin and zymosan

Zymosan BIOLOGICAL

Adjuvant used in vaccine preparation DL1: 10 mcg DL Original 2: 100 mcg DL2: 10 mcg DL3: 10 mcg D1b: 10 mcg D1e: 20 mcg D1f: 20 mcg D1g: 1o mcg (D1g will only be utilized if D1c is deemed too toxic)

Preventitive a-lactalbumin and zymosan; Standard of Care with a-lactalbumin and zymosan; Treatment α-lactalbumin and zymosan

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Triple Negative Cohort:
• Histologically proven invasive breast cancer.
• Primary tumor must be ER-negative (ER in \<1% of cells), PR-negative (PR in \<1% of cells), and HER2-negative (0-1+ by IHC or FISH ratio\<2.0 with signal number \<6/cell), or consistent with contemporary NCCN guidelines (https://www.nccn.org/).
• Patients must be high risk, defined as either:
• Pathologic stage IIA, IIB, IIIA, IIIB, or IIIC by AJCC 8, or
• Residual invasive cancer in breast or regional nodes following preoperative chemotherapy.
• Patients must have no convincing evidence of recurrent disease based on one of the following:
• bone scan and imaging scans of the chest/abdomen/pelvis or
• FDG PET scan.
• ≥1 months since last active therapy (chemotherapy, radiation therapy, or surgery) and ≤ 36 months since the initiation of treatment for the current cancer, based on the period of highest risk for patients with Stages I-III triplenegative breast cancer \[33, 34\].
• Treatment prior to enrollment must be consistent with NCCN guidelines extant at the time treatment was given, found at: https://www.nccn.org/.
• Age greater than or equal to 18 years.
• ECOG Performance Status 0-1.
• Adequate major organ function, defined as:
• WBC ≥ 3,000/mcl, hemoglobin ≥ 10.0 gm/dL, platelets ≥ 100,000/mcL, total bilirubin within normal limits, ALT/AST \<3 x upper limits of normal (ULN), serum creatinine ≤ 1.5 x ULN.

You may not qualify if:

• Triple Negative Cohort:
• Receipt of cytotoxic chemotherapy within 4 weeks of study entry (except for capecitabine in subjects enrolled in the pembrolizumab cohort).
• Radiation therapy within 4 weeks of study entry.
• Failure to recover from the toxicity of the previous therapy to CTCAE Grade 0-1, except for alopecia and grade 2 neuropathy.
• Need for systemic corticosteroid use (except as physiologic replacement, defined as prednisone 10 mg/day or equivalent).
• Need for immunosuppression (e.g., for a history of organ transplantation).
• Known HIV infection.
• Active or planned lactation or pregnancy.
• Patients taking or planning to take oral contraceptives will be excluded, as there is some evidence that such agents can induce lactational foci. This includes patients using hormone containing IUD's.
• Refusal to use effective non-hormonal contraception. Acceptable contraception methods include but may not be limited to barrier contraception (diaphragm or condom), non-hormonal intrauterine device, vasectomy of male partner.
• Subjects receiving any other investigational agents within the last 4 weeks.
• Subjects with any known recurrence or metastasis.
• Subjects with a history of another active invasive malignancy within 5 years of study entry.
• History of allergic reactions to α-lactalbumin, human milk (excluding lactose intolerance), zymosan, or other agents used in this study.
• Subjects with uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.

Sponsors & Collaborators

• George T. Budd: lead
• United States Department of Defense: collaborator
• Anixa Biosciences, Inc.: collaborator

Study Sites (1)

Cleveland Clinic, Case Comprehensive Cancer Center

Cleveland, Ohio, 44915, United States

Location

MeSH Terms

Conditions

Triple Negative Breast Neoplasms; Neoplasm, Residual

Interventions

Zymosan

Condition Hierarchy (Ancestors)

Breast Neoplasms; Neoplasms by Site; Neoplasms; Breast Diseases; Skin Diseases; Skin and Connective Tissue Diseases; Neoplastic Processes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

beta-Glucans; Glucans; Polysaccharides; Carbohydrates

Study Officials

• George T Budd, MD

  Cleveland Clinic, Case Comprehensive Cancer Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: early phase 1
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: December 13, 2020
• First Posted: December 19, 2020
• Study Start: October 1, 2021
• Primary Completion: November 1, 2025
• Study Completion: May 1, 2026
• Last Updated: May 23, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR, ANALYTIC CODE
• Time Frame: The data will become available during the course of the trial and indefinitely thereafter.
• Access Criteria: The data will be available to the FDA and DOD. Otherwise, a confidentiality agreement will need to be in place.

Locations

US (1)