QUILT-3.067: NANT Triple Negative Breast Cancer (TNBC) Vaccine: Molecularly Informed Integrated Immunotherapy in Subjects With TNBC Who Have Progressed on or After Standard-of-care Therapy.

Sponsor

ImmunityBio, Inc. (Industry)

Overall Status

Active, not recruiting

CT.gov ID

NCT03387085

Collaborator

(none)

Enrollment

Location

Arm

57.6

Anticipated Duration (Months)

1.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is a phase 1b/2 study to evaluate the safety and efficacy of metronomic combination therapy in subjects with TNBC who have progressed on or after previous SoC chemotherapy. Phase 2 will be based on Simon's two-stage optimal design.

Condition or Disease	Intervention/Treatment	Phase
Triple Negative Breast Cancer	Drug: Aldoxorubicin HCl Biological: N-803 Biological: ETBX-011 Biological: ETBX-051 Biological: ETBX-061 Biological: GI-4000 Biological: GI-6207 Biological: GI-6301 Biological: haNK for Infusion Biological: avelumab Biological: bevacizumab Drug: Capecitabine Drug: Cisplatin Drug: Cyclophosphamide Drug: 5-Fluorouracil Drug: Leucovorin Drug: nab-Paclitaxel Procedure: SBRT	Phase 1/Phase 2

Detailed Description

Treatment will be administered in two phases, an induction and a maintenance phase, as described below. Subjects will continue induction treatment for up to 1 year. Treatment in the study will be discontinued if the subject experiences progressive disease (PD) or unacceptable toxicity (not corrected with dose reduction), withdraws consent, or if the Investigator feels it is no longer in the subject's best interest to continue treatment. Those who have a complete response (CR) in the induction phase will enter the maintenance phase of the study. Subjects who experience ongoing stable disease (SD) or an ongoing partial response (PR) at 1 year may enter the maintenance phase at the Investigator's discretion. Subjects may remain on the maintenance phase of the study for up to 1 year. Treatment will continue in the maintenance phase until the subject experiences PD or unacceptable toxicity (not corrected with dose reduction), withdraws consent, or if the Investigator feels it is no longer in the subject's best interest to continue treatment. The maximum time on study treatment, including both the induction and maintenance phases, is 2 years.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

79 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

NANT Triple Negative Breast Cancer (TNBC) Vaccine: Molecularly Informed Integrated Immunotherapy Combining Innate High-affinity Natural Killer (haNK) Cell Therapy With Adenoviral and Yeast-based Vaccines to Induce T-cell Responses in Subjects With TNBC Who Have Progressed on or After Standard-of-care Therapy.

Actual Study Start Date :

Mar 16, 2018

Anticipated Primary Completion Date :

Dec 1, 2022

Anticipated Study Completion Date :

Jan 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: NANT triple negative breast cancer (TNBC) Vaccine A combination of agents will be administered to subjects in this study: Aldoxorubicin HCl, N-803, ETBX-011, ETBX-051, ETBX-061, GI-4000, GI-6207, GI-6301, haNK, avelumab, bevacizumab, capecitabine, cisplatin, cyclophosphamide, 5-fluorouracil, leucovorin, nab-paclitaxel, SBRT.	Drug: Aldoxorubicin HCl Aldoxorubicin hydrochloride Biological: N-803 Recombinant human super agonist interleukin-15 (IL-15) complex Biological: ETBX-011 Ad5 [E1-, E2b-]-CEA Biological: ETBX-051 Ad5 [E1-, E2b-]-Brachyury vaccine Biological: ETBX-061 Ad5 [E1-, E2b-]-MUC1 Biological: GI-4000 Vaccine derived from recombinant Saccharomyces cerevisiae yeast expressing mutant Ras proteins Biological: GI-6207 Vaccine derived from recombinant Saccharomyces cerevisiae yeast expressing mutant CEA proteins Biological: GI-6301 Vaccine derived from recombinant Saccharomyces cerevisiae yeast expressing mutant Brachyury yeast proteins Biological: haNK for Infusion NK-92 [CD16.158V, ER IL-2] Biological: avelumab Recombinant human anti-PD-L1 IgG1 monoclonal antibody Biological: bevacizumab Recombinant human anti-VEGF IgG1 monoclonal Drug: Capecitabine 5'-deoxy-5-fluoro-N-[(pentyloxy) carbonyl]-cytidine Drug: Cisplatin cis-diamminedichloroplatinum(II) Drug: Cyclophosphamide 2-[bis(2-chloroethyl)amino]tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide monohydrate Drug: 5-Fluorouracil 5-fluoro-2,4 (1H,3H)-pyrimidinedione Drug: Leucovorin L-Glutamic acid, N-[4-[[(2-amino-5-formyl-1,4,5,6,7,8-hexahydro-4-oxo-6-pteridinyl)methyl]amino]benzoyl]-, calcium salt Drug: nab-Paclitaxel Benzenepropanoic acid, β-(benzoylamino)-α-hydroxy-(2aR, 4S, 4aS, 6R, 9S, 11S, 12S, 12aR, 12bS)-6,12b-bis(acetyloxy)-12-(benzoyloxy)-2a, 3, 4, 4a, 5, 6, 9, 10, 11, 12, 12a, 12b-dodecahydro-4,11-dihydroxy-4a, 8, 13, 13-tetramethyl-5-oxo-7,11-methano-1H-cyclodeca[3,4]benz[1,2-b]oxet-9-y1ester,(αR,βS)-(9CI) bound to albumin Procedure: SBRT Stereotactic Body Radiation Therapy

Arm

Intervention/Treatment

Experimental: NANT triple negative breast cancer (TNBC) Vaccine

A combination of agents will be administered to subjects in this study: Aldoxorubicin HCl, N-803, ETBX-011, ETBX-051, ETBX-061, GI-4000, GI-6207, GI-6301, haNK, avelumab, bevacizumab, capecitabine, cisplatin, cyclophosphamide, 5-fluorouracil, leucovorin, nab-paclitaxel, SBRT.

Drug: Aldoxorubicin HCl

Aldoxorubicin hydrochloride

Biological: N-803

Recombinant human super agonist interleukin-15 (IL-15) complex

Biological: ETBX-011

Ad5 [E1-, E2b-]-CEA

Biological: ETBX-051

Ad5 [E1-, E2b-]-Brachyury vaccine

Biological: ETBX-061

Ad5 [E1-, E2b-]-MUC1

Biological: GI-4000

Vaccine derived from recombinant Saccharomyces cerevisiae yeast expressing mutant Ras proteins

Biological: GI-6207

Vaccine derived from recombinant Saccharomyces cerevisiae yeast expressing mutant CEA proteins

Biological: GI-6301

Vaccine derived from recombinant Saccharomyces cerevisiae yeast expressing mutant Brachyury yeast proteins

Biological: haNK for Infusion

NK-92 [CD16.158V, ER IL-2]

Biological: avelumab

Recombinant human anti-PD-L1 IgG1 monoclonal antibody

Biological: bevacizumab

Recombinant human anti-VEGF IgG1 monoclonal

Drug: Capecitabine

5'-deoxy-5-fluoro-N-[(pentyloxy) carbonyl]-cytidine

Drug: Cisplatin

cis-diamminedichloroplatinum(II)

Drug: Cyclophosphamide

2-[bis(2-chloroethyl)amino]tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide monohydrate

Drug: 5-Fluorouracil

5-fluoro-2,4 (1H,3H)-pyrimidinedione

Drug: Leucovorin

L-Glutamic acid, N-[4-[[(2-amino-5-formyl-1,4,5,6,7,8-hexahydro-4-oxo-6-pteridinyl)methyl]amino]benzoyl]-, calcium salt

Drug: nab-Paclitaxel

Benzenepropanoic acid, β-(benzoylamino)-α-hydroxy-(2aR, 4S, 4aS, 6R, 9S, 11S, 12S, 12aR, 12bS)-6,12b-bis(acetyloxy)-12-(benzoyloxy)-2a, 3, 4, 4a, 5, 6, 9, 10, 11, 12, 12a, 12b-dodecahydro-4,11-dihydroxy-4a, 8, 13, 13-tetramethyl-5-oxo-7,11-methano-1H-cyclodeca[3,4]benz[1,2-b]oxet-9-y1ester,(αR,βS)-(9CI) bound to albumin

Procedure: SBRT

Stereotactic Body Radiation Therapy

Outcome Measures

Primary Outcome Measures

Incidence of treatment-emergent Adverse Events (AEs) and Serious Adverse Events (SAEs), graded using the NCI CTCAE Version 4.03. [8 weeks]
Phase 1b primary endpoint
Objective response rate by RECIST [8 weeks]
Phase 2 primary endpoint

Secondary Outcome Measures

Objective response rate by RECIST [8 weeks]
Phase 1b secondary endpoint
Objective response rate by irRC [8 weeks]
Phase 1b secondary endpoint
Progression-free survival by RECIST during Phase 1b [8 weeks]
Phase 1b secondary endpoint
Progression-free survival by irRC during Phase 1b [8 weeks]
Phase 1b secondary endpoint
Overall survival [8 weeks]
Phase 1b secondary endpoint
Duration of response by RECIST and irRC [1 year]
Phase 1b secondary endpoint
Disease control rate (confirmed complete response, partial response, or stable disease lasting for at least 2 months) by RECIST and irRC. [1 year]
Phase 1b secondary endpoint
Patient-reported outcomes of pancreatic cancer symptoms [8 weeks]
Phase 1b secondary endpoint
Objective response rate by irRC [1 year]
Phase 2 secondary endpoint
Progression-free survival by RECIST during Phase 2 [1 year]
Phase 2 secondary endpoint
Progression-free survival by irRC during Phase 2 [1 year]
Phase 2 secondary endpoint
Overall survival [1 year]
Phase 2 secondary endpoint
Duration of response by RECIST and irRC [1 year]
Phase 2 secondary endpoint
Disease control rate (confirmed complete response, partial response, or stable disease lasting for at least 2 months) by RECIST and irRC. [1 year]
Phase 2 secondary endpoint
Patient-reported outcomes of pancreatic cancer symptoms [1 year]
Phase 2 secondary endpoint
Incidence of treatment-emergent Adverse Events (AEs) and Serious Adverse Events (SAEs), graded using the NCI CTCAE Version 4.03. [1 year]
Phase 2 secondary endpoint

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Age ≥ 18 years old.
Able to understand and provide a signed informed consent that fulfills the relevant IRB or Independent Ethics Committee (IEC) guidelines.
Histologically-confirmed metastatic or unresectable TNBC that has either progressed on or after anthracycline-based chemotherapy (or other approved standard of care therapy) or subject has refused anthracycline-based chemotherapy, or other taxane- and platinum-based therapies. TNBC is defined as breast cancer that lacks estrogen receptor (ER) and progesterone receptor (PR) expression, and human epidermal growth factor receptor 2 (HER2) overexpression and/or amplification.
Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.
Have at least 1 measurable lesion of ≥ 1.0 cm.
Must have a recent formalin-fixed, paraffin-embedded (FFPE) tumor biopsy specimen following the conclusion of the most recent anticancer treatment. If an historic specimen is not available, the subject must be willing to undergo a biopsy during the screening period, if considered safe by the Investigator. If safety concerns preclude collection of a biopsy during the screening period, a tumor biopsy specimen collected prior to the conclusion of the most recent anticancer treatment may be used.
Must be willing to provide blood samples prior to the start of treatment on this study.
Must be willing to provide a tumor biopsy specimen 8 weeks after the start of treatment, if considered safe by the Investigator.
Ability to attend required study visits and return for adequate follow-up, as required by this protocol.
Agreement to practice effective contraception for female subjects of child-bearing potential and non-sterile males. Female subjects of child-bearing potential must agree to use effective contraception for up to 1 year after completion of therapy, and non-sterile male subjects must agree to use a condom for up to 4 months after treatment. Effective contraception includes surgical sterilization (eg, vasectomy, tubal ligation), two forms of barrier methods (eg, condom, diaphragm) used with spermicide, intrauterine devices (IUDs), and abstinence.

Exclusion Criteria:

Serious uncontrolled concomitant disease that would contraindicate the use of the investigational drug used in this study or that would put the subject at high risk for treatment-related complications.
Systemic autoimmune disease (eg, lupus erythematosus, rheumatoid arthritis, Addison's disease, autoimmune disease associated with lymphoma).
History of organ transplant requiring immunosuppression.
History of or active inflammatory bowel disease (eg, Crohn's disease, ulcerative colitis).
Inadequate organ function, evidenced by the following laboratory results:
Absolute neutrophil count < 1000 cells/mm3.
Platelet count < 75,000 cells/mm3.
Uncorrectable grade 3 anemia (hemoglobin < 8 g/dL).
Total bilirubin greater than the upper limit of normal (ULN; unless the subject has documented Gilbert's syndrome).
Aspartate aminotransferase (AST [SGOT]) or alanine aminotransferase (ALT [SGPT])

2.5 × ULN (> 5 × ULN in subjects with liver metastases).

Alkaline phosphatase levels > 2.5 × ULN (> 5 × ULN in subjects with liver metastases, or >10 × ULN in subjects with bone metastases).
Serum creatinine > 2.0 mg/dL or 177 μmol/L.
Serum anion gap > 16 mEq/L or arterial blood with pH < 7.3.
Uncontrolled hypertension (systolic > 160 mm Hg and/or diastolic > 110 mm Hg) or clinically significant (ie, active) cardiovascular disease, cerebrovascular accident/stroke, or myocardial infarction within 6 months prior to first study medication; unstable angina; congestive heart failure of New York Heart Association grade 2 or higher; or serious cardiac arrhythmia requiring medication. Subjects with uncontrolled hypertension should be medically managed on a stable regimen to control hypertension prior to study entry.
Serious myocardial dysfunction defined by ECHO as absolute left ventricular ejection fraction (LVEF) 10% below the institution's lower limit of predicted normal.
Dyspnea at rest due to complications of advanced malignancy or other disease requiring continuous oxygen therapy.
Positive results of screening test for human immunodeficiency virus (HIV).
Current chronic daily treatment (continuous for > 3 months) with systemic corticosteroids (dose equivalent to or greater than 10 mg/day methylprednisolone), excluding inhaled steroids. Short-term steroid use to prevent IV contrast allergic reaction or anaphylaxis in subjects who have known contrast allergies is allowed.
Known hypersensitivity to any component of the study medication(s).
Subjects taking any medication(s) (herbal or prescribed) known to have an adverse drug reaction with any of the study medications.
Concurrent or prior use of a strong cytochrome P450 (CYP)3A4 inhibitor (including ketoconazole, itraconazole, posaconazole, clarithromycin, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole, and grapefruit products) or strong CYP3A4 inducers (including phenytoin, carbamazepine, rifampin, rifabutin, rifapentin, phenobarbital, and St John's Wort) within 14 days before study day 1.
Concurrent or prior use of a strong CYP2C8 inhibitor (gemfibrozil) or moderate CYP2C8 inducer (rifampin) within 14 days before study day 1.
Participation in an investigational drug study or history of receiving any investigational treatment within 30 days prior to initiation of treatment on this study, except for testosterone-lowering therapy in men with prostate cancer.
Assessed by the Investigator to be unable or unwilling to comply with the requirements of the protocol.
Concurrent participation in any interventional clinical trial.
Pregnant and nursing women.