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The purpose of this study is to understand the safety and estimate the efficacy of anti-CD3 x anti-HER2 bispecific antibody (HER2Bi) armed fresh peripheral blood mononuclear cells (HER2 FPBMC) for patients with metastatic breast or prostate cancer. Participants receive 5 weekly doses of CD33 FPBMC by intravenous infusion followed by 4 infusions every other week.
Once subjects are determined to be eligible, white blood cells (lymphocytes) are collected via leukapheresis procedure. The T cells in the mononuclear cells are coated with bispecific antibody to activate the T cells and the mononuclear cells are re-infused into the patients so the T cells can multiply and kill cancer cells. At least 72 hours after the leukapheresis procedure, study treatment will start. After 5 HER2 FPBMC infusions, participants will have another leukapheresis procedure. Before, throughout and following study treatment, research blood will be collected to better understand immune response. Disease status will be checked regularly during and after study treatment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| HER2 FPBMC | Experimental | Five weekly infusions of HER2 fresh peripheral blood mononuclear cells (FPBMC) followed by 4 HER2 FPBMC infusions every other week |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| HER2 FPBMC | Drug | Participants will receive 5 weekly infusions of HER2 FPBMC infusions followed by 4 additional infusions every other week. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Dose limiting toxicities (DLTs) | DLTs in the dose escalation phase | During the first 5 infusions (5 weeks) for each participant |
| Measure | Description | Time Frame |
|---|---|---|
| Total cells collected | Total cells collected for each participant (for creation of cell product) at each timepoint for collection | For each participant, prior to starting study treatment (induction) and then prior to boost/retreatment infusions (about 9-10 weeks later) |
| Overall response rate |
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Inclusion Criteria:
Provision of signed and dated informed consent form
Stated willingness to comply with all study procedures and availability for the duration of the study
Age ≥ 18 years at the time of signing informed consent
Expected survival ≥ 3 months in the judgment of the investigator
ECOG PS 0-1
Adequate Organ Function per the following criteria (within 10 days of study registration):
Agreement to adhere to Lifestyle Considerations throughout study duration
A diagnosis of either of the following:
a. Prostate Cancer: i. Histological and/or cytological confirmation of prostate adenocarcinoma. ii. Participants must have progressive mCRPC at screening iii. Serum testosterone levels <50 ng/dL during screening. iv. Must have progressed on at least one prior ARPI (abiraterone acetate, enzalutamide, apalutamide, or darolutamide).
v. Participants must have ≥1 metastatic lesion that is present on baseline CT, MRI, or bone scan obtained ≤28 days prior to registration.
b. Breast Cancer i. Histological and/or cytological confirmation of invasive breast cancer. ii. Participants must have previously treated metastatic breast cancer at screening. Metastatic breast cancer must be evaluable by RECIST 1.1 criteria.
iii. Must have progressed on at least two prior endocrine or targeted therapies or at least two lines of cytotoxic chemotherapy. If HER2 positive, then must have progressed on or been intolerant of at least one HER2 targeted therapy.
iv. Participants must have ≥1 metastatic lesion that is present on baseline CT, MRI, or bone scan obtained ≤28 days prior to registration.
Exclusion Criteria:
Pregnancy (must have negative pregnancy test within 7 days prior to study registration) or lactation
History of a recent myocardial infarction (within one year) or a past myocardial infarction (more than one year prior to enrollment) who are actively requiring nitroglycerine more than once per week
Inadequate cardiac function, as defined as any of the following:
Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to study registration. Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
Serious non-healing wound, ulcer, bone fracture, major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to registration
Active liver disease such as cirrhosis, chronic active hepatitis, or chronic persistent hepatitis
Is HIV positive or has evidence of active Hepatitis C virus or active Hepatitis B virus.
Active bleeding or a pathological condition that is associated with a high risk of bleeding (therapeutic anticoagulation is allowed)
Has an active infection requiring systemic therapy
A serious uncontrolled medical disorder that in the opinion of the Investigator may be jeopardized by the treatment with protocol therapy
Has a known history of active TB (Bacillus Tuberculosis)
Has received a live vaccine within 30 days of study registration.
Treatment with any investigational agent within 3 weeks prior to study registration
Active second malignancy requiring systemic treatment. Exceptions include basal cell carcinoma of the skin, treated cervical cancer, and squamous cell carcinoma of the skin
Has active autoimmune disease that has required systemic treatment in the 2 years prior to registration (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the patient's participation for the full duration of the trial, or is not in the best interest of the patient to participate, in the opinion of the treating investigator.
Patient may be excluded if, in the opinion of the PI and investigator team, the patient is not capable of being compliant
Additional Exclusion Criteria for Patients with Prostate Cancer:
Additional Exclusion Criteria for Patients with Breast Cancer:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ashley Lamont | Contact | (434) 243-6377 | ZWZ6JM@uvahealth.org | |
| Laura Livingston | Contact | 434-882-5578 | LL9TE@uvahealth.org |
| Name | Affiliation | Role |
|---|---|---|
| Paul Viscuse, MD | University of Virginia | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Virginia | Recruiting | Charlottesville | Virginia | 22903 | United States |
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| ID | Term |
|---|---|
| D001943 | Breast Neoplasms |
| D011471 | Prostatic Neoplasms |
| ID | Term |
|---|---|
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D001941 | Breast Diseases |
| D012871 | Skin Diseases |
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Percent of participants that have a response (complete or partial) to study treatment |
| During and immediately after study treatment for each participant (a maximum of ~20 weeks) |
| Progression free survival | Time from start of study treatment through first disease progression afterward (for each participant) | For up to 3 years after last infusion for each participant (about 3 1/2 years) |
| Overall survival | Time from start of study treatment through death from any cause (for each participant) | For up to 3 years after last infusion for each participant (about 3 1/2 years) |
| Adverse events | As described using CTCAE v5.0 | During and through ~30 days after end of study treatment (maximum of about 24 weeks) |
| Development of specific cytotoxicity by PBMCs (of participants) as measured by cytotoxicity or IFN-γ EliSpots responses | To breast and prostate cancer cell lines, respectively | Multiple timepoints during and through ~30 days after end of study treatment (maximum of about 24 weeks) |
| Serum antibodies to breast or prostate cancer cell lines and ELISA for IgG-specific antibody to HER2 and EGFR2 | Multiple timepoints during and through ~30 days after end of study treatment (maximum of about 24 weeks) |
| Survival kinetics of HER2 FPBMCs after a single infusion | Multiple timepoints before and after the first 5 infusions (week 5) |
| D017437 |
| Skin and Connective Tissue Diseases |
| D005834 | Genital Neoplasms, Male |
| D014565 | Urogenital Neoplasms |
| D005832 | Genital Diseases, Male |
| D000091662 | Genital Diseases |
| D000091642 | Urogenital Diseases |
| D011469 | Prostatic Diseases |
| D052801 | Male Urogenital Diseases |