Implantable Microdevice for TNBC - Pilot Study

Breast Cancer Clinical Trial

Official title:

Pilot Study of an Implantable Microdevice to Evaluate Drug Responses in Situ in Early-stage Triple-negative Breast Cancer

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT05774886
• Other study ID #: 22-508
• Status: Withdrawn
• Phase: Phase 1
• Start date: May 2023
• Est. completion date: September 1, 2028

Study information

• Verified date: May 2023
• Source: Dana-Farber Cancer Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this research study is to evaluate the safety and feasibility of implanting and retrieving a microdevice that releases microdoses of a specific drug or combination of drugs as a possible tool to evaluate the effectiveness of several cancer drugs against early stage Triple Negative Breast Cancer (TNBC).

The name of the intervention involved in this study is:

Implantable Microdevice (IMD)

Description:

This is a single-arm, pilot research study to evaluate the safety and feasibility of using an implantable microdevice to measure local intratumoral response to chemotherapy and other clinically relevant drugs in triple-negative breast cancer (TNBC). A pilot study means that this is the first time investigators are examining this study intervention in TNBC. Participants selected for this study must have a diagnosis of Stage II-III TNBC and are scheduled to undergo neoadjuvant systemic therapy.

This study involves implanting 2 microdevices, each small enough to fit inside the tip of a needle, into a tumor. The microdevices will release microdoses of up to 30 different cancer drugs via passive diffusion. The drugs will only penetrate the local tumor tissues. After approximately 72 hours, the microdevices and small regions of surrounding tissue will be removed and studied.

The U.S. Food and Drug Administration (FDA) has not approved the microdevice as treatment for any disease. For this study, the drugs used are agents approved by the U.S. FDA for the treatment of different types of cancer.

The research study procedures include screening for eligibility, study treatment with evaluations, radiology scans of tumors, blood tests, tumor biopsies, mammograms, and follow-up visits.

It is expected that about 24 people will take part in this research study.

Participants will be followed on this study for up to 3 years.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: September 1, 2028
• Est. primary completion date: September 1, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Participants must have histologically or cytologically confirmed invasive breast cancer.

• Anatomic stage II-III breast cancer per AJCC 8th edition classification system. Primary breast tumor must be at least 2 cm in size (per imaging and/or physical exam). Participants must be considered candidates for neoadjuvant systemic therapy with the intention to undergo surgery (breast +/- axillary).

• Estrogen-receptor and progesterone-receptor expression both <10% by immunohistochemistry (IHC), and HER2-negative status as determined by the current ASCO/CAP guidelines.

• Participant must agree to undergo the percutaneous procedures for implantation and removal of the microdevice.

• Participant must be evaluated by a surgeon and/or medical oncologist who will determine the clinically appropriate treatment strategy based on clinical history and extent of disease. Participant must be deemed medically fit to undergo the percutaneous procedures for microdevice implantation and removal.

• Participant must have a primary breast tumor that is considered amenable to percutaneous placement and removal of the microdevice. Participants with history of prior malignancy (invasive or in situ) in the ipsilateral breast are not eligible.

• Patients with multifocal or multicentric disease are eligible, if not known to be HER2-positive. Pathologic confirmation of multifocal or multicentric is at physician´s discretion; however, if pathologic confirmation is obtained, receptor status must be available prior to registration.

• Patients with bilateral breast cancers are eligible, if not known to be HER2-positive. Pathologic confirmation of bilateral breast cancer is at physician´s discretion; however, if pathologic confirmation is obtained, receptor status must be available prior to registration.

• Prior systemic therapy: No prior chemotherapy, biologic therapy, hormonal therapy or investigational therapy for this breast cancer.

• Prior radiation therapy: No prior radiation to the ipsilateral breast.

• Prior surgery: No prior surgery to the ipsilateral breast.

• The subject is = 18 years old.

• ECOG performance status = 2 (Appendix A).

• Participants will undergo laboratory testing within 7 days prior to the microdevice placement. Participants must have normal coagulation and marrow function as defined below:

• Absolute neutrophil count = 1,500/mcL

• Platelets = 75,000/mcL

• PT (INR) < 1.5

• PTT < 1.5 x control

• Female subjects of childbearing potential must have a negative serum or urine pregnancy test within 7 days prior registration. Childbearing potential is defined as: participants who have not reached a postmenopausal state (= 12 continuous months of amenorrhea with no identified cause other than menopause) and have not undergone surgical sterilization (removal of ovaries and/or uterus).

• Patients must have the ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

• Uncontrolled, significant intercurrent or recent illness including, but not limited to, ongoing or active infection, uncontrolled non-malignant systemic disease, uncontrolled seizures, or psychiatric illness/social situation that would limit compliance with study requirements in the opinion of the treating investigator.

• Prior hypersensitivity to any of the study drugs implanted with the device.

• Pregnant women are excluded from this study because of the possible increased dose of radiation from imaging associated with the device placement (e.g., if placement cannot be performed guided by ultrasound or MRI, if additional imaging and/or procedures are required due to potential complication of the device placement or removal).

• Uncorrectable bleeding or coagulation disorder known to cause increased risk with surgical or percutaneous biopsy procedures.

• Significant risk factors (including, but not limited to, high risk of venous thrombosis, pulmonary embolism, stroke, or myocardial infarction) precluding the safe cessation of anticoagulation medication as per Radiology guidelines. (Patients taking low-dose aspirin only do not need to be excluded.)

Related Conditions & MeSH terms

• Breast Cancer
• Breast Cancer Stage II
• Breast Cancer Stage III
• Breast Carcinoma
• Breast Neoplasms
• Carcinoma
• Triple Negative Breast Cancer
• Triple Negative Breast Neoplasms

Intervention

Combination Product:
• Implantable Microdevice (IMD)
Small, implantable device with 30 reservoirs for drug and drug combinations. Placement of 2 microdevices into tumor will be performed via needle, percutaneously, and guided by interventional radiologic techniques. Drugs include all or a subset of the following: Doxorubicin, Paclitaxel, Carboplatin, Eribulin, Pembrolizumab, Atezolizumab, Tazemetostat, Panobinostat, Olaparib, Capecitabine, Sacituzumab govitecan, Abemaciclib, Venetoclax, Doxorubicin + cyclophosphamide (combination), Doxorubicin + cyclophosphamide + paclitaxel + carboplatin (combination), Carboplatin + paclitaxel (combination), Doxorubicin + cyclophosphamide + pembrolizumab (combination), Doxorubicin + cyclophosphamide + paclitaxel + carboplatin + Pembrolizumab (combination), Paclitaxel + atezolizumab (combination), Paclitaxel + pembrolizumab (combination), Carboplatin + gemcitabine + pembrolizumab (combination), Carboplatin + paclitaxel + pembrolizumab (combination), Trastuzumab deruxtecan

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Dana-Farber Cancer Institute

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of Participants with Adverse Events	Defined by assessment of adverse events as defined by CTCAE v5.0.	up to 80 hours
Primary	Number of Participants with Successful Procedure	Defined as the ability to retrieve two implanted microdevices with sufficient tissue, of sufficient quality, for downstream histopathology analysis and interpretation of at least 67% of the microdevice reservoirs in each device.	up to 80 hours
Secondary	Local Intratumoral Response (per Apoptosis)	Descriptive statistics will be used to summarize the quantitative measurement of apoptosis (apoptotic index) for drug-treated regions compared to untreated regions of the device.	up to 80 hours
Secondary	Local Intratumoral Response (per Proliferation)	Descriptive statistics will be used to summarize the quantitative measurement of proliferation (Ki67) for drug-treated regions compared to untreated regions of the device.	up to 80 hours
Secondary	Response to Systemic Neoadjuvant Therapy (RCB Class)	Correlation between local intratumoral response with the microdevice and response to systemic neoadjuvant therapy will be evaluated. Clinical response to systemic neoadjuvant therapy will be defined using residual cancer burden (RCB) class.	up to 3 years
Secondary	Response to Systemic Neoadjuvant Therapy (RCB Score)	Correlation between local intratumoral response with the microdevice and response to systemic neoadjuvant therapy will be evaluated. Clinical response to systemic neoadjuvant therapy will be defined using RCB score.	up to 3 years
Secondary	Invasive disease-free survival	Correlation between local intratumoral response with the microdevice and invasive disease-free survival, defined as the time from registration until the occurrence of local/regional recurrence, contralateral invasive breast cancer, distant recurrence, second primary invasive non-breast cancer, or death due to any cause or censored at date of last disease evaluation.	up to 3 years
Secondary	Overall survival	Correlation between local intratumoral response with the microdevice and overall survival, defined as the time from registration until death due to any cause or censored at the date of last known alive.	up to 3 years