A Phase 2 interventional study of Ipilimumab and Laboratory Biomarker Analysis in HER2/Neu Negative, Recurrent Inflammatory Breast Carcinoma and Stage IV Breast Cancer, sponsored by Northwestern University. Terminated at 1 site in United States. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2020-07-16.
Sponsored by Northwestern University · Phase 2, Interventional, and Treatment
The purpose of this research study is to look at the efficacy (the effect on tumor) and the safety (the effect on body) of the study drugs when given as a combination in patients with metastatic recurrent epidermal growth factor receptor 2 (HER2) negative inflammatory breast cancer. This is a phase II study of 2 drugs used in combination: nivolumab and ipilimumab. The combination of these drugs is already approved by the Food and Drug Administration (FDA) to treat advanced melanoma (a type of skin cancer). Nivolumab and ipilimumab are not approved by the FDA for patients with metastatic recurrent HER2 negative inflammatory breast cancer, hence the treatment is considered experimental or investigational.
PRIMARY OBJECTIVES:
I. To determine progression free survival (PFS) in patients with newly recurrent HER2 negative inflammatory breast cancer (IBC) treated with nivolumab and ipilimumab according to Response Evaluation Criteria in Solid Tumors (RECIST) version (v) 1.1.
SECONDARY OBJECTIVES:
I. To assess the overall response rate (ORR) and clinical benefit rate (CBR) according to RECIST criteria v1.1, in patients with recurrent IBC treated with nivolumab and ipilimumab.
II. To assess overall survival in patients with recurrent HER2 negative IBC treated with nivolumab and ipilimumab.
III. To assess the safety and tolerability of nivolumab and ipilimumab in patients with recurrent IBC according to the National Cancer Institute Common Terminology Criteria for Adverse Events v 4.03.
TERTIARY OBJECTIVES:
I. To assess the predictive value of baseline iSCORE and programmed cell death 1 ligand 1 (PDL-1) expression using archival tissue samples as well as any standard of care tissue obtained during study treatment.
II. To assess the predictive value of circulating cell-free tumor DNA (ctDNA) and immune signature by exosome analysis using blood samples at baseline.
OUTLINE:
Patients receive nivolumab intravenously (IV) over 30 minutes every 2 weeks (Q2W) and ipilimumab IV over 90 minutes every 6 weeks (Q6W) in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 4 weeks for 12 weeks, and then every 3 months for up to 2 years.
6,741 studies on the registry are indexed under Carcinoma; 1,161 are open to participants now.
This study's enrollment of 3 is below the median of 45 across 5,170 interventional studies indexed under Carcinoma.
Browse Carcinoma studies →Northwestern University is the lead sponsor of 1,396 studies on the registry; 199 are open to participants now.
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NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:
Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for > 12 months)
Exclusion Criteria:
Patients who have had prior exposure to immune checkpoint inhibitors are not eligible; please contact principal investigator, Ricardo Costaat 312-472-1234 for specific questions on potential interactions
Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including chronic prolonged systemic corticosteroids (defined as corticosteroid use of duration one month or greater), should be excluded; these include but are not limited to patients with a history of:
Patients who have an uncontrolled intercurrent illness including, but not limited to any of the following, are not eligible:
No other prior malignancy is allowed except for the following:
Patients receive nivolumab IV over 30 minutes Q2W and ipilimumab IV over 90 minutes Q6W in the absence of disease progression or unacceptable toxicity.
Biological: Ipilimumab · Other: Laboratory Biomarker Analysis · Biological: Nivolumab
Given IV
Also known as: Anti-Cytotoxic T-Lymphocyte-Associated Antigen-4 Monoclonal Antibody, BMS-734016, MDX-010, MDX-CTLA4, Yervoy
Correlative studies
Given IV
Also known as: BMS-936558, MDX-1106, NIVO, ONO-4538, Opdivo
Progression Free Survival (PFS)
PFS in patients with newly recurrent HER2 negative IBC treated with nivolumab and ipilimumab as evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) v 1.1 assessed from the date of first study treatment to the date of disease progression or death from any cause, assessed up to 2 years.
Time frame: Up to 2 years
Overall Response Rate (ORR)
Evaluate the ORR according to RECIST criteria v1.1 in patients with recurrent Inflammatory Breast Cancer (IBC) treated with nivolumab and ipilimumab. ORR will be the number of patients with complete response plus the number of patients with partial response. Patients will have imaging scans every 12 weeks assessed up to 2 years. In general: Complete Response (CR): Disappearance of all target and non target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10mm. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: Every 12 weeks from treatment initiation for up to 2 years. Range of cycles patients completed 1-3 cycles (1 cycle =12 weeks)
Clinical Benefit Rate (CBR)
Evaluate the CBR according to RECIST criteria v1.1 in patients with recurrent Inflammatory Breast Cancer (IBC) treated with nivolumab and ipilimumab. CBR will be the number of patients with complete response plus the number of patients with partial response plus those with stable disease. Patients will have imaging scans every 12 weeks assessed up to 2 years. In general: Complete Response (CR): Disappearance of all target and non target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10mm. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time frame: Every 12 weeks from treatment initiation for up to 2 years. Range of cycles patients completed 1-3 cycles (1 cycle =12 weeks)
Overall Survival (OS)
To assess overall survival in patients with recurrent HER2 negative IBC treated with nivolumab and ipilimumab, patients will be followed from the start of treatment until 2 years post-treatment or death, whichever occurs first, and average survival time will be measured.
Time frame: Up to 2 years
Number of Adverse Events of Nivolumab and Ipilimumab Combination Treatment
Assess the safety and tolerability of nivolumab and ipilimumab in patients with recurrent Inflammatory Breast Cancer (IBC) by measuring the number, frequency, and severity of adverse events according to the National Cancer Institute Common Terminology Criteria Adverse events (CTCAE) v 4.03. AEs that were determined to be at least possibly related to study drug and grade 3-5 are reported. In general grading is as follows: Grade 1 - mild Grade 2 - moderate Grade 3 - severe Grade 4 - life threatening Grade 5 - fatal
Time frame: From the initiation of treatment until 12 weeks after study discontinuation. Range of cycles completed by patients 1-3 (1 cycle =12weeks)
iScore
Assess the predictive value of baseline iSCORE using tissue samples.
Time frame: At baseline
PD-L1 Expression Measured in Tissue Samples
Time frame: At baseline
ctDNA Assessed by Exosome Analysis in Blood Samples
Time frame: At baseline
Immune Signature Assessed by Exosome Analysis in Blood Samples
Time frame: At baseline
The study opened to accrual on September 5, 2017 with a total accrual goal of 29. The first patient started treatment October 18, 2017. The study was closed permanently January 21 2019 with 3 patients treated on study.
| Milestone | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Started | 3 |
| Completed 1st cycle/response at 12 weeks | 1 |
| Went on to start cycle 2 | 1 |
| Completed | 1 |
| Not completed | 2 |
| Withdrew: Progressive disease | 2 |
| Milestone | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Started | 3 |
| Completed | 0 |
| Not completed | 3 |
| Withdrew: Death | 2 |
| Withdrew: Study closed early | 1 |
PFS in patients with newly recurrent HER2 negative IBC treated with nivolumab and ipilimumab as evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) v 1.1 assessed from the date of first study treatment to the date of disease progression or death from any cause, assessed up to 2 years.
No measurements were reported for this outcome.
Evaluate the ORR according to RECIST criteria v1.1 in patients with recurrent Inflammatory Breast Cancer (IBC) treated with nivolumab and ipilimumab. ORR will be the number of patients with complete response plus the number of patients with partial response. Patients will have imaging scans every 12 weeks assessed up to 2 years. In general: Complete Response (CR): Disappearance of all target and non target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10mm. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
| patients | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Overall Response Rate (ORR) | 0 |
Evaluate the CBR according to RECIST criteria v1.1 in patients with recurrent Inflammatory Breast Cancer (IBC) treated with nivolumab and ipilimumab. CBR will be the number of patients with complete response plus the number of patients with partial response plus those with stable disease. Patients will have imaging scans every 12 weeks assessed up to 2 years. In general: Complete Response (CR): Disappearance of all target and non target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10mm. Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
| number of patients | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Clinical Benefit Rate (CBR) | 1 |
To assess overall survival in patients with recurrent HER2 negative IBC treated with nivolumab and ipilimumab, patients will be followed from the start of treatment until 2 years post-treatment or death, whichever occurs first, and average survival time will be measured.
| patients | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Overall Survival (OS) | 1 |
Assess the safety and tolerability of nivolumab and ipilimumab in patients with recurrent Inflammatory Breast Cancer (IBC) by measuring the number, frequency, and severity of adverse events according to the National Cancer Institute Common Terminology Criteria Adverse events (CTCAE) v 4.03. AEs that were determined to be at least possibly related to study drug and grade 3-5 are reported. In general grading is as follows: Grade 1 - mild Grade 2 - moderate Grade 3 - severe Grade 4 - life threatening Grade 5 - fatal
| Adverse Events | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Number of Adverse Events of Nivolumab and Ipilimumab Combination Treatment | 1 |
Assess the predictive value of baseline iSCORE using tissue samples.
Results for this outcome have not been posted.
Results for this outcome have not been posted.
Results for this outcome have not been posted.
Results for this outcome have not been posted.
Collected over Adverse events were collected from treatment initiation through 12 weeks post last dose of study drug with the range of cycles completed by patients 1 - 3. (1 Cycle = 12 Weeks). Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Treatment (Nivolumab, Ipilimumab) | 2/3 (66.7%) | 2/3 (66.7%) | 3/3 (100%) |
| Event | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Acute Hypoxic Respiratory FailureRespiratory, thoracic and mediastinal disorders | 1/3 |
| PneumonitisRespiratory, thoracic and mediastinal disorders | 1/3 |
| Event | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Lymphocyte Count DecreasedInvestigations | 2/3 |
| Aspartate Aminotransferase IncreasedInvestigations | 2/3 |
| HyperglycemiaMetabolism and nutrition disorders | 2/3 |
| InsomniaPsychiatric disorders | 2/3 |
| HypertensionVascular disorders | 2/3 |
| ConstipationGastrointestinal disorders | 1/3 |
| FatigueGeneral disorders | 1/3 |
| Upper Respiratory InfectionInfections and infestations | 1/3 |
| Neutrophil Count DecreasedInvestigations | 1/3 |
| HypoalbuminemiaMetabolism and nutrition disorders | 1/3 |
| Age, Categorical(Participants) | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| <=18 years | 0 |
| Between 18 and 65 years | 3 |
| >=65 years | 0 |
| Sex: Female, Male(Participants) | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Female | 3 |
| Male | 0 |
| Ethnicity (NIH/OMB)(Participants) | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| Hispanic or Latino | 0 |
| Not Hispanic or Latino | 3 |
| Unknown or Not Reported | 0 |
| Race (NIH/OMB)(Participants) | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 0 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 0 |
| White | 3 |
| More than one race | 0 |
| Unknown or Not Reported | 0 |
| Region of Enrollment(Participants) | Treatment (Nivolumab, Ipilimumab) |
|---|---|
| United States | 3 |
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