Abstract OT1-18-04: A phase II study of dual immune checkpoint blockade (ICB) plus bicalutamide to enhance thymic T-cell production and immunotherapy response in metastatic breast cancer (MBC)

Abstract

Abstract Background: The addition of anti-programmed death 1/ligand 1 (anti-PD-1/L1) improves progression-free survival when combined with chemotherapy in PD-L1-positive triple-negative MBC. However, novel combination therapies are needed to improve efficacy in hormone receptor positive (HR+) MBC, or in patients with PD-L1-negative disease. Dual ICB with nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4) has not been studied in depth in MBC despite its success in other solid tumors. Furthermore, MBCs often express the androgen receptor (AR), which can be targeted therapeutically. AR blockade agents have been shown to stimulate thymic production of naïve T-cell clones. It is proposed that ICB in conjunction with AR blockade may facilitate thymopoeisis and subsequent activation of novel, tumor-reactive T-cell clones. Trial design: This is a phase II, open-label trial investigating the combination of ICB (nivolumab 240mg IV q2w; ipilimumab 1mg/kg IV q6w) and AR blockade (bicalutamide, 150mg PO daily) in MBC. Two cohorts will be studied: AR-positive TNBC [ > 1% by IHC, constituting ~50% of TNBCs]; and HR+ MBC (of which the great majority are AR-positive). Eligibility: Patients must have RECIST1.1 measurable disease, ECOG performance score 0-1, and adequate hematological and hepatic function. Subjects may have received no more than 1 prior non-curative chemotherapy. Specific aims: Subjects will be assessed for clinical benefit by iRECIST criteria and safety by CTCAE v4.0, with clinical efficacy defined as >20% improvement in week 24 clinical benefit rate, over historical control (30% per EMBRACE clinical trial). Statistical analysis will be performed by a Simon 2-stage design to minimize futility (n = 46/cohort, stage I: n = 15). As exploratory aims, thymic generation of T-cells will be measured via quantitative deep sequencing of T-cell receptors (TcR, ImmunoSEQ assay), TcR excision circles (TRECs), and flow cytometry using markers of recent thymic emigration. Present accrual: As of 7/8/2021, n=19 subjects are enrolled (4 TNBC, 15 HR+). The trial is open at Providence Cancer Institute (Portland, OR) and Memorial Sloan Kettering Cancer Center (New York, NY). Target accrual: stage I: n=15 per arm; a maximum of 138 patients (46 per cohort) may be enrolled in expansion cohorts. Contact: Dr. David Page (David.page2@providence.org) Clinicaltrials.gov#: NCT03650894 Citation Format: David B Page, Krystle L Collins, Brie Chun, Zhaoyu Sun, William L Redmond, Maritza Martel, Yaping Wu, Nicole Moxon, Staci L Mellinger, Walter J Urba, Tiffany A Traina, Ayca Gucalp. A phase II study of dual immune checkpoint blockade (ICB) plus bicalutamide to enhance thymic T-cell production and immunotherapy response in metastatic breast cancer (MBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-18-04.