A Phase 2 Study of Palliative Radiation in Combination with Pembrolizumab in Subjects with Unresectable Metastatic Stage IV Breast Cancer: Twisted Pink
This is a phase 2, open-label, single-arm trial designed to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) in combination with pembrolizumab following disease progression after two prior lines of standard therapy in unresectable metastatic stage IV breast cancer
• 1\. Subject has provided informed consent/assent prior to initiation of any study specific activities/procedures.
• 2\. Female age ≥ 18 years at the time of informed consent. 3. Histologically confirmed diagnosis of breast cancer. 4. Disease stage: unresectable or metastatic stage IV breast cancer. 5. Candidate for palliative SBRT independent from study enrollment 6. Measurable disease, defined as at least 1 visceral or nodal/soft tissue breast cancer lesion that can be accurately and serially measured in at least 1 dimension and for which the longest diameter is ≥ 10 mm as measured by Computer Tomography scan or Magnetic Resonance Imaging. Lymph nodes must measure ≥ 15 mm in their short axis to be considered measurable by Computer Tomography scan or Magnetic Resonance Imaging or Positron Emission Tomography-CT.
• 7\. If subject received major surgery, must have recovered adequately from toxicity and/or complications from the intervention prior to enrollment.
• 8\. Subject must have received two prior lines of therapy and include a taxane in the adjuvant/neoadjuvant or metastatic setting.
⁃ Triple negative breast cancer patients must have received two lines of chemotherapy in the metastatic setting.
⁃ ER+/ PR+, ER-/PR+, and ER+/PR- must have received prior Cyclin Dependent Kinase 4/6 Inhibitor in combination with Aromatase Inhibitor or fulvestrant. However, ER+/Her2 overexpressed patients are not required to have received CDK 4/6 inhibitor.
⁃ Her2 overexpressed breast cancer must have had prior trastuzumab/per (in the neoadjuvant/adjuvant or metastatic setting, and prior Ado-trastuzumab TDM1 therapy.
‣ 9\. Adequate organ function determined within 14 days prior to enrollment, defined as follows:
∙ Absolute neutrophil (ANC) \>1.5 x 109/L
∙ Platelet count\>50 x 109/L
∙ Hemoglobin\>8 g/dL
∙ Serum creatinine \<2.0 x upper limit of normal
∙ Serum bilirubin \< 2.0 x ULN OR direct bilirubin ≤ ULN for a subject with total bilirubin level \> 2.0 x ULN
∙ Aspartate aminotransferase (AST) \<2.5 x ULN OR \<5 x ULN for subject with liver metastases
∙ Alanine aminotransferase (ALT) \<2.5 x ULN OR \<5 x ULN for subject with liver metastases
∙ International normalization ratio (INR) or prothrombin time (PT) \<1.5 x ULN unless the subject is receiving anticoagulant therapy as long as PT and partial thromboplastin time (PTT)/activated PTT (aPTT) is within therapeutic range of intended use of anticoagulants
∙ Lactate dehydrogenase (LDH) levels ≤ 1.5 X upper limit of normal (ULN) within 28 days prior to enrollment
∙ Female subject of childbearing potential must have a negative urine or serum pregnancy test within 72 hours prior to enrollment. If the urine pregnancy test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
∙ ECOG performance status of 0, 1 or 2.