Patient case: 72-year-old male with melanoma; genetic feature: TP53 loss of function

Clinical trial: Gene Therapy Plus Chemotherapy in Treating Patients With Breast Cancer

Summary: Phase I trial to study the effectiveness of gene therapy plus chemotherapy in treating patients who have breast cancer. Inserting the p53 gene into a person's cancer cells may improve the body's ability to fight cancer or make the cancer more sensitive to chemotherapy. Combining chemotherapy with gene therapy may kill more tumor cells.

Detailed description: OBJECTIVES:
  I. Determine the effect of adenovirus p53 (Ad-p53) on chemotherapy-induced apoptosis in lesions in patients with breast cancer.
  II. Determine p53 protein expression following intralesional injections of Ad-p53 by immunohistochemistry and reverse transcriptase polymerase chain reaction in this patient population.
  III. Determine the time course and magnitude of the development of a humoral antibody response to the adenoviral vector in this patient population.
  IV. Determine the ability of transfected p53 to upregulate downstream signals important in G1 arrest by assaying for WAF1 mRNA and apoptosis in this patient population.
  V. Determine the toxicities and side effects of intralesional injections of Ad-p53 given in combination with standard chemotherapy in patients with cutaneous and subcutaneous metastatic breast cancer amenable to injections and biopsies.
  VI. Determine if there is an increase in apoptosis induced by Ad-53 compared to baseline in this patient population.
  OUTLINE:
  Patients undergo biopsy of one of their skin nodules prior to any treatment. Patients receive the Ad-p53 gene therapy in one nodule and injection of a second nodule with Dulbecco's phosphate buffered saline. The next day, patients begin chemotherapy, which may be given weekly and continues every 21-28 days for up to 6 courses. On day 3, patients return for biopsy of injected nodules. Biopsies are only performed during the first course. Patients may receive further injections of the Ad-p53 gene with subsequent courses of chemotherapy, for up to six courses.
  Patients are followed monthly for 4 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed epithelial breast cancer
  -  At least 3 cutaneous or subcutaneous lesions required
  -  Measurable disease that includes, but is not limited to, cutaneous or subcutaneous metastases
  PATIENT CHARACTERISTICS:
  -  Age: Over 18
  -  Performance status: ECOG 0-2
  -  Absolute granulocyte count at least 1,500/mm3
  -  Hemoglobin greater than 8 g/dL
  -  Platelet count greater than 100,000/mm3
  -  Bilirubin less than 2 mg/dL
  -  PT/PTT within normal range
  -  SGOT/SGPT less than 2 times upper limit of normal
  -  Creatinine less than 1.8 mg/dL
  -  Not pregnant
  -  Fertile patients must use effective contraception during and for 3 months after therapy
  PRIOR CONCURRENT THERAPY:
  -  Concurrent cytotoxic chemotherapy allowed, if stable and responding
  -  At least 4 weeks since prior chemotherapy, if starting a new regimen
  -  At least 4 weeks since radiotherapy
  -  Prior adjuvant radiotherapy to the chest wall allowed
  -  At least 6 months since radiotherapy to lesions that are to be injected
  -  Recovered from prior therapy

Relevance to patient case: not relevant