Window of Opportunity Trial of Entinostat in Patients With Newly Diagnosed Stage I-IIIC,TNBC

This study is investigational and is not designed to treat cancer. In other words, the study drug, entinostat, is not being given to treat cancer. Instead, the study team is looking at the effects of entinostat on tumor tissue for research purposes only.

Approximately 246,660 cases of breast cancer were diagnosed in the United States in 2016. Its detection and treatment remains a major concern in women's healthcare. In particular, TNBC accounts for approximately 15-20% of all breast cancers. Research into treatment for breast cancer relies more and more on understanding how the cancer cells act when they are exposed to an anti-cancer drug. How most cancer cells act when exposed to anti-cancer drugs and which patients as a result may benefit the most from these drugs is not well known. Additional studies are required to determine the cells' reactions. The purpose of part 1 of this study is to better understand how TNBC tumors react to one particular cancer drug, entinostat. Entinostat is currently being studied across multiple clinical trials for the treatment of breast cancer, other solid tumors and blood cancers. Entinostat is investigational and has not yet been FDA approved for the treatment of cancer.

Studies have shown that a good way to determine how cancer acts when exposed to anti-cancer drugs is a short-term preoperative window study. In this type of study, subjects receive a study drug a couple of days before surgery. Leftover tissue from surgery is then used to determine some of the effects that a study drug may have on the tumor. In this study, subjects will receive two doses of entinostat prior to undergoing planned surgery. Leftover tissue from this surgery will then be used to determine the effects entinostat has on tumor cells. For example, the study team will examine if the types of genes and proteins that the tumor expresses as a result of entinostat exposure increases or decreases the likelihood that the tumor will not continue to grow. A gene is a unit of DNA. Genes make up the chemical structure carrying your genetic information that may determine human characteristics (i.e., eye color, height and sex). This study will focus on discovering how entinostat affects a wide variety of genes in tumor cells.

Primary Objective and Endpoint To identify decrease in Ki-67 mRNA following treatment with entinostat across TNBC breast cancers.

Secondary Objectives and Endpoints To identify messenger ribonucleic acid (mRNA) gene expression changes following treatment with entinostat, across TNBC.

To evaluate changes in the proliferation signature by mRNA expression following treatment with entinostat across TNBC.

To identify differential kinome activation before and after treatment with entinostat across TNBC

To correlate mutation and/or copy number variations by whole exome sequencing (WES) with mRNA gene expression changes and reduction of proliferation signature following treatment with entinostat across TNBC.

To correlate protein lysine hyperacetylation in peripheral blood and tumor from pre- and post-entinostat treated TNBCs.

To explore molecular subtype, Programmed death-ligand 1 (PD-L1) and other immune checkpoint molecule expression, immune gene and innate anti-programed cell death-1 resistance (IPRES) expression signatures and phenotypes of tumor-infiltrating lymphocytes, including delineation of effector and regulatory T cells, and define T cell receptor (TCR) repertoire prior to and following entinostat treatment in TNBCs. We will also explore mutation and copy number variation status, and predicted major histocompatibility complex (MHC) class I neoantigen burden.

To document safety of entinostat in patients with TNBC prior to their scheduled surgical resection per National Cancer Institute - Common Terminology for Adverse Events (NCI-CTCAE v4.0).

Eligibility Criteria:
Inclusion Criteria:

* Is female, age ≥ 18 years of age.
* For Part 1: Has histologically confirmed newly diagnosed Stage I-IIIC invasive breast cancer that is triple negative (ER/PR \<1%, Her2 negative) and is scheduled to undergo definitive surgery (either lumpectomy, mastectomy) and meets the criteria listed below:

  1. Scheduled for lumpectomy or mastectomy and not considered a candidate for neoadjuvant systemic treatment
  2. No prior or current therapy for breast cancer
  3. Amenable to a baseline research breast biopsy

For Part 2: Has histologically confirmed newly diagnosed Stage I-IIIC invasive breast cancer that is ER positive (+/- PR positive) and is scheduled to undergo definitive surgery (either lumpectomy, mastectomy) and meets the criteria listed below:

* Scheduled for lumpectomy or mastectomy and not considered a candidate for neoadjuvant systemic treatment b. No prior or current therapy for breast cancer c. Amenable to a baseline research breast biopsy
* Must have sufficient time to receive two doses of entinostat 7 days apart or exemestane for 8 consecutive days with or without entinostat prior to surgery.
* Has an Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1.
* Demonstrates adequate organ function
* Has normal cardiac function based on an electrocardiogram (ECG) with no clinically significant abnormalities or risks including any of the following:

  * Current uncontrolled hypertension (systolic \>150 mm Hg and/or diastolic \>100 mmHg) or unstable angina
  * History of serious cardiac arrhythmia requiring treatment (exceptions: atrial fibrillation, paroxysmal supraventricular tachycardia)
  * History of myocardial infarction within 6 months of day 1 of dosing
  * History of congestive heart failure according to New York Heart Association (NYHA) criteria.
* For women of childbearing potential: Has a negative serum pregnancy test at screening within 72 hrs of receiving study treatment. In addition, female subjects must either:

  1. agree to the use of an approved method of contraception (ie, two adequate barrier methods throughout the study starting with the screening visit) and to continue its use for the duration of the study treatment through 120 days after the last dose of entinostat if a woman of child-bearing potential, or
  2. has documented inability to become pregnant (e.g., hysterectomy, bilateral tubal ligation or oophorectomy, or post-menopausal as defined as total cessation of menses for ≥ 2 years). Documented hysterectomy or oophorectomy must be confirmed with medical records of the actual procedure or confirmed by an ultrasound. Tubal ligation must be confirmed with medical records of the actual procedure otherwise the patient must be willing to use 2 adequate barrier methods throughout the study.
* Is able to swallow and retain oral medication.
* As determined by the enrolling physician or protocol designee, ability of the subject to understand and comply with study procedures for the entire length of the study.

Exclusion Criteria:

* Stage IV breast cancer.
* Has clinically significant a) abnormal laboratory or ECG findings, b) history of myocardial infarction or arterial thromboembolic events within 6 months of screening or c) unstable angina, d) New York Heart Association (NYHA) Class III or IV disease or e) a corrected QT (QTc) interval \> 470 msec.
* Medical history of uncontrolled hypertension (NCI CTCAE grade 3 or 4) or diabetes mellitus.
* Known active central nervous system metastases and/or carcinomatous meningitis.
* Prior history of another cancer within the previous 5 years with the exception of adequately treated basal cell carcinoma or cervical intraepithelial neoplasia, cervical carcinoma in situ or melanoma in situ.
* Another known malignancy other than breast cancer that is progressing or requires active treatment.
* Is pregnant or lactating, or is of child-bearing potential and not willing to use an approved method of contraception.
* Has a concomitant medical condition that precludes adequate study treatment compliance or assessment, such as bleeding disorders or any other medical condition that would increase risks of additional core biopsy for biomarkers.
* Is currently receiving treatment with a medication on the prohibited medication list for entinostat (See section 11.1 Appendix A and section 4.5).
* Has allergy to benzamides or inactive components of the study medication (entinostat).
* Inability to take oral medications (eg, impairment of gastrointestinal (GI) function or GI disease that may significantly alter the absorption of oral medications such as ulcerative diseases, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection).
* Is participating in another therapeutic clinical trial or has received another investigational agent within 30 days prior to informed consent.
* Known human immunodeficiency virus (HIV), Hepatitis B Virus (HBV), or Hepatitis C Virus (HCV) infection (with the exception of chronic or cleared HBV and HCV infection which is allowed).
* Has acute or currently active/requiring anti-viral therapy, hepatic or biliary disease (with the exception of patients with Gilbert's syndrome, asymptomatic gallstones, or stable chronic liver disease per investigator assessment).
* Known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the study.
* Medical history of an autoimmune disease that requires ongoing steroid therapy for \> 14 days.