Biological Therapy in Treating Women With Stage IV Breast Cancer

RATIONALE: Biological therapies use different ways to stimulate the immune system and stop cancer cells from growing. Combining different types of biological therapies may kill more tumor cells.

PURPOSE: Phase I/II trial to study the effectiveness of combining different biological therapies in treating women who have stage IV breast cancer.

OBJECTIVES:

* Determine the maximum tolerated dose of armed activated T cells given in combination with interleukin-2 and sargramostim (GM-CSF) in women with stage IV breast cancer.
* Determine the toxicity profile of this regimen in these patients.
* Determine the clinical response and overall and progression-free survival of patients treated with this regimen.

OUTLINE: This is a dose-escalation study of armed activated T cells.

Patients undergo peripheral blood mononuclear cell (PBMC) collection. The PBMCs are treated ex vivo with monoclonal antibody OKT3 to form armed activated T cells (ATC). The armed ATC are expanded for 14 days in interleukin-2 (IL-2).

Patients receive armed ATC IV over 30 minutes twice weekly for 4 weeks. Patients also receive IL-2 subcutaneously (SC) once daily and sargramostim (GM-CSF) SC twice weekly beginning 3 days before the first infusion of armed ATC and continuing until 7 days after the last infusion of armed ATC.

Cohorts of 3-6 patients receive escalating doses of armed ATC until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Once the MTD is determined, additional patients are treated at that dose.

Patients are followed at 1, 2, and 5 months and then every 6 months thereafter.

PROJECTED ACCRUAL: A total of 15-30 patients will be accrued for the phase I portion of this study and a total of 18-33 patients will be accrued for the phase II portion of this study within 4-6 years.

PLEASE NOTE: THIS STUDY WAS INTENDED TO BE A PHASE I/II STUDY, BUT NEVER MOVED FORWARD TO PHASE II. (4-22-09)

Eligibility Criteria:
DISEASE CHARACTERISTICS:

Phase I:

* Histologically confirmed infiltrating ductal carcinoma of the breast
* Metastatic disease

  * Clinically asymptomatic with non-life-threatening metastases allowed
* Measurable or evaluable disease by radiograph, CT scan, MRI, nuclear medicine bone scan, or physical examination

  * No measurable disease allowed if tumor or metastasis has been removed or successfully treated prior to study
* No rapidly progressive symptomatic disease affecting major organ systems (e.g., lungs and liver)
* Stable or unstable disease for 3 months on hormonal therapy
* Stable or unstable disease for at least 1 month after chemotherapy
* No active brain metastases

  * Brain metastases previously treated with definitive radiotherapy and/or surgical resection allowed
* Hormone receptor status:

  * Estrogen and progesterone receptor status known

Phase II:

* All Phase I criteria
* HER2/neu overexpression (2+ or 3+) by immunohistochemistry

  * Prior trastuzumab (Herceptin) allowed if disease still overexpresses HER2/neu

PATIENT CHARACTERISTICS:

Age:

* 18 and over

Sex:

* Female

Menopausal status:

* Not specified

Performance status:

* Karnofsky 70-100% OR
* ECOG 0-2

Life expectancy:

* At least 3 months

Hematopoietic:

* Granulocyte count at least 1,500/mm\^3
* Platelet count at least 50,000/mm\^3
* Hemoglobin at least 8 g/dL

Hepatic:

* Bilirubin less than 1.5 times normal
* SGOT less than 1.5 times normal

Renal:

* Creatinine no greater than 1.8 mg/dL
* Creatinine clearance at least 60 mL/min
* BUN no greater than 1.5 times normal

Cardiovascular:

* No myocardial infarction within the past year
* No prior myocardial infarction with coronary symptoms requiring medication and/or depressed left ventricular function (LVEF less than 50% by MUGA)
* No angina or coronary symptoms requiring medication and/or with depressed left ventricular function (LVEF less than 50% by MUGA)
* No congestive heart failure requiring medical management
* LVEF at least 50% at rest by MUGA
* No uncontrolled hypertension (i.e., systolic blood pressure \[BP\] ≥ 130 mm Hg or diastolic BP ≥ 80 mm Hg)

Pulmonary:

* FEV1, DLCO, and FVC at least 50% predicted

Other:

* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception
* HIV negative
* No other serious medical or psychiatric illness that would preclude study participation
* No other prior or concurrent malignancy within the past 5 years except curatively treated squamous cell carcinoma in situ of the cervix, basal cell skin cancer, or any other curatively treated disease in complete remission

PRIOR CONCURRENT THERAPY:

Biologic therapy:

* See Disease Characteristics
* Prior trastuzumab allowed for phase I

Chemotherapy:

* See Disease Characteristics
* At least 4 weeks since prior chemotherapy

Endocrine therapy:

* See Disease Characteristics
* Concurrent hormonal therapy for breast cancer must continue during study
* No other concurrent hormonal therapy except steroids for adrenal failure, septic shock, or pulmonary toxicity or hormonal therapy for non-disease-related conditions (e.g., insulin for diabetes)

Radiotherapy:

* See Disease Characteristics

Surgery:

* See Disease Characteristics