Evaluation of Changes in the Immunological Microenvironment Surrounding Subcutaneous Breast Cancer Metastases After Liquid Nitrogen Cryotherapy

Study Overview
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Brief Summary
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Cryotherapy is a cold ablation technique used in many tumor locations. The destruction of tissues by cryoablation preserves proteins and in particular anti-tumor antigens, which could induce the stimulation of an immune response. Compared to other interventional radiology techniques, cryotherapy induces a higher immunogenic response. Studies describe complex responses with elevated levels of activating NK cells, circulating and anti-tumor T cells, and pro-inflammatory and NF-KB dependent cytokines. In breast cancer, whether or not an immune response is triggered depends on the type of cryoablation used. Indeed, high intensity cryoablation (rapid freezing in one cycle of the entire tumor volume) seems to induce a tumor-specific immunodestructive response, whereas low frequency cryoablation (several small repetitive cycles until a sufficient volume of ice is obtained) does not induce an immunogenic response and can even induce an immunoregulation with immunotolerance of the tumor cells The University Hospital of Nîmes has recently acquired a new liquid nitrogen cryotherapy technique, more powerful than the one classically performed with Argon. This technique is used for palliative and analgesic purposes in patients with metastatic breast cancer presenting painful subcutaneous metastases. The aim of this study is to evaluate in these patients the changes in the tumor microenvironment and the immune response potentially induced by this very high intensity cryotherapy. The study investigators hypothesize that locoregional treatment with liquid nitrogen cryotherapy of subcutaneous breast cancer metastases will allow a systemic response through the induction of an immune response. A better understanding of the type of immune response induced will allow the development of combined therapeutic strategies with curative and not only palliative and analgesic aims.

Official Title
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Evaluation of Changes in the Immunological Microenvironment Surrounding Subcutaneous Breast Cancer Metastases After Liquid Nitrogen Cryotherapy: Descriptive Pilot Study.

Conditions
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Breast Cancer

Intervention / Treatment
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* Procedure: Cryotherapy treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The patient must have given their free and informed consent The patient must be a member or beneficiary of a health insurance plan Patient with metastatic breast cancer with painful subcutaneous metastases. Patient eligible for cryotherapy. Therapeutic decision of antalgic and palliative treatment by cryotherapy taken in Pluridisciplinary Consultation Meeting. Patient available for 15-day follow-up. Exclusion Criteria: The subject is in a period of exclusion determined by a previous study The subject us unable to express their consent or refuses to sign the consent form The patient is under safeguard of justice or state guardianship

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 95 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cryotherapy<br> | Procedure: Cryotherapy treatment<br>* Cryotherapy treatment administered by an interventional radiologist: the cryotherapy needle is placed under local anesthesia, ultrasound monitoring in real time. A complete cryotherapy cycle is performed with: freezing until the entire tumor is frozen as judged by ultrasound, then thawing for the same duration and refreezing according to the same principle.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Description of the immunological makeup of the tumor before liquid nitrogen cryotherapy treatment | Cytometry by Time Of Flight (CyTOF®) mass cytometry analysis of biopsy samples to identify lymphocyte and macrophage populations and anti-tumor markers | Day 0 | 
| Description of the immunological makeup of the tumor after liquid nitrogen cryotherapy treatment | Cytometry by Time Of Flight (CyTOF®) mass cytometry analysis of biopsy samples to identify lymphocyte and macrophage populations and anti-tumor markers | Day 15 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients' tolerance to cryotherapy treatment | Scoring of complications and adverse events according to Common Terminology Criteria for Adverse Events (CTCAE) criteria | Day 15 | 
| Level of pain related to subcutaneous metastases before cryotherapy treatment | 0-10 Visual analog scale | Day 0 immediately before cryotherapy treatment | 
| Level of pain related to subcutaneous metastases after cryotherapy treatment | 0-10 Visual analog scale | Day 0 immediately after cryotherapy treatment | 
| Level of pain related to subcutaneous metastases after cryotherapy treatment | 0-10 Visual analog scale | Day 15 | 
| Pain related to subcutaneous metastases before cryotherapy treatment | Brief Pain Inventory (BPI): score from 0-120 | Day 0 immediately before cryotherapy treatment | 
| Pain related to subcutaneous metastases after cryotherapy treatment | Brief Pain Inventory (BPI): score from 0-120 | Day 0 immediately after cryotherapy treatment | 
| Pain related to subcutaneous metastases after cryotherapy treatment | Brief Pain Inventory (BPI): score from 0-120 | Day 15 | 
| Patient reported quality of before cryotherapy treatment | European Organisation for Research and Treatment of Cancer - C30 (EORTC QLQ-C30). This questionnaire is composed of 30 items grouped into 15 scales. A good quality of life is associated with a high score for the functional scales and a low score for the symptom scales | Day 0 | 
| Patient reported quality of after cryotherapy treatment | European Organisation for Research and Treatment of Cancer - C30 (EORTC QLQ-C30). This questionnaire is composed of 30 items grouped into 15 scales. A good quality of life is associated with a high score for the functional scales and a low score for the symptom scales | Day 15 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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cryotherapy, cytotoxicity