Protocol Number: 03-C-0040
Patients 18 years of age and older with previously untreated metastatic breast cancer may be eligible for this study. Patients known or found to have metastases in the brain are not eligible for the study. Patients may be newly diagnosed with metastatic breast cancer or known to have breast cancer but newly diagnosed with metastatic disease. Newly diagnosed patients may not have received prior chemotherapy but they may have received hormonal therapy for stage IV disease. Patients previously diagnosed with local disease may have received chemotherapy or radiation therapy but at least 18 months before entering the current study. Candidates will be screened with blood and urine tests, x-rays, and heart and lung tests. Participants undergo the following procedures: 1. Central venous line: Under local or general anesthesia, an intravenous catheter (plastic tube) is inserted into a major vein in the chest. It is used to give chemotherapy and other medications and to withdraw blood samples. 2. Apheresis: Before beginning chemotherapy, patients undergo apheresis to collect white blood cells (lymphocytes) for later re-infusion at the time of immunizations. For this procedure, blood is collected through the central venous catheter and circulated through a machine that separates the white cells from the rest of the blood. The rest of the blood is returned to the patient through the catheter. The white cells are removed and frozen for later use. 3. First vaccine: Before starting chemotherapy, patients receive one subcutaneous (under the skin) injection of a vaccine called rV-CEA-Tricom, along with subcutaneous injections of GM-CSF (Sargramostim), a drug that stimulates the response of the immune system to the vaccine. 4. Chemotherapy. Chemotherapy includes: -Taxol (paclitaxel)/Cytoxan (cyclophosphamide) - Patients receive three to five cycles of Taxol and Cytoxan. Taxol is given as a continuous 72-hour intravenous (through a vein) infusion and Cytoxan is given daily for 3 days intravenously (IV). Cycles are 21 to 42 (usually 28) days. After each cycle, patients also receive G-CSF (a drug that helps boost white cell counts) by injection under the skin. The also receive Mesna, a drug that protects the bladder from harmful side effects of Cytoxan. -Adriamycin (doxorubicin)/Cytoxan: Patients may receive additional chemotherapy with Adriamycin and Cytoxan for a maximum of 4 cycles. Adriamycin is given as a 10-minute IV bolus and Cytoxan is infused IV over 1 hour. Cycles are usually 21 days. -Immune-depleting chemotherapy: Patients receive a final course of chemotherapy (following radiation, if needed) with Cytoxan and fludarabine to lower the immune system in preparation for receiving the white blood cells (lymphocytes) collected before the start of chemotherapy. -Additional vaccines: Starting 3 weeks after immune-depleting chemotherapy, patients receive a series of immunizations once a month with a second type vaccine called rF-EA-Tricom). Starting 10 months after the immune-depleting chemotherapy, they will get a booster shot of the same vaccine every 6 months for four doses, along with four daily injections of Sargramostim. Along with the first series of immunizations, patients receive the white cells (lymphocytes) that were collected during apheresis to boost the body's response to the vaccines. 5. Hormonal treatment: Patients whose tumors are hormone receptor positive will receive hormonal therapy after all chemotherapies are completed. The total length of treatment varies from about 25 to 41 months, depending on the number of cycles patients receive and whether or not they also undergo surgery or radiation therapy. (The last 18 months consist only of one vaccine injection every 6 months)
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