Clinical Trials /

Study Evaluating the Efficacy and Safety of JCAR015 in Adult B-cell Acute Lymphoblastic Leukemia (B-ALL)

NCT02535364

Description:

This single-arm, multicenter Phase 2 trial will treat adult patients who have relapsed or refractory B-ALL with an infusion of the patient's own T cells that have been genetically modified to express a chimeric antigen receptor (CAR) that will bind to leukemia cells that express the CD19 protein on the cell surface. The study will determine if these modified T cells (called JCAR015) help the body's immune system eliminate leukemia cells. The trial will also study the safety of treatment with JCAR015, how long JCAR015 cells stay in the patient's body, the extent to which JCAR015 eliminates minimal residual disease, and the impact of this treatment on survival.

Related Conditions:
  • Acute Lymphoblastic Leukemia
Recruiting Status:

Terminated

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study Evaluating the Efficacy and Safety of JCAR015 in Adult B-cell Acute Lymphoblastic Leukemia (B-ALL)
  • Official Title: A Phase 2, Single-arm, Multicenter Trial to Determine the Efficacy and Safety of JCAR015 in Adult Subjects With Relapsed or Refractory B-Cell Acute Lymphoblastic Leukemia

Clinical Trial IDs

  • ORG STUDY ID: 015001
  • NCT ID: NCT02535364

Conditions

  • Acute Lymphoblastic Leukemia

Interventions

DrugSynonymsArms
JCAR015 (CD19-targeted CAR T cells)JCAR015 (CD19-targeted CAR T cells)

Purpose

This single-arm, multicenter Phase 2 trial will treat adult patients who have relapsed or refractory B-ALL with an infusion of the patient's own T cells that have been genetically modified to express a chimeric antigen receptor (CAR) that will bind to leukemia cells that express the CD19 protein on the cell surface. The study will determine if these modified T cells (called JCAR015) help the body's immune system eliminate leukemia cells. The trial will also study the safety of treatment with JCAR015, how long JCAR015 cells stay in the patient's body, the extent to which JCAR015 eliminates minimal residual disease, and the impact of this treatment on survival.

Detailed Description

      This is a single-arm, multicenter Phase 2 study to determine the efficacy and safety of
      JCAR015 in adult patients with relapsed or refractory B-ALL. The study will have the
      following sequential phases: Part A (screening, leukapheresis, cell product preparation, and
      cytoreductive chemotherapy) and Part B (treatment and follow-up). The follow-up period for
      each participant is approximately 12 months after the final JCAR015 infusion. The total
      duration of the study is expected to be approximately 3 years. Long-term follow-up for
      survival, toxicity, and viral vector safety will continue under a separate long-term
      follow-up protocol per health regulatory authority guidelines, currently up to 15 years after
      the last JCAR015 infusion.
    

Trial Arms

NameTypeDescriptionInterventions
JCAR015 (CD19-targeted CAR T cells)ExperimentalJCAR015 was administered as two intravenous (IV) infusions separated by 14 to 28 days.
  • JCAR015 (CD19-targeted CAR T cells)

Eligibility Criteria

        Inclusion Criteria:

          1. Age ≥ 18 years at the time of consent

          2. Relapsed or refractory B-ALL, defined as:

               -  First or greater bone marrow relapse from CR, or

               -  Any bone marrow relapse after allogeneic hematopoietic stem cell transplant
                  (HSCT); subjects must be at least 100 days from HSCT at the time of screening and
                  off immunosuppressant medication for at least 1 month at the time of screening,
                  and have no active graft-vs-host disease (GVHD), or

               -  Refractory B-ALL, defined by not having achieved a CR or CRi after two attempts
                  at remission induction using standard regimens, or

               -  Ph+ B-ALL if subjects are intolerant to or ineligible for tyrosine kinase
                  inhibitor (TKI) therapy, or have progressed after at least one line of TKI
                  therapy

          3. Morphological evidence of disease in bone marrow (at least 5% blasts)

          4. Evidence of CD19 expression

          5. Eastern Cooperative Oncology Group (ECOG) performance status between 0 and 2 at the
             time of screening

          6. Adequate pulmonary, renal, hepatic, and cardiac function

          7. Adequate central or peripheral vascular access for leukapheresis procedure

        Exclusion Criteria:

          1. Isolated extramedullary disease relapse

          2. Concomitant genetic syndrome or other known bone marrow failure syndrome

          3. Burkitt's lymphoma/leukemia or chronic myelogenous leukemia lymphoid blast crisis
             (p210 BCR-ABL+)

          4. Prior malignancy, unless treated with curative intent and with no evidence of active
             disease present for > 5 years before screening

          5. Prior treatment with any gene therapy product

          6. Active hepatitis B, active hepatitis C, or any human immunodeficiency virus (HIV)
             infection at the time of screening

          7. Systemic fungal, bacterial, viral, or other infection that is not controlled, at the
             time of screening

          8. Presence of Grade II-IV (Glucksberg) or B-D (IBMTR) acute or extensive chronic GVHD at
             the time of screening

          9. Active central nervous system (CNS) involvement by malignancy (defined as CNS-3 per
             National Comprehensive Cancer Network [NCCN] guidelines)

         10. History of any one of the following cardiovascular conditions within the past 6
             months: Class III or IV heart failure as defined by the New York Heart Association
             (NYHA), cardiac angioplasty or stenting, myocardial infarction, unstable angina, or
             other clinically significant cardiac disease

         11. History or presence of clinically relevant CNS pathology such as epilepsy, generalized
             seizure disorder, paresis, aphasia, stroke, severe brain injuries, dementia,
             Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis

         12. Participation in an investigational research study using an investigational agent
             within 30 days of screening

         13. History of treatment with a murine-derived biological product other than blinatumomab
             unless subject has been shown to be negative for human-anti-mouse-antibodies (HAMA)
             prior to or during screening

         14. Pregnant or nursing women

         15. Use of prohibited medications:

               1. Steroids: Therapeutic doses of corticosteroids are prohibited within 7 days prior
                  to leukapheresis.

               2. Allogeneic cellular therapy: Donor lymphocyte infusions (DLI) are prohibited
                  within 4 weeks prior to leukapheresis

               3. GVHD therapies: Any drug used for GVHD within 4 weeks prior to leukapheresis

               4. Chemotherapies: Salvage chemotherapy must be stopped at least 1 week prior to
                  leukapheresis

         16. Treatment with alemtuzumab within 6 months prior to leukapheresis, or treatment with
             clofarabine or cladribine within 3 months prior to leukapheresis
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Percentage of Participants With Complete Remission (CR) or Complete Remission With Incomplete Hematopoietic Recovery (CRi), as Determined by an Independent Review Committee (IRC)
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:Overall remission rate (ORR) is defined as the percentage of participants with CR or CRi based on IRC assessment. For CR, all of the following must be met: (1) in bone marrow, trilineage hematopoiesis and < 5% blasts; (2) in peripheral blood, neutrophils > 1,000/µL, platelets > 100,000/µL, and circulating blasts < 1%; (3) no clinical evidence of extramedullary disease by physical examination and no symptoms suggestive of CNS involvement (if additional assessments such as CSF assessment by lumbar puncture or Ommaya reservoir tap, CNS imaging, or biopsy are performed, results must show no evidence of disease); (4) no platelet and/or neutrophil transfusions ≤ 7 days before the date of peripheral blood sampling, and (5) no clinical evidence of recurrence for 4 weeks. For CRi, all criteria for CR are met except that one or more of the following exists in the peripheral blood: neutrophils ≤ 1,000/µL, platelets ≤ 100,000/µL, or platelet transfusions ≤ 7 days before blood sampling.

Secondary Outcome Measures

Measure:Percentage of Participants With CR or CRi, as Determined by an IRC
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:ORR is defined as the percentage of participants with CR or CRi based on IRC assessment (refer to criteria in Outcome Measure #1)
Measure:Percentage of Participants Who Achieved a CR or CRi, as Determined by an IRC
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:Best overall response (BOR) is defined as the best disease response recorded from the time of the last JCAR015 infusion until the start of another anticancer therapy (refer to Outcome Measure #1 for criteria for CR and CRi).
Measure:Percentage of Participants Who Achieved a CR or CRi, as Determined by an IRC
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:BOR is defined as the best disease response recorded from the time of the last JCAR015 infusion until the start of another anticancer therapy (refer to Outcome Measure #1 for criteria for CR and CRi).
Measure:Percentage of Participants Who Achieved a Minimal Residual Disease (MRD)-Negative CR or CRi
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:Percentage of participants who achieved a CR or CRi, as determined by an IRC, with no evidence of MRD in the bone marrow (refer to Outcome Measure #1 for criteria for CR and CRi). MRD-negative is defined as undetectable leukemic cells in the bone marrow as determined by a polymerase chain reaction (PCR)-based assay.
Measure:Percentage of Participants Who Achieved a MRD-Negative CR or CRi
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:Percentage of participants who achieved a CR or CRi, as determined by an IRC, with no evidence of MRD in the bone marrow (refer to Outcome Measure #1 for criteria for CR and CRi). MRD-negative is defined as undetectable leukemic cells in the bone marrow as determined by a PCR-based assay.
Measure:Relapse-Free Survival (RFS), as Determined by an IRC
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:RFS is defined as the interval from the first documentation of CR or CRi (refer to Outcome Measure #1) to the earlier date of relapse or death due to any cause. Participants who proceeded to hematopoietic stem cell transplant (HSCT) after JCAR015 infusion were censored at the time of HSCT.
Measure:RFS, as Determined by an IRC
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:RFS is defined as the interval from the first documentation of CR or CRi (refer to Outcome Measure #1) to the earlier date of relapse or death due to any cause. Participants who proceeded to HSCT after JCAR015 infusion were censored at the time of HSCT.
Measure:Event-Free Survival (EFS)
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:EFS is defined as the time from the date of the first JCAR015 infusion to the earliest of the following events: death from any cause, relapse, or treatment failure (defined as no response and subsequent discontinuation from the study for adverse event, lack of efficacy or progressive disease, or new anticancer therapy). Participants who proceeded to HSCT after JCAR015 infusion were censored at the time of HSCT.
Measure:EFS
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:EFS is defined as the time from the date of the first JCAR015 infusion to the earliest of the following events: death from any cause, relapse, or treatment failure (defined as no response and subsequent discontinuation from the study for adverse event, lack of efficacy or progressive disease, or new anticancer therapy). Participants who proceeded to HSCT after JCAR015 infusion were censored at the time of HSCT.
Measure:Overall Survival (OS)
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:OS is defined as the interval from the date of the first JCAR015 infusion to the date of death due to any reason.
Measure:OS
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:OS is defined as the interval from the date of the first JCAR015 infusion to the date of death due to any reason.
Measure:Duration of Remission (DOR) as Determined by an IRC
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:DOR is defined as the interval from the first documentation of CR or CRi to the earlier date of relapse or death due to ALL.
Measure:Percentage of Participants Who Achieved a CR or CRi, as Determined by an IRC, at Month 6 After the Final JCAR015 Infusion
Time Frame:Day 1 (first JCAR015 infusion) up to 6 months after the last JCAR015 infusion
Safety Issue:
Description:ORR at Month 6 is defined as the percentage of participants who achieved a CR or CRi at Month 6 after the final JCAR015 infusion without HSCT during the time period between the final JCAR015 infusion and the Month 6 response assessment (refer to Outcome Measure #1 for criteria for CR and CRi).
Measure:Percentage of Participants Who Achieved a Morphologic Remission Within 6 Months After the Final JCAR015 Infusion and Then Proceeded to HSCT
Time Frame:Day 1 (first JCAR015 infusion) up to 12 months after the last JCAR015 infusion
Safety Issue:
Description:Percentage of participants who achieved a morphologic remission within 6 months after the final JCAR015 infusion and then proceeded to HSCT prior to 12 months after the final JCAR015 infusion
Measure:Maximum Concentration of JCAR015 (Cmax) in the Peripheral Blood by Quantitative Polymerase Chain Reaction (qPCR)
Time Frame:Pre-dose Day 1 of each JCAR015 infusion; Day 4, Day 7, Day 14, Day 21, and Day 28 after the first JCAR015 infusion until receipt of the second infusion; and Day 4, Day 7, Day 14, Day 21, and Day 28 after the second JCAR015 infusion (if applicable)
Safety Issue:
Description:Cmax is defined as the highest measured number of copies of JCAR015 transgene per microgram of genomic DNA in peripheral blood cells as assessed by qPCR.
Measure:Maximum Concentration of JCAR015 (Cmax) in the Peripheral Blood by Flow Cytometry
Time Frame:Pre-dose Day 1 of each JCAR015 infusion; Day 4, Day 7, Day 14, Day 21, and Day 28 after the first JCAR015 infusion until receipt of the second infusion; and Day 4, Day 7, Day 14, Day 21, and Day 28 after the second JCAR015 infusion (if applicable)
Safety Issue:
Description:Cmax is defined as the highest measured concentration of JCAR015 CAR T cells per microliter of peripheral blood as measured by flow cytometry.
Measure:Time to Maximum Concentration of JCAR015 (Tmax) in the Peripheral Blood as Measured by qPCR
Time Frame:Pre-dose Day 1 of each JCAR015 infusion; Day 4, Day 7, Day 14, Day 21, and Day 28 after the first JCAR015 infusion until receipt of the second infusion; and Day 4, Day 7, Day 14, Day 21, and Day 28 after the second JCAR015 infusion (if applicable)
Safety Issue:
Description:Tmax is defined as the time after the JCAR015 infusion at which the maximum concentration (Cmax) as measured by qPCR is observed. If Cmax occurred after the second infusion, Tmax was calculated from the time of the second infusion.
Measure:Tmax in the Peripheral Blood as Measured by Flow Cytometry
Time Frame:Pre-dose Day 1 of each JCAR015 infusion; Day 4, Day 7, Day 14, Day 21, and Day 28 after the first JCAR015 infusion until receipt of the second infusion; and Day 4, Day 7, Day 14, Day 21, and Day 28 after the second JCAR015 infusion (if applicable)
Safety Issue:
Description:Tmax is defined as the time after the JCAR015 infusion at which the Cmax as measured by flow cytometry of the JCAR015 CAR is observed. If Cmax occurred after the second infusion, Tmax was calculated from the time of the second infusion.
Measure:Area Under the Concentration-vs-Time Curve (AUC) for JCAR015 in the Peripheral Blood as Measured by qPCR
Time Frame:Pre-dose Day 1 of the first JCAR015 infusion; Day 4, Day 7, Day 14, Day 21, and Day 28 after the first JCAR015 infusion until receipt of the second infusion
Safety Issue:
Description:AUC is defined as the area under the concentration-vs-time curve from Day 1 to Day 29 after the first JCAR015 infusion as measured by qPCR of the JCAR015 transgene. AUC calculation includes pharmacokinetic (PK) results up to the second JCAR015 infusion for subjects who received the second infusion prior to Day 29 after the first JCAR015 infusion.
Measure:AUC for JCAR015 in the Peripheral Blood as Measured by Flow Cytometry
Time Frame:Pre-dose Day 1 of the first JCAR015 infusion; Day 4, Day 7, Day 14, Day 21, and Day 28 after the first JCAR015 infusion until receipt of the second infusion
Safety Issue:
Description:AUC is defined as the area under the concentration-vs-time curve from Day 1 to Day 29 after the first JCAR015 infusion as measured by flow cytometry of the JCAR015 CAR. AUC calculation includes PK results up to the second JCAR015 infusion for subjects who received the second infusion prior to Day 29 after the first JCAR015 infusion.
Measure:Percentage of Participants Who Developed Anti-Therapeutic Antibodies Against JCAR015
Time Frame:Part B Screening; Day 14 after the first JCAR015 infusion; Pre-Dose Day 1 of the second JCAR015 infusion; Day 14 after the second JCAR015 infusion; and Day 28, Month 3, Month 6, and Month 12 after the last JCAR015 infusion
Safety Issue:
Description:Percentage of participants who developed anti-therapeutic antibodies against JCAR015

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Terminated
Lead Sponsor:Juno Therapeutics, a Subsidiary of Celgene

Trial Keywords

  • acute lymphoblastic leukemia
  • ALL
  • chimeric antigen receptor
  • CAR
  • CAR T cells
  • JCAR015
  • autologous T cell therapy
  • cell therapy

Last Updated

May 4, 2020