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Study Evaluating Brexucabtagene Autoleucel (KTE-X19) in Pediatric and Adolescent Participants With Relapsed/Refractory B-precursor Acute Lymphoblastic Leukemia or Relapsed/Refractory B-Cell Non-Hodgkin Lymphoma

NCT02625480

Description:

The primary objectives of this study are to evaluate the safety and efficacy of brexucabtagene autoleucel (KTE-X19) in pediatric and adolescent participants with relapsed/refractory (r/r) B-precursor acute lymphoblastic leukemia (ALL) or relapsed or refractory (r/r) B-cell non-Hodgkin lymphoma (NHL).

Related Conditions:
  • B-Cell Acute Lymphoblastic Leukemia
  • B-Cell Non-Hodgkin Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study Evaluating Brexucabtagene Autoleucel (KTE-X19) in Pediatric and Adolescent Participants With Relapsed/Refractory B-precursor Acute Lymphoblastic Leukemia or Relapsed/Refractory B-Cell Non-Hodgkin Lymphoma
  • Official Title: A Phase 1/2 Multi-Center Study Evaluating the Safety and Efficacy of KTE-X19 in Pediatric and Adolescent Subjects With Relapsed/Refractory B-precursor Acute Lymphoblastic Leukemia or Relapsed/Refractory B-Cell Non-Hodgkin Lymphoma (ZUMA-4)

Clinical Trial IDs

  • ORG STUDY ID: KTE-C19-104
  • SECONDARY ID: 2015-005010-30
  • NCT ID: NCT02625480

Conditions

  • Acute Lymphoblastic Leukemia
  • Relapsed Non Hodgkin Lymphoma
  • Refractory Non-Hodgkin Lymphoma

Interventions

DrugSynonymsArms
Brexucabtagene Autoleucel (KTE-X19)Single Arm
FludarabineSingle Arm
CyclophosphamideSingle Arm

Purpose

The primary objectives of this study are to evaluate the safety and efficacy of brexucabtagene autoleucel (KTE-X19) in pediatric and adolescent participants with relapsed/refractory (r/r) B-precursor acute lymphoblastic leukemia (ALL) or relapsed or refractory (r/r) B-cell non-Hodgkin lymphoma (NHL).

Trial Arms

NameTypeDescriptionInterventions
Single ArmExperimentalA conditioning chemotherapy regimen of fludarabine and cyclophosphamide will be administered followed by a single infusion of chimeric antigen receptor (CAR) transduced autologous T cells administered intravenously at a target dose of 2 x 10^6 anti-CD19 CAR+ T cells/kg or 1 x 10^6 anti-CD19 CAR+ T cells/kg
  • Brexucabtagene Autoleucel (KTE-X19)
  • Fludarabine
  • Cyclophosphamide

Eligibility Criteria

        Key Inclusion Criteria for the ALL Cohort

          -  Relapsed or refractory B-precursor ALL defined as one of the following:

               -  Primary refractory disease

               -  Any relapse within 18 months after first diagnosis

               -  Relapsed or refractory disease after 2 or more lines of systemic therapy

               -  Relapsed or refractory disease after allogeneic transplant provided individual is
                  at least 100 days from stem cell transplant at the time of enrollment

          -  Disease burden defined as at least 1 of the following:

               -  Morphological disease in the bone marrow (> 5% blasts)

               -  Minimal/Measurable Residual Disease (MRD) positive (threshold 10^-4 by flow or
                  Polymerase chain reaction (PCR))

          -  Individuals with Ph+ disease are eligible if they are intolerant to tyrosine kinase
             inhibitor (TKI) therapy, or if they have relapsed/refractory disease despite treatment
             with at least 2 different TKIs

          -  Age ≤ 21 years and weight ≥ 6 kg at the time of assent or consent per Institutional
             Review Board (IRB) guidelines

               -  Note: Individuals with a weight of ≥ 6 kg to < 10kg will only be included once a
                  pediatric formulation becomes available.

          -  Lansky (age < 16 years at the time of assent/consent) or Karnofsky (age ≥ 16 years at
             the time of assent/consent) performance status ≥ 80 at screening

          -  Adequate renal, hepatic, pulmonary and cardiac function defined as:

               -  Creatinine clearance (as estimated by Cockcroft Gault or Schwartz) ≥ 60 mL/min

               -  Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) ≤ 5 x upper
                  limit of normal (ULN)

               -  Total bilirubin ≤ 1.5 x ULN, except in individuals with Gilbert's syndrome

               -  Left ventricular shortening fraction (LVSF) ≥ 30% or left ventricular ejection
                  fraction (LVEF) ≥ 50%, as determined by an echocardiogram or multi-gated
                  acquisition scan (MUGA), no evidence of pericardial effusion (except trace or
                  physiological) as determined by an echocardiogram (ECHO) and no clinically
                  significant arrhythmias

               -  No clinically significant pleural effusion

               -  Baseline oxygen saturation > 92% on room air

        Key Exclusion Criteria for the ALL Cohort

          -  Diagnosis of Burkitt's leukemia/lymphoma according to the World Health Organization
             (WHO) classification or chronic myelogenous leukemia lymphoid blast crisis

          -  History of malignancy other than non-melanoma skin cancer or carcinoma in situ (e.g.
             cervix, bladder, breast) unless disease free for at least 3 years

          -  History of severe hypersensitivity reaction to aminoglycosides or any of the agents
             used in this study

          -  Central nervous system (CNS) involvement and abnormalities:

               -  Any CNS tumor mass by imaging and/or parameningeal mass (cranial and/or spinal)

               -  Presence of central nervous system (CNS)-3 disease, defined as white blood cell
                  (WBC) ≥ 5/µL in Cerebrospinal Fluid (CSF) with presence of lymphoblasts with or
                  without neurologic symptoms

               -  CNS-2 disease,defined as WBC < 5/µL in CSF with presence of lymphoblasts and with
                  neurologic symptoms (see note below for further clarification).

               -  Note: Neurologic symptoms may include but are not limited to cranial nerve palsy
                  (if not explained by extracranial tumor) and clinical cord compression.

               -  (Individuals with CNS-1 (no detectable lymphoblasts in the CSF) and those with
                  CNS-2 without clinically evident neurological changes are eligible to participate
                  in the study)

               -  History or presence of CNS disorder, such as cerebrovascular ischemia/hemorrhage,
                  dementia, cerebellar disease, or any autoimmune disease with CNS involvement,
                  posterior reversible encephalopathy syndrome (PRES), or cerebral edema with
                  confirmed structural defects by appropriate imaging. History of stroke or
                  transient ischemic attack within 12 months before enrollment. Individuals with
                  seizure disorders requiring active anticonvulsive medication.

          -  History of concomitant genetic syndrome such as Fanconi anemia, Kostmann syndrome,
             Shwachman-Diamond syndrome or any other known bone marrow failure syndrome

          -  History of myocardial infarction, cardiac angioplasty or stenting, unstable angina, or
             other clinically significant cardiac disease within 12 months of enrollment

          -  History of symptomatic deep vein thrombosis or pulmonary embolism within 6 months of
             enrollment.

          -  Primary immunodeficiency

          -  History of human immunodeficiency virus (HIV) infection or acute / chronic active
             hepatitis B or C infection. Individuals with a history of hepatitis infection must
             have cleared their infection as determined by standard serological and genetic testing
             per current Infectious Diseases Society of America guidelines or applicable country
             guidelines.

          -  Presence or suspicion of fungal, bacterial, viral, or other infection that is
             uncontrolled or requiring IV antimicrobials for management.

          -  Prior medication:

               -  Prior CD19 directed therapy (other than blinatumomab), including CAR+ T cell,
                  bispecific T cell engager (BiTE), and antibody drug conjugate (ADC), with the
                  exception of individuals who received brexucabtagene autoleucel (KTE-X19) in this
                  study and are eligible for re-treatment

               -  Treatment with alemtuzumab within 6 months prior to leukapheresis, or treatment
                  with clofarabine or cladribine within 3 months prior to leukapheresis

               -  Donor lymphocyte infusion (DLI) within 28 days prior to enrollment

               -  Any drug used for graft-versus-host disease (GVHD) within 4 weeks prior to
                  enrollment

          -  Acute GVHD grade II-IV by Glucksberg criteria or severity B-D by IBMTR index; acute or
             chronic GVHD requiring systemic treatment within 4 weeks prior to enrollment

          -  Live vaccine ≤ 6 weeks prior to enrollment

          -  Women of child-bearing potential who are pregnant or breastfeeding because of the
             potentially dangerous effects of the preparative chemotherapy on the fetus or infant.
             Females who have undergone surgical sterilization are not considered to be of
             childbearing potential

          -  Individuals of both genders of child-bearing potential who are not willing to use a
             birth control method considered to be highly effective per protocol from the time of
             consent through 6 months after conditioning chemotherapy or brexucabtagene autoleucel
             (KTE-X19) infusion, whichever is longer.

        Key Inclusion Criteria for the NHL Cohort

          -  Histologically confirmed aggressive B cell NHL

          -  Relapsed or refractory histologically confirmed aggressive B-cell NHL per 1 or more of
             the following:

               -  Primary refractory disease

               -  Relapsed or refractory disease after 2 or more lines of systemic therapy

               -  Relapsed or refractory disease after autologous /allogeneic transplant provided
                  individual is at least 100 days from stem cell transplant at the time of
                  enrollment

          -  Individuals must have received adequate prior therapy including at a minimum all of
             the following:

               -  Anti-CD20 monoclonal antibody, unless the investigator determines that the tumor
                  is CD20 negative

               -  An anthracycline-containing chemotherapy regimen

          -  Age <18 years old and weight ≥ 6kg

               -  Note: Individuals with a weight of ≥ 6 kg to < 10kg will only be included once a
                  pediatric formulation becomes available.

          -  Lansky (age < 16 years at the time of assent/consent) or Karnofsky (age ≥ 16 years at
             the time of assent/consent) performance status ≥ 80 at screening

          -  Adequate renal, hepatic, pulmonary, and cardiac function defined as the following:

               -  Creatinine clearance (as estimated by Cockcroft Gault or Schwartz) ≥ 60 mL/min

               -  Serum ALT/AST ≤ 5 ULN

               -  Total bilirubin ≤1.5 x ULN except in individuals with Gilbert's syndrome

               -  Left ventricular shortening fraction(LVSF) ≥ 30% or left ventricular ejection
                  fraction (LVEF) ≥ 50%, as determined by ECHO or MUGA, no evidence of pericardial
                  effusion (except trace or physiological) as determined by an ECHO, and no
                  clinically significant arrhythmias

               -  Baseline oxygen saturation > 92% on room air

        Key Exclusion Criteria for the NHL Cohort

          -  History of malignancy other than nonmelanoma skin cancer, carcinoma in situ (eg,
             cervix, breast), or follicular lymphoma (FL) unless disease free for at least 3 years

          -  Prior CD19 targeted therapy other than blinatumomab

          -  History of severe, immediate hypersensitivity reaction attributed to aminoglycosides

          -  Presence or suspicion of fungal, bacterial, viral, or other infection that is
             uncontrolled or requiring IV antimicrobials for management.

          -  History of HIV infection or acute/chronic active hepatitis B or C infection.
             Individuals with a history of hepatitis infection must have cleared their infection as
             determined by standard serological and genetic testing per current Infectious Diseases
             Society of America guidelines or applicable country guidelines

          -  Acute GVHD grade II-IV by Glucksberg criteria or severity B-D by International Bone
             Marrow Transplant Registry (IBMTR) index; acute or chronic GVHD requiring systemic
             treatment within 4 weeks prior to enrollment.

          -  CNS involvement and abnormalities:

               -  Any CNS tumor mass by imaging and/or parameningeal mass (cranial and/or spinal)

               -  Presence of CNS-3 disease, defined as WBC ≥ 5/µL in CSF with presence of
                  lymphoblasts with or without neurologic symptoms.

               -  Presence of CNS-2 disease defined as WBC < 5/µL in CSF with presence of
                  lymphoblasts and with neurologic symptoms (see note below for further
                  clarification).

               -  Note: Neurologic symptoms may include but are not limited to cranial nerve palsy
                  (if not explained by extracranial tumor) and clinical cord compression.

               -  (Individuals with CNS-1 (no detectable lymphoblasts in the CSF) and those with
                  CNS-2 without clinically evident neurological changes are eligible to participate
                  in the study).

               -  History or presence of any CNS disorder such as a seizure disorder,
                  cerebrovascular ischemia/hemorrhage, dementia, cerebellar disease, any autoimmune
                  disease with CNS involvement, posterior reversible encephalopathy syndrome
                  (PRES), or cerebral edema with confirmed structural defects by appropriate
                  imaging. History of stroke or transient ischemic attack within 12 months before
                  enrollment. Individuals with seizure disorders requiring active anti-convulsive
                  medication.

          -  History of myocardial infarction, cardiac angioplasty or stenting, unstable angina, or
             other clinically significant cardiac disease within 12 months of enrollment

          -  Primary immunodeficiency

          -  History of severe immediate hypersensitivity reaction to any of the agents used in
             this study

          -  Live vaccine ≤ 6 weeks prior to planned start of conditioning regimen

          -  Individuals of both genders of child-bearing potential who are not willing to use a
             birth control considered to be highly effective per protocol from the time of consent
             through 6 months after the completion of conditioning chemotherapy or brexucabtagene
             autoleucel (KTE-X19) infusion, whichever is longer.

          -  Prior medication:

               -  Prior CD19 directed therapy (other than blinatumomab), including CAR+ T cell,
                  BiTE, and ADC, with the exception of individuals who received brexucabtagene
                  autoleucel (KTE-X19) in this study and are eligible for re-treatment

               -  Treatment with alemtuzumab within 6 months prior to leukapheresis, or treatment
                  with clofarabine or cladribine within 3 months prior to leukapheresis

               -  DLI within 28 days prior to enrollment

               -  Any drug used for GVHD within 4 weeks prior to enrollment

        Note: Other protocol defined Inclusion/Exclusion criteria may apply.
      
Maximum Eligible Age:21 Years
Minimum Eligible Age:N/A
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Phase 1: Percentage of Participants Experiencing Adverse Events Defined as Dose-Limiting Toxicities (DLT)
Time Frame:Up to 28 days
Safety Issue:
Description:Dose-limiting toxicity is defined as protocol-defined brexucabtagene autoleucel (KTE-X19)-related events with onset within the first 28 days following brexucabtagene autoleucel (KTE-X19) infusion.

Secondary Outcome Measures

Measure:Minimum Residual Disease Negative Remission Rate in the ALL Cohort
Time Frame:Up to 3 months
Safety Issue:
Description:Minimal residual disease (MRD) response rate is defined as MRD < 10^-4 per the standard assessment.
Measure:Allogeneic Stem Cell Transplant Rate in the ALL Cohort
Time Frame:Up to 24 months
Safety Issue:
Description:The incidence of allogeneic stem cell transplant will be analyzed.
Measure:Changes Over Time in Patient Reported Outcomes (PRO) Scores in the ALL and NHL Cohorts
Time Frame:Up to 15 years
Safety Issue:
Description:The PRO scores will be measured by the Pediatric Quality of Life Inventory (PedsQL) for children and adolescents and European Quality-of-Life-5 Dimension (EQ-5D) for all participants. The PedsQL comprises of 23 items in the dimensions of physical, emotional, social, and school functioning. Transformed total, physical health summary, and psychosocial health summary scores range from 0-100 with higher scores indicating better health-related quality of life. The EQ-5D is a generic questionnaire for assessing the participant's overall health status. The EQ-5D consists of a 5 dimension descriptive system including mobility, self-care, usual activities, pain/comfort, and anxiety/depression and a visual analogue scale (EQ-VAS) which allows the respondent to record health. The VAS allows a participant to indicate self-reported health on a vertical scale, ranging from 0 (worst imaginable health state) to 100 (best imaginable health state). The PedsQL scores and EQ-5D scores will be reported.
Measure:Overall Complete Remission Rate in the ALL Cohort
Time Frame:Up to 15 years
Safety Issue:
Description:
Measure:Relapse-Free Survival for the ALL Cohort
Time Frame:Up to 24 months
Safety Issue:
Description:Relapse-Free Survival is defined as the time from the brexucabtagene autoleucel (KTE-X19) infusion date to the date of disease relapse or death from any cause.
Measure:Progression Free Survival in the NHL Cohort
Time Frame:Up to 15 years
Safety Issue:
Description:
Measure:Overall Survival in the ALL and NHL Cohorts
Time Frame:Up to 15 years
Safety Issue:
Description:Overall survival is defined as the time from brexucabtagene autoleucel (KTE-X19) infusion to the date of death from any cause.
Measure:Duration of Remission in the ALL and NHL Cohorts
Time Frame:Up to 24 months
Safety Issue:
Description:Duration of remission is defined as the time between the participant's first complete response per independent review to relapse or any death in the absence of documented relapse.
Measure:Percentage of Participants with Anti-Brexucabtagene Autoleucel (KTE-X19) Antibodies in Blood in the ALL and NHL Cohorts
Time Frame:Up to 15 years
Safety Issue:
Description:
Measure:Percentage of Participants Experiencing Adverse Events and Common Terminology Criteria for Adverse Events (CTCAE) Grade Changes in Safety Laboratory Values in ALL and NHL Cohorts
Time Frame:Up to 15 years
Safety Issue:
Description:

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Kite, A Gilead Company

Last Updated

June 26, 2020