Clinical Trials /

Anti-ESO (Cancer/Test Antigen) mTCR-transduced Autologous Peripheral Blood Lymphocytes and Combination Chemotherapy in Treating Patients With Metastatic Cancer That Expresses NY-ESO-1

NCT02774291

Description:

This pilot clinical trial studies the side effects of anti-ESO (cancer/test antigen) murine T-cell receptor (mTCR)-transduced autologous peripheral blood lymphocytes and combination chemotherapy with cyclophosphamide and fludarabine phosphate in treating patients with cancer that has spread to other places in the body (metastatic) and expresses the gene NY-ESO-1. Donor white blood cells that are treated in the laboratory with anti-cluster of differentiation (CD)3 may help treat metastatic cancer. Drugs used in chemotherapy, such as cyclophosphamide and fludarabine phosphate, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Aldesleukin may stimulate white blood cells, including natural killer cells, to kill metastatic cancer cells. Giving anti-ESO (cancer/test antigen) mTCR-transduced autologous peripheral blood lymphocytes together with combination chemotherapy and aldesleukin may kill more cancer cells.

Related Conditions:
  • Lymphoma
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

N/A

Trial Eligibility

Document

Title

  • Brief Title: Anti-ESO (Cancer/Test Antigen) mTCR-transduced Autologous Peripheral Blood Lymphocytes and Combination Chemotherapy in Treating Patients With Metastatic Cancer That Expresses NY-ESO-1
  • Official Title: Pilot Study of Adoptive Cell Transfer for the Treatment of Metastatic Cancer That Expresses NY-ESO-1 Using Lymphodepleting Conditioning Followed by Infusion of Anti-NY ESO-1 Murine TCR-Gene Engineered Lymphocytes

Clinical Trial IDs

  • ORG STUDY ID: 2015-5254
  • SECONDARY ID: NCI-2015-01781
  • SECONDARY ID: 2015-5254
  • SECONDARY ID: P30CA013330
  • NCT ID: NCT02774291

Conditions

  • HLA-A2 Positive Cells Present
  • Metastatic Malignant Neoplasm
  • Metastatic Malignant Neoplasm in the Brain

Interventions

DrugSynonymsArms
Aldesleukin125-L-Serine-2-133-interleukin 2, Proleukin, r-serHuIL-2, Recombinant Human IL-2, Recombinant Human Interleukin-2Treatment (mTCR, aldesleukin)
Anti-thyroglobulin mTCR-transduced Autologous Peripheral Blood LymphocytesAnti-thyroglobulin mTCR-transduced Autologous PBLTreatment (mTCR, aldesleukin)
Cyclophosphamide(-)-Cyclophosphamide, 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate, Carloxan, Ciclofosfamida, Ciclofosfamide, Cicloxal, Clafen, Claphene, CP monohydrate, CTX, CYCLO-cell, Cycloblastin, Cycloblastine, Cyclophospham, Cyclophosphamid monohydrate, Cyclophosphamidum, Cyclophosphan, Cyclophosphane, Cyclophosphanum, Cyclostin, Cyclostine, Cytophosphan, Cytophosphane, Cytoxan, Fosfaseron, Genoxal, Genuxal, Ledoxina, Mitoxan, Neosar, Revimmune, Syklofosfamid, WR- 138719Treatment (mTCR, aldesleukin)
FilgrastimFilgrastim XM02, G-CSF, Neupogen, r-metHuG-CSF, Recombinant Methionyl Human Granulocyte Colony Stimulating Factor, rG-CSF, Tbo-filgrastim, TevagrastimTreatment (mTCR, aldesleukin)
Fludarabine Phosphate2-F-ara-AMP, 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl)-, Beneflur, Fludara, Oforta, SH T 586Treatment (mTCR, aldesleukin)

Purpose

This pilot clinical trial studies the side effects of anti-ESO (cancer/test antigen) murine T-cell receptor (mTCR)-transduced autologous peripheral blood lymphocytes and combination chemotherapy with cyclophosphamide and fludarabine phosphate in treating patients with cancer that has spread to other places in the body (metastatic) and expresses the gene NY-ESO-1. Donor white blood cells that are treated in the laboratory with anti-cluster of differentiation (CD)3 may help treat metastatic cancer. Drugs used in chemotherapy, such as cyclophosphamide and fludarabine phosphate, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving more than one drug (combination chemotherapy) may kill more cancer cells. Aldesleukin may stimulate white blood cells, including natural killer cells, to kill metastatic cancer cells. Giving anti-ESO (cancer/test antigen) mTCR-transduced autologous peripheral blood lymphocytes together with combination chemotherapy and aldesleukin may kill more cancer cells.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To determine the safety and tolerability of the administration of anti-ESO (cancer/test
      antigen) mTCR (T cell receptor)-engineered peripheral blood lymphocytes (anti-thyroglobulin
      mTCR-transduced autologous peripheral blood lymphocytes) plus high-dose aldesleukin following
      a nonmyeloablative lymphoid depleting preparative regimen in human leukocyte antigen (HLA)-A2
      positive patients with metastatic cancer expressing the ESO antigen.

      SECONDARY OBJECTIVES:

      I. Determine the in vivo survival of T-cell receptor (TCR) gene-engineered cells.

      II. Determine the objective response rate by Response Evaluation Criteria in Solid Tumors
      (RECIST) criteria.

      OUTLINE:

      Patients receive standard cyclophosphamide intravenously (IV) over 1 hour on days -7 to -6
      and fludarabine phosphate via intravenous piggy back (IVPB) over 30 minutes on days -5 to -1
      followed by anti-ESO (cancer/test antigen) mTCR-transduced autologous peripheral blood
      lymphocytes IV over 20-30 minutes on day 0 and aldesleukin IV over 15 minutes approximately
      every 8 hours on days 0-4. Patients also receive filgrastim subcutaneously (SC) on days 1-4.

      After completion of study treatment, patients are followed up at 6 weeks, annually for 5
      years, and then periodically for 10 years thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (mTCR, aldesleukin)ExperimentalPatients receive standard cyclophosphamide IV over 1 hour on days -7 to -6 and fludarabine phosphate via IVPB over 30 minutes on days -5 to -1 followed by anti-ESO (cancer/test antigen) mTCR-transduced autologous peripheral blood lymphocytes IV over 20-30 minutes on day 0 and aldesleukin IV over 15 minutes approximately every 8 hours on days 0-4. Patients also receive filgrastim SC on days 1-4.
  • Aldesleukin
  • Anti-thyroglobulin mTCR-transduced Autologous Peripheral Blood Lymphocytes
  • Cyclophosphamide
  • Filgrastim
  • Fludarabine Phosphate

Eligibility Criteria

        Inclusion Criteria:

          -  Measurable metastatic cancer that expresses NY ESO-1 as assessed by one of the
             following methods: reverse transcriptase-polymerase chain reaction (RT-PCR) on tumor
             tissue, or by immunohistochemistry of resected tissue, or serum antibody reactive with
             ESO

          -  Confirmation of diagnosis of metastatic cancer by the Laboratory of Pathology at the
             Montefiore Medical Center

          -  Patients must have previously received systemic standard care (or effective salvage
             chemotherapy regimens) for metastatic disease, if known to be effective for that
             disease, and have been either non-responders (progressive disease) or have recurred

          -  3 or fewer brain metastases; Note: if lesions are symptomatic or greater than or equal
             to 1 cm each, these lesions must have been treated and stable for 3 months for the
             patient to be eligible

          -  More than four weeks must have elapsed since any prior systemic therapy at the time
             the patient receives the preparative regimen, and patients' toxicities must have
             recovered to a grade 1 or less (except for toxicities such as alopecia or vitiligo);
             Note: patients may have undergone minor surgical procedures within the past 3 weeks,
             as long as all toxicities have recovered to grade 1 or less or as specified in the
             eligibility criteria

          -  Eight weeks must have elapsed from the time of any antibody therapy that could affect
             an anti-cancer immune response, including anti-cytotoxic T-lymphocyte-associated
             protein 4 (CTLA 4) therapy, at the time the patient receives the preparative regimen
             to allow antibody levels to decline; Note: patients who have previously received
             ipilimumab and have documented gastrointestinal (GI) toxicity must have a normal
             colonoscopy with normal colonic biopsies

          -  Willing to sign a durable power of attorney

          -  Able to understand and sign the informed consent document

          -  Clinical performance status of Eastern Cooperative Oncology Group (ECOG) 0 or 1

          -  Life expectancy of greater than three months

          -  Patients must be HLA-A*0201 positive

          -  Patients of both genders must be willing to practice birth control from the time of
             enrollment on this study and for up to four months after cells are no longer detected
             in the blood

          -  Serology:

               -  Seronegative for human immunodeficiency virus (HIV) antibody; (the experimental
                  treatment being evaluated in this protocol depends on an intact immune system;
                  patients who are HIV seropositive can have decreased immune-competence and thus
                  be less responsive to the experimental treatment and more susceptible to its
                  toxicities)

               -  Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody;
                  if hepatitis C antibody test is positive, then patient must be tested for the
                  presence of antigen by RT-PCR and be hepatitis C virus (HCV) ribonucleic acid
                  (RNA) negative

          -  Women of child-bearing potential must have a negative pregnancy test because of the
             potentially dangerous effects of the treatment on the fetus

          -  Absolute neutrophil count greater than 1000/mm^3 without the support of filgrastim

          -  White blood cell (WBC) >= 3000/mm^3

          -  Platelet count >= 100,000/mm^3

          -  Hemoglobin > 8.0 g/dl

          -  Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) =< to 2.5 times
             the upper limit of normal

          -  Serum creatinine =< to 1.6 mg/dl

          -  Total bilirubin =< to 1.5 mg/dl, except in patients with Gilbert's Syndrome who must
             have a total bilirubin less than 3.0 mg/dl

        Exclusion Criteria:

          -  Women of child-bearing potential who are pregnant or breastfeeding because of the
             potentially dangerous effects of the treatment on the fetus or infant

          -  Any form of primary immunodeficiency (such as severe combined immunodeficiency
             disease)

          -  Active systemic infections, coagulation disorders or other major medical illnesses of
             the cardiovascular, respiratory or immune system, myocardial infarction, cardiac
             arrhythmias, obstructive or restrictive pulmonary disease

          -  Concurrent opportunistic infections (the experimental treatment being evaluated in
             this protocol depends on an intact immune system; patients who have decreased immune
             competence may be less responsive to the experimental treatment and more susceptible
             to its toxicities)

          -  Concurrent systemic steroid therapy

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

          -  History of coronary revascularization or ischemic symptoms

          -  History of or active central nervous system (CNS) or peripheral nerve stimulation
             (PNS) involvement

          -  Documented left ventricular ejection fraction (LVEF) of less than or equal to 45%;
             testing is required in patients with:

               -  Clinically significant atrial and/or ventricular arrhythmias including but not
                  limited to: atrial fibrillation, ventricular tachycardia, second or third degree
                  heart block

               -  Age >= 60 years old

          -  Pulmonary function testing in patients with:

               -  A prolonged history of cigarette smoking (20 pk/yr of smoking within the past two
                  years)

               -  Symptoms of respiratory dysfunction
      
Maximum Eligible Age:66 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of toxicity, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0
Time Frame:Up to 15 years
Safety Issue:
Description:

Secondary Outcome Measures

Measure:In vivo survival of TCR gene-engineered cells
Time Frame:Up to 15 years
Safety Issue:
Description:Descriptive statistics will be used to determine the in vivo survival of TCR gene-engineered cells.
Measure:Objective response rate, graded according to RECIST criteria
Time Frame:Up to 15 years
Safety Issue:
Description:Descriptive statistics will be used to determine the objective response rate.

Details

Phase:N/A
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Albert Einstein College of Medicine

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