Description:
This first time in human study is intended for men and women between 18 and 75 years of age
who have advanced liver cancer which has grown or returned after being treated or another AFP
expressing tumor. Those who did not tolerate or refused other therapies may also participate.
The purpose of this study is to test the safety of genetically changed T cells that target
alpha-fetoprotein (AFP) and find out what effects, if any, they have in subjects with liver
cancer or other AFP expressing tumor types. This study is for subjects who have a blood test
positive for appropriate HLA-A*02 P Group and have adequate AFP protein in blood or tumor,
and whose noncancerous liver tissue has very little AFP protein (Liver only).
The study will take the subject's T cells, which are a natural type of immune cell in the
blood, and send them to a laboratory to be modified. The changed T cells used in this study
will be the subject's own T cells that have been genetically changed with the aim of
attacking and destroying cancer cells.
The manufacturing of T cells takes about 1 month to complete. The T cells will be given back
to the subject through an intravenous infusion after 3 days of chemotherapy. The study will
evaluate three different cell dose levels in order to find out the target cell dose. Once the
target cell dose is determined, additional subjects will be enrolled to further test the
safety and effects at this cell dose.
Subjects will be hospitalized for at least 1 week after receiving their T cells back and then
seen frequently by the Study Physician for the next 6 months. After that, subjects will be
seen every three months. If subjects have disease progression or withdraw from the study,
they will then be entered into a long-term follow up for safety monitoring. In long-term
follow up, subjects will be seen every 6 months by their Study Physician for the first 5
years after the T cell infusion and annually for the next 10 years.
Title
- Brief Title: AFPᶜ³³²T in Advanced HCC
- Official Title: A Phase I Open Label Clinical Trial Evaluating the Safety and Anti-Tumor Activity of Autologous T Cells Expressing Enhanced TCRs Specific for Alpha Fetoprotein (AFPᶜ³³²T) in HLA-A2 Positive Subjects With Advanced Hepatocellular Carcinoma (HCC) or Other AFP Expressing Tumor Types
Clinical Trial IDs
- ORG STUDY ID:
ADP-0033-001
- NCT ID:
NCT03132792
Conditions
- Hepatocellular Cancer
- AFP Expressing Tumors
Purpose
This first time in human study is intended for men and women between 18 and 75 years of age
who have advanced liver cancer which has grown or returned after being treated or another AFP
expressing tumor. Those who did not tolerate or refused other therapies may also participate.
The purpose of this study is to test the safety of genetically changed T cells that target
alpha-fetoprotein (AFP) and find out what effects, if any, they have in subjects with liver
cancer or other AFP expressing tumor types. This study is for subjects who have a blood test
positive for appropriate HLA-A*02 P Group and have adequate AFP protein in blood or tumor,
and whose noncancerous liver tissue has very little AFP protein (Liver only).
The study will take the subject's T cells, which are a natural type of immune cell in the
blood, and send them to a laboratory to be modified. The changed T cells used in this study
will be the subject's own T cells that have been genetically changed with the aim of
attacking and destroying cancer cells.
The manufacturing of T cells takes about 1 month to complete. The T cells will be given back
to the subject through an intravenous infusion after 3 days of chemotherapy. The study will
evaluate three different cell dose levels in order to find out the target cell dose. Once the
target cell dose is determined, additional subjects will be enrolled to further test the
safety and effects at this cell dose.
Subjects will be hospitalized for at least 1 week after receiving their T cells back and then
seen frequently by the Study Physician for the next 6 months. After that, subjects will be
seen every three months. If subjects have disease progression or withdraw from the study,
they will then be entered into a long-term follow up for safety monitoring. In long-term
follow up, subjects will be seen every 6 months by their Study Physician for the first 5
years after the T cell infusion and annually for the next 10 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Autologous genetically modified AFPᶜ³³²T cells | Experimental | | |
Eligibility Criteria
Key Inclusion Criteria:
1. Subject is ≥ 18 years and ≤ 75 years of age and has voluntarily agreed to participate
by giving written informed consent in accordance with ICH GCP Guidelines and
applicable local regulations.
2. Histologically confirmed HCC, not amenable to transplant, resection. Subjects may
undergo loco-regional therapy after enrollment but not at time of lymphodepletion. Or
Histologically confirmed diagnosis of another AFP expressing tumor (e.g.
cholangiocarcinoma).
3. Measurable disease according to RECIST 1.1 criteria prior to lymphodepletion.
4. Progressive disease following or intolerant of or refuses standard of care systemic
therapy prior to lymphodepletion.
5. Positive for any A*02:01 P group allele.
6. a) Group 1, 2, 3, (HCC) Subjects will be eligible for enrollment if they meet either
one of these AFP expression criteria:
- AFP expression of ≥1+ in ≥20% of tumor cells by immunohistochemistry and their
non-cancerous liver tissue has ≤5% cells stained for AFP at any intensity by
immunohistochemistry.
- Serum AFP levels of ≥100ng/mL and their non-cancerous liver tissue has ≤5% cells
stained for AFP at any intensity by immunohistochemistry.
6. b) Group 4 (other AFP expressing tumor types) Subjects will be eligible for enrollment
if they meet either one of these AFP expression criteria:
o Serum AFP levels of ≥100ng/mL and their non-cancerous liver tissue (if applicable) has
≤5% cells stained for AFP at any intensity by immunohistochemistry.
7. Life expectancy of > 4 months 8. Child-Pugh score ≤ 6 9. Eastern Cooperative Oncology
Group (ECOG) 0-1 10. Subject must have adequate organ function as defined in the protocol.
Key Exclusion Criteria:
1. Positive for any of the HLA-A*02 allele other than HLA-A*02:01 P Group, HLA-A*02:03 P
group or null alleles or positive for the following alleles: HLA-C*04:04 or
HLA-B*51:03.
2. Prior liver transplant
3. Received the following prior to leukapheresis:
1. Cytotoxic chemotherapy, immune therapy and biological therapy within 3 weeks
2. Corticosteroids or any other immunosuppressive therapy within 2 weeks. NOTE: Use
of inhaled or topical steroids is not exclusionary
3. Sorafenib/Regorafenib/Lenvatinib within 1 week
4. Cabozantinib within 2 weeks
5. Duration of treatment free intervals for any other anti-cancer therapies must be
discussed with Adaptimmune Study Physician.
4. Received the following prior to lymphodepleting chemotherapy :
1. Cytotoxic chemotherapy or loco-regional therapy within 3 weeks, liver directed
radiation therapy within three months.
2. Corticosteroids or any other immunosuppressive therapy within 2 weeks. NOTE: Use
of inhaled or topical steroids is not exclusionary
3. Bone/soft tissue directed palliative radiotherapy within 4 weeks.
4. Investigational treatment or clinical trial within 4 weeks.
5. Sorafenib/Regorafenib/Lenvatinib within 1 week.
6. Cabozantinib within 2 weeks
7. Prior cancer-directed immunotherapy within 4 weeks, including monoclonal
antibodies against PD-1 receptor or ligand.
8. Use of an experimental vaccine within 2 months in the absence of tumor response.
The subject should be excluded if their disease is responding to an experimental
vaccine given within 6 months
9. Any previous gene therapy using an integrated vector
10. Duration of treatment free intervals for any other anti-cancer therapies must be
discussed with Adaptimmune Study Physician.
5. Toxicity persisting from previous anti-cancer therapy of ≥ Grade 2 (except for
non-clinically significant toxicities, e.g., alopecia, vitiligo). Subjects with Grade
2 toxicities that are deemed stable or irreversible (e.g. peripheral neuropathy) can
be enrolled on a case-by-case basis with prior consultation and agreement with the
Sponsor Study Physician.
6. Major surgery within 4 weeks prior to lymphodepletion; subjects should have been fully
recovered from any surgical related toxicities.
7. Bleeding ≥ Grade 2 in the past 3 months prior to lymphodepletion
8. Therapeutic anticoagulation from lymphodepletion until platelet count recovery
(prophylactic heparin allowed)
9. Clinically or radiographically detectable ascites (beyond trace/rim of ascites) or
ascites requiring medication
10. Clinically detectable hepatic encephalopathy or hepatic encephalopathy requiring
medication
11. Active viral hepatitis Subjects positive for hepatitis B surface antigen not on
antiviral treatment/prophylaxis or subjects with detectable hepatitis B DNA
1. Subjects with resolved (surface antigen negative, core antibody positive) or
chronic stable (surface antigen positive) hepatitis B on antiviral
treatment/prophylaxis with DNA levels of ≤100 IU/mL are allowed with HBV DNA
monitoring after treatment
2. Subjects with hepatitis C allowed provided they meet all other eligibility
criteria
12. Positive serology for HIV
13. Positive serology for HTLV 1 or 2
14. History of chronic or recurrent (within the last year) severe autoimmune or immune
mediated disease requiring steroids or other immunosuppressive treatments. Subjects
with history of idiopathic autoimmune hepatitis are excluded. Subjects who experienced
hepatitis during treatment with check point inhibiting antibodies are not excluded.
15. Subject has brain metastases.
16. Other active malignancy besides HCC or other eligible AFP expressing tumor types
within 3 years.
17. Electrocardiogram (ECG) showing clinically significant abnormality at Screening or
showing a QTc interval ≥450 msec in males and ≥470 msec in females (≥480 msec for
subjects with Bundle Branch Block (BBB) over consecutive ECGs).
18. Bacterial or opportunistic infection within 3 months of treatment (upper respiratory
infection and uncomplicated urinary tract infection allowed)
19. Uncontrolled intercurrent illness considered by the Investigator to add appreciable
risk to study participation, including but not limited to:
1. Clinically significant cardiac disease defined by CHF New York Heart Association
(NYHA) > Class 1; uncontrolled clinically significant arrhythmia in last 6
months; Acute Coronary Syndrome (ACS) (angina or myocardial infarction) in last 6
months.
2. Oxygen dependent lung disease.
3. Clinically significant psychiatric illness/social situations that would limit
compliance with study requirements.
4. History of stroke or central nervous system bleeding; transient ischemic attack
(TIA) or reversible ischemic neurologic deficit (RIND) in last 6 months.
20. Pregnant or breastfeeding
21. Alcohol or illicit drug dependency
22. Known contraindication to cyclophosphamide, fludarabine, mesna, G-CSF or other agents
associated with study treatment.
Maximum Eligible Age: | 75 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of subjects with dose-limiting toxicity (DLT) and adverse events (AEs) and determination of optimally tolerated dose range, including serious adverse events (SAE). |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Determine if treatment with autologous genetically modified T cells, (AFPᶜ³³²T) is safe and tolerable through assessment of DLTs, AEs, including SAEs; laboratory assessments including chemistry, hematology, coagulation, cardiac assessments including ECG, and cardiac Troponin |
Secondary Outcome Measures
Measure: | Proportion of subjects with a confirmed Complete Response (CR) or Partial Response (PR) |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Evaluation of the efficacy of the treatment by assessment of the Overall Response Rate according to RECIST v1.1 |
Measure: | Interval between the date of first T cell infusion dose and first documented evidence of CR or PR |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Evaluation of the efficacy of the treatment by assessment of time to first response |
Measure: | Interval between the date of first documented evidence of CR or PR until first documented disease progression or death due to any cause |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Evaluation of the efficacy of the treatment by assessment of duration of response |
Measure: | Interval between the date of first documented evidence of SD until first documented disease progression or death due to any cause |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Evaluation of the efficacy of the treatment by assessment of duration of stable disease |
Measure: | Interval between the date of first T cell infusion and the earliest date of disease progression or death due to any cause |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Evaluation of the efficacy of the treatment by assessment of progression-free survival |
Measure: | Interval between the date of first T cell infusion and date of disease progression or death due to any cause |
Time Frame: | 2 years |
Safety Issue: | |
Description: | Evaluation of the efficacy of the treatment by assessment of overall survival |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Adaptimmune |
Trial Keywords
- Alpha-fetoprotein
- Cell Therapy
- T Cell Therapy
- SPEAR T Cell
- Immuno-oncology
- Metastatic
- Previously treated
- T Cell Receptor
Last Updated
June 3, 2021