Clinical Trials /

Trial to Determine the Efficacy and Safety of JCAR017 in Adult Subjects With Aggressive B-Cell Non-Hodgkin Lymphoma

NCT03484702

Description:

This open-label Phase 2 study will evaluate the safety and efficacy of modified T cells (JCAR017) administered to adult patients with aggressive B-cell non-Hodgkin lymphoma (NHL). The study will also help determine how long the modified T cells stay in the patient's body. Furthermore, changes in the patient's quality of life will be described. Phase 2 (autologous T cells expressing anti-CD19 chimeric antigen receptor) (DLBCL NOS [de novo or tFL], follicular lymphoma Grade 3B [FL3B], high grade B-cell Lymphoma [HGBL] and primary central nervous system lymphoma [PCNSL]).

Related Conditions:
  • Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
  • Grade 3b Follicular Lymphoma
  • Primary Central Nervous System Lymphoma
  • Transformed Non-Hodgkin Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Trial to Determine the Efficacy and Safety of JCAR017 in Adult Subjects With Aggressive B-Cell Non-Hodgkin Lymphoma
  • Official Title: A Phase 2, Single-arm, Multi-center Trial to Determine the Efficacy and Safety of JCAR017 in Subjects With Relapsed or Refractory Diffuse Large B-Cell Lymphoma or With Other Aggressive B-Cell Malignancies

Clinical Trial IDs

  • ORG STUDY ID: JCAR017-BCM-001
  • SECONDARY ID: U1111-1209-4055
  • SECONDARY ID: 2017-000106-38
  • NCT ID: NCT03484702

Conditions

  • Lymphoma, Non-Hodgkin

Interventions

DrugSynonymsArms
JCAR017Lisocabtagene Maraleucel (liso-cel)Administration of JCAR017

Purpose

This open-label Phase 2 study will evaluate the safety and efficacy of modified T cells (JCAR017) administered to adult patients with aggressive B-cell non-Hodgkin lymphoma (NHL). The study will also help determine how long the modified T cells stay in the patient's body. Furthermore, changes in the patient's quality of life will be described. Phase 2 (autologous T cells expressing anti-CD19 chimeric antigen receptor) (DLBCL NOS [de novo or tFL], follicular lymphoma Grade 3B [FL3B], high grade B-cell Lymphoma [HGBL] and primary central nervous system lymphoma [PCNSL]).

Detailed Description

      This is a single-arm, multi-cohort, multi-center, Phase 2 study to determine the efficacy and
      safety of JCAR017 in adult patients with aggressive B-cell NHL. The study will enroll
      patients in Europe and Japan with diffuse large B-cell lymphoma (DLBCL) not otherwise
      specified (NOS; de novo or transformed follicular lymphoma [tFL]), high-grade B-cell lymphoma
      with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (HGBL), follicular lymphoma
      Grade 3B (FL3B), and primary central nervous system lymphoma (PCNSL). Patients with secondary
      central nervous system (CNS) involvement are allowed.

      Once enrolled, patients will undergo leukapheresis to enable JCAR017 cell product generation.
      Upon successful JCAR017 cell product generation, patients will receive lymphodepleting
      chemotherapy followed by infusion of JCAR017. JCAR017 will be administered at a dose of 100 x
      10^6 JCAR017-positive transfected viable T cells by intravenous infusion. Patients will be
      followed for approximately 2 years after their JCAR017 infusion for safety, disease status,
      survival and health-related quality of life.

      Delayed adverse events following exposure to gene modified T cells will be assessed and
      long-term persistence of these modified T cells will continue to be monitored under a
      separate long-term follow-up protocol for up to 15 years after JCAR017 infusion as per
      competent authority guidelines.
    

Trial Arms

NameTypeDescriptionInterventions
Administration of JCAR017ExperimentalJCAR017 will be infused at a dose of 100 x 10^6 JCAR017-positive transfected viable T cells (50 × 10^6 CD8+ CAR+ T cells and 50 × 10^6 CD4+ CAR+ T cells), on Day 1 (2 to 7 days after completion of lymphodepleting chemotherapy (LD) chemotherapy)
  • JCAR017

Eligibility Criteria

        Inclusion Criteria:

        Subjects must satisfy the following criteria to be enrolled in the study:

          1. Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF)

          2. Subject must understand and voluntarily sign an ICF prior to any study-related
             assessments/procedures being conducted

          3. Subject is willing and able to adhere to the study visit schedule and other protocol
             requirements

          4. Investigator considers the subject is appropriate for adoptive T cell therapy

          5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Subjects not
             eligible for transplant (TNE) in Cohorts 2 and 3 and subjects in Cohort 5 may be
             enrolled with ECOG of 2 only if they meet all other inclusion/exclusion criteria.

          6. Subjects with one of the following:

             Cohort 1: Subjects with DLBCL NOS (de novo or tFL), HGBL and FL3B per WHO 2016
             classification (Swerdlow, 2016), after ≥ 2 lines of therapy*, including an
             anthracycline and rituximab (or other CD20-targeted agent) Cohort 2: Transplant not
             eligible subjects with DLBCL NOS (de novo or tFL), HGBL and FL3B per WHO 2016
             classification (Swerdlow, 2016), who failed first line therapy*, including an
             anthracycline and rituximab (or other CD20-targeted agent)

               -  Transplant not eligible subjects will include those who are deemed ineligible for
                  high-dose chemotherapy and HSCT due to age, performance status or comorbidity,
                  while also having adequate organ function for CAR T cell treatment. At the very
                  least, subjects have to meet one of the following criteria:

                    1. Age ≥ 70 years

                    2. ECOG performance status ≥ 2

                    3. Impaired pulmonary function (DLCO ≤ 60%, adjusted for hemoglobin
                       concentration using the Dinakara equation)

                    4. Impaired cardiac function (LVEF < 50%)

                    5. Impaired renal function (CrCl < 60 mL/min)

                    6. Impaired hepatic function (AST/ALT > 2 x ULN, bilirubin ≥ 2 mg/dL or
                       cirrhosis Child-Pugh B or C)

               -  Subjects must fulfil all other inclusion and exclusion criteria Cohort 3 (Japan
                  only): Subjects meeting eligibility criteria for either Cohort 1 or 2 Cohort 4:
                  Subjects with newly diagnosed HGBL. Subjects must be eligible for anthracycline
                  and rituximab (or other CD20-targeted agent) containing regimen as induction
                  prior to consolidation with JCAR017** Cohort 5: Subjects with PCNSL who failed
                  first line therapy with HDCT and ASCT Cohort 7: Subjects meeting eligibility
                  criteria for Cohort 1 and suitable for outpatient treatment***

                    -  For subjects with transformed disease, the subject should have had at least
                       2 lines of systemic therapy for his/her transformed disease (ie, DLBCL) for
                       Cohort 1 and 1 line for Cohort 2 to be eligible. Lines of therapy do not
                       include those given for a previously indolent condition (ie, follicular
                       lymphoma). Subjects do NOT have to have anthracycline for their DLBCL if
                       received for indolent disease.

                         -  For subjects already undergoing anthracycline and rituximab containing
                            regimen, eligibility is to be discussed with Medical Monitor. Subjects
                            with complete metabolic response after 2 cycles of induction will
                            proceed with JCAR017 infusion only at time of relapse, if applicable.

                              -  Subjects must meet the conditions for outpatient treatment and
                                 monitoring as outlined in the Outpatient Administration and
                                 Monitoring Guidance for Lisocabtagene Maraleucel.

             Note: Subjects with secondary CNS lymphoma involvement may enroll in Cohorts 1 to 4
             and 7; subjects with PCNSL are eligible for Cohort 5. Subject selection must consider
             clinical risk factors for severe adverse events (AEs) and alternative treatment
             options. Subjects should only be enrolled if the Investigator considers the potential
             benefit outweighs the risk for the subject. For Cohort 5 and to not compromise safety,
             subject selection has been restricted to those fit enough to HDCT and ASCT as their
             prior therapy.

          7. Histological confirmation of diagnosis at last relapse. Enough tumor material must be
             available for central confirmation of diagnosis, otherwise a new tumor biopsy is
             mandated.

             Note: If the subject did not experience CR since last biopsy, the most recent biopsy
             will be considered adequate to participate in the trial. For subjects with PCNSL, at a
             minimum, corresponding pathology report is required if archival tumor material is not
             available and repeated biopsy not feasible.

          8. For subjects with NHL (except Cohort 5): Subjects must have positron emission
             tomography (PET)-positive disease as per Lugano Classification (Cheson, 2014)

          9. For subjects with PCNSL: Subjects must have disease that is objectively measurable by
             International Workshop to Standardize Baseline Evaluation and Response Criteria in
             Primary Central Nervous System Lymphoma (Abrey, 2005). Cerebrospinal fluid (CSF)
             cytology will be repeated (in case of leptomeningeal disease)

         10. Adequate organ function, defined as:

               -  Adequate bone marrow function to receive LD chemotherapy as assessed by the
                  Investigator

               -  Serum creatinine < 1.5 x ULN or creatinine clearance > 30 mL/min (estimated
                  glomerular filtration rate [eGFR] by Cockroft Gault)

               -  Alanine aminotransferase (ALT) ≤ 5 x ULN and total bilirubin < 2.0 mg/dL (or <
                  3.0 mg/dL for subjects with Gilbert's syndrome or lymphomatous infiltration of
                  the liver)

               -  Adequate pulmonary function, defined as ≤ Grade 1 dyspnea according to Common
                  Terminology Criteria for Adverse Events (CTCAE) and oxygen saturation (SaO2) ≥
                  92% on room air

               -  Adequate cardiac function, defined as LVEF ≥ 40% as assessed by echocardiogram or
                  multigated acquisition (MUGA) scan performed within 4 weeks prior to
                  leukapheresis

         11. Adequate vascular access for leukapheresis procedure

         12. Subjects must agree to not donate blood, organs, sperm or semen, and egg cells for
             usage in other individuals after the JCAR017 infusion

         13. Female subjects of childbearing potential (FCBP) must:

               1. Have two negative pregnancy tests as verified by the Investigator (one negative
                  serum beta human chorionic gonadotropin [ß-hCG] pregnancy test result at
                  screening and one negative serum pregnancy test within 48 hours prior to the
                  first dose of LD chemotherapy). This applies even if the subject practices true
                  abstinence* from heterosexual contact

               2. Either commit to true abstinence* from heterosexual contact (which must be
                  reviewed on a monthly basis and source documented) or agree to use, and be able
                  to comply with, effective contraception without interruption. Contraception
                  methods must include 1 highly effective (barrier) method of contraception from
                  screening until at least 12 months following LD chemotherapy

        Note: Highly effective methods are defined as those that result in a low failure rate (ie,
        less than 1% per year) when used consistently and correctly. The following are examples of
        contraception:

          -  Highly effective methods:

          -  Intrauterine device (IUD)

          -  Hormonal (birth control pill, injections, implants)

          -  Tubal ligation

          -  Partner's vasectomy c) Agree to abstain from breastfeeding during study participation
             and for at least 12 months following LD chemotherapy d) There is insufficient exposure
             data to provide any recommendation concerning the duration of contraception and the
             abstaining from breastfeeding following treatment with JCAR017. Any decision regarding
             contraception and breastfeeding after JCAR017 infusion should be discussed with the
             treating physician 14. Male subjects must:

               1. Practice true abstinence* (which must be reviewed on a monthly basis and source
                  documented) or agree to use a condom during sexual contact with a pregnant female
                  or a female of childbearing potential while participating in the study and until
                  at least 12 months following Lymphodepleting (LD) chemotherapy even if he has
                  undergone a successful vasectomy

               2. There is insufficient exposure data to provide any recommendation concerning the
                  duration of contraception following treatment with JCAR017. Any decision
                  regarding contraception after JCAR017 infusion should be discussed with the
                  treating physician * True abstinence is acceptable when this is in line with the
                  preferred and usual lifestyle of the subject. In contrast, periodic abstinence
                  (eg, calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal
                  are not acceptable methods of contraception.

        Exclusion Criteria:

        The presence of any of the following will exclude a subject from enrollment:

          1. Subject has any significant medical condition, laboratory abnormality, or psychiatric
             illness that would prevent the subject from participating in the study

          2. Subject has any condition including the presence of laboratory abnormalities, which
             would place the subject at unacceptable risk if participating in the study

          3. Subject has any condition that confounds the ability to interpret data from the study

          4. Subjects with T cell rich/histiocyte rich large B-cell lymphoma (THRBCL), primary
             cutaneous large B-cell lymphoma, primary mediastinal B-cell lymphoma (PMBCL),
             Epstein-Barr virus (EBV) positive DLBCL of the elderly, Burkitt lymphoma, and
             intraocular lymphoma

          5. Subjects with prior history of malignancies, other than aggressive r/r NHL, unless the
             subject has been in remission for ≥ 2 years with the exception of the following
             non-invasive malignancies:

               -  Basal cell carcinoma of the skin

               -  Squamous cell carcinoma of the skin

               -  Carcinoma in situ of the cervix

               -  Carcinoma in situ of the breast

               -  Incidental histologic finding of prostate cancer (T1a or T1b using the TNM
                  [tumor, nodes, metastasis] clinical staging system) or prostate cancer that is
                  curative

               -  Other completely resected stage 1 solid tumor with low risk for recurrence

          6. Treatment with any prior gene therapy product

          7. Subjects who have received previous CD19-targeted therapy

          8. Human immunodeficiency virus (HIV) infection, hepatitis B, or hepatitis C:

               -  Subjects with a history of or active HIV are excluded

               -  Subjects with active hepatitis B, or active hepatitis C are excluded Subjects
                  with a negative polymerase chain reaction (PCR) assay for viral load for
                  hepatitis B or C are permitted. Subjects positive for hepatitis B surface antigen
                  and/or anti-hepatitis B core antibody with negative viral load are eligible and
                  should be considered for prophylactic antiviral therapy

          9. Subjects with uncontrolled systemic fungal, bacterial, viral or other infection
             (including tuberculosis) despite appropriate antibiotics or other treatment at the
             time of leukapheresis or JCAR017 infusion

         10. Presence of acute or chronic graft-versus-host disease (GVHD)

         11. Active autoimmune disease requiring immunosuppressive therapy

         12. History of any one of the following cardiovascular conditions within the past 6
             months:

               -  Heart failure class III or IV as defined by the New York Heart Association (NYHA)

               -  Cardiac angioplasty or stenting

               -  Myocardial infarction

               -  Unstable angina

               -  Other clinically significant cardiac disease

         13. History or presence of clinically relevant CNS pathology not related to disease under
             study such as epilepsy, seizure, aphasia, stroke, cerebral edema, severe brain
             injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome,
             or psychosis

         14. Pregnant or nursing women

         15. Treatment with alemtuzumab within 6 months of leukapheresis, or treatment with
             fludarabine or cladribine within 3 months of leukapheresis

         16. Use of the following (see Section 8.2 for full details):

               -  Therapeutic doses of corticosteroids (defined as > 20 mg/day prednisone or
                  equivalent) within 7 days prior to leukapheresis or 72 hours prior to JCAR017
                  infusion. Physiologic replacement, topical, and inhaled steroids are permitted.

               -  Low-dose chemotherapy (eg, vincristine, rituximab, cyclophosphamide ≤ 300 mg/m2)
                  given after leukapheresis to maintain disease control must be stopped ≥ 7 days
                  prior to LD chemotherapy

               -  Cytotoxic chemotherapeutic agents that are not considered lymphotoxic within 1
                  week prior to leukapheresis. Oral anticancer agents, including lenalidomide and
                  ibrutinib, are allowed if at least 3 half-lives have elapsed prior to
                  leukapheresis

               -  Lymphotoxic chemotherapeutic agents (eg, cyclophosphamide > 300 mg/m2,
                  ifosfamide, bendamustine) within 2 weeks prior to leukapheresis

               -  Experimental agents within 4 weeks prior to leukapheresis unless no response or
                  progressive disease (PD) is documented on the experimental therapy and at least 3
                  half-lives have elapsed prior to leukapheresis

               -  Immunosuppressive therapies within 4 weeks prior to leukapheresis and JCAR017
                  infusion (eg, calcineurin inhibitors, methotrexate or other chemotherapeutics,
                  mycophenolate, rapamycin, thalidomide, immunosuppressive antibodies such as
                  anti-tumor necrosis factor [TNF], anti-IL-6, or anti-IL-6R)

               -  Donor lymphocyte infusions (DLI) within 6 weeks prior to JCAR017 infusion

               -  Radiation within 6 weeks prior to leukapheresis. Subjects must have progressive
                  disease in irradiated lesions or have additional non-irradiated, PET-positive
                  lesions to be eligible. Radiation to a single lesion, if additional
                  non-irradiated, measurable PET-positive lesions are present, is allowed up to 2
                  weeks prior to leukapheresis. Prior WBRT for subjects enrolled in Cohort 5 is not
                  allowed

               -  Allogeneic HSCT within 90 days prior to leukapheresis

               -  Prior hematopoietic stem cell transplant (only applicable to Cohort 2) Systemic
                  immunostimulatory agents (including but not limited to interferon and IL-2)
                  within 6 weeks or 5 half-lives of the drug, whichever is shorter, prior to
                  JCAR017 infusion

         17. Progressive vascular tumor invasion, thrombosis, or embolism

         18. Venous thrombosis or embolism not managed on a stable regimen of anticoagulation

         19. Known severe hypersensitivity to DMSO or Dextran
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Overall Response Rate (ORR) of JCAR017 in subjects with Non-Hodgkin Lymphoma (NHL; including secondary central nervous system (CNS) involvement)
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Proportion of subjects achieving a complete response (CR) or partial response (PR) based on the Lugano classification (Cheson, 2014)

Secondary Outcome Measures

Measure:Adverse Events (AEs)
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Type, frequency, and severity of AEs, including serious adverse events (SAEs) and laboratory abnormalities
Measure:Overall Response Rate (ORR) in subjects intended to be treated as outpatients
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Proportion of subjects achieving a complete response (CR) or partial response (PR) based on the Lugano classification (Cheson, 2014)
Measure:Complete response rate (CRR)
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Proportion of subjects achieving a CR (or CR and CRu for subjects with PCNSL) following JCAR017 infusion
Measure:Event-free survival (EFS)
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Time from JCAR017 infusion to death from any cause, progressive disease (PD), or starting a new anticancer therapy, whichever occurs first
Measure:Progression-free survival (PFS)
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Time from JCAR017 infusion to the first documentation of PD, or death due to any cause, whichever occurs first
Measure:Overall survival (OS)
Time Frame:Up to 2 years after last patient's JCAR017 infusion
Safety Issue:
Description:Time from JCAR017 infusion to time of death due to any cause
Measure:Duration of response (DOR)
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Time from first response to progressive disease or death from any cause, whichever occurs first
Measure:Pharmacokinetics by quantitative polymerase chain reaction (qPCR) - Cmax
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Maximum concentration
Measure:Pharmacokinetics by qPCR - Tmax
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Time to peak concentration
Measure:Pharmacokinetics by qPCR - AUC
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Area under the curve
Measure:Patient-Reported Outcomes - EORTC QLQ-C30
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:The European Organization for Research and Treatment of Cancer - Quality of Life C30 questionnaire will be used as a measure of health-related quality of life
Measure:Patient-Reported Outcomes - FACT-LymS
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Functional Assessment of Cancer Therapy-Lymphoma "Additional concerns" subscale: Only the LYM subscale will be administered in this study. This scale addresses symptoms and functional limitations (15 item) that are important to lymphoma patients.
Measure:Adverse Events (AEs) in subjects treated as outpatients
Time Frame:Up to 2 years after JCAR017 infusion
Safety Issue:
Description:Type, frequency, and severity of AEs, including serious adverse events (SAEs) and laboratory abnormalities

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Celgene

Trial Keywords

  • Non-Hodgkin lymphoma
  • Aggressive B-cell non-Hodgkin lymphoma
  • Diffuse large B-cell lymphoma
  • Relapse / refractory lymphoma
  • Transplant not eligible
  • High-grade B-cell lymphoma
  • Primary central nervous system lymphoma
  • Transformed follicular lymphoma
  • Follicular lymphoma Grade 3B
  • JCAR017
  • Liso-Cel

Last Updated

June 18, 2021