Description:
This is a Phase 1 study of central nervous system (CNS) locoregional adoptive therapy with
autologous CD4 and CD8 T cells lentivirally transduced to express a HER2-specific chimeric
antigen receptor (CAR) and EGFRt, delivered by an indwelling catheter in the tumor resection
cavity or ventricular system in children and young adults with recurrent or refractory
HER2-positive CNS tumors. A child or young adult with a refractory or recurrent CNS tumor
will have their tumor tested for HER2 expression by immunohistochemistry (IHC) at their home
institution or at Seattle Children's Hospital. If the tumor is HER2 positive and the patient
meets all other eligibility criteria, including having a CNS catheter placed into the tumor
resection cavity or into their ventricular system, and meets none of the exclusion criteria,
then they can be apheresed, meaning T cells will be collected. The T cells will then be
bioengineered into a second-generation CAR T cell that targets HER2-expressing tumor cells.
The patient's newly engineered T cells will then be administered via the indwelling CNS
catheter for two courses. In the first course they will receive a weekly dose of CAR T cells
for three weeks, followed by a week off, an examination period, and then another course of
weekly doses for three weeks. Following the two courses, patient's will undergo a series of
studies including MRI to evaluate the effect of the CAR T cells and may have the opportunity
to continue receiving up to a total of six courses of CAR T cells if the patient has not had
adverse effects and if more of their T cells are available.
The hypothesis is that an adequate amount of HER2-specific CAR T cells can be manufactured to
complete two courses of treatment with three doses given on a weekly schedule followed by one
week off in each course. The other hypothesis is that HER-specific CAR T cells safely can be
administered through an indwelling CNS catheter to allow the T cells to directly interact
with the tumor cells for each patient enrolled on the study safely can be delivered directly
into the brain via indwelling catheter. Secondary aims of the study will include to evaluate
CAR T cell distribution with the cerebrospinal fluid (CSF), the extent to which CAR T cells
egress or traffic into the peripheral circulation or blood stream, and, if tissues samples
from multiple time points are available, also evaluate the degree of HER2 expression at
diagnosis versus at recurrence.
Title
- Brief Title: HER2-specific CAR T Cell Locoregional Immunotherapy for HER2-positive Recurrent/Refractory Pediatric CNS Tumors
- Official Title: Phase 1 Study of HER2-Specific CAR T Cell Locoregional Immunotherapy for HER2 Positive Recurrent/Refractory Pediatric Central Nervous System Tumors
Clinical Trial IDs
- ORG STUDY ID:
BrainChild-01
- NCT ID:
NCT03500991
Conditions
- Central Nervous System Tumor, Pediatric
- Glioma
- Ependymoma
- Medulloblastoma
- Germ Cell Tumor
- Atypical Teratoid/Rhabdoid Tumor
- Primitive Neuroectodermal Tumor
- Choroid Plexus Carcinoma
- Pineoblastoma
Interventions
| Drug | Synonyms | Arms |
|---|
| HER2-specific chimeric antigen receptor (CAR) T cell | | ARM A (Tumor Cavity Infusion) |
Purpose
This is a Phase 1 study of central nervous system (CNS) locoregional adoptive therapy with
autologous CD4 and CD8 T cells lentivirally transduced to express a HER2-specific chimeric
antigen receptor (CAR) and EGFRt, delivered by an indwelling catheter in the tumor resection
cavity or ventricular system in children and young adults with recurrent or refractory
HER2-positive CNS tumors. A child or young adult with a refractory or recurrent CNS tumor
will have their tumor tested for HER2 expression by immunohistochemistry (IHC) at their home
institution or at Seattle Children's Hospital. If the tumor is HER2 positive and the patient
meets all other eligibility criteria, including having a CNS catheter placed into the tumor
resection cavity or into their ventricular system, and meets none of the exclusion criteria,
then they can be apheresed, meaning T cells will be collected. The T cells will then be
bioengineered into a second-generation CAR T cell that targets HER2-expressing tumor cells.
The patient's newly engineered T cells will then be administered via the indwelling CNS
catheter for two courses. In the first course they will receive a weekly dose of CAR T cells
for three weeks, followed by a week off, an examination period, and then another course of
weekly doses for three weeks. Following the two courses, patient's will undergo a series of
studies including MRI to evaluate the effect of the CAR T cells and may have the opportunity
to continue receiving up to a total of six courses of CAR T cells if the patient has not had
adverse effects and if more of their T cells are available.
The hypothesis is that an adequate amount of HER2-specific CAR T cells can be manufactured to
complete two courses of treatment with three doses given on a weekly schedule followed by one
week off in each course. The other hypothesis is that HER-specific CAR T cells safely can be
administered through an indwelling CNS catheter to allow the T cells to directly interact
with the tumor cells for each patient enrolled on the study safely can be delivered directly
into the brain via indwelling catheter. Secondary aims of the study will include to evaluate
CAR T cell distribution with the cerebrospinal fluid (CSF), the extent to which CAR T cells
egress or traffic into the peripheral circulation or blood stream, and, if tissues samples
from multiple time points are available, also evaluate the degree of HER2 expression at
diagnosis versus at recurrence.
Trial Arms
| Name | Type | Description | Interventions |
|---|
| ARM A (Tumor Cavity Infusion) | Experimental | patients with supratentorial tumors for which CAR T cells will be delivered into the tumor resection cavity
Intervention: HER2-specific chimeric antigen receptor (CAR) T cell | - HER2-specific chimeric antigen receptor (CAR) T cell
|
| ARM B (Ventricular System Infusion) | Experimental | patients with either infratentorial tumors or leptomeningeal tumors for which the CAR T cells will be delivered into the fourth ventricle or lateral ventricle, respectively
Intervention: HER2-specific chimeric antigen receptor (CAR) T cell | - HER2-specific chimeric antigen receptor (CAR) T cell
|
Eligibility Criteria
Inclusion Criteria:
1. Age ≥ 1 and ≤ 26 years
2. Histologically diagnosed HER2-positive Central Nervous System (CNS) tumor
3. Evidence of refractory or recurrent CNS disease for which there is no standard therapy
4. Able to tolerate apheresis, or has apheresis product available for use in
manufacturing
5. CNS reservoir catheter, such as an Ommaya or Rickham catheter
6. Life expectancy ≥ 8 weeks
7. Lansky or Karnofsky score ≥ 60
8. If patient does not have previously obtained apheresis product, patient must have
recovered from acute toxic effects of all prior chemotherapy, immunotherapy, and
radiotherapy and discontinue the following prior to enrollment:
1. ≥ 7 days post last chemotherapy/biologic administration
2. 3 half-lives or 30 days, whichever is shorter post last dose of anti-tumor
antibody therapy
3. Must be at least 30 days from most recent cell infusion
4. All systemically administered corticosteroid treatment therapy must be stable or
decreasing within 1 week prior to enrollment with maximum dexamethasone dose of
2.5 mg/m2/day. Corticosteroid physiologic replacement therapy is allowed.
9. Adequate organ function
10. Adequate laboratory values
11. Patients of childbearing/fathering potential must agree to use highly effective
contraception
Exclusion Criteria:
1. Diagnosis of classic diffuse intrinsic pontine glioma (DIPG)
2. Presence of Grade ≥ 3 cardiac dysfunction or symptomatic arrhythmia requiring
intervention
3. Presence of primary immunodeficiency/bone marrow failure syndrome
4. Presence of clinical and/or radiographic evidence of impending herniation
5. Presence of active malignancy other than the primary CNS tumor under study
6. Presence of active severe infection
7. Receiving any anti-cancer agents or chemotherapy
8. Pregnant or breastfeeding
9. Subject and/or authorized legal representative unwilling or unable to provide
consent/assent for participation in the 15-year follow up period
10. Presence of any condition that, in the opinion of the investigator, would prohibit the
patient from undergoing treatment under this protocol
| Maximum Eligible Age: | 26 Years |
| Minimum Eligible Age: | 1 Year |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
Primary Outcome Measures
| Measure: | Establish the safety, defined by the adverse events, of HER2-specific CAR T cell infusions delivered by a central nervous system (CNS) catheter into the tumor resection cavity or ventricular system |
| Time Frame: | up to 6 months |
| Safety Issue: | |
| Description: | The type, frequency, severity, and duration of adverse events as a result of HER2-specific CAR T cell infusion will be summarized |
Secondary Outcome Measures
| Measure: | Assess the distribution of CNS-delivered HER2-specific CAR T cells within the cerebrospinal fluid (CSF) and peripheral blood |
| Time Frame: | up to 6 months |
| Safety Issue: | |
| Description: | The trafficking of HER2-specific CAR T cell product through the CSF by measuring remaining CAR T cells from a prior infusion at the time of each infusion and the trafficking of HER2-specific CAR T cells from the CSF into the peripheral blood will be evaluated |
| Measure: | Assessment of whether HER2 expression changes in relapsed CNS tumors that were HER2 positive prior to treatment with CAR T cells |
| Time Frame: | 28 days |
| Safety Issue: | |
| Description: | The changes in HER2 expression at diagnosis and recurrence of central nervous system (CNS) tumors, if samples from multiple time points is available, will be investigated by evaluating pathology specimens from previous surgeries |
| Measure: | Assessment of disease response of HER2-expressing refractory or recurrent central nervous system (CNS) tumors to HER2 specific CAR T cell therapy delivered directly into the CNS |
| Time Frame: | up to 6 months |
| Safety Issue: | |
| Description: | The response of recurrent or refractory central HER2-expressing CNS tumors to HER2-specific CAR T cell therapy delivered directly into the CNS will be determined by evaluating CSF for tumor cells and by CNS imaging with MRIs |
Details
| Phase: | Phase 1 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | Seattle Children's Hospital |
Trial Keywords
- CNS, CAR T cell, HER2-positive, brain tumor
- pediatric, young adults
Last Updated
March 15, 2021
