Clinical Trials /

Study of CRISPR-Cas9 Mediated PD-1 and TCR Gene-knocked Out Mesothelin-directed CAR-T Cells in Patients With Mesothelin Positive Multiple Solid Tumors.

NCT03545815

Description:

Multiple solid tumors have positive targets of mesothelin expressed on the surfaces of the tumor cells, we use the technique of CRISPR-Cas9 to knocked out the PD-1 and TCR of chimeric antigen receptor (CAR) T cells to effect the immuno-microenvironment around tumors.

Related Conditions:
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Study of CRISPR-Cas9 Mediated PD-1 and TCR Gene-knocked Out Mesothelin-directed CAR-T Cells in Patients With Mesothelin Positive Multiple Solid Tumors.
  • Official Title: Phase I Study to Evaluate Treatment of CRISPR-Cas9 Mediated PD-1 and TCR Gene-knocked Out Chimeric Antigen Receptor (CAR) T Cells in Patients With Mesothelin Positive Multiple Solid Tumors.

Clinical Trial IDs

  • ORG STUDY ID: CHN-PLAGH-BT-028
  • NCT ID: NCT03545815

Conditions

  • Solid Tumor, Adult

Interventions

DrugSynonymsArms
anti-mesothelin CAR-T cellsanti-mesothelin CAR-T cells

Purpose

Multiple solid tumors have positive targets of mesothelin expressed on the surfaces of the tumor cells, we use the technique of CRISPR-Cas9 to knocked out the PD-1 and TCR of chimeric antigen receptor (CAR) T cells to effect the immuno-microenvironment around tumors.

Detailed Description

      1. To evaluate the feasibility and safety of CRISPR-Cas9 mediated PD-1 and TCR gene-knocked
           out chimeric antigen receptor (CAR) T cells in patients with mesothelin positive
           multiple solid tumors.

        2. To evaluate the duration of in vivo persistence of transferred CAR-T cells.

        3. To observe and measure anti-tumor responses for patients with detectable mesothelin
           positive tumor lesions.
    

Trial Arms

NameTypeDescriptionInterventions
anti-mesothelin CAR-T cellsExperimentalPatients receive mesothelin-directed CAR-T cells infusion with dose escalation will occur using a standard 3+3 dose escalation approach, beginning in dose level I with dose cohorts and rules for escalation and de- escalation. Patients receive anti-mesothelin-CAR T cells on day 0.
  • anti-mesothelin CAR-T cells

Eligibility Criteria

        Inclusion Criteria:

          1. Histologically confirmed with mesothelin positive multiple solid tumors.

          2. Failure of at least one prior standard of care chemotherapy for advanced stage
             disease.

          3. Subjects must have measureable disease as defined by RECIST 1.1 criteria or modified
             RECIST criteria.

          4. Patients > 18 years of age.

          5. Eastern Cooperative Oncology Group (ECOG) performance status of 0-3.

          6. Life expectancy > 12 weeks.

          7. Satisfactory organ and bone marrow function as defined by the following (of note, the
             minimal blood counts should be in the absence of transfusion or cytokine support):

             i. Absolute neutrophil count > 1,000/μl ii. Platelets >75,000/μl iii. Hemoglobin > 9
             g/dL iv. Bilirubin < 2.0x the institutional normal upper limit unless secondary to
             bile duct obstruction by tumor v. Creatinine < 1.5x the institutional normal upper
             limit vi. Albumin ≥2 vii. Serum alanine aminotransferase (ALT) or aspartate
             aminotransferase (AST) < 5x the institutional normal upper limit viii. Cardiac
             ejection fraction of >55% as measured by resting echocardiogram, with no significant
             pericardial effusion.

          8. Blood coagulation parameters: PT such that international normalized ratio (INR) is ≤
             1.5 and a PTT < 1.2 time the upper limit of normal unless the patient is
             therapeutically anti-coagulated for history of cancer-related thrombosis and has
             stable coagulation parameters.

          9. Ability to understand and the willingness to provide written informed consent.

         10. Male and Female subjects of reproductive potential agree to use approved contraceptive
             methods (e.g. birth control pills, barrier device, intrauterine device, abstinence)
             and abstain from other methods of conception during the study and for 6 months
             following the study cell infusion or proof of sterility.

        Exclusion Criteria

          1. Sarcomatoid MPM histology which is known in the literature to not express mesothelin;
             biphasic MPM is also excluded.

          2. This refers to non-commercially approved investigational drugs different than those
             used in this protocol.Participated in any other trial in which receipt of an
             investigational study drug occurred within 28 days prior to enrollment and anticipated
             treatment with another investigational product while on study.

          3. Anticipated need for systemic chemotherapy within 2 weeks before apheresis and
             infusion of CART-meso cells.

          4. Active invasive cancer other than the one of the three cancers in this study. Patients
             with active non-invasive cancers (such as non-melanoma skin cancer, superficial
             cervical and bladder and prostate cancer with PSA level < 1.0) are not
             excluded.CART-meso in mesothelin expressing cancers

          5. HIV, HCV, or HBV infections

          6. Active autoimmune disease (including but not limited to: systemic lupus
             erythromatosis, Sjogren's syndrome, rheumatoid arthritis, psoriasis, multiple
             sclerosis, inflammatory bowel disease, etc.) requiring immunosuppressive therapy
             within the past 4 weeks, with exception of thyroid replacement.

          7. Patients with ongoing or active infection.

          8. Planned concurrent treatment with systemic high dose corticosteroids. Patients may be
             on a stable low dose of steroids (<10mg equivalent of prednisone) for chronic
             respiratory conditions.

          9. Patients requiring supplemental oxygen therapy.

         10. Prior therapy with gene modified cells.

         11. Previous experimental therapy with SS1 moiety, murine or chimeric antibodies (human
             and humanized antibodies are allowed).

         12. History of allergy to murine proteins

         13. History of allergy or hypersensitivity to study product excipients (human serum
             albumin, DMSO, and Dextran 40)

         14. Any clinically significant pericardial effusion; CHF (NY Heart Association Grade
             II-IV) or cardiovascular condition that would preclude assessment of mesothelin
             induced pericarditis or that may worsen as a result of toxicities expected for this
             study. This determination will be made by a cardiologist.

         15. Any clinically significant pleural or peritoneal effusion that cannot be drained with
             standard approaches. An indwelling drainage device placed prior to enrollment is
             acceptable.

         16. Pregnant or breastfeeding women. Female study participants of reproductive potential
             must have a negative urine pregnancy test of enrollment. A serum pregnancy test will
             be performed within 2 weeks before infusion.
      
Maximum Eligible Age:70 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:study of related adverse events
Time Frame:24 weeks
Safety Issue:
Description:Grade 3 signs/symptoms, toxicities and clinical

Secondary Outcome Measures

Measure:clinical responses to anti-mesothelin cell infusions
Time Frame:24 weeks
Safety Issue:
Description:Disease control rate(DCR)

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Chinese PLA General Hospital

Trial Keywords

  • mesothelin, CRISPR-Cas9, PD-1, TCR

Last Updated

August 10, 2020