Clinical Trials /

Multi-antigen T Cell Infusion Against Neuro-oncologic Disease

NCT03652545

Description:

This Phase I dose-escalation trial is designed to determine the safety and feasibility of rapidly generated tumor multi-antigen associated specific cytotoxic T lymphocytes (TAA-T) in patients with newly diagnosed diffuse intrinsic pontine gliomas DIPGs (Group A) or recurrent, progressive, or refractory non-brainstem CNS malignancies (Group B). Pediatric and adult patients who have high-risk CNS tumors known to typically have positivity for one or more Tumor Antigen Associated (TAA) (WT1, PRAME and/or Survivin) will be eligible. TAA-T will all be generated from patient peripheral blood mononuclear cells (PBMC). Group A patients (DIPG): The first TAA-T dose will be infused any time >14 days after completion of radiotherapy. Group B patients (other recurrent/progressive/refractory CNS tumors): The first TAA-T dose will be infused any time >14 days after completing most recent course of conventional (non-investigational) therapy for their disease AND after appropriate washout periods as detailed in eligibility criteria.

Related Conditions:
  • Central Nervous System Embryonal Neoplasm
  • Choroid Plexus Carcinoma
  • Diffuse Intrinsic Pontine Glioma
  • Ependymoma
  • Malignant Glioma
  • Medulloblastoma
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Multi-antigen T Cell Infusion Against Neuro-oncologic Disease
  • Official Title: Phase I REsearch on Multi-antigen T Cell Infusion Against Neuro-oncologic Disease

Clinical Trial IDs

  • ORG STUDY ID: Pro00010463
  • NCT ID: NCT03652545

Conditions

  • Brain Tumor

Interventions

DrugSynonymsArms
TAA-TTAA-T

Purpose

This Phase I dose-escalation trial is designed to determine the safety and feasibility of rapidly generated tumor multi-antigen associated specific cytotoxic T lymphocytes (TAA-T) in patients with newly diagnosed diffuse intrinsic pontine gliomas DIPGs (Group A) or recurrent, progressive, or refractory non-brainstem CNS malignancies (Group B). Pediatric and adult patients who have high-risk CNS tumors known to typically have positivity for one or more Tumor Antigen Associated (TAA) (WT1, PRAME and/or Survivin) will be eligible. TAA-T will all be generated from patient peripheral blood mononuclear cells (PBMC). Group A patients (DIPG): The first TAA-T dose will be infused any time >14 days after completion of radiotherapy. Group B patients (other recurrent/progressive/refractory CNS tumors): The first TAA-T dose will be infused any time >14 days after completing most recent course of conventional (non-investigational) therapy for their disease AND after appropriate washout periods as detailed in eligibility criteria.

Detailed Description

      This protocol is designed as a phase I dose-escalation study. Three different TAA-T dose
      levels will be evaluated in each treatment group (A and B) (see below) with 2 to 4 patients
      enrolled at each dose level.

      Dose Level 1: 2 x 107 cells/m2 Dose Level 2: 4 x 107 cells/m2 Dose Level 3: 8 x 107 cells/m2

      Two patients will be initially enrolled to the lowest dose level cohort (separately on each
      arm) and followed for 42 days after initial TAA-T for DLT evaluations. The decision on
      whether it is safe to escalate to next dose level or not will be made after at least two
      patients in each dose level have finished their 42-days toxicity follow up after initial
      TAA-T. If the first two patients have not finished their 42 days follow-up, up to 2
      additional incoming patients can be enrolled at the current dose level.

      Ideally, patients should not receive other systemic antineoplastic agents for at least 42
      days after infusion of TAA-T (for purposes of evaluation), although such treatment may be
      added if deemed critical for patient care by the attending physician.

      Each patient will receive at least one TAA-T infusion and may receive a maximum of 8
      subsequent infusions. The first and second infusions will be administered at least 42 days
      apart then additional infusions will be spaced at least 28 days apart from each other. The
      expected volume of each infusion is 1 to 10 ml.

      If patients with disease have a response of stable disease or better by RANO criteria (see
      section 3.2.2.4) at the day 28 evaluation after the second infusion OR if they have clinical
      stability and a clinical assessment of possible pseudoprogression on MRI, they are eligible
      to receive up to 6 additional infusions of TAA-T at 28 day intervals if available. Each
      subsequent infusion will be the same as the enrollment dose level (i.e. no subsequent dose
      escalation). The first and second infusions will be administered at least 42 days apart then
      additional infusions will be spaced at least 28 days apart from each other. Following the
      first infusion, if a patient's TAA-T supply is insufficient for subsequent infusions at the
      enrollment dose level, further treatments may be administered at a lower dose level at the
      treating physician's discretion.

      If patients who are clinically stable are deemed to have likely pseudoprogression at the
      disease evaluation after the second infusion or on subsequent imaging, then these patients
      may still be eligible for infusion if serial imaging and clinical assessments demonstrate
      stability most consistent with pseudoprogression. In these patients, disease assessment after
      the imaging that first raises the concern for pseudoprogression (potential progressive
      disease versus pseudoprogression) must be at least stable when compared with the first scan
      demonstrating pseudoprogression.
    

Trial Arms

NameTypeDescriptionInterventions
TAA-TExperimentalThree different dosing schedules will be evaluated. Dose Level One: 2 x 107 cells/m2 Dose Level Two: 4 x 107 cells/m2 Dose Level Three: 8 x 107 cells/m2 Group A patients (DIPG): The first TAA-T dose will be infused any time more than or equal to 14 days after completion of radiotherapy. Group B patients (other recurrent/progressive/refractory CNS tumors): TAA-T will be infused any time more than or equal to 14 days after completing most recent course of conventional (non-investigational) therapy for their disease AND after appropriate washout periods as detailed in eligibility criteria. Ideally, patients should not receive other systemic antineoplastic agents for at least 42 days after the infusion of TAA-T, although such treatment may be added if deemed critical for patient care by the attending physician.
  • TAA-T

Eligibility Criteria

        Inclusion Criteria:

        Recipient Procurement Inclusion Criteria

          -  Diagnosis of high-risk CNS tumors: DIPG, high-grade glioma, medulloblastoma,
             ependymoma, embryonal tumors, choroid plexus carcinoma, other aggressive CNS
             malignancies.

             o Group A (newly diagnosed DIPG): Radiographic diagnosis with DIPG defined as tumors
             with a pontine epicenter and diffuse intrinsic involvement of the pons. For Group A,
             procurement within the first 12 weeks after completion of radiotherapy is required.

               -  Group B: Recurrent, progressive, or refractory disease after standard treatment.
                  Refractory disease includes high-risk tumors with residual disease after
                  completion of standard treatment or tumors with known poor cure rates with
                  standard treatment.

          -  6 months to 80 years of age at enrollment

          -  Karnofsky/Lansky score of ≥ 60%

          -  Organ function:

             o ANC greater than or equal to750/µL

             o Platelets greater than or equal to 75K

             o Bilirubin less than or equal to 1.5x ULN

             o AST/ALT less than or equal to 5x ULN

             o Serum creatinine less than or equal to 1.0mg/dL or 1.5x ULN for age (whichever is
             higher)

               -  Pulse oximetry > 90% on room air

          -  Agree to use contraceptive measures during study protocol participation (when age
             appropriate)

          -  Patient or parent/guardian capable of providing informed consent

          -  Available pre-trial tumor tissue (Optional for Group B patients, but highly
             encouraged. Also optional for Group A)

          -  Patient deemed to be of sufficient size in order to provide the necessary blood volume
             for TAA-T generation

        Recipient Procurement Exclusion Criteria

          -  Patients with uncontrolled infections

          -  Patients with known HIV infection

          -  Pregnancy** or lactating females

          -  Prior immunotherapy with an investigational agent within the last 28 days prior to
             procurement

          -  Patients with previous history of allogeneic stem cell transplantation (however,
             patients who have received autologous stem-cell infusions will remain eligible).

          -  Bulky tumor o Group B - patients who have bulky tumor on imaging are ineligible. These
             include the following: Tumor with any evidence of uncal herniation or significant
             midline shift Tumor with a significant brainstem component Patients who are deemed to
             have overly bulky tumor by the PI of the study

               -  Pregnancy assessment on all patients >7 years will be performed. If patient has
                  child bearing potential (per PI/Sub-I discretion), then pregnancy testing will be
                  performed.

        Recipient Inclusion Criteria for Initial TAA-T Administration and for Subsequent Infusions

          -  Steroids < 0.5 mg/kg/day dexamethasone or equivalent

          -  Karnofsky/Lansky score of greater than or equal to 60%

          -  Organ function:

             o ANC greater than or equal to750/µL

             o Platelets greater than or equal to 75K

               -  Bilirubin less than or equal to 1.5x ULN

               -  AST/ALT less than or equal to 5x ULN

               -  Serum creatinine less than or equal 1.0mg/dL or 1.5x ULN for age (whichever is
                  higher)

               -  Pulse oximetry > 90% on room air

          -  Patients must have received their last dose of known:

             o Myelosuppressive chemotherapy (including completing radiotherapy for group A
             patients): greater than or equal to14 days prior to TAA-T infusion or demonstrated
             count recovery

             o Investigational agent: 28 days prior to TAA-T infusion. For investigational agents
             that have known adverse events occurring beyond 28 days after administration, this
             period must be extended beyond the time when new adverse events are known to commonly
             occur.

               -  Biologic agents: 7 days prior to TAA-T infusion. For agents that have known
                  adverse events occurring beyond 7 days after administration, this period must be
                  extended beyond the time when new adverse events are known to commonly occur.

               -  Bevacizumab: bevacizumab may be used if clinically indicated in order to control
                  potential pseudoprogression* or inflammation thought to be due to the cellular
                  product. There will not be a standard required washout period for bevacizumab if
                  used for this indication.

               -  Surgery: patients must have recovered from all acute effects of prior surgical
                  intervention

          -  Neurologic status: Patients with neurologic deficits must have deficits that are
             stable for a minimum of 7 days prior to TAA-T infusion

               -  Pseudoprogression is a retrospective assessment that some (or all) noted tumor
                  enlargement by radiographic criteria may reflect immune cell infiltration rather
                  than true tumor progression. This diagnosis is commonly accepted to be
                  retrospectively true if, in the context of clinical stability, radiographic
                  progression plateaus when it would have been expected to progress.

        Recipient Exclusion Criteria for Initial and Subsequent TAA-T Infusions

          -  Patients with uncontrolled infections

          -  Bulky tumor*** o Group B - patients who have bulky tumor on imaging are not eligible.
             These include the following: Tumor with evidence of uncal herniation or significant
             midline shift Tumor with a significant brainstem component Patients who are deemed to
             have overly bulky tumor by the PI of the study

          -  Patients who received ATG, Campath or other immunosuppressive T cell monoclonal
             antibodies within 28 days of TAA-T cell infusion.

        Pregnancy** or lactating females

        ** Pregnancy assessment on all patients >7 years will be performed. If patient has child
        bearing potential (per PI/Sub-I discretion), then pregnancy testing will be performed.

        *** For subsequent infusions, the most recent disease assessments (as obtained per standard
        of care) will be used to determine eligibility.
      
Maximum Eligible Age:80 Years
Minimum Eligible Age:6 Months
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of Product- Adverse Events
Time Frame:Within 42 days of the first TAA-T dose
Safety Issue:
Description:Number of Participants With Treatment-Related Adverse Events as Assessed by CTCAE v4.03, change from Baseline Infusion related toxicity at 42 days.

Secondary Outcome Measures

Measure:TAA-T responses
Time Frame:1 year
Safety Issue:
Description:Determine the number of patients who respond to tumor associated antigen lymphocytes from base line to one year.

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Catherine Bollard

Last Updated

July 16, 2020