Clinical Trials /

Non-Viral TCR Gene Therapy

NCT04102436

Description:

Background: A person s white blood cells can be modified in a lab to recognize certain changes in their tumor. Many of these cells are collected from the person, modified, then given back to the person. This may help treat some cancers. Objective: To learn if a person s white blood cells modified with T-cell receptors can cause solid tumors to shrink. Eligibility: People ages 18-70 who have cancer of the gastrointestinal tract, genitourinary tract, ovary, breast, or lung that has spread, or who have glioblastoma. Design: Participants will be screened and have their cells prepared for treatment in another protocol. Participants will be hospitalized one week before treatment. They will stay approximately 3 - 4 weeks after treatment. Participants will get the modified white blood cells and chemotherapy through an IV catheter, which is a small plastic tube inserted in a vein. Participants will take drugs by mouth to prevent infection. They will receive filgrastim as a shot or injection under the skin. Participants will have tests before, during, and after treatment: Heart, blood, and urine tests Chest X-ray Physical exam Scans: They will lie in a machine that takes pictures of the body. Possible apheresis: The participant s blood is removed through a needle in an arm. The blood goes through a machine that removes the white blood cells. The rest of the blood is returned through a needle in the other arm. Participants will have visits about 6 and 12 weeks after treatment. If they are responding to treatment, they will then have visits every 3-6 months for 3 years. Then they will join another study and be followed about 12 more years.

Related Conditions:
  • Bladder Small Cell Neuroendocrine Carcinoma
  • Breast Carcinoma
  • Cervical Carcinoma
  • Digestive System Neoplasm
  • Extragonadal Embryonal Carcinoma
  • Glioblastoma
  • Malignant Bladder Neoplasm
  • Malignant Ovarian Germ Cell Tumor
  • Malignant Renal Pelvis Neoplasm
  • Malignant Reproductive System Neoplasm
  • Malignant Ureter Neoplasm
  • Malignant Urethral Neoplasm
  • Non-Small Cell Lung Carcinoma
  • Ovarian Carcinoma
  • Ovarian Embryonal Carcinoma
  • Renal Pelvis and Ureter Carcinoma
  • Testicular Embryonal Carcinoma
  • Transitional Cell Carcinoma
  • Ureter Small Cell Carcinoma
  • Urothelial Carcinoma
  • Uterine Corpus Neuroendocrine Neoplasm
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Non-Viral TCR Gene Therapy
  • Official Title: A Phase II Study Using the Administration of Autologous T-Cells Engineered Using the Sleeping Beauty Transposon/Transposase System to Express T-Cell Receptors Reactive Against Mutated Neoantigens in Patients With Metastatic Cancer

Clinical Trial IDs

  • ORG STUDY ID: 190143
  • SECONDARY ID: 19-C-0143
  • NCT ID: NCT04102436

Conditions

  • Glioblastoma
  • Non-Small Cell Lung Cancer
  • Breast Cancer
  • Gastrointestinal/Genitourinary Cancer

Interventions

DrugSynonymsArms
Fludarabine1/Experimental Therapy
Cyclophosphamide1/Experimental Therapy
Aldesleukin1/Experimental Therapy
Sleeping Beauty Transposed PBL1/Experimental Therapy

Purpose

Background: A person s white blood cells can be modified in a lab to recognize certain changes in their tumor. Many of these cells are collected from the person, modified, then given back to the person. This may help treat some cancers. Objective: To learn if a person s white blood cells modified with T-cell receptors can cause solid tumors to shrink. Eligibility: People ages 18-70 who have cancer of the gastrointestinal tract, genitourinary tract, ovary, breast, or lung that has spread, or who have glioblastoma. Design: Participants will be screened and have their cells prepared for treatment in another protocol. Participants will be hospitalized one week before treatment. They will stay approximately 3 - 4 weeks after treatment. Participants will get the modified white blood cells and chemotherapy through an IV catheter, which is a small plastic tube inserted in a vein. Participants will take drugs by mouth to prevent infection. They will receive filgrastim as a shot or injection under the skin. Participants will have tests before, during, and after treatment: Heart, blood, and urine tests Chest X-ray Physical exam Scans: They will lie in a machine that takes pictures of the body. Possible apheresis: The participant s blood is removed through a needle in an arm. The blood goes through a machine that removes the white blood cells. The rest of the blood is returned through a needle in the other arm. Participants will have visits about 6 and 12 weeks after treatment. If they are responding to treatment, they will then have visits every 3-6 months for 3 years. Then they will join another study and be followed about 12 more years.

Detailed Description

      Background:

        -  The administration of autologous tumor infiltrating lymphocytes (TIL) can mediate
           complete, durable regressions in 20-25% of patients with metastatic melanoma. Recent
           studies have shown that these TIL predominantly recognize unique mutated neoantigens
           expressed by the cancer not shared by other melanomas.

        -  Administration of bulk autologous TIL to patients with a variety of other solid cancers,
           including cancers of the gastrointestinal tract and genitourinary tract, have little if
           any therapeutic impact.

        -  Recent studies in the Surgery Branch, NCI, have shown that TIL from non-melanoma solid
           cancers can also contain T-cells reactive against non-shared unique mutated neoantigens
           expressed in the cancer. The frequency of these T-cells is very low (often < 0.1%) and
           it is thus difficult to isolate and grow mutation reactive T-cells to levels required
           for effective therapy.

        -  In several patients with chemo-refractory metastatic epithelial cancers, we were able to
           grow an enriched population of neoantigen reactive TIL and administration of these cells
           mediated several partial regressions of metastatic disease and one complete regression
           of all metastatic breast cancer now lasting more than 3 years.

        -  We have now developed approaches to identify these rare neoantigen reactive T-cells from
           common non-melanoma cancers, to isolate their T-cell receptors (TCR), and to genetically
           engineer autologous peripheral blood lymphocytes (PBL) using the Sleeping Beauty system
           to express these TCRs with high efficiency. The neoantigen TCR gene- modified cells can
           recognize and destroy the autologous cancer in vitro.

        -  We are now proposing a clinical protocol to treat patients with refractory solid cancers
           using the adoptive transfer of autologous PBL transposed with genes encoding TCRs that
           recognize unique mutated neoantigens expressed by the cancer.

      Objective:

      -To determine the rate of objective response (using RECIST v1.1 criteria) of patients with
      solid cancers who receive autologous PBL that have been genetically modified with genes
      encoding TCRs that recognize mutated neoantigens in the autologous cancer using the Sleeping
      Beauty system.

      Eligibility:

      Patients who are age greater than or equal to 18 years and less than or equal to 70 years
      must have:

        -  Measurable solid cancer with at least one lesion that is resectable for TIL generation
           with minimal morbidity plus at least one other lesion that can be measured that falls
           into one of four cohorts: (1) gastrointestinal and genitourinary, (2) breast and
           ovarian, (3) non- small cell lung cancer (NSCLC), and (4) glioblastoma. Metastatic
           disease is required for Cohorts 1-3 but not for Cohort 4.

        -  Evaluable solid cancer that has recurred following standard chemotherapy or standard
           erapy OR therapy has been declined

        -  Adequate organ function

        -  No allergies or hypersensitivity to cyclophosphamide, fludarabine, or aldesleukin.

        -  No concurrent major medical illnesses or any form of immunodeficiency

      Design:

        -  Patients will undergo resection or biopsy to obtain tumor for generation of autologous
           TIL cultures. Patients will be entered into four cohorts that include (1)
           gastrointestinal and genitourinary tract cancers, (2) breast and ovarian cancers, (3)
           non-small cell lung cancer (NSCLC), and (4) glioblastomas. Exome sequencing and often
           RNA Seq will be performed to identify the mutations expressed in the patient s cancer.
           Multiple autologous TIL cultures will be grown and tested for reactivity against
           mutations from the autologous tumor using assays we have developed that involve the
           exposure of autologous antigen presenting cells to long peptides containing the mutation
           or tandem mini genes encoding the mutation.

        -  T-cell cultures with reactivity against mutations will be identified and the individual
           TCRs that recognize the mutation will be synthesized and used to transfect the TCR into
           patient s autologous PBL using the Sleeping Beauty system.

        -  Transposed autologous PBL will then be expanded to large numbers using our standard
           rapid expansion protocol and administered to the patient following a non-myeloablative
           lymphodepleting regimen.

        -  All patients will receive a non-myeloablative lymphodepleting preparative regimen of
           cyclophosphamide and fludarabine. Patients will then receive the infusion of autologous
           transposed PBL and begin high-dose aldesleukin (720,000 IU/kg IV every 8 hours for up to
           10 doses).

        -  Clinical and immunologic response will be evaluated approximately 4-6 weeks after cell
           infusion and periodically thereafter.

        -  It is anticipated that approximately one patient per month will enroll into the trial
           for each of the four histologic groups. Thus, accrual of up to 4 x 50=200 total
           evaluable patients may be completed in approximately 2-4 years. In order to allow for a
           small number of inevaluable patients the accrual ceiling will be set to 210.
    

Trial Arms

NameTypeDescriptionInterventions
1/Experimental TherapyExperimentalNon-myeloablative, lymphodepleting preparative regimen of cyclophosphamide and fludarabine + Sleeping Beauty Transposed PBL + high- or low-dosealdesleukin.
  • Fludarabine
  • Cyclophosphamide
  • Aldesleukin
  • Sleeping Beauty Transposed PBL

Eligibility Criteria

        -  INCLUSION CRITERIA:

          -  Patients with histologically confirmed solid cancer that falls into one of four
             cohorts:

               -  Gastrointestinal and genitourinary (Cohort 1),

               -  Breast and ovarian (Cohort 2),

               -  Non-small cell lung cancer (NSCLC), NSCLC includes but is not limited to squamous
                  cell carcinoma, adenosquamous carcinoma or adenocarcinomas (Cohort 3),

               -  Glioblastoma (Cohort 4)

          -  Patients must have evaluable or measurable disease per RECIST 1.1 with at least one
             lesion that is resectable for TIL generation with minimal morbidity plus at least one
             other lesion that can be measured. Metastatic disease is required for Cohorts 1-3 but
             is not required for Cohort 4.

          -  Patients must have:

               -  previously received standard systemic therapy for their advanced cancer and have
                  been either non-responders or have recurred, specifically:

                    -  Patients with metastatic colorectal cancer must have received oxaliplatin or
                       irinotecan (or similar agents)

                    -  Patients with breast and ovarian cancer must be refractory to first-line
                       treatments

                    -  Patients with lung cancer must have received at least one platinum-based
                       chemotherapy regimen and at least one FDA-approved targeted treatment (when
                       appropriate)

                    -  Patients with glioblastoma must have progression of disease after
                       radiotherapy (including patients that undergo surgery for recurrent disease
                       and are rendered NED). This includes recurrent GBM after receiving all
                       standard first-line treatment, including surgery (if feasible due to
                       neurosurgical and neuro- anatomical considerations) and adjuvant
                       radiotherapy +/- chemotherapy. OR

               -  declined standard treatment

          -  For Cohorts 1-3: Patients with 3 or fewer brain metastases that are < 1 cm in diameter
             and asymptomatic are eligible. Lesions that have been treated with stereotactic
             radiosurgery must be clinically stable for one month after treatment for the patient
             to be eligible. Patients with surgically resected brain metastases are eligible.

          -  For Cohort 3: Patients must have documented FEV1 > 60% predicted.

          -  Age greater than or equal to 18 years and less than or equal to 70 years.

          -  For Cohorts 1-3: Clinical performance status of ECOG 0 or 1.

          -  For Cohort 4: Patients must have Karnofsky performance status of greater than or equal
             to 60.

          -  The effects of study treatment on the developing human fetus are unknown. For this
             reason, women of child-bearing potential and men must agree to use adequate
             contraception (hormonal or barrier method of birth control; abstinence) at time of
             study entry, for the duration of treatment and up to 4 months after the last dose of
             study treatment. Should a woman become pregnant or suspect she is pregnant while she
             or her partner is participating in this study, she should inform her treating
             physician immediately.

          -  Serology

               -  Seronegative for HIV antibody. (The experimental treatment being evaluated in
                  this protocol depends on an intact immune system. Patients who are HIV
                  seropositive can have decreased immune competence and thus may be less responsive
                  to the experimental treatment and more susceptible to its toxicities.)

               -  Seronegative for active hepatitis B, and seronegative for hepatitis C antibody.
                  If hepatitis C antibody test is positive, then patient must be tested for the
                  presence of antigen by RT-PCR and be HCV RNA negative.

          -  Hematology

               -  ANC > 1,000/mm^3 without the support of filgrastim

               -  WBC greater than or equal to 3,000/mm^3

               -  Platelet count greater than or equal to 100,000/mm^3

               -  Hemoglobin > 8.0 g/dL. Subjects may be transfused to reach this cut-off.

          -  Chemistry

               -  Serum ALTlAST less than or equal to 5.0 x ULN

               -  Serum creatinine less than or equal to 1.6 mgldL

               -  Total bilirubin less than or equal to 1.5 mg/dL, except in patients with Gilbert
                  s Syndrome, who must have a total bilirubin < 3.0 mg/dL.

          -  More than four weeks must have elapsed since completion of any prior systemic therapy
             and enrollment.

        Note: Patients may have undergone minor surgical procedures or limited field radiotherapy
        (with the exception of patients with glioblastoma) within the four weeks before enrollment,
        as long as any related major organ toxicities have recovered to less than or equal to grade
        1.

          -  For Cohort 3: More than two weeks must have elapsed since any prior palliation for
             major bronchial occlusion or bleeding and enrollment, and patient s toxicities must
             have recovered to less than or equal to grade 1.

          -  For Cohort 4: Patients must be at least four weeks from radiation therapy.
             Additionally, patients must be at least six weeks from nitrosoureas, four weeks from
             temozolomide, three weeks from procarbazine, two weeks from vincristine and four weeks
             from last bevacizumab administration. Patients must be at least four weeks from other
             cytotoxic therapies not listed above and two weeks for non-cytotoxic agents (e.g.,
             interferon) including investigative agents. Patient s toxicities must have recovered
             to less than or equal to grade 1.

          -  Ability of subject to understand and the willingness to sign a written informed
             consent document.

          -  Willing to sign a durable power of attorney.

          -  Subjects must be co-enrolled on protocol 03-C-0277.

        EXCLUSION CRITERIA:

          -  Pregnant women are excluded from this study because study treatment s potential for
             teratogenic or abortifacient effects is unknown. Because there is an unknown but
             potential risk for adverse events in nursing infants secondary to treatment of the
             mother with study therapy, breastfeeding should be discontinued if the mother is
             treated on this trial.

          -  Concurrent systemic steroid therapy, except for patients with glioblastoma (Cohort 4).

          -  Active systemic infections requiring anti-infective treatment, coagulation disorders
             or any other active or uncompensated major medical illnesses.

          -  For Cohort 3: Any major bronchial occlusion or bleeding not amenable to palliation.

          -  For Cohort 4: Clinically significant hemorrhagic or ischemic stroke, including
             transient ischemic attacks and other central nervous system bleeding in the preceding
             six months that were not related to glioma surgery.

        Note: History of prior intratumoral bleeding is not an exclusion criterion; however,
        patients with a history of prior intratumoral bleeding will need to undergo a non- contrast
        head CT to exclude acute bleeding.

          -  Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency
             Disease).

          -  Concurrent opportunistic infections (The experimental treatment being evaluated in
             this protocol depends on an intact immune system. Patients who have decreased immune-
             competence may be less responsive to the experimental treatment and more susceptible
             to its toxicities.)

          -  History of severe immediate hypersensitivity reaction to cyclophosphamide,
             fludarabine, or aldesleukin.

          -  History of coronary revascularization or ischemic symptoms.

          -  Documented LVEF less than or equal to 45% tested in patients:

               -  Age greater than or equal to 65 years

               -  With clinically significant atrial and/or ventricular arrhythmias, including but
                  not limited to: atrial fibrillation, ventricular tachycardia, second- or
                  third-degree heart block, or have a history of ischemic heart disease and/or
                  chest pain.

          -  Documented FEVl less than or equal to 50% predicted tested in patients with:

               -  A prolonged history of cigarette smoking (greater than or equal to 20 pack-year
                  smoking history within the past two years).

               -  Symptoms of respiratory dysfunction.

          -  Clinically significant patient history which in the judgment of the Principal
             Investigator (PI) would compromise the patients ability to tolerate high-dose
             aldesleukin.

          -  Patients who are receiving any other investigational agents.
      
Maximum Eligible Age:70 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Response rate
Time Frame:6 and 12 weeks after cell infusion, then every 3 months x3, then every 6 months x 2 years, then per PI discretion
Safety Issue:
Description:Percentage of patients who have a clinical response to treatment (objective tumor regression)

Secondary Outcome Measures

Measure:Phenotypic and functional characteristics of PBL
Time Frame:2-4 years post cell infusion
Safety Issue:
Description:Patient PBL will be obtained from whole blood and then evaluated for function and phenotype
Measure:Safety and tolerance
Time Frame:6 weeks (+/- 2 weeks) following administration of the cell product
Safety Issue:
Description:Using standard CTCAE 5.0

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Adoptive Cell Therapy
  • Cell Therapy
  • Immunotherapy
  • Gene Therapy

Last Updated

November 21, 2019