Description:
This phase I trial studies the side effects and best dose of chimeric antigen receptor (CAR)
T cells with a chlorotoxin tumor-targeting domain in treating patients with MPP2+
glioblastoma that has come back (recurrent) or that is growing, spreading, or getting worse
(progressive). Vaccines made from a gene-modified virus may help the body build an effective
immune response to kill tumor cells.
Title
- Brief Title: Chimeric Antigen Receptor (CAR) T Cells With a Chlorotoxin Tumor-Targeting Domain for the Treatment of MPP2+ Recurrent or Progressive Glioblastoma
- Official Title: A Phase 1 Study to Evaluate Chimeric Antigen Receptor (CAR) T Cells With a Chlorotoxin Tumor-Targeting Domain for Patients With MMP2+ Recurrent or Progressive Glioblastoma
Clinical Trial IDs
- ORG STUDY ID:
19309
- SECONDARY ID:
NCI-2019-08393
- SECONDARY ID:
19309
- NCT ID:
NCT04214392
Conditions
- Recurrent Glioblastoma
- Recurrent Malignant Glioma
- Recurrent WHO Grade II Glioma
- Recurrent WHO Grade III Glioma
Interventions
Drug | Synonyms | Arms |
---|
Chlorotoxin (EQ)-CD28-CD3zeta-CD19t-expressing CAR T-lymphocytes | Chlorotoxin-CD28-CD3z-CD19t-expressing CAR T-cells | Treatment (CAR T cell therapy) |
Purpose
This phase I trial studies the side effects and best dose of chimeric antigen receptor (CAR)
T cells with a chlorotoxin tumor-targeting domain in treating patients with MPP2+
glioblastoma that has come back (recurrent) or that is growing, spreading, or getting worse
(progressive). Vaccines made from a gene-modified virus may help the body build an effective
immune response to kill tumor cells.
Detailed Description
PRIMARY OBJECTIVES:
I. Assess the feasibility and safety of dual delivery of chlorotoxin
(EQ)-CD28-CD3zeta-CD19t-expressing CAR T-lymphocytes NCI SYs (chlorotoxin [CLTX]-CAR T cells)
for participants with MMP2+ recurrent or progressive glioblastoma.
II. Determine the maximum tolerated dose schedule (MTD) and a recommended phase 2 dosing plan
(RP2D) for dual delivery of CLTX-CAR T cells for participants with MMP2+ recurrent or
progressive glioblastoma.
SECONDARY OBJECTIVES:
I. Describe persistence, expansion, and phenotype of endogenous and CLTX-CAR CAR T cells in
tumor cyst fluid (TCF), peripheral blood (PB), and cerebrospinal fluid (CSF).
II. Describe cytokine levels in PB, TCF, and CSF over the study period.
III. In research participants who receive the full schedule of 3 cycles of CLTX-CAR T cells:
IIIa. Estimate the six month progression free survival (PFS) rate. IIIb. Estimate the nine
month overall survival (OS) rate. IIIc. Estimate disease response rates. IIId. Estimate
median overall survival (OS).
IV. In study participants who undergo an additional biopsy/resection or autopsy:
IVa. Evaluate CAR T cell persistence in the tumor tissue and the location of the CAR T cells
with respect to the injection site.
IVb. Evaluate CLTX-targeted antigen expression levels on tumor tissue pre and post CAR T cell
therapy.
V. Use mathematical modeling of tumor growth to evaluate benefit of treatment.
OUTLINE: This is a dose-escalation study.
Patients receive chlorotoxin (EQ)-CD28-CD3zeta-CD19t-expressing CAR T-lymphocytes NCI SYs via
dual delivery starting on day 0 for 3 weekly cycles over 28 days. Each treatment cycle begins
with one or two CAR T cell infusions (one at each catheter site) and lasts for 1 week.
Beginning 1 week after cycle 3, patients may continue with CAR T treatment per principal
investigator and patient discretion. Treatment continues in the absence of disease
progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 30 days, 3, 6, 9, and 12
months, and then yearly for up to 15 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (CAR T cell therapy) | Experimental | Patients receive chlorotoxin (EQ)-CD28-CD3zeta-CD19t-expressing CAR T-lymphocytes NCI SYs via dual delivery starting on day 0 for 3 weekly cycles over 28 days. Each treatment cycle begins with one or two CAR T cell infusions (one at each catheter site) and lasts for 1 week. Beginning 1 week after cycle 3, patients may continue with CAR T treatment per principal investigator and patient discretion. Treatment continues in the absence of disease progression or unacceptable toxicity. | - Chlorotoxin (EQ)-CD28-CD3zeta-CD19t-expressing CAR T-lymphocytes
|
Eligibility Criteria
Inclusion Criteria:
- Documented informed consent of the participant and/or legally authorized
representative. Assent, when appropriate, will be obtained per institutional
guidelines
- Agreement to allow the use of archival tissue from diagnostic tumor biopsies. If
unavailable, exceptions may be granted with study principal investigator (PI) approval
- Karnofsky performance status (KPS) >= 60%
- Eastern Cooperative Oncology Group (ECOG) =< 2
- Life expectancy >= 4 weeks
- Participant has a prior histologically-confirmed diagnosis of a grade IV glioblastoma,
or has a prior histologically-confirmed diagnosis of a grade II or III malignant
glioma and now has radiographic progression consistent with a grade IV glioblastoma
- Relapsed disease: radiographic evidence of recurrence/progression of measurable
disease after standard therapy, and >= 12 weeks after completion of front-line
radiation therapy
- City of Hope (COH) Clinical Pathology confirms matrix metalloproteinase (MMP)2+ tumor
expression by immunohistochemistry (>= 20% moderate/high MMP2 [2+/3+])
- White blood cell (WBC) > 2000 /dl (or absolute neutrophil count [ANC] >= 1,000/mm^3)
(to be performed within 14 days prior to leukapheresis unless otherwise stated)
- Platelets >= 75,000/mm^3 (to be performed within 14 days prior to leukapheresis unless
otherwise stated)
- Hemoglobin >= 8 g/dl (to be performed within 14 days prior to leukapheresis unless
otherwise stated)
- Total bilirubin =< 1.5 upper limit of normal (ULN) (to be performed within 14 days
prior to leukapheresis unless otherwise stated)
- Aspartate aminotransferase (AST) =< 2.5 x ULN (to be performed within 14 days prior to
leukapheresis unless otherwise stated)
- Alanine aminotransferase (ALT) =< 2.5 x ULN (to be performed within 14 days prior to
leukapheresis unless otherwise stated)
- Serum creatinine =< 1.6 mg/dL (to be performed within 14 days prior to leukapheresis
unless otherwise stated)
- Oxygen (O2) saturation >= 95% on room air (to be performed within 14 days prior to
leukapheresis unless otherwise stated)
- Seronegative for human immunodeficiency virus (HIV) antigen (Ag)/antibody (Ab) combo
(to be performed within 14 days prior to leukapheresis unless otherwise stated)
- Women of childbearing potential (WOCBP): negative urine or serum pregnancy test (to be
performed within 14 days prior to leukapheresis unless otherwise stated)
- If the urine test is positive or cannot be confirmed as negative, a serum
pregnancy test will be required
- Agreement by females and males of childbearing potential* to use an effective method
of birth control or abstain from heterosexual activity for the course of the study
through at least 3 months after the last dose of CAR T cells
- Childbearing potential defined as not being surgically sterilized (men and women)
or have not been free from menses for > 1 year (women only)
Exclusion Criteria:
- Owing to higher frequency of wound-related complications, participants who have had
prior bevacizumab therapy are excluded
- Participant has not yet recovered from toxicities of prior therapy
- Uncontrolled seizure activity and/or clinically evident progressive encephalopathy
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to study agent
- Active diarrhea
- Clinically significant uncontrolled illness
- Active infection requiring antibiotics
- Known history of immunodeficiency virus (HIV) or hepatitis B or hepatitis C infection
- Other active malignancy
- Females only: Pregnant or breastfeeding
- Any other condition that would, in the investigator's judgment, contraindicate the
subject's participation in the clinical study due to safety concerns with clinical
study procedures
- Prospective participants who, in the opinion of the investigator, may not be able to
comply with all study procedures (including compliance issues related to
feasibility/logistics)
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose limiting toxicity (DLT) |
Time Frame: | 28 days |
Safety Issue: | |
Description: | Will be assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 5.0). Rate and associated 90% Clopper and Pearson binomial confidence limits (90% confidence interval) will be estimated for participants experiencing DLTs at the recommended phase 2 dose schedule. Tables will be created to summarize all toxicities and side effects by dose, time post treatment, organ, severity, and arm. |
Secondary Outcome Measures
Measure: | Chimeric antigen receptor (CAR) T cell |
Time Frame: | 15 years |
Safety Issue: | |
Description: | Will assess its levels and phenotype detected in tumor cyst fluid (TCF), peripheral blood (PB), and cerebrospinal fluid (CSF) (absolute number per ul by flowcytometry). Statistical and graphical methods will be used. |
Measure: | Endogenous T cell |
Time Frame: | 15 years |
Safety Issue: | |
Description: | Will assess its level and phenotype detected in TCF, PB, and CSF (absolute number per ul by flowcytometry). Statistical and graphical methods will be used. |
Measure: | Cytokine levels in TCF, PB and CSF |
Time Frame: | 15 years |
Safety Issue: | |
Description: | |
Measure: | Progression free survival time |
Time Frame: | At 6 months |
Safety Issue: | |
Description: | |
Measure: | Disease response |
Time Frame: | At 6 months |
Safety Issue: | |
Description: | Will be assessed by modified Response Assessment in Neuro-Oncology Criteria (RANO) criteria with the need for bevacizumab as an additional indicator of progression. |
Measure: | Overall survival (OS) |
Time Frame: | At 9 months |
Safety Issue: | |
Description: | Kaplan Meier methods will be used to estimate median OS and graph the results. |
Measure: | CAR T cells detected in tumor tissue |
Time Frame: | 15 years |
Safety Issue: | |
Description: | Will be assessed by immunohistochemistry. |
Measure: | Chlorotoxin-targeted antigen expression levels in tumor tissue |
Time Frame: | 15 years |
Safety Issue: | |
Description: | Will assess the pathology H score. |
Measure: | Biomathematical modeling of tumor growth |
Time Frame: | 15 years |
Safety Issue: | |
Description: | Will assess perfusion and growth parameters based on serial brain magnetic resonance imaging (MRI)s. |
Details
Phase: | Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | City of Hope Medical Center |
Last Updated
June 15, 2021