Description:
The CAROUSEL Trial is a single-centre, non-randomised, open label Phase I clinical trial of
an Advanced Therapy Investigational Medicinal Product (ATIMP) in adults (age ≥16) with
relapsed/refractory Primary CNS Lymphoma.
The study will evaluate the feasibility of generating the ATIMP, the safety of administering
CD19CAR T-cell therapy and how effectively CD19CAR T-cells engraft, expand and persist
following administration in patients with relapsed/refractory primary CNS lymphoma.
Title
- Brief Title: Immunotherapy Using CAR T-cells to Target CD19 for Relapsed/Refractory CD19+ Primary CNS Lymphoma
- Official Title: Immunotherapy Using CAR T-cells to Target CD19 for Relapsed/Refractory CD19+ Primary Central Nervous System (CNS) Lymphoma
Clinical Trial IDs
- ORG STUDY ID:
UCL/126892
- NCT ID:
NCT04443829
Conditions
Interventions
| Drug | Synonyms | Arms |
|---|
| CD19CAR T-cells | | CD19CAR T-cells |
Purpose
The CAROUSEL Trial is a single-centre, non-randomised, open label Phase I clinical trial of
an Advanced Therapy Investigational Medicinal Product (ATIMP) in adults (age ≥16) with
relapsed/refractory Primary CNS Lymphoma.
The study will evaluate the feasibility of generating the ATIMP, the safety of administering
CD19CAR T-cell therapy and how effectively CD19CAR T-cells engraft, expand and persist
following administration in patients with relapsed/refractory primary CNS lymphoma.
Detailed Description
The CAROUSEL Trial is a single-centre, non-randomised, open label Phase I clinical trial of
an Advanced Therapy Investigational Medicinal Product (ATIMP) in adults (age ≥16) with
relapsed/refractory Primary CNS Lymphoma. The ATIMP for this study is cryopreserved
autologous patient-derived T-cells transduced with CD19CAR vector to generate CD19CAR
T-cells.
Patients will undergo an unstimulated leucapheresis for the generation of the ATIMP which
will take approximately 15 days to generate. During this period, patients may receive
"holding" chemotherapy as per institutional practice to maintain disease control. Patients
will receive pre-conditioning lymphodepleting (LD) chemotherapy with cyclophosphamide 60mg/kg
on Day -6, fludarabine 30mg/m2 administered over 3 days (Day -5 to Day -3) and pembrolizumab
200mg on Day -1.
All patients will be treated on Theme 1 of the study with 250 x 10^6 CD19 CAR T-cells i.v.
following LD chemotherapy as described above. Patients with response of Stable Disease (SD)
or Progressive Disease (PD) at Day 28 (or frank relapse beyond Day 28) and in the absence of
severe toxicity related to the ATIMP, will be potentially eligible for Theme 2 of the study
where they can receive Dose 2, a single dose of 25 x 10^6 CD19CAR T-cells intraventricularly
via an Ommaya reservoir following LD chemotherapy as described above.
The study will evaluate the feasibility of generating the ATIMP, the safety of administering
CD19CAR T-cell therapy and how effectively CD19CAR T-cells engraft, expand and persist
following administration in patients with relapsed/refractory primary CNS lymphoma.
Following infusion of CD19CAR T-cell therapy patients will be monitored for between 2-4 weeks
as an inpatient. Following discharge, patients will enter the interventional follow up phase
and be followed up for 2 years. Patients will be seen monthly for the first 6 months, then 6
weekly to 12 months and then 3 monthly until 2 years post CD19CAR T-cell infusion.
If patients relapse within the first 2 years post CD19CAR T-cell infusion they will come off
the interventional follow up and will be followed up annually until the end of trial is
declared.
After completing the interventional phase of the study all patients, irrespective of whether
they progressed or responded to treatment, will enter long term follow up until the end of
trial is declared.
Trial Arms
| Name | Type | Description | Interventions |
|---|
| CD19CAR T-cells | Experimental | Treatment with the ATIMP: CD19CAR T-cells | |
Eligibility Criteria
Inclusion Criteria (Registration):
1. Age ≥16
2. Patients with a diagnosis of Primary CNS Lymphoma (PCNSL) with refractory or relapsed
histologically confirmed CD19+ PCNSL following standard therapy requiring salvage in
whom alternative therapies are deemed inappropriate by their treating physician
3. Agreement to have a pregnancy test, use adequate contraception (if applicable)
4. Written informed consent
Exclusion Criteria (Registration):
1. CD19 negative disease
2. Evidence of secondary CNS lymphoma
3. Prior allogeneic haematopoietic stem cell transplant
4. Active hepatitis B, C or HIV infection
5. Oxygen saturation ≤90% on air
6. Bilirubin >2 x upper limit of normal
7. Glomerular Filtration Rate (GFR) <50ml/min
8. Women who are pregnant or breast feeding
9. Inability to tolerate leucapheresis
10. Karnofsky score <60% (ECOG 0-2 (appendix 3)
11. Known allergy to albumin or Dimethyl sulfoxide (DMSO)
12. Life expectancy <3months
13. Arrhythmias or significant cardiac disease and left ventricular ejection fraction <40%
14. Pre-existing neurological disorders (other than CNS involvement of underlying
haematological malignancy)
15. Any contraindications to PD-1 antibody Pembrolizumab
16. History of autoimmune disease (e.g. Crohn's, rheumatoid arthritis, systemic lupus)
resulting in end organ injury or requiring systemic immunosuppression/systemic disease
modifying agents within the last 24 months
17. Evidence of active pneumonitis on chest computed tomography (CT) or positron emission
tomography (PET)-CT scan at screening or history of drug-induced pneumonitis,
idiopathic pulmonary fibrosis, organising pneumonia (e.g. bronchiolitis obliterans),
or idiopathic pneumonitis. Prior radiation pneumonitis in the radiation field
(fibrosis) is allowed (if >24 weeks since the event)
18. Prior limited radiation therapy (e.g. radiation to bone metastasis for pain control)
within 4 weeks of CAR T infusion or chest/mediastinal radiation within 24 weeks of CAR
T infusion
Exclusion criteria: for CD19CAR T-cell infusion ( Dose 1/i.v. and Dose 2/intraventricular):
1. Severe intercurrent infection at the time of scheduled CD19CAR T-cell infusion
2. Requirement for supplementary oxygen or active pulmonary infiltrates at the time of
scheduled CD19CAR T-cell infusion
3. Theme 2 only: absence of grade 3 or 4 Immune Effector Cell Associated Neurotoxicity
(ICANS) following infusion of Dose 1
| Maximum Eligible Age: | N/A |
| Minimum Eligible Age: | 16 Years |
| Eligible Gender: | All |
| Healthy Volunteers: | No |
Primary Outcome Measures
| Measure: | Toxicity evaluated by the incidence of grade 3-5 toxicity causally related to the ATIMP |
| Time Frame: | 28 days |
| Safety Issue: | |
| Description: | Toxicity following CD19CAR T-cell administration as evaluated by the incidence of grade 3-5 toxicity causally related to the ATIMP |
Secondary Outcome Measures
| Measure: | Response at 1 and 3 months |
| Time Frame: | From CD19CAR T-cells infusion to 1 and 3 months |
| Safety Issue: | |
| Description: | Proportion of patients achieving a Complete Response (CR) or Partial Response (PR) at 1 and 3 months post CD19CAR T-cells infusion: Theme 1 (i.v.) and Theme 2 (intraventricular) |
| Measure: | Frequency of circulating CD19CAR T-cells in peripheral blood |
| Time Frame: | From CD19CAR T-cells infusion up to 2 years post CD19CAR T-cells infusion |
| Safety Issue: | |
| Description: | Frequency of circulating CD19CAR T-cells in peripheral blood as assessed by flow cytometry and qPCR |
| Measure: | Incidence of B-cell aplasia |
| Time Frame: | From CD19CAR T-cells infusion up to 2 years post CD19CAR T-cells infusion |
| Safety Issue: | |
| Description: | Incidence of B-cell aplasia |
| Measure: | Relapse rate at 1 and 2 years |
| Time Frame: | At 1 year and 2 years after CD19CAR T-cells infusion |
| Safety Issue: | |
| Description: | Proportion of patients who have relapsed at 1 and 2 years after CD19CAR T-cells infusion |
| Measure: | Progression Free Survival (PFS) at 1 and 2 years |
| Time Frame: | At 1 year and 2 years after CD19CAR T-cells infusion |
| Safety Issue: | |
| Description: | Progression Free Survival at 1 and 2 years after CD19CAR T-cells infusion |
| Measure: | Overall Survival (OS) at 1 and 2 years |
| Time Frame: | At 1 year and 2 years after CD19CAR T-cells infusion |
| Safety Issue: | |
| Description: | Overall Survival at 1 and 2 years after immunotherapy with CD19CAR T-cells infusion |
Details
| Phase: | Phase 1 |
| Primary Purpose: | Interventional |
| Overall Status: | Recruiting |
| Lead Sponsor: | University College, London |
Last Updated
April 30, 2021