Clinical Trials /

Immunotherapy Combination: Irradiated PD-L1 CAR-NK Cells Plus Pembrolizumab Plus N-803 for Subjects With Recurrent/Metastatic Gastric or Head and Neck Cancer

NCT04847466

Description:

Background: Immunotherapy is a powerful tool in the fight against cancer. It uses the body s own immune system to fight the cancer. Unfortunately, cancer cells can find ways to escape from destruction by the body s immune system, even when immunotherapy is used. Natural killer (NK) cells are an important part of the body s immune system and can help fight cancer. In combination with immunotherapy, researchers are using engineered NK cells that recognize and kill cancer cells trying to escape destruction by the immune system. Objective: To test the effectiveness of irradiated PD-L1 CAR-NK cells, combined with pembrolizumab and N-803, in people with advanced forms of gastric or head and neck cancer. Eligibility: Adults ages 18 and older with advanced gastric or head and neck cancer who have already had standard cancer treatment. Design: Participants will be screened with a medical history and physical exam. Their symptoms and ability to do normal activities will be assessed. They will have blood and urine tests. They will have imaging scans of the chest, abdomen, and pelvis. Participants will get PD-L1 CAR-NK cells by intravenous (IV) infusion. They will get the cells once a week for 6 weeks. Then they will get the cells once every 2 weeks. Before each infusion, an IV catheter will be placed in a large arm vein for infusion of these treatments. Participants will get pembrolizumab by IV every 6 weeks. They will get N-803 under the skin every 4 weeks. Participants will get the study drugs for up to 2 years. They will have study visits every 1-2 weeks during treatment. They will have a safety visit 28 days after treatment ends. After treatment ends, participants will be contacted for follow-up every 2 months for a year. Then they will be contacted every 6 months. They will have tumor scans every 6-12 weeks until their cancer gets worse.

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Gastric Carcinoma
  • Head and Neck Squamous Cell Carcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Immunotherapy Combination: Irradiated PD-L1 CAR-NK Cells Plus Pembrolizumab Plus N-803 for Subjects With Recurrent/Metastatic Gastric or Head and Neck Cancer
  • Official Title: A Phase II Study of Immunotherapy Combination: Irradiated PD-L1 CAR-NK Cells Plus Pembrolizumab Plus N-803 for Subjects With Recurrent/Metastatic Gastric or Head and Neck Cancer

Clinical Trial IDs

  • ORG STUDY ID: 10000096
  • SECONDARY ID: 000096-C
  • NCT ID: NCT04847466

Conditions

  • Gastroesophageal Junction (GEJ) Cancers
  • Advanced HNSCC

Interventions

DrugSynonymsArms
N-8031/Arm 1
Pembrolizumab1/Arm 1
PD-L1 t-haNK1/Arm 1

Purpose

Background: Immunotherapy is a powerful tool in the fight against cancer. It uses the body s own immune system to fight the cancer. Unfortunately, cancer cells can find ways to escape from destruction by the body s immune system, even when immunotherapy is used. Natural killer (NK) cells are an important part of the body s immune system and can help fight cancer. In combination with immunotherapy, researchers are using engineered NK cells that recognize and kill cancer cells trying to escape destruction by the immune system. Objective: To test the effectiveness of irradiated PD-L1 CAR-NK cells, combined with pembrolizumab and N-803, in people with advanced forms of gastric or head and neck cancer. Eligibility: Adults ages 18 and older with advanced gastric or head and neck cancer who have already had standard cancer treatment. Design: Participants will be screened with a medical history and physical exam. Their symptoms and ability to do normal activities will be assessed. They will have blood and urine tests. They will have imaging scans of the chest, abdomen, and pelvis. Participants will get PD-L1 CAR-NK cells by intravenous (IV) infusion. They will get the cells once a week for 6 weeks. Then they will get the cells once every 2 weeks. Before each infusion, an IV catheter will be placed in a large arm vein for infusion of these treatments. Participants will get pembrolizumab by IV every 6 weeks. They will get N-803 under the skin every 4 weeks. Participants will get the study drugs for up to 2 years. They will have study visits every 1-2 weeks during treatment. They will have a safety visit 28 days after treatment ends. After treatment ends, participants will be contacted for follow-up every 2 months for a year. Then they will be contacted every 6 months. They will have tumor scans every 6-12 weeks until their cancer gets worse.

Detailed Description

      Background:

        -  Natural killer (NK) cells are an important component of an anti-tumor immune response.

        -  PD-L1 CAR-NK (PD-L1 t-haNKs) is an off the shelf, irradiated human, allogeneic, NK cell
           line that is frozen, shipped, thawed and then infused.

        -  PD-L1 CAR-NK cells have been engineered to have 3 adaptive modifications:

             -  Expression of a chimeric antigen receptor (CAR) targeting the tumor-associated
                antigen PD-L1

             -  Expression of the high-affinity variant (158V) of the human Fc >= receptor (Fc
                >=RIIIa/CD16a)

             -  An endoplasmic reticulum-retained version of the human interleukin-2 (ERIL-2)
                cytokine.

        -  To improve the safety profile, PD-L1 CAR-NK cells are irradiated, thus inhibiting
           proliferation while maintaining cytotoxicity.

        -  Irradiated PD-L1 CAR-NK cells are highly effective at lysing PD-L1 expressing tumor
           cells as well as PD-L1 null tumor cells (via expression of native NK cell receptors).

        -  Preliminary clinical data from 10 participants treated with PD-L1 CAR-NK cells
           (NCT04050709) suggest PD-L1 CAR-NK are well tolerated at a dose of 2x109 cells
           intravenous (IV) twice per week. An additional 8 participants have received irradiated
           PD-L1 CAR-NK under single patient INDs. PD-L1 CAR-NK cell treatment combined with PD-1
           blockade and cytokine therapy may synergistically activate the T-cell and NK cell arms
           of the immune system and enhance anti-tumor activity.

        -  The combination of N-803 + PD-1/PD-L1 interaction blockade has a manageable safety
           profile

      Objectives:

      Determine the clinical response rate (CR+PR) with irradiated PD-L1 CAR-NK cells in
      combination with N-803 plus pembrolizumab in participants with Head and neck squamous cell
      carcinoma and gastric/GEJ cancer.

      Eligibility:

        -  Gastric/GEJ Cancer Cohort

             -  Participants must have metastatic or unresectable locally advanced Gastric/GEJ
                cancer.

             -  Participants must have measurable disease by RECISTv1.1

             -  Participants must have completed, had disease progression on, or been ineligible to
                receive first-line systemic chemotherapy for advanced/metastatic disease.

             -  Participants with HER2 positive disease must have received HER2-targeted systemic
                therapy.

        -  Head and neck squamous cell carcinoma Cohort

             -  Participants must have metastatic or unresectable locally advanced HNSCC.

             -  Participants must have measurable disease by RECISTv1.1

             -  Participants must have received or been ineligible to receive first-line systemic
                chemotherapy and must have received systemic anti-PD-1 therapy (in the first-line
                or subsequent-line setting).

        -  Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.

        -  Men or women, Age >= 18 years

      Design:

        -  This is an open-label, single-center, phase II trial using a safety lead-in to assess
           the safety and tolerability of irradiated PD-L1 CAR-NK cells in combination with N-803
           plus pembrolizumab in participants with head and neck squamous cell carcinoma and/or
           gastric/GEJ cancer

        -  The phase II objective of this study is to determine the clinical response rate (CR+PR)
           with irradiated PD-L1 CAR-NK cells in combination with N-803 plus pembrolizumab in
           participants with head and neck squamous cell carcinoma and gastric/GEJ cancer.

        -  Cohorts 1 and 2 enroll simultaneously.

        -  Initially, up to 12 participants from Cohort 1 and/or Cohort 2 will enroll and receive 1
           dose of PD-L1 CAR-NK cell monotherapy (week -1) for PK/PD studies before starting the
           combined treatment of Pembrolizumab and N-803 one week later (week 0). PD-L1 CAR-NK
           cells (2x109) will be given intravenously every week until week 6 and then every two
           weeks from 6 weeks onward.

        -  Administration of pembrolizumab will be at the fixed dose of 400 mg intravenous every 6
           weeks starting at week 0.

        -  Administration of N-803 will be at 15mcg/kg subcutaneously every 4 weeks starting at
           week 0.

        -  Participants will receive treatments in cycles (1 week=1 cycle) consisting of 7 (+/- 2)
           days with a minimum of 5 days between treatments.

        -  It is expected that 1-2 participants per month may be enrolled on this trial; thus, an
           accrual of 50 evaluable participants is expected to be completed within 3-4 years. To
           allow for a small number of inevaluable participants, the accrual ceiling will be set at
           55 participants.
    

Trial Arms

NameTypeDescriptionInterventions
1/Arm 1Experimental1-week lead in for PD-L1 CAR NK cell monotherapy followed by combination therapy of Pembrolizumab plus N-803
  • N-803
  • Pembrolizumab
  • PD-L1 t-haNK

Eligibility Criteria

        -  INCLUSION CRITERIA:

          -  Gastric/GEJ cancer Cohort:

               -  Participants must have metastatic or unresectable locally advanced Gastric/GEJ
                  cancer that has been histologically confirmed.

               -  Participants must have measurable disease by RECISTv1.1.

               -  Participants must have received or been ineligible to receive first line systemic
                  chemotherapy for Gastric/GEJ cancer. Participants with HER2 positive disease must
                  have received HER2-targeted therapy.

          -  Head and neck squamous cell carcinoma Cohort

               -  Participants must have metastatic or unresectable locally advanced HNSCC that has
                  been histologically confirmed.

               -  Participants must have measurable disease by RECISTv1.1.

               -  Participants must have received or been ineligible to receive first-line systemic
                  chemotherapy and must have received systemic anti-PD-1 therapy (in the first-line
                  or subsequent-line setting).

          -  Age >=18 years. Because no dosing or adverse event data are currently available on the
             use of this investigation combination therapy in participants <18 years of age,
             children are excluded from this study, but will be eligible for future pediatric
             trials.

          -  ECOG performance status <2

          -  Participants must have adequate organ and marrow function as defined below:

               -  leukocytes greater than or equal to 3,000/mcL

               -  absolute neutrophil count greater than or equal to 1,500/mcL

               -  platelets greater than or equal to 100,000/mcL

               -  total bilirubin within normal institutional limits

               -  AST(SGOT)/ALT(SGPT) less than or equal to 2.5 X institutional upper limit of
                  normal

               -  creatinine Creatinine within 1.5X upper limit of normal institutional limits

          -  Participants with treated brain metastases are eligible if follow-up brain imaging
             after central nervous system (CNS)-directed therapy shows no evidence of progression.

          -  Participants with new or progressive brain metastases (active brain metastases) or
             leptomeningeal disease are eligible if the treating physician determines that
             immediate CNS specific treatment is not required and is unlikely to be required during
             the first 7 weeks of therapy.

          -  Participants with a history of hepatitis C virus (HCV) infection must have been
             treated and cured. For participants with HCV infection who are currently on treatment,
             they are eligible if they have an undetectable HCV viral load.

          -  Participants on therapeutic anticoagulation with warfarin must have an international
             normalized ratio (INR) that is within target range for their condition at the time of
             enrollment.

          -  The effects of PD-L1 t-haNKs with N-803 and pembrolizumab on the developing human
             fetus are unknown. For this reason and because these investigational agents
             teratogenicity is unknown, women of child-bearing potential and men must agree to use

        adequate contraception (hormonal or barrier method of birth control; abstinence) prior to
        study entry for the duration of study participation and for at least 4 months after last
        dose of study drug pembrolizumab.

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

        EXCLUSION CRITERIA:

          -  Participants who are receiving any other investigational agents or concurrent
             anticancer treatment. Palliative radiotherapy is allowed.

          -  Participants with concurrent use of systemic steroids (within 10 days of enrollment),
             except for physiologic doses of systemic steroid replacement or local (topical, nasal,
             intraarticular or inhaled) steroid use.

          -  Participants with active systemic autoimmune disease (e.g., lupus erythematosus,
             rheumatoid arthritis, Addison s disease, autoimmune disease associated with lymphoma,
             inflammatory bowel disease). Participants with autoimmune endocrine disorders
             controlled with medical management (e.g. thyroid disorders, type 1 diabetes, or
             adrenal insufficiency) will not be excluded

          -  Participants with a history of grade 3 or higher immune-related adverse events
             attributed to pembrolizumab or other anti-PD-1, anti-PD-L1, or anti-CTLA-4 therapy.
             This exclusion does not apply to participants with permanent endocrine insufficiencies
             (e.g. adrenal insufficiency or hypothyroidism) under satisfactory medical management.
             Additionally, participants with grade 2 adverse events attributed to these classes of
             agents will be excluded with the exception of rash, transient hyperthyroidism,
             transient liver enzyme abnormalities or other transient events that resolved without
             steroids or immunomodulatory agents.

          -  HIV or HBV infection due to unknown effect of PD-L1 targeting via a CAR or N-803 in
             these chronic viral infections.

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris,
             uncontrolled serious cardiac arrhythmia, clinically significant coagulopathy or
             psychiatric illness/social situations that would limit compliance with study
             requirements.

          -  Pregnant women are excluded from this study because PD-L1 targeting via a CAR has
             unknown potential for teratogenic or abortifacient effects. Because there is an
             unknown but potential risk for adverse events in nursing infants secondary to
             treatment of the

        mother with PD-L1 targeting via a CAR and N-803, breastfeeding should be discontinued if
        the mother is treated on this study for the duration of study participation and for at
        least 4 months after last dose of any study drug.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To determine the clinical response rate (CR+PR) with irradiated PD-L1 CAR-NK cells in combination with N-803 plus pembrolizumab in patients with head and neck squamous cell carcinoma and gastric/GEJ cancer.
Time Frame:every 6 weeks
Safety Issue:
Description:Clinical response rate (CR+PR)

Secondary Outcome Measures

Measure:To assess the progression free survival (PFS) in patients with HNSCC and/or gastric/GEJ cancer treated with irradiated PD-L1 CAR-NK cells in combination with N-803 plus pembrolizumab
Time Frame:Until progression or death
Safety Issue:
Description:The proportion of patients that have progressive disease after 18 months
Measure:To assess the safety and tolerability of irradiated PD-L1 CAR-NK cells in combination with N-803 plus pembrolizumab in patients with head and neck squamous cell carcinoma and/or gastric/GEJ cancer
Time Frame:28 days after treatment (Study Calendar-Last AE evaluation)
Safety Issue:
Description:List of adverse event frequency
Measure:To assess duration of response in patients with HNSCC and/or gastric/GEJ cancer treated with irradiated PD-L1 CAR-NK cells in combination with N-803 plus pembrolizumab
Time Frame:Until progression or death
Safety Issue:
Description:The time when the proportion of patient's tumors shrunk after therapy

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • PD-L1 t-haNK cells
  • GEJ cancer
  • Advanced HNSCC
  • Cellular Therapy
  • Keytruda

Last Updated

September 1, 2021