Clinical Trials /

Study of E7777 Prior to Kymriah for R/R DLBCL

NCT04855253

Description:

This is a single institution Phase I study to determine the maximum tolerated dose (MTD) of E7777 when given prior to cyclophosphamide/fludarabine (CY/Flu) lymphodepletion (LD) chemotherapy and Kymriah, a commercial tisagenlecleucel product, for the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who are at a higher risk for failure of CAR-T therapy.

Related Conditions:
  • Diffuse Large B-Cell Lymphoma
  • Transformed Non-Hodgkin Lymphoma
Recruiting Status:

Recruiting

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study of E7777 Prior to Kymriah for R/R DLBCL
  • Official Title: Phase I/II Trial Using E7777 to Enhance Regulatory T-Cell Depletion Prior to Tisagenlecleucel (Kymriah) Therapy for Relapsed/Refractory Diffuse Large B-Cell Lymphoma (DLBCL)

Clinical Trial IDs

  • ORG STUDY ID: 2020LS100
  • SECONDARY ID: MT2020-27
  • NCT ID: NCT04855253

Conditions

  • DLBCL
  • Diffuse Large B Cell Lymphoma
  • High-grade B-cell Lymphoma
  • DLBCL Arising From Follicular Lymphoma

Interventions

DrugSynonymsArms
E7777Dose level 1 : E7777 at 5 mcg/kg

Purpose

This is a single institution Phase I study to determine the maximum tolerated dose (MTD) of E7777 when given prior to cyclophosphamide/fludarabine (CY/Flu) lymphodepletion (LD) chemotherapy and Kymriah, a commercial tisagenlecleucel product, for the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) who are at a higher risk for failure of CAR-T therapy.

Detailed Description

      E7777 is a recombinant fusion toxin consisting of full-length human IL-2 fused to the
      catalytic domains of diphtheria toxin. This trial is designed to augment lymphodepletion
      prior to CAR-T cells by administration of a targeted immunotoxin against CD25-expressing
      T-cells. CD25 is expressed at high levels on Tregs but also on activated effector T cells.
      The use of the CAR-T cell product and associated apheresis and LD chemotherapy is considered
      standard of care (SOC).
    

Trial Arms

NameTypeDescriptionInterventions
Dose level 1 : E7777 at 5 mcg/kgExperimentalSingle dose of E7777 given on Day -7 two days prior to the start of lymphodepleting chemotherapy
  • E7777
Dose level 1 : E7777 at 7 mcg/kgExperimentalSingle dose of E7777 given on Day -7 two days prior to the start of lymphodepleting chemotherapy
  • E7777
Dose level 1 : E7777 at 9 mcg/kgExperimentalSingle dose of E7777 given on Day -7 two days prior to the start of lymphodepleting chemotherapy
  • E7777
MTD from phase 1ExperimentalSingle dose of E7777 (Maximum tolerated dose level identified in phase 1) given on Day -7 two days prior to the start of lymphodepleting chemotherapy
  • E7777

Eligibility Criteria

        Inclusion Criteria:

          -  Diagnosis of a relapse or refractory (r/r) large B cell lymphoma, for which treatment
             with Kymriah is planned, including:

               -  diffuse large B-cell lymphoma (DLBCL) not otherwise specified,

               -  high grade B-cell lymphoma

               -  DLBCL arising from follicular lymphoma

          -  Considered at high risk for progression after CAR-T therapy by meeting one or more of
             the following factors:

               -  refractory to last line of therapy

               -  myc over expression >40% in any prior biopsy

               -  ≥2 sites of extranodal disease

          -  Received two or more lines of systemic therapy

          -  Has secured insurance coverage for Kymriah administration either in the outpatient or
             inpatient setting.

          -  Age 18 years or older at the time of signing consent.

          -  ECOG performance status of 0, 1, or 2

          -  Adequate bone marrow reserve defined as:

               -  Absolute neutrophil count (ANC) > 1,000/mm^3

               -  Platelets ≥ 50,000/mm^3 (transfusion support can be provided)

               -  Hemoglobin >8.0 mg/dl (transfusion support can be provided) Bone marrow
                  involvement at disease assessment is an exclusion as these patients are at an
                  increased risk of severe CRS and/or neurotoxicity

          -  Adequate organ function at enrollment and within 14 days of planned E7777 treatment
             including:

               -  renal function: eGFR ≥ 50 mL/min/1.73 m^2

               -  liver function: ALT ≤ 3 times the upper limit of normal (ULN) for age, AST ≤ 3
                  times the ULN, total bilirubin ≤ 2.0 mg/dl with the exception of patients with
                  Gilbert syndrome; may be included if their total bilirubin is ≤ 3.0 x ULN and
                  direct bilirubin ≤ 1.5 x ULN (if liver is involved by lymphoma, the exception are
                  allowed upon approval of PI)

               -  albumin ≥ 3.0 g/dl

          -  Must have a minimum level of pulmonary reserve defined as ≤ Grade 1 dyspnea (CTCAE v5)
             and pulse oxygenation SpO2 > 91% on room air. Pulmonary function tests within 28 days
             of enrollment: >50% corrected DLCO and FEV1

          -  Hemodynamically stable and LVEF ≥ 50% confirmed by echocardiogram or MUGA

          -  Life expectancy ≥12 weeks in the opinion of the enrolling investigator as documented
             in the medical record

          -  Women of child bearing potential and sexually active males with partners of child
             bearing potential must agree to use birth control for at least 30 days after study
             treatment or at least at least 4 months after the final dose of CY, whichever is
             longer Female participants: Two forms of birth control, one of which must be a barrier
             method, for example: use of intrauterine device (IUD) or oral contraceptives, plus a
             barrier method such as a condom, diaphragm or cervical cap Male participants: If
             possible to father a child (unless a successful vasectomy with confirmed azoospermia)
             participant and female partner, must use adequate contraception

          -  Written voluntary consent prior to the performance of any research related tests or
             procedures

        Exclusion Criteria:

          -  Pregnant or breastfeeding - Females of childbearing potential must have a blood test
             or urine study within 14 days prior to study enrollment to rule out pregnancy. All
             females will be considered to be of childbearing potential unless they are
             postmenopausal (amenorrheic for at least 12 consecutive months, in the appropriate age
             group, and without other known or suspected cause) or have been sterilized surgically
             (i.e., bilateral tubal ligation, total hysterectomy, or bilateral oophorectomy, all
             with surgery at least 1 month before dosing)

          -  Known bone marrow involvement, if history of bone marrow involvement must have a BM
             biopsy to rule-out current involvement

          -  Prior allogeneic transplant

          -  Ocular disease or complaints visual acuity impairment, color or shape distortion, or
             blurred vision - potential participants are required to have an ophthalmological
             examine as part of screening

          -  Known CNS involvement by malignancy - if clinically suspicious, must be ruled-out by
             examination of cerebrospinal fluid (CSF) by flow cytometry

          -  Uncontrolled active hepatitis B or hepatitis C

          -  Active or inactive HIV infection

          -  Untreated active bacterial, viral or fungal infection (e.g. blood culture positive ≤
             72 hours prior to enrollment)

          -  History of heart failure or pulmonary edema, evidence of pleural effusion or active
             lower extremity edema

          -  Uncontrolled unstable angina and/or myocardial infarction within 3 months of
             enrollment

          -  Investigational medicinal product within the last 7 days prior to apheresis or CAR-T
             infusion
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Number of participants experiencing dose limiting toxicity events
Time Frame:28 Days Post E7777 infusion
Safety Issue:
Description:Dose Limiting Toxicity (DLT) is defined as any of the following events based on CTCAE v5 from the 1st infusion of E7777 through 21 days after the administration of tisagenlecleucel (~28 days after E7777). Grade 4 infusion related reaction (IRR) associated with E7777 Grade 4 or Grade 3 capillary leak syndrome (CLS) Grade 3 or 4 liver function test abnormality that do not resolve to <Grade 2 within 5 days Grade 3 or 4 non-hematologic toxicity event that occurs after the administration of E7777 and before lymphodepleting therapy Any adverse event that results in a delay of lymphodepleting therapy for more than 72 hours and attributed to E7777 Any Grade 5 adverse event

Secondary Outcome Measures

Measure:Number of participants experiencing adverse events
Time Frame:100 days Post E7777 infusion
Safety Issue:
Description:Number of participants experiencing adverse events related to E7777 to determine safety of the E7777
Measure:Number of participants experiencing disease free survival (DFS)
Time Frame:1 year Post E7777 infusion
Safety Issue:
Description:Number of participants experiencing disease free survival (DFS) at 1 year
Measure:Number of participants experiencing overall survival (OS)
Time Frame:1 year Post E7777 infusion
Safety Issue:
Description:Number of participants experiencing overall survival (DFS) at 1 year
Measure:Number of non-relapse mortality incidents at day 100
Time Frame:100 days Post E7777 infusion
Safety Issue:
Description:Number of participants experiencing non-relapse mortality at day 100 post E7777 infusion
Measure:Number of Grade 3 or 4 cytokine release syndrome (CRS) incidents
Time Frame:28 Days Post E7777 infusion
Safety Issue:
Description:Number of participants experiencing Grade 3 or 4 cytokine release syndrome (CRS) after tisagenlecleucel therapy.
Measure:Number of Grade 3 or 4 immune effector cell associated neurotoxicity (ICAN) syndrome incidents
Time Frame:28 Days Post E7777 infusion
Safety Issue:
Description:Number of participants experiencing Grade 3 or 4 immune effector cell associated neurotoxicity (ICAN) syndrome after tisagenlecleucel therapy.

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:Masonic Cancer Center, University of Minnesota

Last Updated

July 14, 2021