Gene Modified Immune Cells (IL13Ralpha2 CAR T Cells) After Conditioning Regimen for the Treatment of Stage IIIC or IV Melanoma

Breast Cancer Clinical Trial

Official title:

Phase 1 Dose Escalation Study of Systemically Administered IL13Ra2 Chimeric Antigen Receptor (CAR) T Cells After a Nonmyeloablative Conditioning Regimen in Patients With Metastatic Melanoma

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04119024
• Other study ID #: 19-001145
• Secondary ID: NCI-2019-05764
• Status: Recruiting
• Phase: Phase 1
• Start date: November 27, 2019
• Est. completion date: October 1, 2025

Study information

• Verified date: October 2023
• Source: Jonsson Comprehensive Cancer Center
• Contact: Jacob Naparstek
• Phone: 310-206-9926
• Email: JNaparstek[@]mednet.ucla.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This phase I trial studies the side effects and best dose of modified immune cells (IL13Ralpha2 CAR T cells) after a chemotherapy conditioning regimen for the treatment of patients with stage IIIC or IV melanoma. The study agent is called IL13Ralpha2 CAR T cells. T cells are a special type of white blood cell (immune cells) that have the ability to kill tumor cells. The T cells are obtained from the patients own blood, grown in a laboratory, and modified by adding the IL13Ralpha2 CAR gene. The IL13Ralpha2 CAR gene is inserted into T cells with a virus called a lentivirus. The lentivirus allows cells to make the IL13Ralpha2 CAR protein. This CAR has been designed to bind to a protein on the surface of tumor cells called IL13Ralpha2. This study is being done to determine the dose at which the gene-modified immune cells are safe, how long the cells stay in the body, and if the cells are able to attack the cancer.

Description:

PRIMARY OBJECTIVE: I. Safety. SECONDARY OBJECTIVES: I. Clinical response. II. Chimeric antigen receptor (CAR) T-cell tumor infiltration and persistence. III. Impact of IL-2 on the persistence and tumor infiltration of IL13Ralpha2 CAR T cells. EXPLORATORY OBJECTIVES: I. Cytokine release syndrome analysis. II. Evaluation of endogenous anti-tumor immune response. OUTLINE: This is a dose-escalation study of IL13Ralpha2-specific hinge-optimized 4-1BB-co-stimulatory CAR/truncated (Cluster of Differentiation 19) CD19-expressing autologous TN/MEM cells (IL13Ralpha2 CAR T cells). Patients receive cyclophosphamide intravenously (IV) over 1 hour on days -5 to -4 and fludarabine phosphate IV over 15-30 minutes on days -4 to -1. Patients then receive IL13Ralpha2 CAR T cells IV on day 0. Patients may also receive recombinant interleukin-2 subcutaneously (SC) twice daily (BID) on days 1-7. After completion of study treatment, patients are followed every 2-3 months for 2 years, every 6 months for 3 years, then every year for at least 15 years.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 24
• Est. completion date: October 1, 2025
• Est. primary completion date: October 1, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Histologically confirmed melanoma that is considered surgically incurable with either:
• Stage IIIC melanoma including locally relapsed, satellite, in-transit lesions or bulky draining node metastasis
• Stage IV melanoma
• Confirmed IL13Ralpha2 tumor expression by immunohistochemistry (>= 20%, 1+)
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
• A minimum of one measurable lesion defined as:
• Meeting the criteria for measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST), OR
• Skin lesion(s) selected as non-completely biopsied target lesion(s) that can be accurately measured and recorded by color photography with a ruler to document the size of the target lesion(s)
• Absolute neutrophil count (ANC) >= 1 x 10^9 cells/L (determined within 30?60 days prior to enrollment; re-evaluated within 14 days of beginning conditioning chemotherapy)
• Platelets >= 75 x 10^9/L (determined within 30?60 days prior to enrollment; re-evaluated within 14 days of beginning conditioning chemotherapy)
• Hemoglobin >= 8 g/dL (determined within 30?60 days prior to enrollment; re-evaluated within 14 days of beginning conditioning chemotherapy)
• Aspartate and alanine aminotransferases (AST, ALT) =< 2.5 x upper limit of normal (ULN) (determined within 30?60 days prior to enrollment; re-evaluated within 14 days of beginning conditioning chemotherapy)
• Total bilirubin =< 2 x ULN (except patients with documented Gilbert?s syndrome) (determined within 30?60 days prior to enrollment; re-evaluated within 14 days of beginning conditioning chemotherapy)
• Creatinine < 2 mg/dL (or a glomerular filtration rate > 45) (determined within 30?60 days prior to enrollment; re-evaluated within 14 days of beginning conditioning chemotherapy)
• Must have received at least one prior systemic therapy for advanced melanoma (i.e. anti-PD-1 therapy, BRAF plus MEK inhibitor therapy for BRAFV600 mutated melanoma) and is not considered to have an alternate treatment option with curative intent
• Must be willing and able to accept at least one leukapheresis procedure
• Must be willing and able to provide written informed consent

Exclusion Criteria:

• Inability to purify >= 1 x 10^7 T cells from leukapheresis product
• Previously known hypersensitivity to any of the agents used in this study; known sensitivity to cyclophosphamide or fludarabine
• Received systemic treatment for cancer, including immunotherapy, within 14 days prior to initiation of conditioning chemotherapy administration within this protocol
• Potential requirement for systemic corticosteroids or concurrent immunosuppressive drugs based on prior history or received systemic steroids within the last 2 weeks prior to enrollment (inhaled or topical steroids at standard doses are allowed)
• Human immunodeficiency virus (HIV) seropositivity or other congenital or acquired immune deficiency state, which would increase the risk of opportunistic infections and other complications during chemotherapy-induced lymphodepletion. If there is a positive result in the infectious disease testing that was not previously known, the patient will be referred to their primary physician and/or infectious disease specialist
• Hepatitis B or C seropositivity with evidence of ongoing liver damage, which would increase the likelihood of hepatic toxicities from the chemotherapy conditioning regimen and supportive treatments. If there is a positive result in the infectious disease testing that was not previously known, the patient will be referred to their primary physician and/or infectious disease specialist
• Dementia or significantly altered mental status that would prohibit the understanding or rendering of informed consent and compliance with the requirements of this protocol
• A Tiffeneau-Pinelli index < 70% of the predicted value. Subjects will be excluded if pulmonary function tests indicate they have insufficient pulmonary capability
• Patients will be excluded if they have a history of clinically significant electrocardiography (ECG) abnormalities, symptoms of cardiac ischemia or arrhythmias and have a left ventricular ejection fraction (LVEF) < 45% on a cardiac stress test (stress thallium, stress multigated acquisition scan (MUGA), dobutamine echocardiogram, or other stress test)
• Patients with ECG results of any conduction delays (PR interval > 200 ms, corrected QT (QTC) > 480 ms), sinus bradycardia (resting heart rate < 50 beats per minute), sinus tachycardia (HR>120 beats per minute) will be evaluated by a cardiologist prior to starting the trial. Patients with any arrhythmias, including atrial fibrillation/atrial flutter, excessive ectopy (defined as > 20 premature ventricular complex [PVC]s per minute), ventricular tachycardia, 3rd degree heart block will be excluded from the study unless cleared by a cardiologist
• Pregnancy or breast-feeding. Female patients must be surgically sterile or be postmenopausal for two years, or must agree to use effective contraception during the period of treatment and for 6 months afterwards. All female patients with reproductive potential must have a negative pregnancy test (serum/urine) at screening and again within 14 days from starting the conditioning chemotherapy. The definition of effective contraception will be based on the judgment of the study investigators. Patients who are breastfeeding are not allowed on this study
• A concomitant active malignancy that would be considered to interfere with the assessment of the primary or secondary endpoints of the study

Related Conditions & MeSH terms

• Acral Melanoma
• Adenocarcinoma of Lung
• Adrenocortical Carcinoma
• Breast Cancer
• Carcinoma
• Clinical Stage IV Cutaneous Melanoma AJCC v8
• Cutaneous Melanoma, Stage III
• Cutaneous Melanoma, Stage IV
• Head and Neck Squamous Cell Carcinoma
• IL13RA2 Positive
• Lung Adenocarcinoma
• Melanoma
• Metastatic Melanoma
• Neuroendocrine Tumors
• Pancreatic Neuroendocrine Tumor
• Paraganglioma
• Skin Neoplasms
• Squamous Cell Carcinoma of Head and Neck
• Thyroid Cancer
• Uveal Melanoma

Intervention

Drug:
• Cyclophosphamide
Given IV
• Fludarabine Phosphate
Given IV

Biological:
• IL13Ralpha2-specific Hinge-optimized 4-1BB-co-stimulatory CAR/Truncated CD19-expressing Autologous TN/MEM Cells
Given IV

Drug:
• Recombinant Interleukin-2
Given SC

Locations

Country	Name	City	State
United States	City of Hope Comprehensive Cancer Center	Duarte	California
United States	UCLA / Jonsson Comprehensive Cancer Center	Los Angeles	California

Sponsors (4)

Lead Sponsor	Collaborator
Jonsson Comprehensive Cancer Center	California Institute for Regenerative Medicine (CIRM), City of Hope National Medical Center, Parker Institute for Cancer Immunotherapy

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Cytokine release syndrome analysis	Plasma or serum collected from the blood at multiple time points after CAR T cell infusion will be frozen and banked; cytokine levels will be quantified in patients exhibiting any > grade-2 CRS.	Up 2 years
Other	Evaluation of an endogenous T cell anti-tumor response	The biopsies will be analyzed by hematoxylin and eosin staining (H&E), immunohistochemistry (IHC) to quantify the numbers of T lymphocytes. If sufficient quantity of tissue is available, the study investigators will attempt to monitor the phenotype of the TIL obtained from tumor biopsy samples by multicolor flow cytometry (FACS), and other immune monitoring assays.	Up 2 years
Primary	Incidence of adverse events	Safety will be reported as incidence rates for adverse events, serious adverse events, and fatal adverse events for Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 grade 3 or higher. Adverse events will be tabulated by treatment group and will include the number of patients for whom the event occurred, the rate of occurrence, and the severity and relationship to study drug.	Up to 90 days from the day of CAR-transgenic cell infusion
Primary	Dose-limiting toxicity (DLT)		Up to 90 days from the day of CAR-transgenic cell infusion
Secondary	Objective response rate	Will be recorded following the Response Evaluation Criteria in Solid Tumors (RECIST) criteria.	Up to 120 days
Secondary	Complete response		At day 60, 120, and every 2-3 months for up to 2 years
Secondary	Partial response		At day 60, 120, and every 2-3 months for up to 2 years
Secondary	Response for in-transit metastasis		Up to 2 years
Secondary	Time to disease progression		Up to 2 years
Secondary	Overall survival		From the date of CAR T cell infusion in the clinical trial until death, whether related to the trial or not, assessed up to 2 years
Secondary	IL13Ralpha2 CAR T cell persistence		At days 1, 7, 14, 30, 60, 90, and 120
Secondary	IL13Ralpha2 CAR T Cell phenotypic monitoring		Up 2 years
Secondary	Impact of IL-2 on systemic persistence of CAR T cells		Up 2 years
Secondary	Impact of IL-2 on tumor infiltration of CAR T cells		Up 2 years