Gastrointestinal Neoplasm Clinical Trial
Official title:
A Phase I/II Trial in Patients With Metastatic Gastrointestinal Epithelial Cancer Administering Tumor-Infiltrating Lymphocytes in Which the Gene Encoding CISH Was Inactivated Using the CRISPR/Cas9 System
Verified date | September 2018 |
Source | National Institutes of Health Clinical Center (CC) |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Background:
The gene CISH can weaken immune cells called lymphocytes. It is found in all cells of the
body but it most negatively impacts lymphocytes. This study may help people with certain
cancers.Lymphocyte cells will be taken from their tumors, the CISH gene will be removed from
those cells, then the cells will be returned to the person. Researchers hope this process
will help the cells work better and fight the tumors.
Objective:
To see if cells with the CISH gene removed are safe and shrink metastatic gastrointestinal
epithelial tumors.
Eligibility:
People 18 70 years old with metastatic gastrointestinal epithelial cancer
Design:
Participants will be screened with physical exam, scans, and heart, lung, blood, and urine
tests.
Participants will have cells collected in another protocol. They must tell their doctor of
any antibiotic allergy.
The cells will be changed in a lab. Participants will stop therapy 4 6 weeks before getting
the cells back.
Participants will have leukapheresis. Blood is sent by a needle in one arm into a machine
that takes out the white blood cells. The blood is returned through a needle in the other
arm.
Participants will have an IV catheter inserted in their upper chest to receive medicines and
the cells.
Participants will stay in the hospital and:
- Have chemotherapy for 1 week
- Get the cells for about a half hour to a little over an hour
- Get a cell growth medicine about every 8 hours for up to 12 doses
- Get medicines to boost blood cells and fight side effects
- Recover for 1 3 weeks.
Participants will have 2 follow-up visits within 12 weeks of treatment, then a couple visits
each year. They will repeat screening tests.
Status | Withdrawn |
Enrollment | 0 |
Est. completion date | September 10, 2018 |
Est. primary completion date | September 10, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 70 Years |
Eligibility |
- INCLUSION CRITERIA: Inclusion Criteria to Enroll and Prepare Cells for Shipping to UMN for Processing: 1. Measurable metastatic gastrointestinal epithelial cancer with at least one lesion that is resectable for TIL generation, plus one other lesion that can be measured. 2. Confirmation of diagnosis of metastatic gastrointestinal epithelial cancer by the NCI Laboratory of Pathology. 3. Patients with 3 or fewer brain metastases that are less than 1 cm in diameter and asymptomatic are eligible. Lesions that have been treated with stereotactic radiosurgery must be clinically stable for 1 month after treatment for the patient to be eligible. Patients with surgically resected brain metastases are eligible. 4. Progressive disease following at least one first line standard therapy. 5. Age greater than or equal to 18 years and less than or equal to 70 years. 6. Clinical performance status of ECOG 0 or 1. 7. Patients of both genders must be willing to practice birth control from the time of enrollment on this study and for up to four months after treatment. 8. Serology: - Seronegative for HIV antibody. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who are HIV seropositive can have decreased immune-competence and thus may be less responsive to the experimental treatment and more susceptible to its toxicities.) - Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then patient must be tested for the presence of antigen by RT-PCR and be HCV RNA negative. - Blood sample submitted for additional testing per national blood banking standards (e.g., anti-HTLV-I/II, anti-T. cruzi, West Nile Virus NAT, anti-CMV, RPR), for purposes of proper handling and storage 9. Willing to sign a durable power of attorney. 10. Ability of subject or Legally Authorized Representative (LAR) to understand and the willingness to sign a written informed consent document 11. Subjects must be co-enrolled on protocol 03-C-0277 (Cell Harvest and Preparation for Surgery Branch Adoptive Cell Therapy Protocols). Inclusion Criteria for Eligibility to Receive Treatment 1. Women of child-bearing potential must have a negative pregnancy test because of the potentially dangerous effects of the treatment on the fetus. 2. Hematology: - Absolute neutrophil count greater than 1000/mm^3 without the support of filgrastim - WBC greater than or equal to 3000/mm^3 - Platelet count greater than or equal to 100,000/mm^3 - Hemoglobin greater than 8.0 g/dl. Subjects may be transfused to reach this cut-off. 3. Chemistry: - Serum ALT/AST less than 5.0 x ULN - Serum creatinine less than or equal to 1.6 mg/dl - Total bilirubin less than or equal to 2.0 mg/dl, except in patients with Gilbert s Syndrome, who must have a total bilirubin less than or equal to 3.0 mg/dl. 4. More than four weeks must have elapsed since any prior systemic therapy at the time the patient receives the preparative regimen, and patients toxicities must have recovered to grade 1 or less (except for toxicities such as alopecia or vitiligo). Note: Patients may have undergone minor surgical procedures within the past 3 weeks, as long as all toxicities have recovered to grade 1 or less. EXCLUSION CRITERIA: Exclusion Criteria for Eligibility to Receive Treatment 1. Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the treatment on the fetus or infant. 2. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease). 3. Concurrent opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have decreased immunecompetence may be less responsive to the experimental treatment and more susceptible to its toxicities). 4. Active systemic infections requiring anti-infective treatment, coagulation disorders or any other active major medical illnesses. 5. Concurrent systemic steroid therapy. 6. History of severe immediate hypersensitivity reaction to cyclophosphamide, fludarabine, or aldesleukin. 7. History of coronary revascularization or ischemic symptoms. 8. Documented LVEF less than or equal to 45% tested in patients: - Age greater than or equal to 65 years - With clinically significant atrial and/or ventricular arrhythmias, including but not limited to: atrial fibrillation, ventricular tachycardia, second- or third-degree heart block, or have a history of ischemic heart disease and/or chest pain. 9. Clinically significant patient history which in the judgment of the PI would compromise the patients ability to tolerate high-dose aldesleukin. 10. Documented FEV1 less than or equal to 50% predicted tested in patients with: - A prolonged history of cigarette smoking (approximately 20 packs/year within the past 2 years). - Symptoms of respiratory dysfunction 11. Patients who are receiving any other investigational agents. |
Country | Name | City | State |
---|---|---|---|
n/a |
Lead Sponsor | Collaborator |
---|---|
National Cancer Institute (NCI) |
Osborn MJ, Webber BR, Knipping F, Lonetree CL, Tennis N, DeFeo AP, McElroy AN, Starker CG, Lee C, Merkel S, Lund TC, Kelly-Spratt KS, Jensen MC, Voytas DF, von Kalle C, Schmidt M, Gabriel R, Hippen KL, Miller JS, Scharenberg AM, Tolar J, Blazar BR. Evaluation of TCR Gene Editing Achieved by TALENs, CRISPR/Cas9, and megaTAL Nucleases. Mol Ther. 2016 Mar;24(3):570-81. doi: 10.1038/mt.2015.197. Epub 2015 Oct 27. — View Citation
Palmer DC, Guittard GC, Franco Z, Crompton JG, Eil RL, Patel SJ, Ji Y, Van Panhuys N, Klebanoff CA, Sukumar M, Clever D, Chichura A, Roychoudhuri R, Varma R, Wang E, Gattinoni L, Marincola FM, Balagopalan L, Samelson LE, Restifo NP. Cish actively silences TCR signaling in CD8+ T cells to maintain tumor tolerance. J Exp Med. 2015 Nov 16;212(12):2095-113. doi: 10.1084/jem.20150304. Epub 2015 Nov 2. — View Citation
Tran E, Ahmadzadeh M, Lu YC, Gros A, Turcotte S, Robbins PF, Gartner JJ, Zheng Z, Li YF, Ray S, Wunderlich JR, Somerville RP, Rosenberg SA. Immunogenicity of somatic mutations in human gastrointestinal cancers. Science. 2015 Dec 11;350(6266):1387-90. doi: 10.1126/science.aad1253. Epub 2015 Oct 29. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Maximum tolerated cell dose (MTD) | Highest dose at which less than or equal to 1 of 6 patients experienced a DLT or the highest dose level studied if DLTs are not observed at any of the dose levels | Before progression to next higher dose level | |
Primary | Response rate | Percentage of patients who have a clinical response to treatment (objective tumor regression) | 6 and 12 weeks after cell infusion, then every 3 months x3, then every 6 months x 5 years, then per PI discretion | |
Primary | Frequency and severity of treatment-related adverse events | Aggregate of all adverse events, as well as their frequency and severity | 5 years after cell infusion | |
Secondary | Survival and persistence of CISH inactivated TIL | Assess for any long-term effects resulting from the cell administration. Samples will be batched and analyzed to check for the presence of the transferred cells. | 3, 6, and 12 months post cell administration, and then yearly for 15 years |
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