Study of B7-H3-Specific CAR T Cell Locoregional Immunotherapy for Diffuse Intrinsic Pontine Glioma/Diffuse Midline Glioma and Recurrent or Refractory Pediatric Central Nervous System Tumors

Glioma Clinical Trial

Official title:

Phase 1 Study of B7-H3-Specific CAR T Cell Locoregional Immunotherapy for Diffuse Intrinsic Pontine Glioma/Diffuse Midline Glioma and Recurrent or Refractory Pediatric Central Nervous System Tumors

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04185038
• Other study ID #: BrainChild-03
• Status: Recruiting
• Phase: Phase 1
• Start date: December 11, 2019
• Est. completion date: May 2041

Study information

• Verified date: December 2023
• Source: Seattle Children's Hospital
• Contact: Nick Vitanza, MD
• Phone: 206-987-2106
• Email: CBDCIntake[@]seattlechildrens.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is a Phase 1 study of central nervous system (CNS) locoregional adoptive therapy with autologous CD4+ and CD8+ T cells lentivirally transduced to express a B7H3-specific chimeric antigen receptor (CAR) and EGFRt. CAR T cells are delivered via an indwelling catheter into the tumor resection cavity or ventricular system in children and young adults with diffuse intrinsic pontine glioma (DIPG), diffuse midline glioma (DMG), and recurrent or refractory CNS tumors.

A child or young adult meeting all eligibility criteria, including having a CNS catheter placed into the tumor resection cavity or into their ventricular system, and meeting none of the exclusion criteria, will have their T cells collected. The T cells will then be bioengineered into a second-generation CAR T cell that targets B7H3-expressing tumor cells. Patients will be assigned to one of 3 treatment arms based on location or type of their tumor. Patients with supratentorial tumors will be assigned to Arm A, and will receive their treatment into the tumor cavity. Patients with either infratentorial or metastatic/leptomeningeal tumors will be assigned to Arm B, and will have their treatment delivered into the ventricular system. The first 3 patients enrolled onto the study must be at least 15 years of age and assigned to Arm A or Arm B. Patients with DIPG will be assigned to Arm C and have their treatment delivered into the ventricular system. The patient's newly engineered T cells will be administered via the indwelling catheter for two courses. In the first course patients in Arms A and B will receive a weekly dose of CAR T cells for three weeks, followed by a week off, an examination period, and then another course of weekly doses for three weeks. Patients in Arm C will receive a dose of CAR T cells every other week for 3 weeks, followed by a week off, an examination period, and then dosing every other week for 3 weeks. Following the two courses, patients in all Arms will undergo a series of studies including MRI to evaluate the effect of the CAR T cells and may have the opportunity to continue receiving additional courses of CAR T cells if the patient has not had adverse effects and if more of their T cells are available.

The hypothesis is that an adequate amount of B7H3-specific CAR T cells can be manufactured to complete two courses of treatment with 3 or 2 doses given on a weekly schedule followed by one week off in each course. The other hypothesis is that B7H3-specific CAR T cells can safely be administered through an indwelling CNS catheter or delivered directly into the brain via indwelling catheter to allow the T cells to directly interact with the tumor cells for each patient enrolled on the study. Secondary aims of the study will include evaluating CAR T cell distribution with the cerebrospinal fluid (CSF), the extent to which CAR T cells egress or traffic into the peripheral circulation or blood stream, and, if tissues samples from multiple timepoints are available, also evaluate disease response to B7-H3 CAR T cell locoregional therapy.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 90
• Est. completion date: May 2041
• Est. primary completion date: May 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 1 Year to 26 Years

Eligibility

Inclusion Criteria:

1. Age = 1 and = 26 years

2. Diagnosis of refractory or recurrent CNS disease for which there is no standard therapy, or diagnosis of DIPG or DMG at any time point following completion of standard therapy

3. Able to tolerate apheresis, or has apheresis product available for use in manufacturing

4. CNS reservoir catheter, such as an Ommaya or Rickham catheter

5. Life expectancy = 8 weeks

6. Lansky or Karnofsky score = 60

7. If patient does not have previously obtained apheresis product, patient must have discontinued, and recovered from acute toxic effects of, all prior chemotherapy, immunotherapy, and radiotherapy and discontinue the following prior to enrollment:

1. = 7 days post last chemotherapy/biologic therapy administration

2. 3 half lives or 30 days, whichever is shorter post last dose of anti-tumor antibody therapy

3. Must be at least 30 days from most recent cellular infusion

4. All systemically administered corticosteroid treatment therapy must be stable or decreasing within 1 week prior to enrollment with maximum dexamethasone dose of 2.5 mg/m2/day. Corticosteroid physiologic replacement therapy is allowed.

8. Adequate organ function

9. Adequate laboratory values

10. Patients of childbearing/fathering potential must agree to use highly effective contraception

Exclusion Criteria:

1. Presence of Grade = 3 cardiac dysfunction or symptomatic arrhythmia requiring intervention

2. Presence of primary immunodeficiency/bone marrow failure syndrome

3. Presence of clinical and/or radiographic evidence of impending herniation

4. Presence of >Grade 3 dysphagia

5. Presence of active malignancy other than the primary CNS tumor under study

6. Presence of active severe infection

7. Receiving any anti-cancer agents or chemotherapy

8. Pregnant or breastfeeding

9. Subject and/or authorized legal representative unwilling or unable to provide consent/assent for participation in the 15 year follow up period

10. Presence of any condition that, in the opinion of the investigator, would prohibit the patient from undergoing treatment under this protocol

Related Conditions & MeSH terms

• Atypical Teratoid/Rhabdoid Tumor
• Central Nervous System Neoplasms
• Central Nervous System Tumor
• Choroid Plexus Carcinoma
• Diffuse Intrinsic Pontine Glioma
• Diffuse Midline Glioma
• Ependymoma
• Germ Cell Tumor
• Glioma
• Medulloblastoma
• Medulloblastoma, Childhood
• Neoplasms
• Nervous System Neoplasms
• Neuroectodermal Tumors
• Neuroectodermal Tumors, Primitive
• Pinealoma
• Pineoblastoma, Childhood
• Primitive Neuroectodermal Tumor
• Rhabdoid Tumor

Intervention

Biological:
• SCRI-CARB7H3(s); B7H3-specific chimeric antigen receptor (CAR) T cel
Autologous CD4+ and CD8+ T cells lentivirally transduced to express a B7H3 specific chimeric antigen receptor (CAR) and EGFRt given via indwelling central nervous system (CNS) catheter

Locations

Country	Name	City	State
United States	Seattle Children's Hospital	Seattle	Washington

Sponsors (1)

Lead Sponsor	Collaborator
Seattle Children's Hospital

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Quantitative biomarker assessment of anti tumor CAR T cell functional activity	The presence of biomarkers of CAR T cell functional activity, such as cytokines, will be quantified via protein expression analysis in CSF. These findings will be correlated with safety determined by occurrence of adverse events, and response determined by disease evaluations via CSF cytology and MRI imaging of the CNS.	up to 6 months
Primary	Establish the safety, defined by the adverse events, of B7H3-specific CAR T cell infusions delivered by a central nervous system (CNS) catheter into the tumor resection cavity or ventricular system	The type, frequency, severity, and duration of adverse events as a result of B7H3-specific CAR T cell infusion will be summarized	up to 7 months
Primary	Establish the feasibility, defined by the ability to produce and administer CAR T cell product, of B7H3-specific CAR T cell product infusions delivered by a central nervous system (CNS) catheter into the tumor resection cavity or ventricular system	The proportion of products successfully manufactured and infused will be measured	28 days
Secondary	Assess the distribution of CNS-delivered B7H3-specific CAR T cells distribution within the cerebrospinal fluid (CSF) and peripheral blood	The trafficking of B7H3-specific CAR T cell product through the CSF by measuring remaining CAR T cells from a prior infusion at the time of each infusion and the trafficking of B7H3-specific CAR T cells from the CSF into the peripheral blood will be evaluated.	up to 6 months
Secondary	Assessment of disease response of B7H3-expressing DIPG and DMG tumors to B7H3 specific CAR T cell therapy delivered into the CNS	The response of DIPG and DMG tumors to B7H3-specific CAR T cell therapy delivered into the CNS will be determined by evaluating CSF for tumor cells and by CNS imaging with MRIs	up to 6 months
Secondary	Assessment of disease response of B7H3-expressing refractory or recurrent central nervous system (CNS) tumors to B7H3 specific CAR T cell therapy delivered into the tumor cavity or into the CNS	The response of refractory or recurrent CNS tumors to B7H3-specific CAR T cell therapy delivered into the tumor cavity or into the CNS will be determined by evaluating CSF for tumor cells and by CNS imaging with MRIs	up to 6 months