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Phase I Study of Cellular Immunotherapy for Recurrent/Refractory Malignant Glioma Using Intratumoral Infusions of GRm13Z40-2, An Allogeneic CD8+ Cytolitic T-Cell Line Genetically Modified to Express the IL 13-Zetakine and HyTK and to be Resistant to Glucocorticoids, in Combination With Interleukin-2

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
City of Hope Medical Center
ClinicalTrials.gov Identifier:
NCT01082926
First received: March 5, 2010
Last updated: October 17, 2013
Last verified: October 2013
  Purpose

RATIONALE: Biological therapies, such as cellular adoptive immunotherapy, may stimulate the immune system in different ways and stop tumor cells from growing. Donor T cells that are treated in the laboratory may be effective treatment for malignant glioma. Aldesleukin may stimulate the white blood cells to kill tumor cells. Combining different types of biological therapies may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best way to give therapeutic donor lymphocytes together with aldesleukin in treating patients with stage III or stage IV malignant glioma.


Condition Intervention Phase
Anaplastic Astrocytoma
Anaplastic Ependymoma
Anaplastic Meningioma
Anaplastic Oligodendroglioma
Brain Stem Glioma
Ependymoblastoma
Giant Cell Glioblastoma
Glioblastoma
Gliosarcoma
Grade III Meningioma
Meningeal Hemangiopericytoma
Mixed Glioma
Pineal Gland Astrocytoma
Brain Tumor
Biological: therapeutic allogeneic lymphocytes
Biological: aldesleukin
Other: laboratory biomarker analysis
Procedure: positron emission tomography
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I Study of Cellular Immunotherapy for Recurrent/Refractory Malignant Glioma Using Intratumoral Infusions of GRm13Z40-2, An Allogeneic CD8+ Cytolitic T-Cell Line Genetically Modified to Express the IL 13-Zetakine and HyTK and to be Resistant to Glucocorticoids, in Combination With Interleukin-2

Resource links provided by NLM:


Further study details as provided by City of Hope Medical Center:

Primary Outcome Measures:
  • Safety of GRm13Z40-2 CTL CNS loco-regional cellular immunotherapy [ Time Frame: Daily for first 2 weeks, weekly for month 1, every other week for month 2 , monthly for 6 months ] [ Designated as safety issue: Yes ]
  • Safety of convection enhanced delivery (CED) of recombinant human Interleukin-2 (rhuIL-2) used in conjunction with GRm13Z40-2 CTL adoptive transfer [ Time Frame: Weeks 1 and 2 ] [ Designated as safety issue: Yes ]
  • Toxicity as assessed by NCI CTCAE version 4.0 [ Time Frame: During treatment and up to 21 days after the last GRm13Z40-2 or CED rhuIL-2 infusion ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Ability of 9-(4-fluoro-3-hydroxy-methyl-butyl) guanine (18FHBG) positron emission tomography PET to image GRm13Z40-2 CTLs [ Time Frame: Prior to immunotherapy and 3 weeks post immunotherapy ] [ Designated as safety issue: No ]
  • Impact of concurrent dexamethasone on the tempo and magnitude of T cell allograft rejection responses by tracking the frequency of anti-GRm13Z40-2 immune responses in serially acquired peripheral blood samples [ Time Frame: Post infusion day 1, weeks 2-4 and week 8 ] [ Designated as safety issue: No ]
  • Evaluation of ganciclovir administration for ablating transferred GRm13Z40-2 in vivo should significant graft-mediated toxicities be encountered [ Time Frame: When/if grade 3 or 4 toxicity occurs ] [ Designated as safety issue: No ]

Enrollment: 6
Study Start Date: May 2010
Primary Completion Date: September 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I
Patients receive intratumoral GRm13Z40-2 therapeutic allogeneic lymphocytes over 10 minutes on days 1 and 3 and intratumoral aldesleukin over 3 hours on days 2-5 (days 1-5 in week 2). Treatment repeats every week for 2 courses in the absence of disease progression or unacceptable toxicity.
Biological: therapeutic allogeneic lymphocytes
Given intratumorally
Other Name: ALLOLYMPH
Biological: aldesleukin
Given intratumorally
Other Names:
  • IL-2
  • interleukin II
  • Proleukin
  • recombinant human interleukin-2
  • recombinant interleukin-2
  • TCGF, interleukin
Other: laboratory biomarker analysis
Optional correlative studies
Procedure: positron emission tomography
Optional correlative studies
Other Names:
  • FDG-PET
  • PET
  • PET scan
  • tomography, emission computed

Detailed Description:

PRIMARY OBJECTIVES:

I. To assess the safety of GRm13Z40-2 CTL CNS loco-regional cellular immunotherapy in research participants with recurrent or refractory/ progressive malignant glioma (WHO Grades 3 or 4).

II. To assess the safety of convection enhanced delivery (CED) of recombinant human Interleukin-2 (rhuIL-2) used in conjunction with GRm13Z40-2 CTL adoptive transfer.

SECONDARY OBJECTIVES:

I. To investigate the ability of 9-(4-fluoro-3-hydroxy-methyl-butyl) guanine (18FHBG) positron emission tomography PET to image GRm13Z40-2 CTL's in research participants.

II. To study the impact of concurrent dexamethasone administration on the tempo and magnitude of T cell allograft rejection responses in treated research participants by tracking the frequency of anti-GRm13Z40-2 immune responses in serially acquired peripheral blood samples.

III. To evaluate ganciclovir administration for ablating transferred GRm13Z40-2 in vivo should significant graft-mediated toxicities be encountered.

OUTLINE: Patients receive GRm13Z40-2 therapeutic allogeneic lymphocytes intratumorally (IT) over 10 minutes on days 1 and 3 and aldesleukin IT over 3 hours on days 2-5 (days 1-5 in week 2). Treatment repeats every week for 2 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed annually for at least 15 years.

  Eligibility

Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histological verification of grade III or IV MG at original diagnosis
  • Radiographic evidence of progression/recurrence of the measurable disease more than 12 weeks after the end of radiation therapy
  • Expression of IL13Ralpha2 by immunohistochemistry
  • Karnofsky performance status (KPS) >= 60
  • Disease recurrence/progression in the cerebral hemisphere, which is in at least one area of enhancement amenable to biopsy after protocol enrollment in the following locations:

    • Adjacent or near previous resection cavity
    • Distant from primary location; this includes tumor spread to contralateral hemisphere, corpus callosum, thalamus, basal ganglion, or subependymal locations
  • Research participant has recovered from toxicity of prior therapies; an interval of at least 12 weeks must have elapsed since the completion of radiation therapy; at least 6 weeks since the completion of a nitrosourea-containing chemotherapy regimen; and at least 4 weeks since the completion of a non-nitrosourea-containing cytotoxic chemotherapy regimen; if a patient's most recent treatment was with a targeted agent only, and s/he has recovered from any toxicity of this targeted agent, then a waiting period of only 2 weeks is needed from the last dose and the start of study treatment, with the exception of bevacizumab where a wash out period of at least 4 weeks is required before starting study treatment
  • History of prior treatment with Temodar if no evidence of intolerance; documentation of intolerance to Temodar is not required
  • Creatinine < 1.6
  • White blood cell (WBC) >= 2,000/dl (or absolute neutrophil count [ANC] > 1,000) Platelets >= 100,000/dl unsupported by transfusion or growth factor, international normalized ratio (INR) < 1.3
  • Bilirubin < 1.5
  • Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT) < 2 X upper limits of normal
  • Female research participants of childbearing potential must not be pregnant as evidenced by a serum beta-HCG pregnancy test obtained within 7 days of enrollment
  • Research participants having reproductive potential must agree to use effective contraception during participation on this protocol
  • In the opinion of the neurosurgeon, research participant requires on-going dexamethasone therapy

Exclusion Criteria:

  • Survival expectation less than 4 weeks
  • Pulmonary- Requirement for supplemental oxygen use that is not expected to resolve within 2 weeks, Cardiac- Uncontrolled cardiac arrhythmia, hypotension requiring pressor support, Renal- Dialysis dependent, Neurologic- refractory seizure disorder, clinically evident progressive encephalopathy
  • Tumors with the following characteristics:

    • Large tumor recurrence causing significant symptoms from brain shift or mass effect, and thus not requiring "decompressive" craniotomy
    • Tumors located primarily in the basal ganglion or thalamus
    • Tumors with significant involvement of midbrain, cerebellum, pons and medulla will be excluded due to neurological risks associated with edema exacerbation from therapy
  • Research participants with any non-malignant intercurrent illness which is either poorly controlled with currently available treatment, or which is of such severity that the investigators deem it unwise to enter the research participant on protocol shall be ineligible
  • Positive human immunodeficiency virus (HIV) serology based on testing within 4 weeks of enrollment
  • Research participants being treated for severe infection or who are recovering from major surgery are ineligible until recovery is deemed complete by the investigator
  • Failure to understand the basic elements of the protocol and/or the risks/benefits of participating in this pilot study
  • History of ganciclovir and/or magnetic resonance imaging (MRI) contrast allergy or intolerance History of intolerance to IL-2
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01082926

Locations
United States, California
City of Hope
Duarte, California, United States, 91010
Sponsors and Collaborators
City of Hope Medical Center
Investigators
Principal Investigator: Behnam Badie Beckman Research Institute
  More Information

No publications provided

Responsible Party: City of Hope Medical Center
ClinicalTrials.gov Identifier: NCT01082926     History of Changes
Other Study ID Numbers: 07082, NCI-2010-00303
Study First Received: March 5, 2010
Last Updated: October 17, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by City of Hope Medical Center:
adult anaplastic ependymoma
adult anaplastic astrocytoma
adult anaplastic meningioma
adult anaplastic oligodendroglioma
adult brain stem glioma
adult ependymoblastoma
adult giant cell glioblastoma
adult glioblastoma
adult gliosarcoma
adult grade III meningioma
adult meningeal hemangiopericytoma
adult mixed glioma
adult pineal gland astrocytoma
recurrent adult brain tumor
Los Angeles

Additional relevant MeSH terms:
Astrocytoma
Brain Neoplasms
Ependymoma
Glioblastoma
Glioma
Gliosarcoma
Hemangiopericytoma
Meningioma
Oligodendroglioma
Brain Diseases
Central Nervous System Diseases
Central Nervous System Neoplasms
Meningeal Neoplasms
Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Germ Cell and Embryonal
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Neoplasms, Neuroepithelial
Neoplasms, Vascular Tissue
Nervous System Diseases
Nervous System Neoplasms
Neuroectodermal Tumors
Aldesleukin
Glucocorticoids
Interleukin-2
Analgesics
Analgesics, Non-Narcotic
Anti-HIV Agents

ClinicalTrials.gov processed this record on November 20, 2014