CMV-specific Cytotoxic T Lymphocytes Expressing CAR Targeting HER2 in Patients With GBM (HERT-GBM)

This study is currently recruiting participants. (see Contacts and Locations)
Verified August 2014 by Baylor College of Medicine
Sponsor:
Collaborators:
The Methodist Hospital System
Center for Cell and Gene Therapy, Baylor College of Medicine
Texas Children's Hospital
Information provided by (Responsible Party):
Nabil Ahmed, Baylor College of Medicine
ClinicalTrials.gov Identifier:
NCT01109095
First received: April 13, 2010
Last updated: August 22, 2014
Last verified: August 2014
  Purpose

This study is for patients that have a type of brain cancer called glioblastoma multiforme (GBM).

The body has different ways of fighting infection and disease. No single way seems perfect for fighting cancers. This research study combines two different ways of fighting cancer: antibodies and T cells. Antibodies are types of proteins that protect the body from infectious diseases and possibly cancer. T cells, also called T lymphocytes, are special infection-fighting blood cells that can kill other cells, including cells infected with viruses and tumor cells. Both antibodies and T cells have been used to treat patients with cancers. They have shown promise, but have not been strong enough to cure most patients.

The antibody used in this study is called anti-HER2 (Human Epidermal Growth Factor Receptor 2). This antibody sticks to GBM cells because of a substance on the outside of these cells called HER2. Up to 80% of GBMs are positive for HER2. HER2 antibodies have been used to treat people with HER2-positive cancers. For this study, the HER2 antibody has been changed so that instead of floating free in the blood it is now attached to T cells. When an antibody is joined to a T cell in this way it is called a chimeric receptor. These chimeric receptor-T cells seem to be able to kill tumors like GBM, but they don't last very long and so their chances of fighting the cancer are limited. Therefore, developing ways to prolong the life of these T cells should help them fight cancer.

We found that T cells work better if we also attach a protein called CD28 to the HER2 chimeric receptor (HER2-CAR). In this study we placed this HER2-CAR into T cells that were pre-selected for their ability to recognize Cytomegalovirus (CMV). This virus exists in most people. These CMV-specific cytotoxic T cells (CMV-T cells) will be more active since they will react to the virus as well as to tumor cells. These HER2-CD28 CMV-T cells are an investigational product not approved by the Food and Drug Administration.

The purpose of this study is to find the largest safe dose of HER2-CD28 CMV-T cells, to learn what the side effects are, and to see whether this therapy might help patients with GBM.


Condition Intervention Phase
Glioblastoma Multiforme (GBM)
Genetic: Genetically modified HER.CAR CMV-specific CTLs
Phase 1

Study Type: Interventional
Study Design: Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Administration of HER2 Chimeric Antigen Receptor Expressing CMV-Specific Cytotoxic T Cells Ins Patients With Glioblastoma Multiforme (HERT-GBM)

Resource links provided by NLM:


Further study details as provided by Baylor College of Medicine:

Primary Outcome Measures:
  • Number of subjects with dose limiting toxicity after CTL infusion [ Time Frame: 6 weeks ] [ Designated as safety issue: Yes ]
    To evaluate the safety of escalating doses of autologous CMV-specific cytotoxic T-lymphocytes (CTL) genetically modified to express chimeric antigen receptors (CAR) targeting the HER2 molecule in patients with HER2-positive Glioblastoma multiforme (GBM: WHO grade IV), who have recurrent or progressive disease after front line therapy.


Secondary Outcome Measures:
  • Decrease in tumor after the CTL infusion [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
    To evaluate the effects of gene modified CTL on measurable disease.

  • Area under the growth curves (AUC) over time for T cell frequencies. [ Time Frame: 15 years ] [ Designated as safety issue: No ]
    To measure the survival and function of gene modified CTL in vivo.


Estimated Enrollment: 18
Study Start Date: October 2010
Estimated Study Completion Date: October 2031
Estimated Primary Completion Date: October 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Genetically modified HER.CAR CMV-specific CTLs
Subject will be assigned a dose level at study entry.
Genetic: Genetically modified HER.CAR CMV-specific CTLs

HER2.CAR CMV-specific CTLs will be given by intravenous injection over 1-10 minutes through either a peripheral or a central line with a minimum 20g cannula. The patient will get one of the following doses:

  • 1 x 10^6/m^2
  • 3 x 10^6/m^2
  • 1 x 10^7/m^2
  • 3 x 10^7/m^2
  • 1 x 10^8/m^2

Detailed Description:

When the patient enrolls on this study, they will be assigned to a dose of HER2-CAR CMV-T cells.

The patient will be given a single injection of cells into the vein through an IV line at the assigned dose. The injection will take between 1 and 10 minutes. The patient will be followed in the clinic after the injection for 1 to 4 hours. If later the subject seems to be experiencing a benefit (confirmed by radiological studies, physical exam and/or symptoms), s/he may be able to receive up to six additional doses of the T cells if they wish. These additional infusions would be at least 6 to 12 weeks apart and at the same dose level received the first time.

Medical tests before treatment--

Before being treated, the patient will receive a series of standard medical tests as follows: Physical exam, Blood tests to measure blood cells, kidney and liver function, Routine heart function tests (Echocardiogram),Measurements of the tumor by routine imaging studies

Medical tests during and after treatment--

The patient will receive standard medical tests when getting the infusions and after:Physical exams, Blood tests to measure blood cells, kidney and liver function, Routine heart function tests (Echocardiogram) at 6 weeks after the infusion, Measurements of the tumor by routine imaging studies 6 weeks after the infusion

To learn more about the way the HER2-CAR CMV-T cells are working and how long they last in the body, blood will be taken on the day of the T-cell infusion, before, 1 hour and 4 hours after the T-cell infusion, 1, 2, 4 and 6 weeks after the T-cell infusion and every 3 months for 1 year, every 6 months for 4 years, then yearly for a total of 15 years.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

INCLUSION CRITERIA:

  • Histopathological verification of glioblastoma multiforme (GBM: WHO grade IV) with recurrent or progressive disease after front line therapy.
  • HER2 positive GBM
  • CMV seropositive
  • Normal ECHO (Left ventricular ejection fraction (LVEF) has to be with in normal, institutional limits)
  • Life expectancy 6 weeks or greater
  • Karnofsky/Lansky score 50 or greater
  • Patient or parent/guardian capable of providing informed consent
  • Bilirubin 3x or less than normal, AST 5x or less than normal, creatinine 2x normal or less for age and Hgb 9.0 g/dl or more; WBC greater than 2,000/ul; ANC greater than 1,000/ul; platelets greater than 100,000/ul
  • Pulse oximetry 90% or more on room air
  • Sexually active patients must be willing to utilize one of the more effective birth control methods for 6 months after the CTL infusion. The male partner should use a condom.
  • Available autologous HER2.CAR-transduced CMV-specific cytotoxic T lymphocytes with 15% or greater expression of HER2.CAR determined by flow-cytometry and killing of HER2-positive targets 20% or more in cytotoxicity assay.
  • Recovered from the acute toxic effects of all prior chemotherapy at least 4 weeks before entering this study. One exception is Temozolomide(TMZ), an alkylation agent used as a radiosensitizer and adjuvant chemotherapeutic agent for GBM. Due to the extremely short half life of TMZ, patients will be allowed to continue receiving it up to two days prior to cell infusion and cannot restart until six weeks after the infusion.

EXCLUSION CRITERIA:

  • Severe intercurrent infection
  • Known HIV positivity
  • Pregnant or lactating
  • History of hypersensitivity reactions to murine protein-containing products
  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: NCT01109095

Contacts
Contact: Nabil Ahmed, MD 832-824-4611 nmahmed@txch.org
Contact: Tara L. Gray 832-824-4391 taraj@bcm.edu

Locations
United States, Texas
Houston Methodist Hospital Recruiting
Houston, Texas, United States, 77030
Contact: Nabil M. Ahmed, MD    832-824-4611    nmahmed@txch.org   
Contact: Tara L. Gray    832-824-4391    taraj@bcm.edu   
Texas Children's Hospital Recruiting
Houston, Texas, United States, 77030
Contact: Nabil Ahmed, MD    832-824-4611    nmahmed@txch.org   
Contact: Tara L. Gray    832-824-4391    taraj@bcm.edu   
Sponsors and Collaborators
Baylor College of Medicine
The Methodist Hospital System
Center for Cell and Gene Therapy, Baylor College of Medicine
Texas Children's Hospital
Investigators
Principal Investigator: Nabil Ahmed, MD Baylor College of Medicine/Texas Children's Hospital
  More Information

No publications provided by Baylor College of Medicine

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Nabil Ahmed, Assistant Professor, Baylor College of Medicine
ClinicalTrials.gov Identifier: NCT01109095     History of Changes
Other Study ID Numbers: H-24487 - HERT GBM
Study First Received: April 13, 2010
Last Updated: August 22, 2014
Health Authority: United States: Institutional Review Board
United States: Food and Drug Administration

Keywords provided by Baylor College of Medicine:
Glioblastoma Multiforme (GBM)
HER2
CMV
Brain Cancer
Autologous HER2.CAR CMV-specific cytotoxic CTL
CMV-specific cytotoxic CTL

Additional relevant MeSH terms:
Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue

ClinicalTrials.gov processed this record on September 16, 2014