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A Cancer Research UK Trial of Anti-GD2 T-cells (1RG-CART)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02761915
Recruitment Status : Recruiting
First Posted : May 4, 2016
Last Update Posted : October 1, 2019
Sponsor:
Information provided by (Responsible Party):
Cancer Research UK

Brief Summary:
The purpose of this first in human study is to determine the safety and feasibility of 1RG-CART therapy in patients with relapsed or refractory neuroblastoma. 1RG-CART therapy is a novel immunotherapy under investigation in which patients have their T-cells (a type of white blood cell) collected and modified in the laboratory, before they are given back to the patient. The T-cells are modified to express a chimeric antigen receptor (CAR) which targets disialoganglioside (GD2), a marker expressed on the surface of neuroblastoma cells.

Condition or disease Intervention/treatment Phase
Relapsed or Refractory Neuroblastoma Genetic: 1RG-CART/m^2 (Dose Level 1) Genetic: 1RG-CART/m^2 (Dose Level 2) Genetic: 1RG-CART/m^2 (Dose Level 3) Genetic: 1RG-CART/m^2 (Dose Level 4) Drug: Cyclophosphamide Drug: Fludarabine Genetic: 1RG-CART/m^2 (Dose Level 5) Phase 1

Detailed Description:

The purpose of this trial is to explore the feasibility of deploying autologous anti-GD2 CAR T-cells for the immunotherapy of neuroblastoma. The CAR T-cell trials employing second generation receptors and lymphodepleting conditioning regimes have produced objective clinical responses in patients with relapsed leukaemias. The current trial aims to evaluate similar CAR T-cells but directed against the antigen GD2. Neuroblastoma is well suited to this form of targeted therapy because of the homogeneous and almost universal expression of GD2 on the surface of neuroblastoma cells, and because of the poor prognosis of eligible patients.

1RG-CART will be administered intravenously. As the CAR T-cells are designed to survive and proliferate on encountering antigen, no direct relationship is anticipated between cell dose and either efficacy or toxicity. Rather, clinical benefit is more likely to be observed in those patients in whom in vivo expansion successfully occurs. A possible key determinant of expansion will be prior lymphodepletion of the patients. For this reason this trial is designed to evaluate a phased introduction of lymphodepletion in successive patient cohorts, rather than T-cell dose escalation. Only if there is insufficient expansion of T-cells following full lymphodepletion will the T-cell dose be escalated.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 27 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Cancer Research UK Phase I Trial of Anti-GD2 Chimeric Antigen Receptor (CAR) Transduced T-cells (1RG-CART) in Patients With Relapsed or Refractory Neuroblastoma
Study Start Date : February 2016
Estimated Primary Completion Date : February 2023
Estimated Study Completion Date : February 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Neuroblastoma

Arm Intervention/treatment
Dose Level 1
Patients in Dose Level1 will receive 1x10^7 1RG-CART/m^2 on Day 0 (intravenously).
Genetic: 1RG-CART/m^2 (Dose Level 1)
Patients in Dose Level1 will receive 1x10^7 1RG-CART/m^2 on Day 0 (intravenously).

Dose Level 2
Patients in Dose Level 2 will receive 300mg/m^2/day of cyclophosphamide for four days (Days -4 to -1) followed by 1x10^7 1RG-CART/m^2 on Day 0.
Genetic: 1RG-CART/m^2 (Dose Level 2)
Patients in Dose Level 2 will receive 300mg/m^2/day of cyclophosphamide for four days (Days -4 to -1) followed by 1x10^7 1RG-CART/m^2 on Day 0.

Drug: Cyclophosphamide
Dose Level 3
Patients in Dose Level 3 will receive 300mg/m^2/day of cyclophosphamide for four days (Days -7 to -4) and 25 mg/m^2/day of fludarabine for five days (Days -8 to -4), followed by 1x10^7 1RG-CART/m^2 on Day 0.
Genetic: 1RG-CART/m^2 (Dose Level 3)
Patients in Dose Level 3 will receive 300mg/m^2/day of cyclophosphamide for four days (Days -7 to -4) and 25 mg/m^2/day of fludarabine for five days (Days -8 to -4), followed by 1x10^7 1RG-CART/m^2 on Day 0.

Drug: Cyclophosphamide
Drug: Fludarabine
Dose Level 4
Patients in Dose Level 4 will receive 300mg/m^2/day of cyclophosphamide for four days (Days -7 to -4) and 25 mg/m^2/day of fludarabine for five days (Days -8 to -4), followed by 1x10^8 1RG-CART/m^2 on Day 0.
Genetic: 1RG-CART/m^2 (Dose Level 4)
Patients in Dose Level 4 will receive 300mg/m^2/day of cyclophosphamide for four days (Days -7 to -4) and 25 mg/m^2/day of fludarabine for five days (Days -8 to -4), followed by 1x10^8 1RG-CART/m^2 on Day 0.

Drug: Cyclophosphamide
Drug: Fludarabine
Dose level 5
If the required level of 1RG-CART survival is not reached, a further cohort of patients (Dose Level 5) will receive 300mg/m^2/day of cyclophosphamide for four days (Days -7 to -4) and 25 mg/m^2/day of fludarabine for five days (Days -8 to -4), followed by 5-10x10^8 1RG-CART/m^2 on Day 0 .
Drug: Cyclophosphamide
Drug: Fludarabine
Genetic: 1RG-CART/m^2 (Dose Level 5)
If the required level of 1RG-CART survival is not reached, a further cohort of patients (Dose Level 5) will receive 300mg/m^2/day of cyclophosphamide for four days (Days -7 to -4) and 25 mg/m^2/day of fludarabine for five days (Days -8 to -4), followed by 5-10x10^8 1RG-CART/m^2 on Day 0 .




Primary Outcome Measures :
  1. Feasibility of 1RG-CART therapy assessed as the percentage of patients who commence T-cell processing and are subsequently evaluable for 1RG-CART engraftment at Day 14. [ Time Frame: Upto Day 14 ]
    To evaluate the feasibility of 1RG-CART therapy in patients with relapsed or refractory neuroblastoma.

  2. Safety and tolerability of 1RG-CART therapy [ Time Frame: Up to 15 Years ]
    Assessed as the incidence, severity and causality of adverse events to 1RG-CART and/or the lymphodepleting regimen. Adverse events will be graded according to NCI CTCAE version 4.02 or a protocol specific grading system for cytokine release syndrome.

  3. 1RG-CART cell counts in peripheral blood and infiltration of 1RG-CART into tumour and bone marrow [ Time Frame: 24 Months ]
    To determine the recommended Phase II regimen for 1RG-CART therapy based on adverse event data


Secondary Outcome Measures :
  1. 1RG-CART counts in the peripheral blood [ Time Frame: Upto 24 Months ]
    To determine the extent and longevity of 1RG-CART engraftment based on numbers of transduced T-cell in the peripheral blood at a range of time points up to 24 months after administration of 1RG-CART

  2. Assessment of tumour response from baseline [ Time Frame: Baseline, Day 28, 2,4,12 and 24 months from 1RG-CART administration ]
    Assessment of tumour response from baseline according to Response Evaluation Criteria in Solid Tumours (RECIST) v1.1,

  3. Assessment of tumour response from baseline [ Time Frame: Baseline, Day 28, 2,4,12 and 24 months from 1RG-CART administration ]
    Assessment of tumour response from baseline according to 1.1,Immune-related Response Criteria (irRC)

  4. Assessment of tumour response from baseline [ Time Frame: Baseline, Day 28, 2,4,12 and 24 months from 1RG-CART administration ]
    Assessment of tumour response from baseline according to International Neuroblastoma Response Criteria (INRC)

  5. Progression free survival [ Time Frame: At 2 years (from first 1RG-CART administration). ]
  6. Overall survival [ Time Frame: At 2 years (from first 1RG-CART administration). ]


Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   1 Year and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Eligibility Criteria for Leukapheresis/Venepuncture

Inclusion Criteria:

  1. Written informed consent* for leukapheresis/venepuncture and transduction of T-cells.
  2. Suitability for leukapheresis/venepuncture defined as:

    Negative for human immunodeficiency virus (HIV), human T-cell lymphotropic virus (HTLV) 1, HTLV 2, syphilis and hepatitis B

    Minimum T-lymphocyte count of 0.25x10^9/L

  3. Relapsed or refractory neuroblastoma (the patient must have evidence of active disease even if they do not currently require active treatment).
  4. Patients must have at least one lesion that can be evaluated for response by imaging and/or diffuse bone marrow infiltration.
  5. Adequate renal function, defined as a glomerular filtration rate (GFR) ≥ 30 mL/min/1.73m^2 (corrected).
  6. Karnofsky score ≥60% if ≥16 years old or Lansky performance score of ≥60% if <16 years old

    • Informed consent from the patient"s parent or legal guardian is required for all patients under 16 years of age. Patients under 16 years of age may also provide written assent to take part in the trial.

Exclusion Criteria:

Patients should not meet (or be anticipated to meet) any of the exclusion criteria for the main trial, see criteria below

Eligibility Criteria for the Main Trial

Inclusion Criteria:

  1. Histologically proven neuroblastoma, which is relapsed or refractory to conventional treatment.
  2. Patients must have at least one lesion that can be evaluated for response by imaging and/or diffuse bone marrow infiltration.
  3. Aged ≥12 months at the time written consent is given for the dose escalation phase or aged ≥6 months at the time written consent is given for the dose expansion phase of the trial.
  4. Life expectancy of at least two months.
  5. Karnofsky score ≥60% if ≥16 years old or Lansky performance score of ≥60% if <16 years old
  6. Adequate renal function, defined as a GFR of ≥30 mL/min/1.73m^2 (corrected).
  7. Written (signed and dated) informed consent to the main trial* and be capable of co-operating with treatment and follow-up.

Exclusion Criteria:

  1. Patients who have received anti-GD2 antibody treatment within the previous 2 weeks (based on the half life of ch14.18 antibody being 1-3 days in children); patients who have received dinutuximab or other anti-GD2-directed antibody may need a longer washout period.
  2. Patients for whom rituximab is contraindicated due to severe previous hypersensitivity or any other reason.
  3. Patients must have recovered from the acute reversible effects of any previous therapy before infusion of the 1RG-CART.
  4. Current CNS involvement (including intradural meningeal involvement). Patients who previously had CNS involvement but have been surgically treated and disease free for ≥2 months are eligible.
  5. Co-existing chronic progressive neurological disease.
  6. Airway compromise by direct tumoural invasion or compression.
  7. Patients with active autoimmune disease requiring systemic treatment.
  8. Patients who are taking or likely to require high dose systemic corticosteroids or other immunosuppressive therapy (patients on steroid replacement therapy are eligible).
  9. Patients at high medical risk because of non-malignant systemic disease including active uncontrolled infection.
  10. Major surgery from which the patient has not yet recovered.
  11. Female patients who are able to become pregnant (or already pregnant or lactating). However, those patients who have a negative serum or urine pregnancy test before enrolment and agree to use two highly effective forms of contraception (oral; injected or implanted hormonal contraception and condom; have an intra-uterine device and condom; diaphragm with spermicidal gel and condom) effective at the first administration of the lymphodepleting regimen or at administration of the 1RG-CART (whichever comes first), throughout the trial and for six months afterwards are considered eligible. Note that for female patients who receive cyclophosphamide or rituximab, the contraceptive period should be extended to 12 months after cyclophosphamide/rituximab administration.
  12. Male patients with partners of child-bearing potential (unless they agree to take measures not to father children by using one form of highly effective contraception [condom plus spermicide] effective at the first administration of the lymphodepleting regimen or at administration of the 1RG-CART [whichever comes first], throughout the trial and for six months afterwards). Men with pregnant or lactating partners must be advised to use barrier method contraception (for example: condom plus spermicidal gel) to prevent exposure to the foetus or neonate.
  13. Known to be serologically positive for hepatitis B, hepatitis C or HIV.
  14. Any other condition which in the Investigator"s opinion would not make the patient a good candidate for the clinical trial.
  15. Is a participant in another clinical trial of an investigational medicinal product (CTIMP). Participation in an observational trial or in the follow-up phase of a CTIMP would be acceptable.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02761915


Contacts
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Contact: John Anderson, Prof 020 7905 2265 j.anderson@ucl.ac.uk

Locations
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United Kingdom
Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) Recruiting
London, United Kingdom, WC1N 3JH
Contact: Person       j.anderson@ucl.ac.uk   
Principal Investigator: John Anderson, Prof         
Sponsors and Collaborators
Cancer Research UK
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Responsible Party: Cancer Research UK
ClinicalTrials.gov Identifier: NCT02761915    
Other Study ID Numbers: 1RG - CART CRUKD15001
First Posted: May 4, 2016    Key Record Dates
Last Update Posted: October 1, 2019
Last Verified: September 2019
Keywords provided by Cancer Research UK:
Neuroblastoma
Immunotherapy
1RG-CART
Cyclophosphamide
Fludarabine
CAR T-cells
Anti-GD2
GD2
CAR
Chimeric Antigen Receptor
Additional relevant MeSH terms:
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Neuroblastoma
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Cyclophosphamide
Fludarabine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists