None listed
Conditions
Brief summary
This study will test the safety, tolerability and effectiveness of an experimental treatment called “LeY CAR-T cell therapy”in treating solid tumours that carry the Lewis Y marker. Who is it for? You may be eligible to join this study if you are aged 18 years or above and have an advanced solid tumour that is positive for the Lewis Y antigen. Study details The Lewis Y antigen is a molecule that coats the surface of a cancer cell and is not usually detected by T-cells. The “LeY CAR-T cell therapy” may help the T-cells to find and destroy the cancer cells more easily. In this study, the T-cells will first be collected using a procedure called “Apheresis” that takes part before the study treatment. Apheresis collects some of the white blood cells (also called Leukocytes) including T-Cells from the blood. The collected T-cells will then be modified in the laboratory by a viral vector, to specifically target the cancer cells that have the Lewis Y marker on their surface. After T-cells have been modified, the viral vector will be separated from modified T-cells and removed. Modified T-cells can now be called CAR-T cells. The finished LeY CAR-T cells will then be infused back into the body, without the viral vector. As well as the LeY CAR-T cell therapy, patients will receive by lymphodepleting conditioning chemotherapy as intravenous fludarabine and cyclophosphamide for 3 consecutive days prior to cell infusion to increase immunosuppression and improve persistence of engineered T-cells. LeY CAR-T cell therapy is an experimental treatment. This means that it is not an approved treatment for LeY expressing solid tumours in Australia.
Interventions
The study treatment consists in a single intravenous infusion of autologous peripheral blood T-lymphocytes transduced with the anti-LeY-scFv-CD28-zeta vector.
The study involves initial pre-screening of tumour tissue for Lewis Y expression to assess patient eligibility for the study protocol. If eligible, the patient will undergo leukapheresis as soon as possible, followed by lymphodepleting conditioning chemotherapy and then infusion of LeY CAR T cells. Patients will then have follow up for ass
The study treatment consists in a single intravenous infusion of autologous peripheral blood T-lymphocytes transduced with the anti-LeY-scFv-CD28-zeta vector. The study involves initial pre-screening of tumour tissue for Lewis Y expression to assess patient eligibility for the study protocol. If eligible, the patient will undergo leukapheresis as soon as possible, followed by lymphodepleting conditioning chemotherapy and then infusion of LeY CAR T cells. Patients will then have follow up for assessment and management of adverse events and evaluation of response. ## Leukapheresis (not less than 12 days from Infusion). Venous access is required for leukapheresis and should be determined according to institutional practice. For the MNC collection an initial apheresis cycle is to be performed to obtain sufficient quantity of PBMCs to generate LeY CAR T cells. If there is an insufficient yield of PBMC following the apheresis, initiation of the cell culture will not proceed. However, the patient may undergo further apheresis procedures. If a sufficient number of PBMC cannot be achieved with a maximum of five collections, the patient may be withdrawn from the study.The turnaround time for the transduction and manufacture of the T cells is 12 days. ## Lymphodepleting conditioning chemotherapy (within 7 days from Infusion) this is not standard of care. To increase immunosuppression and improve persistence of engineered T-cells, patients will receive fludarabine and cyclophosphamide before re-infusion of the transduced T-cells. Upon notification from the sponsor that LeY CAR T cells will be available, Lymphodepleting conditioning chemotherapy should be initiated so as to finish at least 48 hours prior to LeY CAR T cells administration. Patients will receive intravenous fludarabine (25 mg/m2 per day) and Cyclophosphamide (300mg/m2 per day) for 3 consecutive days prior to cell infusion (Note: Lymphodepleting conditioning chemotherapy was previously fludarabine alone for 2 days upto the end of cohort dose #2, ie, patient #06, but was subsequently amended in the study protocol to enable improved cell expansion). Chemotherapy should be started within 7 days of re-infusion of the T-cell product (day 0). Alternative lymphodepleting schedules may be investigated in discussion with the Data Safety Management Committee (DSMC). ## Re-Infusion of LeY CAR T cell(Day0) After the date of infusion of the LeY CAR T cells has been determined, generation of the LeY CAR T-cell product will proceed. LeY CAR T cells are an autologous cellular immunotherapy product containing T cells that have undergone ex vivo activation, gene modification, expansion and formulation in re-infusion medium (normal saline with 5% Albumex 20). LeY CAR T cells will be administered according to the dose level to which the patient is assigned.Decisions to modify the dose increments or the number of patients in each dosing cohort may be made at the discretion of the principal investigator in conjunction with the DSMC in the event of adverse events observed among any patients during dose escalation at an unexpected high incidence or severity. It may also be possible to explore additional dose levels. ##Concomitant treatment will consist of prophylaxis of hypersensitivity reactions to the infusion of the T-cell product by intake of 10 mg of loratadine (oral tablets) or Phenergan (25mg oral or IV) and 1g of paracetamol (oral tablets) 30 minutes prior to the infusion. Whether loratadine or phenergen is administered will be in the the opinion of the treating physician. Only one patient can be treated with the T cell product at any given time point during the dose escalation. No additional patients can progress to T cell infusion until the current patient is 2 or more weeks post infusion during the dose escalation phase. Initially 3 patients will be enrolled into a cohort, starting at dose level cohort 1. #If 0/3 patients report a DLT within the observation period (28 days following infusion of LeY CAR T cells) then 3 patients will be enrolled at one dose level above. If current dose is dose level -1 or dose level 4 then a further 3 patients will be enrolled at the current dose level. # If 1/3 patients report a DLT within the observation period then a further 3 patients will be enrolled at the current dose level. #If 1/6 patients report a DLT within the observation period: - If current dose level was a dose reduction or if it is dose level 4 then the current dose level will be declared the Maximum Tolerated Dose (MTD). - If current dose level was not a dose reduction nor is dose level 4 then 3 patients will be enrolled at one dose level above #If greater than or equal to 2/6 patients report a DLT within the observation period: - If current dose level is dose level -1, the trial will be stopped - If 6 patients were treated at one dose level below, declare one dose below as MTD. - If 0 or 3 patients were enrolled one dose level below, then three patients will be enrolled at one dose level below. If greater than or equal to 2/3 patients report a DLT within the observation period: -If current dose level is dose level -1, the trial will be stopped - If 6 patients were treated at one dose level below, declare one dose below as MTD. -If 0 or 3 patients were enrolled one dose level below, then three patients will be enrolled at one dose level below. Target dose level -1 if needed 1x10e8 cohort 1: 1.2 - 2 x10e8 LeY CAR T cells infused cohort 2: 3 - 5 x 10e8 LeY CAR T cells infused cohort 3: 0.6 -1 x 10e9 LeY CAR T cells infused cohort 4: 3 - 5 x 10e9 LeY CAR T cells infused
Sponsors
Peter MacCallum Cancer Center
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1-Patients with an advanced solid tumour (defined as incurable locally advanced or metastatic disease and excluding any haematologic malignancy). Tumour is positive for Lewis Y expression by immunohistochemistry - defined as a staining of 'greater than or equal to'10 % of tumour cells positive for LeY expression. For the purposes of tumour screening, where possible the most recently available tumour sample should be utilised. A new biopsy is not mandatory where archival tissue is available, but may be considered. 2-Patient is 'greater than or equal to'18 years of age. 3-Patient has an ECOG performance status of 0 – 1 4-Patient has provided written confirmation of informed consent on participant information and consent form 5-Life expectancy of 'greater than or equal to' 12 weeks 6-Patient has adequate organ function satisfying all of the following: -Liver: bilirubin <1.5x upper limit of normal (ULN) unless patient has known Gilbert’s syndrome; -AST/ALT :2.5 x ULN except in patients with known liver metastases where AST/ALT equal to 5.0 - Kidney: either serum creatinine <1.5x ULN or creatinine clearance > 50ml/min. Creatinine clearance is either derived using the Cockcroft-Gault formula or may be measured by 24-h urine collection or nuclear medicine assessment. -Lung: Adequate pulmonary function defined by SaO2 >91% on room air and grade I dyspnoea. -Cardiac: LVEF 40% as confirmed by echocardiogram or multiple uptake gated acquisition (MUGA) -Adequate bone marrow reserve as defined as: - Absolute neutrophil count (ANC) 1.0 x 10e9/L - Absolute lymphocyte count 0.5 x 10e9/L - Platelets 100 x 10e9/L - Haemoglobin >80g/L - WCC <30 x 10e9/L 7-Patient is deemed capable and willing to undergo the planned study procedures in the view of the principal investigator. 8-Patient is able to undergo apheresis of PBMC within 14 days following registration. 9-Women of childbearing potential (defined as all women physiologically capable of becoming pregnant) and all male participants must agree to use highly effective methods of contraception for one year following LeY CAR T therapy. 10-Patient has measurable disease as per RECIST 1.1
Exclusion criteria
1. Patients with known active central nervous system (CNS) involvement by malignancy. Patients with previous treated and/or neurologically stable disease will be eligible. 2. Prior chimeric antigen receptor T (CART) cell therapy 3. Patient has been given chemotherapy and/or G-CSF in the last 4 weeks or is planned to receive such therapy prior to apheresis of PBMC. Patients can only receive cytotoxic drugs as per the schedule of treatment for this protocol. 4. Patient has had immunosuppressive therapy within the last 4 weeks. Therapeutic doses of steroids (defined as > 20 mg/day of Prednisolone (or equivalent) must be able to be stopped > 7 days prior to leukapheresis and 72 hours prior to LeY CART cell infusion Physiologic doses of steroid (e.g. Prednisolone <10mg or equivalent), topical and inhaled steroids are permitted. 5. Patient who are eligible for potentially curative therapy 6. Uncontrolled active or latent Hepatitis B or active Hepatitis C or HIV 7. Patients with uncontrolled systemic fungal, bacterial, viral or other infection despite appropriate antibiotics. 8. History or presence of active clinically relevant CNS pathology such as epilepsy, aphasia, severe brain injury, dementia, Parkinson’s disease, cerebellar disease or psychosis. 9. Radiation therapy within 2 weeks prior to registration 10. Patient has an active haematologic malignancy (any lymphoma, leukaemia, multiple myeloma or myelodysplastic syndrome) 11. Patient has a history of significant pulmonary disease (including radiation pneumonitis) or known, biopsy proven autoimmune inflammatory disease of the gastrointestinal tract. 12. Unstable angina or myocardial infarct within 6 months prior to screening. 13. Patient has known clinically significant autoimmune disease with positive serology for RHF (>20kU/L) or ANA (titre >1:40). 14. Women of child bearing potential who are unwilling or unable to use an effective method of contraception to avoid pregnancy for the entire study period and for at least 12 months after completion of study treatment. 15. Women who are pregnant or breastfeeding. 16. Men who are unwilling or unable to use an acceptable method of contraception for the entire study period and for at least 12 months after completion of study treatment if their sexual partners are WOCBP. 17. Patient has a serious uncontrolled medical disorder, psychological or social factors that which would impair the ability to receive protocol therapy and follow up.
Outcome results
None listed