Ovarian Cancer
Conditions
Keywords
Ovarian Cancer, Cell Therapy, T Cell Therapy, NY-ESO-1, Immuno-oncology, Metastatic, Previously treated, T Cell Receptor
Brief summary
This study, will take a subject's T cells and teach them to be able to recognize and attack the ovarian cancer cells. This is done by putting in a gene or genetic material that will change how a subject's T cells work and hopefully get them to attack and kill ovarian cancer cells. These new T cells are called engineered T cells because the new gene is causing them to become directed toward the ovarian cancer cells rather than their usual targets. These are also called gene-modified T cells. For subjects who have the HLA A2 tissue-type marker, the T cells would be engineered to recognize a substance called NY-ESO-1. After putting this new gene in T cells (a procedure called gene therapy) the investigators will grow the cells in the laboratory and give these cells back to subjects.
Detailed description
This is an open label clinical trial. Patients with the HLA-A201, HLA-A205, and/or HLA-A206 allele and whose tumor expresses the NY-ESO-1 tumor antigen will be eligible to receive NY-ESO-1ᶜ²⁵⁹T. The trial is conducted entirely with outpatient procedures; however, patients may be hospitalized for the cytoreductive chemotherapy at the discretion of the investigator. Upon enrollment, patients will undergo leukapheresis for T cell collection, and their cells will be genetically engineered and expanded ex vivo. Seven days prior to receiving T-cells patients will undergo a cyclophosphamide conditioning regimen to potentiate the immunotherapy. The cell product will be infused as a single infusion (Day 0, typically Monday) to mitigate risks associated with unanticipated infusion reactions. Patients will be followed daily for the first week, weekly until 4 weeks, 8 weeks, and 12 weeks and then at 6 months and every 3 months until disease progression. Patients will undergo disease monitoring by MRI/CT scan (as appropriate for disease) at baseline, day 28, 8 weeks and 12 weeks, and months 6, and every 3 months until progression. Tumor biopsies will be taken at baseline, Week 8, and upon progression. In patients who have progressive disease following initial infusion but whose tumors continue to express NY-ESO-1, these patients may be eligible for a second infusion with redirected T cells. At disease progression, the interventional portion of the protocol ends and long term follow-up (LTFU) begins, in accordance with FDA regulations. LTFU occurs semiannually for up to 5 years post infusion and then annually thereafter for up to 15 years.
Interventions
BIOLOGICALNYESO-1c259 T cells
Cytoreductive chemotherapy followed by infusion with NYESO-1(C259) transduced autologous T cells. Patients will receive at least 1x10⁹ transduced cells, however the target dose for this protocol is for patients to receive 5x10⁹ transduced cells with a maximum possible dose of 6x10⁹ administered as a single intravenous (IV) infusion.
Sponsors
Adaptimmune
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Must have a diagnosis of recurrent epithelial ovarian, primary peritoneal or fallopian tube carcinoma with refractory or platinum resistant disease and/or have received ≥ 2 lines of chemotherapy * Age ≥ 18 years of age * No significant immunodeficiency * Have been informed of other treatment options * Must be HLA A\*0201, HLA-A\*0205, and/or HLA-A\*0206 positive by high resolution testing. * Patient's tumor must be positive by histological assay for NY-ESO-1ᶜ²⁵⁹T, according to the screening algorithm as described in Section 3.3.1. Positive expression is defined as ≥ 50% of cells that are 2+ and/or 3+ by immunohistochemistry * ECOG performance status of 0 or 1 * Life expectancy of \> 4 months * Prior therapies: 1. prior immunotherapy, or prior investigational agents should be washed out 4 weeks before apheresis and must be completed 4 weeks prior to pre-infusion lymphodepletive chemotherapy. 2. monoclonal antibody therapy must be completed at least 6 weeks prior to pre-infusion lymphodepletive chemotherapy 3. All previous cytotoxic chemotherapy, monoclonal antibody therapy, immune therapy should be washed out 3 weeks before apheresis and must be completed at least 3 weeks prior to pre-infusion lymphodepletive chemotherapy. 4. Systemic corticosteroid or other immunosuppressive therapy should be washed out 2 weeks before apheresis and must be completed at least 2 weeks prior to pre-infusion lymphodepletive chemotherapy 5. Biologic or other approved molecular targeted small molecule inhibitors should be washed out 1 week before apheresis and must be completed at least 1 week prior to pre-infusion lymphodepletive chemotherapy. 6. Any grade 3 or 4 -hematologic toxicity of previous therapy must have resolved to grade 2 or less prior to apheresis and any grade 3 or 4 toxicity must have resolved to grade 2 or less prior to pre-infusion lymphodepletive chemotherapy. * Must have measurable disease as defined by RECIST 1.1. * Must have adequate venous access for apheresis. * Women of childbearing potential are requested to use acceptable methods of birth control for the duration of the study and until persistence of the study drug is no longer detected in the patient. This may be a period of several years. Methods for acceptable birth control include: condoms, diaphragm or cervical cap with spermicide, intrauterine device, and hormonal contraception. It is recommended that a combination of two methods be used. Patients must have normal organ and marrow function as defined below: * Leukocytes ≥ 3,000/mcL * Absolute Neutrophil Count ≥ 1,500/mcL * Platelets ≥ 100,000/mcL * Total bilirubin ≤ 1.5 ULN * AST(SGOT)/ALT(SGPT) ≤ 2.5 X institutional upper limit of normal * creatinine ≤ 2.0 mg/dL OR * creatinine clearance \> 60 mL/min for patients with creatinine levels above institutional normal * Patient must understand the investigational nature of this study and sign an Independent Ethics Committee/Institutional Review Board approved written informed consent form prior to receiving any study related procedure.
Exclusion criteria
* Currently receiving any other investigational agents * Patients with active brain metastases. Patients with prior history of brain metastasis who have undergone local therapy (i.e. metastatectomy and/or radiation) and show no evidence of local recurrence or progression over the past 6 months are eligible * History of allergic reactions attributed to compounds of similar chemical or biologic composition to cyclophosphamide or other agents used in the study * Prior malignancy (except non-melanoma skin cancer) within 18 months of study entry NOTE: Patients must be in complete remission from prior malignancy in order to be eligible to enter the study. * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Use of chronic corticosteroids, hydroxyurea, or immunomodulating agents (e.g. interleukin-2, interferon-alpha or gamma, granulocyte colony stimulating factors, etc.) within 30 days prior to study entry. NOTE: Recent or current use of inhaled steroids is not exclusionary. If subjects are prescribed a brief course of oral corticosteroids, the use should be limited to less than 7 days. Use of steroids before apheresis and immune assessment blood draws should be discouraged as it will affect white blood cell function. * Active infection with HIV, HBV or HCV * Receipt of an experimental vaccine within 2 months or in the opinion of the Investigator is responding to an experimental vaccine given within 6 months, or has received any previous gene therapy using an integrating vector * History of severe autoimmune disease requiring steroids or other immunosuppressive treatments * Lack of availability of a patient for immunological and clinical follow-up assessment * Evidence or history of significant cardiac disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adverse Events Related to Study Treatment | Up to 12 months | Number of Participants with Adverse Events related to study treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Tumor Response | Change from baseline, every 4 weeks until month 3 and then every 3 month until disease progression | Number of participants with response as assessed by Immune-related Response Criteria (irRC) |
| Peak Persistence of Modified T-cells in the Peripheral Blood | Days: 1, 2-4, weeks 1 to 4, Week 8, 12 and Month 6, then every 3 months thereafter until progression then during LTFU | Measurement of NY-ESO-1ᶜ²⁵⁹T cells in blood |
| Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | Weeks 4 and 8 post T-cell infusion | Percentage of CD4+pentamer+ or CD8+pentamer+ cells expressing LAG-3, PD-1, TIM-3 in the functionality of NY-ESO-1ᶜ²⁵⁹T cells in the manufactured product and post-treatment blood. |
| Correlate NY-ESO-1 Expression in Tumor Tissue Before Treatment With Archival Tumor Tissue to Assess Impact of Therapy on Expression of NY-ESO-1 Protein | Screening and at Baseline | NY-ESO-1 expression as determined by Histoscore (H score). Histoscore (0-300) represents the amount of NY-ESO-1 protein present in the tissue sample. H-Score formula: \[1 × (% cells 1+) + 2 × (% cells 2+) + 3 × (% cells 3+)\] (It is not clearly established if NY-ESO-1 H score has an association with prognosis.) |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| NY-ESO-1ᶜ²⁵⁹T Participants who received cytoreductive chemotherapy followed by infusion of NY-ESO-1ᶜ²⁵⁹T. | 6 |
| Total | 6 |
Baseline characteristics
| Characteristic | NY-ESO-1ᶜ²⁵⁹T |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 1 Participants |
| Age, Categorical Between 18 and 65 years | 5 Participants |
| Age, Continuous | 58 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 6 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 6 Participants |
| Sex: Female, Male Female | 6 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 6 / 6 |
| other Total, other adverse events | 6 / 6 |
| serious Total, serious adverse events | 5 / 6 |
Outcome results
Primary
Adverse Events Related to Study Treatment
Number of Participants with Adverse Events related to study treatment
Time frame: Up to 12 months
Population: Participants who received cytoreductive chemotherapy followed by infusion of NY-ESO-1ᶜ²⁵⁹T
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| NY-ESO-1ᶜ²⁵⁹T | Adverse Events Related to Study Treatment | 5 Participants |
Secondary
Correlate NY-ESO-1 Expression in Tumor Tissue Before Treatment With Archival Tumor Tissue to Assess Impact of Therapy on Expression of NY-ESO-1 Protein
NY-ESO-1 expression as determined by Histoscore (H score). Histoscore (0-300) represents the amount of NY-ESO-1 protein present in the tissue sample. H-Score formula: \[1 × (% cells 1+) + 2 × (% cells 2+) + 3 × (% cells 3+)\] (It is not clearly established if NY-ESO-1 H score has an association with prognosis.)
Time frame: Screening and at Baseline
Population: Data is presented for 2 subjects, 4 subjects declined Baseline biopsy or biopsy wasn't collected due to safety concerns
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| NY-ESO-1ᶜ²⁵⁹T | Correlate NY-ESO-1 Expression in Tumor Tissue Before Treatment With Archival Tumor Tissue to Assess Impact of Therapy on Expression of NY-ESO-1 Protein | Screening/Archival | 50 H score |
| NY-ESO-1ᶜ²⁵⁹T | Correlate NY-ESO-1 Expression in Tumor Tissue Before Treatment With Archival Tumor Tissue to Assess Impact of Therapy on Expression of NY-ESO-1 Protein | Baseline | 15 H score |
| Week 4 Post-treatment- Mean % CD4+Pentamer+ | Correlate NY-ESO-1 Expression in Tumor Tissue Before Treatment With Archival Tumor Tissue to Assess Impact of Therapy on Expression of NY-ESO-1 Protein | Screening/Archival | 100 H score |
| Week 4 Post-treatment- Mean % CD4+Pentamer+ | Correlate NY-ESO-1 Expression in Tumor Tissue Before Treatment With Archival Tumor Tissue to Assess Impact of Therapy on Expression of NY-ESO-1 Protein | Baseline | 0 H score |
Secondary
Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood.
Percentage of CD4+pentamer+ or CD8+pentamer+ cells expressing LAG-3, PD-1, TIM-3 in the functionality of NY-ESO-1ᶜ²⁵⁹T cells in the manufactured product and post-treatment blood.
Time frame: Weeks 4 and 8 post T-cell infusion
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| NY-ESO-1ᶜ²⁵⁹T | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %LAG-3 | 4 percentage of T cell sub population |
| NY-ESO-1ᶜ²⁵⁹T | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %TIM-3 | 97 percentage of T cell sub population |
| NY-ESO-1ᶜ²⁵⁹T | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %PD-1 | 6 percentage of T cell sub population |
| Week 4 Post-treatment- Mean % CD4+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %TIM-3 | 17 percentage of T cell sub population |
| Week 4 Post-treatment- Mean % CD4+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %LAG-3 | 3 percentage of T cell sub population |
| Week 4 Post-treatment- Mean % CD4+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %PD-1 | 0 percentage of T cell sub population |
| Week 8 Post-treatment - Mean % CD4+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %TIM-3 | 11 percentage of T cell sub population |
| Week 8 Post-treatment - Mean % CD4+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %PD-1 | 3 percentage of T cell sub population |
| Week 8 Post-treatment - Mean % CD4+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %LAG-3 | 0 percentage of T cell sub population |
| Manufactured Product - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %LAG-3 | 3 percentage of T cell sub population |
| Manufactured Product - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %PD-1 | 1 percentage of T cell sub population |
| Manufactured Product - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %TIM-3 | 97 percentage of T cell sub population |
| Week 4 Post-treatment - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %TIM-3 | 24 percentage of T cell sub population |
| Week 4 Post-treatment - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %LAG-3 | 0 percentage of T cell sub population |
| Week 4 Post-treatment - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %PD-1 | 1 percentage of T cell sub population |
| Week 8 Post-treatment - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %PD-1 | 4 percentage of T cell sub population |
| Week 8 Post-treatment - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %TIM-3 | 7 percentage of T cell sub population |
| Week 8 Post-treatment - Mean % CD8+Pentamer+ | Determine Functional Properties and Phenotype of Modified T-cells From Peripheral Blood. | %LAG-3 | 0 percentage of T cell sub population |
Secondary
Peak Persistence of Modified T-cells in the Peripheral Blood
Measurement of NY-ESO-1ᶜ²⁵⁹T cells in blood
Time frame: Days: 1, 2-4, weeks 1 to 4, Week 8, 12 and Month 6, then every 3 months thereafter until progression then during LTFU
Population: Participants who received NY-ESO-1ᶜ²⁵⁹T
| Arm | Measure | Value (MEAN) |
|---|---|---|
| NY-ESO-1ᶜ²⁵⁹T | Peak Persistence of Modified T-cells in the Peripheral Blood | 85862.6 copies of WPRE/mcg of genomic PBMC DNA |
Secondary
Tumor Response
Number of participants with response as assessed by Immune-related Response Criteria (irRC)
Time frame: Change from baseline, every 4 weeks until month 3 and then every 3 month until disease progression
Population: Participants who received cytoreductive chemotherapy followed by infusion of NY-ESO-1ᶜ²⁵⁹T
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| NY-ESO-1ᶜ²⁵⁹T | Tumor Response | 0 Participants |