Cervical Carcinoma
Conditions
Keywords
LN-145, Cell Therapy, Autologous Adoptive Cell Transfer, Autologous Adoptive Cell Therapy, Cellular Immuno-therapy, Tumor Infiltrating Lymphocytes, TIL, IL-2, Pembrolizumab
Brief summary
Prospective, multicenter, multiple cohort, open label, interventional study evaluating adoptive cell therapy (ACT) with autologous tumor infiltrating lymphocytes (TIL) infusion (LN-145), with or without pembrolizumab, followed by IL-2 after a non-myeloablative lymphodepletion (NMA-LD) preparative regimen for the treatment of participants with recurrent, metastatic, or persistent cervical carcinoma.
Detailed description
LN-145 is an adoptive cell transfer therapy that utilizes an autologous TIL manufacturing process, as originally developed by the NCI, for the treatment of participants with recurrent, metastatic, or persistent cervical carcinoma. The cell transfer therapy used in this study involves participants receiving a non-myeloablative lymphodepletion (NMA-LD) preparative regimen, followed by infusion of autologous TIL, with or without pembrolizumab, followed by the administration of a regimen of IL-2.
Interventions
BIOLOGICALLN-145
A tumor sample is resected from each participant and cultured ex vivo to expand the population of tumor infiltrating lymphocytes.
BIOLOGICALLN-145 + pembrolizumab
A tumor sample is resected from each participant and cultured ex vivo to expand the population of tumor infiltrating lymphocytes. The first dose of anti-PD-1 immunotherapy will be administered following tumor resection.
Sponsors
Iovance Biotherapeutics, Inc.
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
To be eligible for the study, participants must meet ALL of the following criteria prior to participation: 1. Must be ≥ 18 years of age at the time of consent. Enrollment of participants \> 70 years of age may be allowed after consultation with the Medical Monitor. 2. Must have recurrent, metastatic, or persistent squamous cell carcinoma (SCC), adenosquamous carcinoma (ASC), or adenocarcinoma (AC) of the cervix that is not amenable to curative treatment with surgery and/or radiation therapy. 3. At least one resectable lesion (or aggregate of lesions resected) of a minimum 1.5 cm in diameter post-resection to generate TIL; surgical removal with minimal morbidity (defined as any procedure for which expected hospitalization is ≤ 3 days) 4. At least one measurable target lesion, as defined by RECIST v1.1. 5. Cohort 1 and Cohort 2: Progression during or following at least one, but no more than three, prior systemic chemotherapeutic treatments for recurrent, metastatic, or persistent cervical carcinoma * A line of systemic therapy is defined as any chemotherapy or multiple-agent chemotherapy regimen that was administered for recurrent, metastatic, or persistent SCC, ASC, or AC of the cervix. * A bevacizumab and chemotherapy combination is encouraged as a prior line of treatment. * Neither chemoradiation, nor chemotherapy in the neoadjuvant or adjuvant settings are considered as a prior line of systemic therapy. Cohort 2: Must also have previously received treatment with a checkpoint inhibitor (ie, PD-1, PD-L1\]) in the setting of recurrent, metastatic, or persistent disease either as monotherapy or in combination (eg, in combination with chemotherapy or another immune agent) Cohort 3 (United States only): Must have not received any therapies other than prior chemoradiation or surgery for loco-regional disease 6. Any prior therapy directed at the malignant tumor, including chemotherapy, biologic/targeted agents, and immunologic agents must be discontinued at least 28 days prior to tumor resection. 7. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 8. Must have adequate organ function. 9. Participant has no evidence of any active viral, bacterial, or fungal infection requiring ongoing systemic treatment. Participants must be seronegative for the human immunodeficiency virus (HIV). Participants with acute or chronic hepatitis infections may be enrolled if the viral load by nucleic acid amplification test (NAAT) is undetectable with/without active treatment 10. Participants of childbearing potential must be willing to take the appropriate precaution to avoid pregnancy for the duration of the study and practice an approved, highly effective method of birth control during treatment and for 12 months after receiving the last protocol-related therapy. 11. Prior to study Enrollment (tumor resection), participant must have documentation of radiological disease progression after the most recent therapy
Exclusion criteria
Participants who meet any of the following criteria are not eligible for participation in this study: 1. Participants who have received an organ allograft or prior cell transfer therapy except for prior LN-145 therapy in the setting of re-treatment only. 2. Participants who require ongoing systemic steroid therapy (\> 10 mg/day of prednisone or other steroid equivalent dose). 3. Participants who currently have prior therapy-related toxicities Grade \> 1 according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0; except for peripheral neuropathy, alopecia, or vitiligo prior to Enrollment (tumor resection). 4. . Participants who have a history of hypersensitivity to any component or excipient of LN-145 or other study drugs: • NMA-LD preparative regimen (cyclophosphamide, mesna, and fludarabine) 5. Participants who have active systemic infections, coagulation disorders, or other active major medical illness(es) of the cardiovascular, respiratory, or immune system, including evidence in the medical history of urinary tract obstruction, a positive cardiac stress test, myocardial infarction, cardiac arrhythmia, obstructive or restrictive pulmonary disease, or other conditions that in the opinion of the Investigator would increase the risk of participation. 6. Participants with symptomatic and/or untreated brain metastases (of any size and any number) • Participants with definitively treated brain metastases may be considered for Enrollment, and must be stable for ≥ 14 days prior to beginning the NMA-LD preparative regimen 7. Participants who have any form of primary immunodeficiency (such as severe combined immunodeficiency \[SCID\] or acquired immunodeficiency syndrome \[AIDS\]) 8. Participants who have a diagnosis of end-stage renal disorder requiring hemodialysis 9. Participants who have a left ventricular ejection fraction (LVEF) \< 45% or who are New York Heart Association (NYHA) Class 2 or higher. 10. Participants who have a documented forced expiratory volume in 1 second (FEV1) of ≤ 60% 11. Participants who have had another primary malignancy within the previous 3 years (except for curatively treated localized malignancy that has not required treatment for \> 1 year, and in the judgement of the Investigator, does not pose a significant risk of recurrence including, but not limited to, non-melanoma skin cancer or bladder cancer) 12. Participants who are of the following protected classes will be excluded, including: * Pregnant, parturient, or breastfeeding women * Persons who are hospitalized without consent or those deprived of liberty because of a judiciary or administrative decision * Participants with a legal protection measure or a person who cannot express his/her consent * Participants in emergency situations who cannot consent to the study 13. Participants who have received a live or attenuated vaccine within 28 days prior to beginning the NMA-LD preparative regimen 14. Participants whose cancer requires immediate attention or who would otherwise suffer a disadvantage by participating in this study 15. Cohort 1 and Cohort 3: Participants who have received prior treatment with immunotherapy (eg, PD-1, PD-L1, or anti-cytotoxic T lymphocyte-associated antigen-4 \[CTLA-4\] antibodies) 16. Participants who have Grade ≥ 2 hemorrhage within 14 days prior to Enrollment (tumor resection) 17. Cohort 3: Participants may not have active or prior documented autoimmune or inflammatory disorders (including pneumonitis, inflammatory bowel disease \[eg, colitis or Crohn's disease\], diverticulitis \[with the exception of diverticulosis\], systemic lupus erythematosus, sarcoidosis syndrome, or Wegener syndrome \[granulomatosis with polyangiitis, Graves' disease, rheumatoid arthritis, hypophysitis, uveitis, etc.\]).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cohort 1 and 2: Objective Response Rate | Up to 60 months | To evaluate the efficacy of LN-145 in participants with recurrent, metastatic, or persistent cervical carcinoma based on the objective response rate (ORR) as assessed by the Investigator per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 |
| Cohort 3: Adverse Events | Up to 60 months | To characterize the safety profile of LN-145 in combination with pembrolizumab in participants with recurrent, metastatic, or persistent cervical carcinoma as assessed by incidence of adverse events. |
| Cohort 4: Adverse Events | Up to 60 months | To explore the safety profile of LN-145 in previously enrolled participants with recurrent, metastatic, or persistent cervical carcinoma as assessed by incidence of adverse events. |
| Cohort 4: Efficacy/Objective Response Rate | Up to 60 months | To explore the efficacy of LN-145 in previously enrolled participants with recurrent, metastatic, or persistent cervical carcinoma based on the objective response rate (ORR). |
| Cohort 5: Adverse Events | Up to 60 months | To explore the safety profile of LN-145 in re-treated participants with recurrent, metastatic, or persistent cervical carcinoma as assessed by incidence of adverse events. |
| Cohort 5: Efficacy/Objective Response Rate | Up to 60 months | To explore the efficacy of LN-145 in re-treated participants with recurrent, metastatic, or persistent cervical carcinoma based on the objective response rate (ORR). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cohort 1 and 2: Duration of Response | Up to 60 months | To evaluate the efficacy parameters of LN-145 in participants with recurrent, metastatic, or persistent cervical carcinoma by assessing duration of response (DOR) as assessed by the Investigator per RECIST v1.1 |
| Cohort 1 and 2: Disease Control Rate | Up to 60 months | To evaluate the efficacy parameters of LN-145 in participants with recurrent, metastatic, or persistent cervical carcinoma by assessing disease control rate (DCR) as assessed by the Investigator per RECIST v1.1. |
| Cohort 1 and 2: Progression-Free Survival | Up to 60 months | To evaluate the efficacy parameters of LN-145 in participants with recurrent, metastatic, or persistent cervical carcinoma by assessing progression-free survival (PFS) as assessed by the Investigator per RECIST v1.1 |
| Cohort 1 and 2: Overall Survival | Up to 60 months | To evaluate overall survival (OS) in participants with recurrent, metastatic, or persistent cervical carcinoma |
| Cohort 1 and 2: Adverse Events | Up to 60 months | To characterize the safety profile of LN-145 in participants with recurrent, metastatic, or persistent cervical carcinoma as assessed by incidence of adverse events |
| Cohort 3: Objective Response Rate | Up to 60 months | To evaluate the efficacy of LN-145 in combination with pembrolizumab in participants with recurrent, metastatic, or persistent cervical carcinoma based on the objective response rate (ORR) as assessed by the Investigator per RECIST v1.1 |
| Cohort 3: Duration of Response | Up to 60 months | To evaluate the efficacy of LN-145 in combination with pembrolizumab in participants with recurrent, metastatic, or persistent cervical carcinoma by assessing duration of response (DOR) as assessed by the Investigator per RECIST v1.1. |
| Cohort 3: Disease Control Rate | Up to 60 months | To evaluate the efficacy of LN-145 in combination with pembrolizumab in participants with recurrent, metastatic, or persistent cervical carcinoma by assessing disease control rate (DCR) as assessed by the Investigator per RECIST v1.1. |
| Cohort 3: Progression-Free Survival | Up to 60 months | To evaluate the efficacy of LN-145 in combination with pembrolizumab in participants with recurrent, metastatic, or persistent cervical carcinoma by assessing progression-free survival (PFS) as assessed by the Investigator per RECIST v1.1. |
| Cohort 3: Overall Survival | Up to 60 months | To evaluate overall survival (OS) in participants with recurrent, metastatic, or persistent cervical carcinoma. |
Countries
France, Germany, Italy, Netherlands, Spain, Switzerland, United Kingdom, United States
Contacts
STUDY_DIRECTORIovance Medical Monitor
Iovance Biotherapeutics, Inc.
Participant flow
Pre-assignment details
Cohorts 1, 2, 3 & 4 refer to the initial treatment. Cohort 5 refers to participants who had progressed following the initial treatment and were retreated with a second TIL regimen. Data are captured in the retreatment period for Cohort 5.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Categorical Initial Treatment <=18 years | 1 Participants |
| Age, Categorical Initial Treatment >=65 years | 0 Participants |
| Age, Categorical Initial Treatment Between 18 and 65 years | 139 Participants |
| Age, Categorical Retreatment <=18 years | 0 Participants |
| Age, Categorical Retreatment >=65 years | 0 Participants |
| Age, Categorical Retreatment Between 18 and 65 years | 2 Participants |
| Age, Continuous Initial Treatment | 45 Years |
| Age, Continuous Retreatment | 49.5 Years |
| Ethnicity (NIH/OMB) Initial Treatment Hispanic or Latino | 17 Participants |
| Ethnicity (NIH/OMB) Initial Treatment Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Initial Treatment Unknown or Not Reported | 0 Participants |
| Ethnicity (NIH/OMB) Retreatment Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Retreatment Not Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Retreatment Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Initial Treatment American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Initial Treatment Asian | 3 Participants |
| Race (NIH/OMB) Initial Treatment Black or African American | 2 Participants |
| Race (NIH/OMB) Initial Treatment More than one race | 0 Participants |
| Race (NIH/OMB) Initial Treatment Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Initial Treatment Unknown or Not Reported | 10 Participants |
| Race (NIH/OMB) Initial Treatment White | 33 Participants |
| Race (NIH/OMB) Retreatment American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Retreatment Asian | 0 Participants |
| Race (NIH/OMB) Retreatment Black or African American | 0 Participants |
| Race (NIH/OMB) Retreatment More than one race | 0 Participants |
| Race (NIH/OMB) Retreatment Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Retreatment Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) Retreatment White | 0 Participants |
| Region of Enrollment France | 1 Participants |
| Region of Enrollment Germany | 1 Participants |
| Region of Enrollment Netherlands | 0 Participants |
| Region of Enrollment Spain | 11 Participants |
| Region of Enrollment Switzerland | 4 Participants |
| Region of Enrollment United Kingdom | 0 Participants |
| Region of Enrollment United States | 35 Participants |
| Sex: Female, Male Initial Treatment Female | 42 Participants |
| Sex: Female, Male Initial Treatment Male | 0 Participants |
| Sex: Female, Male Retreatment Female | 2 Participants |
| Sex: Female, Male Retreatment Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk |
|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 63 / 74 | 34 / 42 | 17 / 26 | 9 / 10 | 2 / 2 |
| other Total, other adverse events | 74 / 74 | 42 / 42 | 26 / 26 | 10 / 10 | 2 / 2 |
| serious Total, serious adverse events | 31 / 74 | 20 / 42 | 18 / 26 | 7 / 10 | 1 / 2 |
Outcome results
None listed