Castration-Resistant Prostate Carcinoma, Metastatic Prostate Carcinoma, Stage IV Prostate Cancer AJCC v8, Stage IVA Prostate Cancer AJCC v8, Stage IVB Prostate Cancer AJCC v8
Conditions
Brief summary
This phase I trial studies side effects and best dose of PSCA-chimeric antigen receptor (CAR) T cells in treating patients with prostate stem cell antigen positive (PSCA+) castration resistant prostate cancer that has spread to other places in the body (metastatic). PSCA-CAR T cells are immune cells that have been engineered in the laboratory to kill tumor cells. This is done by using a virus to insert a piece of deoxyribonucleic acid (DNA) into the immune cells that allows them to recognize prostate tumor cells. It is not yet known how well PSCA-CAR T cells works in killing tumor cells in patients with metastatic castration resistant prostate cancer.
Detailed description
PRIMARY OBJECTIVES: I. Define the safety and tolerability of autologous anti-PSCA-CAR-4-1BB/TCRzeta-CD19t-expressing T lymphocytes (PSCA-CAR T cells) in patients with PSCA+ metastatic castration resistant prostate cancer (mCRPC). II. Define the recommended phase 2 dose (RP2D) of PSCA-CAR T cells in patients with PSCA+ mCRPC. SECONDARY OBJECTIVES: I. Assess the expansion and persistence of PSCA-CAR T cells. II. Assess clinical response based on Prostate Cancer Working Group 3 (PCWG3) criteria. III. Assess survival outcomes (including biochemical progression free survival \[PFS\], radiographic PFS and overall survival \[OS\]). IV. Assess serum cytokine profiles in peripheral blood pre- and post-therapy. V. Describe the PSCA expression level on tumor cells prior to CAR T cell infusion, and the relationship it may have with disease response and observed toxicities. EXPLORATORY OBJECTIVES: I. Characterize the phenotypes and frequencies of immune cell subsets in the peripheral blood pre- and post-therapy. II. Enumerate and characterize tumor-infiltrating lymphocytes (TILs) pre- and post-therapy. III. Enumerate and analyze gene expression of circulating tumor cells (CTC) pre- and post-therapy. IV. Analyze circulating cell-free DNA (cfDNA). V. Determine the immunogenicity of PSCA-CAR T cells. OUTLINE: This is a dose-escalation study. Patients may receive lymphodepleting regimen at the discretion of the treating physician including fludarabine intravenously (IV) on days -5 to -3 and cyclophosphamide IV on days -5 to -3 or on days -4 and/or -3. Patients then receive autologous anti-PSCA-CAR-4-1BB/TCRzeta-CD19t-expressing T lymphocytes IV over 10-15 minutes at day 0. After completion of study treatment, patients are followed up at day 1, every 2 days for up to 14 days, weekly for up to 1 month, every month for up to 1 year, and then annually for up to 15 years.
Interventions
Given IV
DRUGCyclophosphamide
Given IV
DRUGFludarabine
Given IV
DRUGFludarabine Phosphate
Given IV
Sponsors
National Cancer Institute (NCI)
City of Hope Medical Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All participants must have the ability to understand and the willingness to sign a written informed consent * Eastern Cooperative Oncology Group (ECOG) performance status 0 - 2 or KPS ≥70%. * Documented castration resistant prostate cancer (mCRPC) (Note: castration will be defined by a testosterone \< 50 ng/dL achieved by orchiectomy or luteinizing hormone-releasing hormone \[LHRH\] agonist/antagonist therapy) * Documented PSCA+ tumor expression as evaluated by City of Hope (COH) Pathology Care * Progression of disease manifest by one of the following means during treatment with at least one advanced androgen targeted therapy (e.g., abiraterone or enzalutamide) * Rising PSA documented on 2 occasions at least 7 days apart, with absolute increase \> 2 ng/dL despite testosterone \< 50 OR * Radiographic evidence of new metastatic foci on computed tomography (CT) or bone scan, or soft tissue progression by Response Evaluation Criteria in Solid Tumors (RECIST) * Prior chemotherapy with cabazitaxel and/or docetaxel is allowed but not required. If there has been prior chemotherapy, at least 2 weeks must have elapsed prior to leukapheresis * Prior radiotherapy is allowed provided it was not administered to the only evaluable site of disease and was \> 14 days prior to leukapheresis * No known contraindications to leukapheresis, steroids or tocilizumab * Total serum bilirubin =\< 2.0 mg/dL (to be performed within 42 days of signing the main study consent) * Patients with Gilbert syndrome may be included if their total bilirubin is =\< 3.0 x upper limit of normal (ULN) and direct bilirubin =\< 1.5 x ULN * Aspartate aminotransferase (AST) \< 5 x ULN (to be performed within 42 days of signing the main study consent) * Alanine aminotransferase (ALT) \< 5 x ULN (to be performed within 42 days of signing the main study consent) * Creatinine clearance of \>= 50 mL/min per the Cockcroft-Gault formula (to be performed within 42 days of signing the main study consent) * Cardiac function (12 lead-electrocardiography \[ECG\]) without acute abnormalities requiring investigation or intervention (to be performed within 42 days of signing the main study consent) * Left ventricular ejection fraction \> 40% (to be performed within 42 days of signing the main study consent) * Participants of reproductive potential must agree to use acceptable birth control methods throughout study therapy and for 3 months after final dose of study treatment
Exclusion criteria
* Participants with clinically significant arrhythmia or arrhythmias not stable on medical management within two weeks of signing the main consent * Participants with a known history or prior diagnosis of optic neuritis or other immunologic or inflammatory disease affecting the central nervous system, including seizure disorder * History of allergic reactions attributed to compounds of similar chemical or biologic composition or other agents used in this study * Known bleeding disorders (e.g., von Willebrand's disease) or hemophilia * History of stroke or intracranial hemorrhage within 6 months prior to signing the main consent * History of other malignancies, except for malignancy surgically resected (or treated with other modalities) with curative intent, basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin; non-muscle invasive bladder cancer; malignancy treated with curative intent with no known active disease present for \>= 3 years * Uncontrolled active infection * Active hepatitis B or hepatitis C infection * Human immunodeficiency virus (HIV) infection * Any other condition that would, in the investigator's judgment, contraindicate the subject's participation in the clinical study due to safety concerns with clinical study procedures * Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Grade 3 Toxicity Profile | Up to 32 months | Grade 3 toxicity profile as assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v)5 and modified Cytokine Release Syndrome (CRS) grading as applicable post chimeric antigen receptor (CAR) T cell infusion. |
| Number of Participants Experiencing a Dose-limiting Toxicity (DLT) | Up to 28 days post treatment | Defined by any grade 3 or NCI CTCAE toxicities and modified CRS grading as applicable. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percent of Participants With CAR T Cells Persistence at Day 28 | Days 28 post infusion | Persistence is defined as CAR T cells comprising at least 7.5 copies/ug of DNA of total CD3 cells. |
| Expansion of CAR T Cells | Up to 28 days post treatment | Peak expansion (max log10 copies/ug of genomic deoxyribonucleic acid \[DNA\]) will be described. |
| Percent of Participants Achieving Stable Disease | Up to 1 year post treatment | Rates and associated 90% Clopper and Pearson binomial confidence limits will be estimated for response based on Prostate Cancer Working Group 3 (PCWG3) criteria. |
| Percent of Participants Alive at Six Months | From CAR T cell infusion to death from any cause or last contact date, assessed up to 6 months | Rates and associated 95% exact Clopper and Pearson binomial confidence intervals will be estimated. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Dose Level 1 (Starting Dose Level 1) 100 million CAR T+ cells | 3 |
| Dose Level 2 (Dose Level 1b) 100 million CAR T+ cells plus lymphodepletion
Cyclophosphamide: 500 mg/m2 Given IV
Fludarabine: 30 mg/m2 Given IV | 6 |
| Dose Level 3 (Dose Level 1d) 100 million CAR T+ cells plus modified lymphodepletion
Cyclophosphamide: 300 mg/m2 Given IV
Fludarabine: 30 mg/m2 Given IV | 5 |
| Total | 14 |
Baseline characteristics
| Characteristic | Dose Level 1 (Starting Dose Level 1) | Dose Level 2 (Dose Level 1b) | Dose Level 3 (Dose Level 1d) | Total |
|---|---|---|---|---|
| Age, Continuous | 62 years | 70 years | 69 years | 69 years |
| Baseline PSA (Prostate Specific Antigen) | 16.5 ng/mL | 88.0 ng/mL | 235.3 ng/mL | 88.0 ng/mL |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 3 Participants | 6 Participants | 3 Participants | 12 Participants |
| Region of Enrollment United States | 3 participants | 6 participants | 5 participants | 14 participants |
| Sex: Female, Male Female | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Sex: Female, Male Male | 3 Participants | 6 Participants | 5 Participants | 14 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 3 / 3 | 6 / 6 | 5 / 5 |
| other Total, other adverse events | 3 / 3 | 6 / 6 | 5 / 5 |
| serious Total, serious adverse events | 2 / 3 | 2 / 6 | 4 / 5 |
Outcome results
Primary
Grade 3 Toxicity Profile
Grade 3 toxicity profile as assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v)5 and modified Cytokine Release Syndrome (CRS) grading as applicable post chimeric antigen receptor (CAR) T cell infusion.
Time frame: Up to 32 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Rash maculo-papular : Yes | 0 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Hematuria : Yes | 0 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Fatigue : No | 3 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Lymphocyte count decreased : Yes | 1 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Cystitis noninfective : Yes | 0 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Pain : Yes | 0 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Cystitis noninfective : No | 3 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Pain : No | 3 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Anemia : No | 1 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Hematuria : No | 3 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Lymphocyte count decreased : No | 2 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Rash maculo-papular : No | 3 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Anemia : Yes | 2 Participants |
| Dose Level 1 (Starting Dose Level 1) | Grade 3 Toxicity Profile | Fatigue : Yes | 0 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Hematuria : Yes | 1 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Anemia : Yes | 2 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Anemia : No | 4 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Lymphocyte count decreased : Yes | 0 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Lymphocyte count decreased : No | 6 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Fatigue : Yes | 2 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Fatigue : No | 4 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Pain : Yes | 1 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Pain : No | 5 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Cystitis noninfective : Yes | 2 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Cystitis noninfective : No | 4 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Hematuria : No | 5 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Rash maculo-papular : Yes | 1 Participants |
| Dose Level 2 (Dose Level 1b) | Grade 3 Toxicity Profile | Rash maculo-papular : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Rash maculo-papular : Yes | 0 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Cystitis noninfective : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Fatigue : Yes | 0 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Lymphocyte count decreased : No | 4 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Hematuria : Yes | 0 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Lymphocyte count decreased : Yes | 1 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Anemia : Yes | 0 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Hematuria : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Pain : Yes | 0 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Anemia : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Pain : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Fatigue : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Rash maculo-papular : No | 5 Participants |
| Dose Level 3 (Dose Level 1d) | Grade 3 Toxicity Profile | Cystitis noninfective : Yes | 0 Participants |
Primary
Number of Participants Experiencing a Dose-limiting Toxicity (DLT)
Defined by any grade 3 or NCI CTCAE toxicities and modified CRS grading as applicable.
Time frame: Up to 28 days post treatment
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Dose Level 1 (Starting Dose Level 1) | Number of Participants Experiencing a Dose-limiting Toxicity (DLT) | 0 Participants |
| Dose Level 2 (Dose Level 1b) | Number of Participants Experiencing a Dose-limiting Toxicity (DLT) | 2 Participants |
| Dose Level 3 (Dose Level 1d) | Number of Participants Experiencing a Dose-limiting Toxicity (DLT) | 0 Participants |
Secondary
Expansion of CAR T Cells
Peak expansion (max log10 copies/ug of genomic deoxyribonucleic acid \[DNA\]) will be described.
Time frame: Up to 28 days post treatment
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Dose Level 1 (Starting Dose Level 1) | Expansion of CAR T Cells | 2.1 log10 copies/ug of DNA |
| Dose Level 2 (Dose Level 1b) | Expansion of CAR T Cells | 3.3 log10 copies/ug of DNA |
| Dose Level 3 (Dose Level 1d) | Expansion of CAR T Cells | 2.8 log10 copies/ug of DNA |
Secondary
Percent of Participants Achieving Stable Disease
Rates and associated 90% Clopper and Pearson binomial confidence limits will be estimated for response based on Prostate Cancer Working Group 3 (PCWG3) criteria.
Time frame: Up to 1 year post treatment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Level 1 (Starting Dose Level 1) | Percent of Participants Achieving Stable Disease | 0 percentage of participants |
| Dose Level 2 (Dose Level 1b) | Percent of Participants Achieving Stable Disease | 67 percentage of participants |
| Dose Level 3 (Dose Level 1d) | Percent of Participants Achieving Stable Disease | 60 percentage of participants |
Secondary
Percent of Participants Alive at Six Months
Rates and associated 95% exact Clopper and Pearson binomial confidence intervals will be estimated.
Time frame: From CAR T cell infusion to death from any cause or last contact date, assessed up to 6 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Level 1 (Starting Dose Level 1) | Percent of Participants Alive at Six Months | 33 Percentage of participants |
| Dose Level 2 (Dose Level 1b) | Percent of Participants Alive at Six Months | 67 Percentage of participants |
| Dose Level 3 (Dose Level 1d) | Percent of Participants Alive at Six Months | 40 Percentage of participants |
Secondary
Percent of Participants With CAR T Cells Persistence at Day 28
Persistence is defined as CAR T cells comprising at least 7.5 copies/ug of DNA of total CD3 cells.
Time frame: Days 28 post infusion
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Dose Level 1 (Starting Dose Level 1) | Percent of Participants With CAR T Cells Persistence at Day 28 | 66 Percent of participants |
| Dose Level 2 (Dose Level 1b) | Percent of Participants With CAR T Cells Persistence at Day 28 | 66 Percent of participants |
| Dose Level 3 (Dose Level 1d) | Percent of Participants With CAR T Cells Persistence at Day 28 | 60 Percent of participants |