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Spearhead 1 Study in Subjects With Advanced Synovial Sarcoma or Myxoid/Round Cell Liposarcoma

A Phase 2 Single Arm Open-Label Clinical Trial of ADP-A2M4 SPEAR™ T Cells in Subjects With Advanced Synovial Sarcoma or Myxoid/Round Cell Liposarcoma

Status
Active, not recruiting
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04044768
Enrollment
52
Registered
2019-08-05
Start date
2019-08-13
Completion date
2038-04-01
Last updated
2026-08-26

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Myxoid Liposarcoma, Synovial Sarcoma

Keywords

Cell Therapy, T Cell Therapy, SPEAR T Cell, Sarcoma, MRCLS, MAGE A-4, Immuno-oncology

Brief summary

This is a study to investigate the efficacy and safety of ADP-A2M4 in HLA-A\*02 eligible and MAGE-A4 positive subjects with metastatic or inoperable (advanced) Synovial Sarcoma (Cohort 1, 2 and 3 ) or MRCLS (Cohort 1) .

Interventions

GENETICafamitresgene autoleucel (previously ADP-A2M4)

Single infusion of autologous genetically modified afamitresgene autoleucel (previously ADP-A2M4) Dose: 1.0 x109 to 10x109 transduced by a single intravenous infusion

Sponsors

USWM CT, LLC
Lead SponsorINDUSTRY

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
10 Years to 75 Years
Healthy volunteers
No

Inclusion criteria

Key Inclusion Criteria * Age ≥16 (10 years at selected sites) and \<=75 years * Diagnosis of advanced synovial sarcoma (Cohort 1, Cohort 2 and Cohort 3) or myxoid liposarcoma / myxoid round cell liposarcoma (Cohort 1 only) confirmed by cytogenetics. * Previously received either an anthracycline or ifosfamide containing regimen. * Measurable disease according to RECIST v1.1 prior to lymphodepletion * HLA-A\*02:01, HLA-A\*02:02, HLA-A\*02:03 or HLA-A\*02:06 positive * Tumor shows MAGE-A4 expression confirmed by central laboratory. North America Only (United States and Canada): Tumor (either an archival specimen or a fresh biopsy) shows MAGE-A4 expression of ≥1+ staining in ≥10% of the cells by immunohistochemistry. * ECOG Performance Status of 0 or1. For subjects aged ≥10 to ≥16 years old: Lansky Score ≥60%. • Left ventricular ejection fraction (LVEF) ≥50%. Note: other protocol defined Inclusion criteria may apply Key

Exclusion criteria

* HLA-A\*02:05 in either allele * Received or plans to receive the following therapy/treatment prior to leukapheresis or lymphodepleting chemotherapy: Cytotoxic chemotherapy, Tyrosine kinase inhibitor (TKI) (e.g. pazopanib), Immune therapy (including monoclonal antibody therapy, checkpoint inhibitors,), Anti-cancer Vaccine, Gene therapy using an integrating vector (subjects who have received a gene therapy using a lentiviral vector may be eligible for the study), Corticosteroids or any other immunosuppressive therapy, Investigational treatment or interventional clinical trial, Allogeneic hematopoietic stem cell transplant, Radiotherapy to the target lesions, Major surgery * History of allergic reactions attributed to compounds of similar chemical or biologic composition to fludarabine, cyclophosphamide or other agents used in the study. * History of autoimmune or immune mediated disease * Symptomatic CNS metastases including leptomeningeal disease. * Other prior malignancy that is not considered by the Investigator to be in complete remission * Clinically significant cardiovascular disease * Uncontrolled intercurrent illness * Active infection with human immunodeficiency virus, hepatitis B virus, hepatitis C virus, or human T cell leukemia virus * Pregnant or breastfeeding Note: other protocol defined

Design outcomes

Primary

MeasureTime frameDescription
Overall Response Rate (ORR) (Cohort 1)From T-cell infusion until disease progression/recurrence as of data cut off (up to 2 years). Response was assessed at Week 4, Week 8, Week 12, Week 16, and Week 24, and every 2 months +/- 28 days until confirmed disease progression.Percentage of participants with confirmed tumor response (complete \[CR\] or partial \[PR\] response) to treatment as assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 by Independent Radiologist review (Cohort 1)

Secondary

MeasureTime frameDescription
Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AEs, SAEs, and AESIs were collected at each visit from the start of lymphodepletion of the first subject until the last subject discontinued the interventional phase in cohort 1 as of the safety cut off (up to 3.2 years).An AE was defined as any untoward medical occurrence in a subject or clinical study participant temporally associated with the use of the study intervention, whether or not considered related to the study intervention. Therefore, an AE could have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study intervention. The number of participants with AEs (including SAE), SAE and AESI including cytokine release syndrome, neurotoxicity, ICANS, prolonged cytopenia are presented.
The Number of Participants With Replication Competent Lentivirus (RCL)From T-cell infusion to months 3, 6, and 12 post-infusion, then annually post-infusion (up to 2.8 years as of the data cut off).The presence of RCL was assessed by qPCR targeting a segment of the vesicular stomatitis virus glycoprotein (VSV G) coding sequence.
Insertional Oncogenesis (IO)From 10 months post T-cell infusion up to 20 months post T-cell infusion (as of the data cut off)Deoxyribonucleic acid (DNA) from participants peripheral blood mononuclear cell (PBMC) samples was subjected to lentiviral vector integration site analysis by next-generation sequencing, thus evaluating both the clonality status of the transduced cell population and the genomic localization of individual integration sites. The count of participants with integration sites representing more than 5% of all unique sites is presented.
Best Overall Response (BOR) (Cohort 1)From T-cell infusion until disease progression/recurrence as of data cut off (up to 2.6 years). Response was assessed at Week 4, Week 8, Week 12, Week 16, and Week 24, and every 2 months +/- 28 days until confirmed disease progression.BOR is the best response recorded from the start of T-cell infusion until disease progression/recurrence as assessed by Independent Radiologist review. Response categories are confirmed CR, confirmed PR, stable disease and confirmed progressive disease (PD). Best overall response is a stable disease, if CR or PR are unconfirmed.
Time to Response (TTR) (Cohort 1)From T-cell infusion until first documented confirmed CR or confirmed PR. Response was assessed at Week 4, Week 8, Week 12, Week 16, and Week 24, and every 2 months +/- 28 days until confirmed disease progression.TTR was defined as the interval (weeks) from the date of T-cell infusion to the earliest date of the first documented confirmed CR or confirmed PR as assessed by Independent Radiologist review. TTR (in weeks) = \[date of initial confirmed CR or PR - date of T-cell infusion + 1\]/7.
Duration of Response (DoR) (Cohort 1)From initial confirmed response (CR or PR) until PD (or censored date) as of data cut off.DoR (in months) is defined as ((date of PD (or censoring) - date of initial confirmed CR/PR + 1)/365.25)\*12 as assessed by Independent Radiologist review. Outcome Measure not yet reached as participants are ongoing in study
Progression Free Survival (PFS) (Cohort 1)From T-cell infusion until first documented PD or death due to any cause (or censored date), whichever occurs first, as of data cut off (up to 2.6 years). Response was assessed at Week 4, 8,12,16, 24, and every 2 months until confirmed PDPFS is defined as the time from T-cell infusion to the date of the first documentation of PD or death due to any cause, whichever occurs first, as assessed by Independent Radiologist review. PFS (in weeks) was calculated as (date of PD/death \[or censored date\] - first T-cell infusion date + 1)/7.
Overall Survival (OS) (Cohort 1)From T-cell infusion to death due to any reason (or censored date) as of data cut off (up to 2.6 years).OS is defined as the time from the date of T-cell infusion to the date of death (due to any reason) or censored date. OS in months was calculated as ((death date - first T-cell infusion date + 1)/365.25)\*12. Outcome Measure not yet reached as participants are ongoing in study
Peak Persistence (Cohort 1)From T-cell infusion to 3.2 years (as of data cut off).Peak persistence of afamitresgene autoleucel cells was reported as vector copy numbers per microgram of genomic DNA from peripheral blood mononuclear cell (PBMC).
Time Taken to Achieve Peak Expansion of Genetically Engineered T-cells in PBMCs2.5 yearsTime taken to achieve peak expansion of genetically engineered T-cells in PBMCs by flow cytometry
Quantitation of Genetically Engineered T-cells in PBMCs2.5 yearsQuantitation of genetically engineered T-cells in PBMCs by flow cytometry
In Vitro Diagnostic (IVD) Assay for Screening2.5 yearsDevelopment and validation of the MAGE-A4 antigen expression companion diagnostic assay

Countries

Canada, France, Spain, United Kingdom, United States

Contacts

PRINCIPAL_INVESTIGATORDejka Araujo, MD

MD Anderson Cancer Center; Houston TX 77030

Participant flow

Recruitment details

This was a Phase 2, single-arm, open-label study of afamitresgene autoleucel in HLA-A\*02+ participants with MAGE-A4 expressing metastatic or inoperable (advanced) synovial sarcoma or myxoid/round cell liposarcoma (MRCLS) (Cohort 1). Eligible participants received between 1.0 × 10\^9 to 10.0 × 10\^9 transduced cells of afamitresgene autoleucel, administered as a single IV infusion following lymphodepletion with fludarabine and cyclophosphamide.

Pre-assignment details

NOTE: Cohort 1 participant Flow, demographics and efficacy cut off was 29Aug2022; Cohort 1 safety cut off was 29Mar2023

Participants by arm

ArmCount
Synovial Sarcoma
Eligible participants with metastatic or inoperable (advanced) synovial sarcoma received afamitresgene autoleucel as a single infusion in Cohort 1 (as of data cut off)
44
MRCLS
Eligible participants with metastatic or inoperable (advanced) MRCLS received afamitresgene autoleucel as a single infusion in Cohort 1 (as of data cut off)
8
Total52

Baseline characteristics

CharacteristicSynovial SarcomaMRCLSTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
3 Participants0 Participants3 Participants
Age, Categorical
Between 18 and 65 years
41 Participants8 Participants49 Participants
Age, Continuous41.0 years
STANDARD_DEVIATION 13.07
43.4 years
STANDARD_DEVIATION 12.22
41.4 years
STANDARD_DEVIATION 12.86
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants0 Participants2 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
38 Participants5 Participants43 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
4 Participants3 Participants7 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
3 Participants0 Participants3 Participants
Race (NIH/OMB)
Black or African American
2 Participants0 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants2 Participants2 Participants
Race (NIH/OMB)
White
39 Participants6 Participants45 Participants
Sex: Female, Male
Female
22 Participants2 Participants24 Participants
Sex: Female, Male
Male
22 Participants6 Participants28 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
24 / 447 / 8
other
Total, other adverse events
44 / 448 / 8
serious
Total, serious adverse events
23 / 443 / 8

Outcome results

Primary

Overall Response Rate (ORR) (Cohort 1)

Percentage of participants with confirmed tumor response (complete \[CR\] or partial \[PR\] response) to treatment as assessed using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 by Independent Radiologist review (Cohort 1)

Time frame: From T-cell infusion until disease progression/recurrence as of data cut off (up to 2 years). Response was assessed at Week 4, Week 8, Week 12, Week 16, and Week 24, and every 2 months +/- 28 days until confirmed disease progression.

Population: Participants who received afamitresgene autoleucel

ArmMeasureValue (NUMBER)
Synovial SarcomaOverall Response Rate (ORR) (Cohort 1)38.6 percentage of participants
MRCLSOverall Response Rate (ORR) (Cohort 1)25.0 percentage of participants
Secondary

Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)

An AE was defined as any untoward medical occurrence in a subject or clinical study participant temporally associated with the use of the study intervention, whether or not considered related to the study intervention. Therefore, an AE could have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study intervention. The number of participants with AEs (including SAE), SAE and AESI including cytokine release syndrome, neurotoxicity, ICANS, prolonged cytopenia are presented.

Time frame: AEs, SAEs, and AESIs were collected at each visit from the start of lymphodepletion of the first subject until the last subject discontinued the interventional phase in cohort 1 as of the safety cut off (up to 3.2 years).

Population: Participants who received afamitresgene autoleucel

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Synovial SarcomaAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)SAE23 Participants
Synovial SarcomaAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AESI- ICANS1 Participants
Synovial SarcomaAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AESI - cytokine release syndrome33 Participants
Synovial SarcomaAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AESI- Prolonged cytopenia at Week 49 Participants
Synovial SarcomaAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AE including SAE44 Participants
MRCLSAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AESI- Prolonged cytopenia at Week 41 Participants
MRCLSAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AE including SAE8 Participants
MRCLSAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)SAE3 Participants
MRCLSAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AESI - cytokine release syndrome4 Participants
MRCLSAdverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1)AESI- ICANS0 Participants
Secondary

Best Overall Response (BOR) (Cohort 1)

BOR is the best response recorded from the start of T-cell infusion until disease progression/recurrence as assessed by Independent Radiologist review. Response categories are confirmed CR, confirmed PR, stable disease and confirmed progressive disease (PD). Best overall response is a stable disease, if CR or PR are unconfirmed.

Time frame: From T-cell infusion until disease progression/recurrence as of data cut off (up to 2.6 years). Response was assessed at Week 4, Week 8, Week 12, Week 16, and Week 24, and every 2 months +/- 28 days until confirmed disease progression.

Population: Participants who received afamitresgene autoleucel

ArmMeasureCategoryValue (COUNT_OF_PARTICIPANTS)
Synovial SarcomaBest Overall Response (BOR) (Cohort 1)Partial Response17 Participants
Synovial SarcomaBest Overall Response (BOR) (Cohort 1)Complete Response0 Participants
Synovial SarcomaBest Overall Response (BOR) (Cohort 1)Stable Disease23 Participants
Synovial SarcomaBest Overall Response (BOR) (Cohort 1)Progressive Disease4 Participants
MRCLSBest Overall Response (BOR) (Cohort 1)Progressive Disease2 Participants
MRCLSBest Overall Response (BOR) (Cohort 1)Stable Disease4 Participants
MRCLSBest Overall Response (BOR) (Cohort 1)Complete Response0 Participants
MRCLSBest Overall Response (BOR) (Cohort 1)Partial Response2 Participants
Secondary

Duration of Response (DoR) (Cohort 1)

DoR (in months) is defined as ((date of PD (or censoring) - date of initial confirmed CR/PR + 1)/365.25)\*12 as assessed by Independent Radiologist review. Outcome Measure not yet reached as participants are ongoing in study

Time frame: From initial confirmed response (CR or PR) until PD (or censored date) as of data cut off.

Secondary

Insertional Oncogenesis (IO)

Deoxyribonucleic acid (DNA) from participants peripheral blood mononuclear cell (PBMC) samples was subjected to lentiviral vector integration site analysis by next-generation sequencing, thus evaluating both the clonality status of the transduced cell population and the genomic localization of individual integration sites. The count of participants with integration sites representing more than 5% of all unique sites is presented.

Time frame: From 10 months post T-cell infusion up to 20 months post T-cell infusion (as of the data cut off)

Population: Participants who received afamitresgene autoleucel and had a sample analyzed for IO

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Synovial SarcomaInsertional Oncogenesis (IO)0 Participants
MRCLSInsertional Oncogenesis (IO)0 Participants
Secondary

In Vitro Diagnostic (IVD) Assay for Screening

Development and validation of the MAGE-A4 antigen expression companion diagnostic assay

Time frame: 2.5 years

Secondary

Overall Survival (OS) (Cohort 1)

OS is defined as the time from the date of T-cell infusion to the date of death (due to any reason) or censored date. OS in months was calculated as ((death date - first T-cell infusion date + 1)/365.25)\*12. Outcome Measure not yet reached as participants are ongoing in study

Time frame: From T-cell infusion to death due to any reason (or censored date) as of data cut off (up to 2.6 years).

Secondary

Peak Persistence (Cohort 1)

Peak persistence of afamitresgene autoleucel cells was reported as vector copy numbers per microgram of genomic DNA from peripheral blood mononuclear cell (PBMC).

Time frame: From T-cell infusion to 3.2 years (as of data cut off).

Population: Participants who received afamitresgene autoleucel

ArmMeasureValue (MEDIAN)
Synovial SarcomaPeak Persistence (Cohort 1)229562.050 DNA copies/microgram
MRCLSPeak Persistence (Cohort 1)203534.150 DNA copies/microgram
Secondary

Progression Free Survival (PFS) (Cohort 1)

PFS is defined as the time from T-cell infusion to the date of the first documentation of PD or death due to any cause, whichever occurs first, as assessed by Independent Radiologist review. PFS (in weeks) was calculated as (date of PD/death \[or censored date\] - first T-cell infusion date + 1)/7.

Time frame: From T-cell infusion until first documented PD or death due to any cause (or censored date), whichever occurs first, as of data cut off (up to 2.6 years). Response was assessed at Week 4, 8,12,16, 24, and every 2 months until confirmed PD

Population: Participants who received afamitresgene autoleucel

ArmMeasureValue (MEDIAN)
Synovial SarcomaProgression Free Survival (PFS) (Cohort 1)16.4 Weeks
MRCLSProgression Free Survival (PFS) (Cohort 1)10.6 Weeks
Secondary

Quantitation of Genetically Engineered T-cells in PBMCs

Quantitation of genetically engineered T-cells in PBMCs by flow cytometry

Time frame: 2.5 years

Secondary

The Number of Participants With Replication Competent Lentivirus (RCL)

The presence of RCL was assessed by qPCR targeting a segment of the vesicular stomatitis virus glycoprotein (VSV G) coding sequence.

Time frame: From T-cell infusion to months 3, 6, and 12 post-infusion, then annually post-infusion (up to 2.8 years as of the data cut off).

Population: Participants who received afamitresgene autoleucel and had a sample tested for VSV-G by qPCR (RCL) at or after 3 months post-infusion

ArmMeasureValue (COUNT_OF_PARTICIPANTS)
Synovial SarcomaThe Number of Participants With Replication Competent Lentivirus (RCL)0 Participants
MRCLSThe Number of Participants With Replication Competent Lentivirus (RCL)0 Participants
Secondary

Time Taken to Achieve Peak Expansion of Genetically Engineered T-cells in PBMCs

Time taken to achieve peak expansion of genetically engineered T-cells in PBMCs by flow cytometry

Time frame: 2.5 years

Secondary

Time Taken to Achieve Peak Expansion of Genetically Engineered T-cells in PBMCs

Time taken to achieve peak expansion of genetically engineered T-cells in PBMCs by qPCR

Time frame: 2.5 years

Secondary

Time to Response (TTR) (Cohort 1)

TTR was defined as the interval (weeks) from the date of T-cell infusion to the earliest date of the first documented confirmed CR or confirmed PR as assessed by Independent Radiologist review. TTR (in weeks) = \[date of initial confirmed CR or PR - date of T-cell infusion + 1\]/7.

Time frame: From T-cell infusion until first documented confirmed CR or confirmed PR. Response was assessed at Week 4, Week 8, Week 12, Week 16, and Week 24, and every 2 months +/- 28 days until confirmed disease progression.

Population: Participants who received afamitresgene autoleucel and had a confirmed CR or confirmed PR as of data cut off.

ArmMeasureValue (MEDIAN)
Synovial SarcomaTime to Response (TTR) (Cohort 1)4.9 Weeks
MRCLSTime to Response (TTR) (Cohort 1)6.2 Weeks

Source: ClinicalTrials.gov · Data processed: Aug 27, 2026