Myxoid Liposarcoma, Synovial Sarcoma
Conditions
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
Single infusion of autologous genetically modified afamitresgene autoleucel (previously ADP-A2M4) Dose: 1.0 x109 to 10x109 transduced by a single intravenous infusion
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| 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
| Measure | Time frame | Description |
|---|---|---|
| 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 PD | 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. |
| 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 PBMCs | 2.5 years | Time taken to achieve peak expansion of genetically engineered T-cells in PBMCs by flow cytometry |
| Quantitation of Genetically Engineered T-cells in PBMCs | 2.5 years | Quantitation of genetically engineered T-cells in PBMCs by flow cytometry |
| In Vitro Diagnostic (IVD) Assay for Screening | 2.5 years | Development and validation of the MAGE-A4 antigen expression companion diagnostic assay |
Countries
Canada, France, Spain, United Kingdom, United States
Contacts
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
| Arm | Count |
|---|---|
| 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 |
| Total | 52 |
Baseline characteristics
| Characteristic | Synovial Sarcoma | MRCLS | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 3 Participants | 0 Participants | 3 Participants |
| Age, Categorical Between 18 and 65 years | 41 Participants | 8 Participants | 49 Participants |
| Age, Continuous | 41.0 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 Participants | 0 Participants | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 38 Participants | 5 Participants | 43 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 4 Participants | 3 Participants | 7 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 0 Participants | 3 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) White | 39 Participants | 6 Participants | 45 Participants |
| Sex: Female, Male Female | 22 Participants | 2 Participants | 24 Participants |
| Sex: Female, Male Male | 22 Participants | 6 Participants | 28 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 24 / 44 | 7 / 8 |
| other Total, other adverse events | 44 / 44 | 8 / 8 |
| serious Total, serious adverse events | 23 / 44 | 3 / 8 |
Outcome results
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
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Synovial Sarcoma | Overall Response Rate (ORR) (Cohort 1) | 38.6 percentage of participants |
| MRCLS | Overall Response Rate (ORR) (Cohort 1) | 25.0 percentage of participants |
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
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Synovial Sarcoma | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | SAE | 23 Participants |
| Synovial Sarcoma | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AESI- ICANS | 1 Participants |
| Synovial Sarcoma | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AESI - cytokine release syndrome | 33 Participants |
| Synovial Sarcoma | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AESI- Prolonged cytopenia at Week 4 | 9 Participants |
| Synovial Sarcoma | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AE including SAE | 44 Participants |
| MRCLS | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AESI- Prolonged cytopenia at Week 4 | 1 Participants |
| MRCLS | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AE including SAE | 8 Participants |
| MRCLS | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | SAE | 3 Participants |
| MRCLS | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AESI - cytokine release syndrome | 4 Participants |
| MRCLS | Adverse Events (AE) Including Serious Adverse Events (SAE), SAE, and Adverse Events of Special Interest (AESI) (Cohort 1) | AESI- ICANS | 0 Participants |
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
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Synovial Sarcoma | Best Overall Response (BOR) (Cohort 1) | Partial Response | 17 Participants |
| Synovial Sarcoma | Best Overall Response (BOR) (Cohort 1) | Complete Response | 0 Participants |
| Synovial Sarcoma | Best Overall Response (BOR) (Cohort 1) | Stable Disease | 23 Participants |
| Synovial Sarcoma | Best Overall Response (BOR) (Cohort 1) | Progressive Disease | 4 Participants |
| MRCLS | Best Overall Response (BOR) (Cohort 1) | Progressive Disease | 2 Participants |
| MRCLS | Best Overall Response (BOR) (Cohort 1) | Stable Disease | 4 Participants |
| MRCLS | Best Overall Response (BOR) (Cohort 1) | Complete Response | 0 Participants |
| MRCLS | Best Overall Response (BOR) (Cohort 1) | Partial Response | 2 Participants |
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.
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
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Synovial Sarcoma | Insertional Oncogenesis (IO) | 0 Participants |
| MRCLS | Insertional Oncogenesis (IO) | 0 Participants |
In Vitro Diagnostic (IVD) Assay for Screening
Development and validation of the MAGE-A4 antigen expression companion diagnostic assay
Time frame: 2.5 years
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).
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Synovial Sarcoma | Peak Persistence (Cohort 1) | 229562.050 DNA copies/microgram |
| MRCLS | Peak Persistence (Cohort 1) | 203534.150 DNA copies/microgram |
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
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Synovial Sarcoma | Progression Free Survival (PFS) (Cohort 1) | 16.4 Weeks |
| MRCLS | Progression Free Survival (PFS) (Cohort 1) | 10.6 Weeks |
Quantitation of Genetically Engineered T-cells in PBMCs
Quantitation of genetically engineered T-cells in PBMCs by flow cytometry
Time frame: 2.5 years
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
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Synovial Sarcoma | The Number of Participants With Replication Competent Lentivirus (RCL) | 0 Participants |
| MRCLS | The Number of Participants With Replication Competent Lentivirus (RCL) | 0 Participants |
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
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
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.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Synovial Sarcoma | Time to Response (TTR) (Cohort 1) | 4.9 Weeks |
| MRCLS | Time to Response (TTR) (Cohort 1) | 6.2 Weeks |