Malignant Pleural Mesotheliomas
Conditions
Keywords
Mesothelioma, Pleural Mesothelioma, Peritoneal Mesothelioma, MSLN, FAP, Dual-Target CAR-NK, Locoregional Cell Therapy, Solid Tumor Immunotherapy
Brief summary
This example study evaluates locoregional allogeneic dual-target mesothelin/FAP CAR-NK cells in adults with unresectable, recurrent, or refractory pleural or peritoneal mesothelioma. Eligible participants must have central confirmation of MSLN-positive tumor cells and FAP-positive tumorassociated stroma. The phase 1 portion defines the recommended phase 2 dose and schedule, and the phase 2 expansion explores preliminary antitumor activity, persistence, and biomarker response in pleural and peritoneal disease cohorts.
Detailed description
Mesothelioma remains a difficult serosal malignancy with limited curative options in recurrent or refractory disease. Mesothelin (MSLN) is a well-established tumor-associated antigen in malignant pleural mesothelioma and other serosal tumors, while fibroblast activation protein (FAP) is relevant in the dense, immunosuppressive stromal compartment that can limit immune-cell trafficking and persistence. For this example, MSLN is retained as the anchor target and FAP is selected as the preferred second target after assessment. Screening includes central pathology review using archival or fresh tissue and, where available, complementary liquid-biopsy profiling. Participants enter this dual-target study only if both MSLN and FAP meet pre-specified positivity thresholds. If only one actionable target is confirmed, the participant should be considered for a companion single-target protocol rather than this draft dual target protocol. The study is designed as an open-label, biomarker-guided phase 1/2 trial with two nonrandomized parallel cohorts defined by disease site: pleural mesothelioma and peritoneal mesothelioma. Part 1uses staggered locoregional dose escalation to determine the recommended phase 2 dose and schedule. Part 2 expands each cohort at the selected dose. Participants receive lymphodepleting chemotherapy with fludarabine and cyclophosphamide before CAR-NK infusion. Delivery is intrapleural for pleural mesothelioma and intraperitoneal for peritoneal mesothelioma. A repeat infusion may be permitted between Day 21 and Day 35 if there is no dose-limiting toxicity and no radiographic progression. Key objectives are to characterize safety, define the recommended dose and schedule, estimate preliminary antitumor activity, and study pharmacodynamic effects including CAR-NK persistence in blood and serosal fluid, changes in soluble mesothelin-related peptide (SMRP), ctDNA dynamics, and cytokine modulation within pleural or peritoneal compartments.
Interventions
BIOLOGICALEB-MF-CAR-NK-01
Example investigational product: donor-derived allogeneic NK cells engineered to recognize both MSLN-positive tumor cells and FAPpositive stromal elements, manufactured under GMP
DRUGFludarabine
Lymphodepleting chemotherapy administered before CAR-NK infusion
DRUGCyclophosphamide
Lymphodepleting chemotherapy administered before CAR-NK infusion.
Sponsors
Beijing Biotech
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
No masking is used because this is a first-in-disease-site early-phase cell-therapy study with route-specific locoregional administration, dose-escalation decisions, and intensive safety monitoring that require real-time knowledge of treatment assignment.
Intervention model description
Two open-label, nonrandomized locoregional cohorts run in parallel according to disease site (pleural vs peritoneal mesothelioma). Part 1 uses staggered dose escalation in both cohorts to identify the recommended phase 2 dose and schedule. Part 2 expands each cohort separately at the selected dose. Assignment is based on disease anatomy and biomarker positivity, not randomization.
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 to 75 years at the time of consent. * Histologically confirmed malignant pleural mesothelioma or malignant peritoneal mesothelioma; unresectable, recurrent, metastatic, or refractory disease. * Prior receipt of at least one standard systemic regimen for mesothelioma, or documented ineligibility, intolerance, or refusal of standard therapy considered reasonable by the investigator. * Central biomarker confirmation of MSLN-positive tumor cells and FAP-positive tumorassociated stroma at protocol-defined thresholds. * At least one measurable or evaluable lesion by cohort-appropriate imaging criteria. * ECOG performance status 0 to 1. * Adequate bone marrow, renal, hepatic, coagulation, cardiac, and pulmonary function to undergo lymphodepletion and locoregional cell infusion. * Safe procedural access for intrapleural or intraperitoneal administration, as applicable. * Recovery to Grade 1 or better from prior anticancer therapy toxicities, except alopecia, stable neuropathy, or controlled endocrine replacement. * Life expectancy of at least 12 weeks. * Negative pregnancy test for participants of childbearing potential and agreement to use protocoldefined contraception. * Ability to understand and sign informed consent
Exclusion criteria
* Active or untreated CNS metastases, leptomeningeal disease, or uncontrolled seizures. * Uncontrolled bacterial, fungal, viral, or mycobacterial infection, including empyema, active pleural space infection, peritonitis, or uncontrolled HBV, HCV, or HIV infection. * Autoimmune disease requiring systemic immunosuppression within 14 days before lymphodepletion, or prednisone equivalent greater than 10 mg/day. * Clinically significant cardiovascular disease, uncontrolled arrhythmia, unstable angina, recent myocardial infarction, or other condition judged to increase infusion risk. * Severe interstitial lung disease, baseline oxygen requirement, or other pulmonary compromise making pleural therapy unsafe. * Bowel perforation risk, uncontrolled bowel obstruction, uncontrolled ascites, or any abdominal condition that makes intraperitoneal infusion unsafe in the peritoneal cohort. * Prior gene-modified cell therapy directed against MSLN or FAP within the protocol washout period, or active graft-versus-host disease after prior transplant. * Need for concurrent systemic anticancer therapy other than protocol-permitted supportive care. * Pregnancy or breastfeeding. * Any medical, psychiatric, social, or logistical condition that, in the investigator's judgment, could compromise safety, compliance, or interpretability of study results.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of dose-limiting toxicities (DLTs) after first CAR-NK infusion | 28 days | — |
| ncidence and severity of treatment-emergent adverse events (TEAEs) | 12 months | ncidence and severity of treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), cytokine release syndrome, neurotoxicity, pleuritis/peritonitis, infusion reactions, and on-target/off-tumor toxicities graded by CTCAE v5.0 and ASTCT crit |
| Determination of recommended phase 2 dose and schedule (RP2D/RP2S) | 6 months | — |
Secondary
| Measure | Time frame |
|---|---|
| Objective response rate (ORR) by modified RECIST for the pleural cohort and RECIST 1.1 for the peritoneal cohort | 12 months |
| Disease control rate (DCR) at 12 weeks | 12 weeks |
| Duration of response (DOR) | 24 months |
| Progression-free survival (PFS) | 24 months |
| Overall survival (OS) | 24 months |
Countries
China
Contacts
CONTACTSeni S Lu, Phd
Outcome results
None listed