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A Study Evaluating Temferon in Patients With Glioblastoma & Unmethylated MGMT (TEM-GBM)

Primary Purpose

Glioblastoma Multiforme

Status
Recruiting
Phase
Phase 1
Locations
Italy
Study Type
Interventional
Intervention
Temferon
Sponsored by
Genenta Science
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma Multiforme focused on measuring Temferon, Gene Therapy, Immunotherapy, Solid tumor

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Histologically confirmed, newly diagnosed supratentorial glioblastoma with unmethylated MGMT gene promoter.
  • Patients have undergone complete or partial tumor resection.
  • Able and willing to provide written informed consent and comply with the study protocol and procedures.
  • Eligible for radiotherapy.
  • Life expectancy of 6 months or more at Screening.
  • Women of child-bearing potential enrolled in the study must have a negative pregnancy test at screening and agree to use acceptable methods of contraception during the trial.
  • Men enrolled in the study with partners who are women of child-bearing potential, must be willing to use an acceptable barrier contraceptive method during the trial or have undergone successful vasectomy at least 6 months prior to entry into the study. Successful vasectomy needs to have been confirmed by semen analysis.
  • Karnofsky performance score (KPS)≥70.

Additional inclusion criteria to be assessed within 20 days of Temferon administration:

  • Adequate cardiac, renal, hepatic and pulmonary function as evidenced by:
  • Left ventricular ejection fraction (LVEF) ≥ 45% by echo and normal electrocardiogram (ECG) or presence of abnormalities not significant for cardiac disease.
  • Absence of severe pulmonary hypertension;
  • Diffusing capacity of the lung for carbon monoxide (DLCO) >50% and forced expiratory volume in 1 sec (FEV1) and forced expiratory vital capacity (FVC) > 60% predicted (if non cooperative: pulse oximetry > 95% in room air);
  • Serum creatinine < 2x upper limit normal and estimated glomerular filtration rate (eGFR) ≥ 30ml/min/1.73m^2;
  • Alkaline phosphatase (ALP), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 x upper limit of normal (ULN), and total bilirubin ≤ 2.0 mg/dl.
  • Hemoglobin ≥10 g/dL, platelet count ≥100000/mm^3, absolute neutrophil count >1500/mm^3.

Exclusion Criteria:

  • Use of other investigational agents or procedures within 4 weeks prior to study enrolment (within 6 weeks if use of long-acting agents) or participation in a previous gene therapy study.
  • Known hypersensitivity to carmustine (or any other nitrosurea), busulfan, thiotepa, lenograstim, plerixafor, or any excipients used in these products.
  • Receipt of any oral or parenteral chemotherapy or immunotherapy within 2 years of Screening.
  • Previous allogeneic bone marrow transplantation, kidney or liver transplant.
  • Clinical evidence of persistent raised intracranial pressure following surgical resection.
  • Clinically relevant active viral, bacterial, or fungal infection at eligibility evaluation.
  • Active autoimmune disease or a relevant history of important autoimmune manifestations, in particular psoriasis, systemic lupus erythematosus (SLE), rheumatoid arthritis, vasculitis, immunemediated peripheral neuropathies.
  • History of sarcoidosis.
  • History or current evidence of neuropsychiatric illness including depression, schizophrenia, bipolar disorders, impaired cognitive function, dementia or suicidal tendency.
  • History of severe cardiovascular disease such as prior stroke, coronary artery disease requiring intervention or unresolved arrhythmias in the past 6 months.
  • Evidence of any hematological neoplasm.
  • Positivity for human immunodeficiency virus type 1 or 2 (HIV-1, HIV-2) (serology or RNA), and/or Hepatitis B Virus Surface Antigen (HbsAg) and/or Hepatitis B Virus (HBV) DNA and/or Hepatitis C virus (HCV) RNA (or negative HCV RNA but on antiviral treatment) and/or Treponema Pallidum or Mycoplasma active infection.
  • Active alcohol or substance abuse within 6 months of the study.
  • Current pregnancy or lactation.
  • Known bleeding diathesis or history of abnormal bleeding, or any other known coagulation abnormalities that would contraindicate lumbar puncture for CSF or future surgery.
  • Use of immunosuppressants with the exception of steroids. The maximum permitted dexamethasone (or equivalent) dose is 4 mg per day.

Sites / Locations

  • Ospedale San Raffaele
  • Fondazione IRCCS Istituto Neurologico "Carlo Besta"Recruiting
  • Policlinico Universitario Fondazione Agostino Gemelli

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Temferon

Arm Description

Autologous CD34+-enriched hematopoietic progenitor cells exposed in vitro to specific lentiviral vector encoding for the human interferon-alpha 2 gene. Its expression is tightly controlled by the human TIE2 enhancer/promoter sequence and by a post-transcriptional regulation layer represented by target miRNA sequences. This enables suppression of interferon-alpha2 expression in HSPCs, thereby further increasing the specificity of the delivery strategy for their Tie2 expressing myeloid cell progeny.

Outcomes

Primary Outcome Measures

Tolerability and safety of Temferon over the first 90 days following administration as determined by the incidence of adverse events
Routine clinical and laboratory surveillance

Secondary Outcome Measures

Long term tolerability and safety of Temferon as determined by the incidence of adverse events
Routine clinical and laboratory surveillance
Proportion of patients achieving haematologic recovery by Day +30 (defined as the first of at least 3 consecutive days with a neutrophil count >0.5 x 10^9/L and platelet count >20 x 10^9/L)
Hematologic recovery is defined as the first of at least 3 consecutive days with a neutrophil count >0.5 x 10^9/L and platelet count >20 x 10^9/L.
Determine the maximum tolerated dose of Temferon
Presence of a CTCAE Grade 3-5 adverse event (AE) that occurs within the first 30 days and is attributed to Temferon.
Identify presence of transduced myeloid cells in bone marrow as determined by vector copy number
VCN
Incidence of adverse events attributed to the conditioning regimen
Adverse events for BCNU and thiotepa, busulfan and thiotepa, or busulfan monotherapy up to Day +45
Identify presence of transduced myeloid cells in peripheral blood as determined by vector copy number
VCN
Determine clinical response in patients as determined by iRANO criteria
iRANO criteria
Determine progression free survival in patients
MRI
Determine overall survival in patients
Survival data
Changes in functional status (Eastern Cooperative Oncology Group)
ECOG assessment: 0 Fully active, able to carry on all pre-disease performance without restriction Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours Completely disabled; cannot carry on any selfcare; totally confined to bed or chair Dead
Changes in functional status (Karnofsky)
Karnofsky assessment
Changes in Quality of Life (European Organisation for Research and Treatment of Cancer EORTC C30)
EORTC C30 questionnaire
Changes in Quality of Life (BN20)
European Organisation for Research and Treatment of Cancer BN20 questionnaire

Full Information

First Posted
March 5, 2019
Last Updated
January 18, 2023
Sponsor
Genenta Science
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1. Study Identification

Unique Protocol Identification Number
NCT03866109
Brief Title
A Study Evaluating Temferon in Patients With Glioblastoma & Unmethylated MGMT
Acronym
TEM-GBM
Official Title
A Phase I/IIa Dose Escalation Study Evaluating the Safety and Efficacy of Autologous CD34+-Enriched HSPCs Genetically Modified With Human Interferon-α2 in Patients With Glioblastoma Multiforme and Unmethylated MGMT Gene Promoter
Study Type
Interventional

2. Study Status

Record Verification Date
January 2022
Overall Recruitment Status
Recruiting
Study Start Date
March 5, 2019 (Actual)
Primary Completion Date
December 2023 (Anticipated)
Study Completion Date
December 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Genenta Science

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a non-randomized, open label, phase I/IIa, dose-escalation study, involving a single injection of Temferon, an investigational advanced therapy consisting of autologous CD34+-enriched hematopoietic stem and progenitor cells exposed to transduction with a lentiviral vector driving myeloid specific interferon-alpha2 expression, which will be administered to up to 27 patients affected by GBM who have an unmethylated MGMT promoter. Part A will evaluate the safety and tolerability of 5 escalating doses of Temferon and 3 different conditioning regimens in up to 27 patients, following first line treatment.
Detailed Description
This is a non-randomized, open label, multicenter, phase I/IIa, therapeutic-exploratory, dose escalation, prospective study, involving a single injection of Temferon, an investigational ATMP consisting of autologous CD34+-enriched HSPCs exposed to transduction with a 3rd generation lentiviral vector driving myeloid-specific IFN-alpha2 expression, which will be administered to up to 27 patients affected by GBM who have an unmethylated MGMT promoter. The study will recruit and follow-up patients at a specialist neurosurgical and neuro-oncology units in Italy. Administration of Temferon and hematological follow up will take place at specialist hematology and bone marrow transplantation units. Potentially eligible patients will be identified immediately after surgical resection of GBM once the MGMT promoter methylator status is known. Once written, informed consent is obtained, and screening procedures have been completed, harvesting of HSPCs will occur. A standard of care regimen lasting approximately 6 weeks, will then take place . During this time, Temferon manufacturing will occur. Following completion of radiotherapy, patients will be admitted for receipt of a conditioning regimen consisting of BCNU and thiotepa (Cohorts 1-6), busulfan and thiotepa (Cohort 5), or busulfan (Cohorts 7 and 8). This will be followed by administration of Temferon. In-patient monitoring will occur until hematological recovery occurs. Thereafter, regular follow-up of patients will occur up to 2 years (+720 days) with the majority of assessments and procedures. At the +720 day visit, patients will be invited to participate in a long term follow-up study which will last for an additional 6 years. In Part A of the study, 8 cohorts of 3 patients will receive 5 escalating doses of Temferon. On completion of dose escalation in Part A, a conditioning regimen and single dose of Temferon will be selected to be studied in up to a further 6 patients. In the event that GBM disease progression occurs, patients will be managed with second line therapies including second surgery, TMZ, BCNU, fotemustine or any other approved therapy for GBM.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma Multiforme
Keywords
Temferon, Gene Therapy, Immunotherapy, Solid tumor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
8 cohorts: Cohorts 1-4, 6: Thiotepa and BCNU Conditioning; Temferon dose 0.5 - 3 x10^6 CD34+ cells/kg; Cohort 5: Thiotepa and Busulfan Condtioning; Temferon 2 x 10^6 CD34+ cells/kg; Cohort 7: Busulfan conditioning; Temferon 3 x 10^6 CD34+ cells/kg; Cohort 8: Busulfan conditioning; Temferon 4 x 10^6 CD34+ cells/kg;
Masking
None (Open Label)
Allocation
N/A
Enrollment
27 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Temferon
Arm Type
Experimental
Arm Description
Autologous CD34+-enriched hematopoietic progenitor cells exposed in vitro to specific lentiviral vector encoding for the human interferon-alpha 2 gene. Its expression is tightly controlled by the human TIE2 enhancer/promoter sequence and by a post-transcriptional regulation layer represented by target miRNA sequences. This enables suppression of interferon-alpha2 expression in HSPCs, thereby further increasing the specificity of the delivery strategy for their Tie2 expressing myeloid cell progeny.
Intervention Type
Drug
Intervention Name(s)
Temferon
Intervention Description
Genetically modified HSPCs
Primary Outcome Measure Information:
Title
Tolerability and safety of Temferon over the first 90 days following administration as determined by the incidence of adverse events
Description
Routine clinical and laboratory surveillance
Time Frame
90 days
Secondary Outcome Measure Information:
Title
Long term tolerability and safety of Temferon as determined by the incidence of adverse events
Description
Routine clinical and laboratory surveillance
Time Frame
2 years
Title
Proportion of patients achieving haematologic recovery by Day +30 (defined as the first of at least 3 consecutive days with a neutrophil count >0.5 x 10^9/L and platelet count >20 x 10^9/L)
Description
Hematologic recovery is defined as the first of at least 3 consecutive days with a neutrophil count >0.5 x 10^9/L and platelet count >20 x 10^9/L.
Time Frame
30 days
Title
Determine the maximum tolerated dose of Temferon
Description
Presence of a CTCAE Grade 3-5 adverse event (AE) that occurs within the first 30 days and is attributed to Temferon.
Time Frame
30 days
Title
Identify presence of transduced myeloid cells in bone marrow as determined by vector copy number
Description
VCN
Time Frame
Over 2 years
Title
Incidence of adverse events attributed to the conditioning regimen
Description
Adverse events for BCNU and thiotepa, busulfan and thiotepa, or busulfan monotherapy up to Day +45
Time Frame
Day +30
Title
Identify presence of transduced myeloid cells in peripheral blood as determined by vector copy number
Description
VCN
Time Frame
Over 2 years
Title
Determine clinical response in patients as determined by iRANO criteria
Description
iRANO criteria
Time Frame
Over 2 years
Title
Determine progression free survival in patients
Description
MRI
Time Frame
Over 2 years
Title
Determine overall survival in patients
Description
Survival data
Time Frame
2 years
Title
Changes in functional status (Eastern Cooperative Oncology Group)
Description
ECOG assessment: 0 Fully active, able to carry on all pre-disease performance without restriction Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours Completely disabled; cannot carry on any selfcare; totally confined to bed or chair Dead
Time Frame
2 years
Title
Changes in functional status (Karnofsky)
Description
Karnofsky assessment
Time Frame
2 years
Title
Changes in Quality of Life (European Organisation for Research and Treatment of Cancer EORTC C30)
Description
EORTC C30 questionnaire
Time Frame
2 years
Title
Changes in Quality of Life (BN20)
Description
European Organisation for Research and Treatment of Cancer BN20 questionnaire
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed, newly diagnosed supratentorial glioblastoma with unmethylated MGMT gene promoter. Patients have undergone complete or partial tumor resection. Able and willing to provide written informed consent and comply with the study protocol and procedures. Eligible for radiotherapy. Life expectancy of 6 months or more at Screening. Women of child-bearing potential enrolled in the study must have a negative pregnancy test at screening and agree to use acceptable methods of contraception during the trial. Men enrolled in the study with partners who are women of child-bearing potential, must be willing to use an acceptable barrier contraceptive method during the trial or have undergone successful vasectomy at least 6 months prior to entry into the study. Successful vasectomy needs to have been confirmed by semen analysis. Karnofsky performance score (KPS)≥70. Additional inclusion criteria to be assessed within 20 days of Temferon administration: Adequate cardiac, renal, hepatic and pulmonary function as evidenced by: Left ventricular ejection fraction (LVEF) ≥ 45% by echo and normal electrocardiogram (ECG) or presence of abnormalities not significant for cardiac disease. Absence of severe pulmonary hypertension; Diffusing capacity of the lung for carbon monoxide (DLCO) >50% and forced expiratory volume in 1 sec (FEV1) and forced expiratory vital capacity (FVC) > 60% predicted (if non cooperative: pulse oximetry > 95% in room air); Serum creatinine < 2x upper limit normal and estimated glomerular filtration rate (eGFR) ≥ 30ml/min/1.73m^2; Alkaline phosphatase (ALP), alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≤ 2.5 x upper limit of normal (ULN), and total bilirubin ≤ 2.0 mg/dl. Hemoglobin ≥10 g/dL, platelet count ≥100000/mm^3, absolute neutrophil count >1500/mm^3. Exclusion Criteria: Use of other investigational agents or procedures within 4 weeks prior to study enrolment (within 6 weeks if use of long-acting agents) or participation in a previous gene therapy study. Known hypersensitivity to carmustine (or any other nitrosurea), busulfan, thiotepa, lenograstim, plerixafor, or any excipients used in these products. Receipt of any oral or parenteral chemotherapy or immunotherapy within 2 years of Screening. Previous allogeneic bone marrow transplantation, kidney or liver transplant. Clinical evidence of persistent raised intracranial pressure following surgical resection. Clinically relevant active viral, bacterial, or fungal infection at eligibility evaluation. Active autoimmune disease or a relevant history of important autoimmune manifestations, in particular psoriasis, systemic lupus erythematosus (SLE), rheumatoid arthritis, vasculitis, immunemediated peripheral neuropathies. History of sarcoidosis. History or current evidence of neuropsychiatric illness including depression, schizophrenia, bipolar disorders, impaired cognitive function, dementia or suicidal tendency. History of severe cardiovascular disease such as prior stroke, coronary artery disease requiring intervention or unresolved arrhythmias in the past 6 months. Evidence of any hematological neoplasm. Positivity for human immunodeficiency virus type 1 or 2 (HIV-1, HIV-2) (serology or RNA), and/or Hepatitis B Virus Surface Antigen (HbsAg) and/or Hepatitis B Virus (HBV) DNA and/or Hepatitis C virus (HCV) RNA (or negative HCV RNA but on antiviral treatment) and/or Treponema Pallidum or Mycoplasma active infection. Active alcohol or substance abuse within 6 months of the study. Current pregnancy or lactation. Known bleeding diathesis or history of abnormal bleeding, or any other known coagulation abnormalities that would contraindicate lumbar puncture for CSF or future surgery. Use of immunosuppressants with the exception of steroids. The maximum permitted dexamethasone (or equivalent) dose is 4 mg per day.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Carlo Russo, MD
Phone
+39 02 2643 3982
Email
info-trial@genenta.com
First Name & Middle Initial & Last Name or Official Title & Degree
Stefania Mazzoleni, PhD
Phone
+39 02 2643 3982
Email
info-trial@genenta.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gaetano Finocchiaro, MD
Organizational Affiliation
Ospedale San Raffaele
Official's Role
Study Chair
Facility Information:
Facility Name
Ospedale San Raffaele
City
Milan
ZIP/Postal Code
20132
Country
Italy
Individual Site Status
Enrolling by invitation
Facility Name
Fondazione IRCCS Istituto Neurologico "Carlo Besta"
City
Milan
ZIP/Postal Code
20133
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Marica Eoli, MD
Facility Name
Policlinico Universitario Fondazione Agostino Gemelli
City
Rome
Country
Italy
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Alessandro Olivi, MD

12. IPD Sharing Statement

Plan to Share IPD
No

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A Study Evaluating Temferon in Patients With Glioblastoma & Unmethylated MGMT

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