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Adoptive Cell Therapy With (LN-145) in Combination With Pembrolizumab in Treating Patients With Unresectable or Metastatic Transitional Cell Cancer Who Have Failed Cisplatin-Based Chemotherapy

Primary Purpose

Metastatic Bladder Urothelial Carcinoma, Metastatic Renal Pelvis Urothelial Carcinoma, Metastatic Ureter Urothelial Carcinoma

Status
Withdrawn
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Cyclophosphamide
Fludarabine
Fludarabine Phosphate
Pembrolizumab
Autologous Tumor Infiltrating Lymphocytes LN-145
Aldesleukin
Sponsored by
Roswell Park Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Bladder Urothelial Carcinoma

Eligibility Criteria

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

Inclusion Criteria:

  • The subject must understand the requirements of the study and voluntarily sign the informed consent form (ICF)
  • All subjects must have a histologically confirmed unresectable TCC (including renal pelvis, ureters, urinary bladder, and urethra)
  • Failed one and only one line of cisplatin-based chemotherapy per FDA guidelines.
  • Subjects must have an area of tumor amenable to excisional biopsy for the generation of TIL separate from, and in addition to , a target lesion to be used for response assessment.Have at least one resectable lesion to generate TILs
  • At least one measurable target lesion as defined by RECIST version 1.1
  • An Eastern Cooperative Oncology Group (ECOG) performance status of =< 1
  • Estimated life expectancy of >= 6 months
  • Adequate bone marrow function
  • Adequate organ function
  • Subjects must be seronegative for the human immunodeficiency virus (HIV)
  • Recovered from all prior anticancer therapy-related AEs to grade 1 or less
  • Negative serum pregnancy test (female subjects of childbearing potential)
  • Subjects of childbearing potential must be willing to practice an approved method of birth control starting at the time of informed consent and for 12 months after the completion of the study treatment regimen
  • Must be able and willing to comply with the study visit schedule and protocol requirements including long-term follow-up

Exclusion Criteria:

  • Have had another primary malignancy within the previous 3 years (with the exception of carcinoma in situ of the breast, cervix, or localized prostate cancer and non-melanoma skin cancer that has been adequately treated)
  • Have received prior cell transfer therapy that included a nonmyeloablative or myeloablative chemotherapy regimen
  • Prior treatment with anti-PD-1, or anti-PD-L1 therapeutic antibody, or pathway-targeting agents
  • Chemotherapy or radiotherapy with projected completion within 4 weeks of initiating study treatment
  • Bisphosphonate therapy for symptomatic hypercalcemia
  • Have had treatment with systemic immunostimulatory agents (including, but not limited to, interferon [IFN]-alpha or interleukin [IL]-2) within 6 weeks before initiation of study treatment
  • Active or prior documented autoimmune or inflammatory disorders
  • Subjects who have any form of human immondeficiency virus (HIV)infection
  • Have severe infections within 4 weeks before initiation of study treatment
  • Have received a live or attenuated vaccine within 28 days of the non-myeloablative lymphodepletion (NMA-LD regimen)
  • Subjects with a history of hypersensitivity reaction(s) to any component of the LN-145 therapy and/or the other study drugs

    • Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) >= 450 msec for males (and >= 470 msec for females) calculated from 3 electrocardiograms (ECGs) (within a 30-minute timeframe) or history of familiar long-QT syndrome
  • Subjects who have a left ventricular ejection fraction (LVEF) < 45% or who are New York Heart Association functional classification class II or higher
  • Serious illnesses or medical conditions, which would pose increased risk for study participation and/or compliance with the protocol
  • Known clinically significant liver disease
  • Have obstructive or restrictive pulmonary disease and have a documented FEV1 (forced expiratory volume in 1 second) of =< 60%
  • Subjects with known primary central nervous system (CNS) malignancy or symptomatic CNS metastases
  • Subjects who are pregnant or breastfeeding
  • Active infection including tuberculosis (TB), hepatitis B, hepatitis C, or human immunodeficiency virus
  • Treatment with any other investigational agent within 4 weeks before initiation of study treatment

Sites / Locations

  • Roswell Park Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (cyclophosphamide, fludarabine, pembrolizumab)

Arm Description

Patients receive cyclophosphamide IV over 2 hours on days -8 and -7, fludarabine IV over 30 minutes on days -6 to -2, and pembrolizumab IV over 30 minutes on day -1. At least 24 hours later, patients receive autologous tumor infiltrating lymphocytes LN-145 IV on day 0, and receive aldesleukin IV over 30 minutes for up to 6 doses on days 1-4. Patients then continue receiving pembrolizumab IV over 30 minutes beginning on day 21. Cycles of pembrolizumab repeat every 21 days for 12 months in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Objective response rate
The proportion of subjects who achieve either a confirmed partial response (PR) or complete response (CR) as best response as assessed per Response Evaluation Criteria in Solid Tumors 1.1. Will be evaluated per each disease assessment and calculated with the corresponding 95% two-sided confidence interval

Secondary Outcome Measures

Incidence of adverse events (AEs)
Will be assessed using National Cancer Institute Common Terminology Criteria for Adverse Events version 5 by grade of severity and relationship to the study treatment.
Duration of response
Will be assessed by Kaplan-Meier methods
Disease Control Rate
Derived as the sum of the number of subjects who achieved confirmed PR/CR or sustained stable disease (at least 6 weeks) divided by the number of subjects in the all-treated population x 100%. Will be assessed by Kaplan-Meier methods
Progression-free survival
Will be assessed by Kaplan-Meier methods
Overall Survival
From time of lymphodepletion to death due to any cause

Full Information

First Posted
April 30, 2019
Last Updated
December 27, 2019
Sponsor
Roswell Park Cancer Institute
Collaborators
Iovance Biotherapeutics, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03935347
Brief Title
Adoptive Cell Therapy With (LN-145) in Combination With Pembrolizumab in Treating Patients With Unresectable or Metastatic Transitional Cell Cancer Who Have Failed Cisplatin-Based Chemotherapy
Official Title
Phase 2 Study of Autologous Tumor Infiltrating Lymphocytes (LN-145) With Pembrolizumab, in Subjects Who Have Failed Cisplatin-Based Chemotherapy With Locally Advanced (Unresectable) or Metastatic Transitional Cell Cancer (TCC) of the Urothelium
Study Type
Interventional

2. Study Status

Record Verification Date
December 2019
Overall Recruitment Status
Withdrawn
Why Stopped
no accrual
Study Start Date
June 20, 2019 (Actual)
Primary Completion Date
May 1, 2022 (Anticipated)
Study Completion Date
May 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Roswell Park Cancer Institute
Collaborators
Iovance Biotherapeutics, Inc.

4. Oversight

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

5. Study Description

Brief Summary
This phase II trial studies how well autologous tumor infiltrating lymphocytes (LN-145) and pembrolizumab work in treating patients with transitional cell cancer that cannot be removed by surgery or has spread to other places in the body and have failed cisplatin-based chemotherapy. LN-145 is made up of specialized immune cells called lymphocytes or T cells that are taken from a patient's tumor, grown in a manufacturing facility and infused back into the preconditioned patient to attack the tumor. Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Giving LN-145 may help control transitional cell bladder cancer when given together with pembrolizumab
Detailed Description
PRIMARY OBJECTIVES: I. To evaluate the efficacy of autologous tumor infiltrating lymphocytes LN-145 (LN-145) in combination with pembrolizumab in subjects with advanced transitional cell bladder cancer (TCC) using the objective response rate (ORR) and the duration of response (DoR), using the Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST version [v] 1.1). SECONDARY OBJECTIVES: I. To evaluate the efficacy of LN-145 in combination with pembrolizumab in subjects with TCC based on the progression-free survival (PFS) and overall survival (OS). II. To evaluate the safety of LN-145 in combination with pembrolizumab in subjects with TCC based on the adverse event (AE) profile per Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE v5.0).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Bladder Urothelial Carcinoma, Metastatic Renal Pelvis Urothelial Carcinoma, Metastatic Ureter Urothelial Carcinoma, Metastatic Urethral Urothelial Carcinoma, Unresectable Renal Pelvis Urothelial Carcinoma, Unresectable Ureter Urothelial Carcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (cyclophosphamide, fludarabine, pembrolizumab)
Arm Type
Experimental
Arm Description
Patients receive cyclophosphamide IV over 2 hours on days -8 and -7, fludarabine IV over 30 minutes on days -6 to -2, and pembrolizumab IV over 30 minutes on day -1. At least 24 hours later, patients receive autologous tumor infiltrating lymphocytes LN-145 IV on day 0, and receive aldesleukin IV over 30 minutes for up to 6 doses on days 1-4. Patients then continue receiving pembrolizumab IV over 30 minutes beginning on day 21. Cycles of pembrolizumab repeat every 21 days for 12 months in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
1-bis(2-chloroethyl)-amino-1-oxo-2-aza-5-oxaphosphoridin monohydrate, 2-[bi(2-chloroethyl)amino]tetrahydro-2H-1,3,2-oxazaphosphorine 2-oxide monohydrate, Cyclostine, Revimmune, Syklofosfamid, WR- 138719
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Other Intervention Name(s)
118218, 2-Fluoro-9-beta-arabinofuranosyladenine, 2-Fluorovidarabine, 21679-14-1, 9-Beta-D-arabinofuranosyl-2-fluoro-9H-purin-6-amine, 9-Beta-D-arabinofuranosyl-2-fluoroadenine, Fluradosa
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Fludarabine Phosphate
Other Intervention Name(s)
2-F-ara-AMP, 312887, 328002, 75607-67-9, 9H-Purin-6-amine, 2-fluoro-9-(5-O-phosphono-.beta.-D-arabinofuranosyl, Fludarabine-5'-Monophosphate, SH T 586
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
1374853-91-4, Immunoglobulin G4, Anti-(Human Programmed Cell Death 1)
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
Autologous Tumor Infiltrating Lymphocytes LN-145
Other Intervention Name(s)
Autologous TILs LN-145, LN-145, LN145
Intervention Description
Given IV
Intervention Type
Biological
Intervention Name(s)
Aldesleukin
Other Intervention Name(s)
110942-02-4, 125-L-Serine-2-133-interleukin 2, Recombinant Human Interleukin-2
Intervention Description
Given IV
Primary Outcome Measure Information:
Title
Objective response rate
Description
The proportion of subjects who achieve either a confirmed partial response (PR) or complete response (CR) as best response as assessed per Response Evaluation Criteria in Solid Tumors 1.1. Will be evaluated per each disease assessment and calculated with the corresponding 95% two-sided confidence interval
Time Frame
Up to 3 years
Secondary Outcome Measure Information:
Title
Incidence of adverse events (AEs)
Description
Will be assessed using National Cancer Institute Common Terminology Criteria for Adverse Events version 5 by grade of severity and relationship to the study treatment.
Time Frame
From the first dose of cyclophosphamide up to 30 days from the last dose of IL-
Title
Duration of response
Description
Will be assessed by Kaplan-Meier methods
Time Frame
Up to 3 years
Title
Disease Control Rate
Description
Derived as the sum of the number of subjects who achieved confirmed PR/CR or sustained stable disease (at least 6 weeks) divided by the number of subjects in the all-treated population x 100%. Will be assessed by Kaplan-Meier methods
Time Frame
Up to 3 years
Title
Progression-free survival
Description
Will be assessed by Kaplan-Meier methods
Time Frame
Up to 3 years
Title
Overall Survival
Description
From time of lymphodepletion to death due to any cause
Time Frame
Up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: The subject must understand the requirements of the study and voluntarily sign the informed consent form (ICF) All subjects must have a histologically confirmed unresectable TCC (including renal pelvis, ureters, urinary bladder, and urethra) Failed one and only one line of cisplatin-based chemotherapy per FDA guidelines. Subjects must have an area of tumor amenable to excisional biopsy for the generation of TIL separate from, and in addition to , a target lesion to be used for response assessment.Have at least one resectable lesion to generate TILs At least one measurable target lesion as defined by RECIST version 1.1 An Eastern Cooperative Oncology Group (ECOG) performance status of =< 1 Estimated life expectancy of >= 6 months Adequate bone marrow function Adequate organ function Subjects must be seronegative for the human immunodeficiency virus (HIV) Recovered from all prior anticancer therapy-related AEs to grade 1 or less Negative serum pregnancy test (female subjects of childbearing potential) Subjects of childbearing potential must be willing to practice an approved method of birth control starting at the time of informed consent and for 12 months after the completion of the study treatment regimen Must be able and willing to comply with the study visit schedule and protocol requirements including long-term follow-up Exclusion Criteria: Have had another primary malignancy within the previous 3 years (with the exception of carcinoma in situ of the breast, cervix, or localized prostate cancer and non-melanoma skin cancer that has been adequately treated) Have received prior cell transfer therapy that included a nonmyeloablative or myeloablative chemotherapy regimen Prior treatment with anti-PD-1, or anti-PD-L1 therapeutic antibody, or pathway-targeting agents Chemotherapy or radiotherapy with projected completion within 4 weeks of initiating study treatment Bisphosphonate therapy for symptomatic hypercalcemia Have had treatment with systemic immunostimulatory agents (including, but not limited to, interferon [IFN]-alpha or interleukin [IL]-2) within 6 weeks before initiation of study treatment Active or prior documented autoimmune or inflammatory disorders Subjects who have any form of human immondeficiency virus (HIV)infection Have severe infections within 4 weeks before initiation of study treatment Have received a live or attenuated vaccine within 28 days of the non-myeloablative lymphodepletion (NMA-LD regimen) Subjects with a history of hypersensitivity reaction(s) to any component of the LN-145 therapy and/or the other study drugs Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) >= 450 msec for males (and >= 470 msec for females) calculated from 3 electrocardiograms (ECGs) (within a 30-minute timeframe) or history of familiar long-QT syndrome Subjects who have a left ventricular ejection fraction (LVEF) < 45% or who are New York Heart Association functional classification class II or higher Serious illnesses or medical conditions, which would pose increased risk for study participation and/or compliance with the protocol Known clinically significant liver disease Have obstructive or restrictive pulmonary disease and have a documented FEV1 (forced expiratory volume in 1 second) of =< 60% Subjects with known primary central nervous system (CNS) malignancy or symptomatic CNS metastases Subjects who are pregnant or breastfeeding Active infection including tuberculosis (TB), hepatitis B, hepatitis C, or human immunodeficiency virus Treatment with any other investigational agent within 4 weeks before initiation of study treatment
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gurkamal Chatta, MD
Organizational Affiliation
Roswell Park Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Roswell Park Cancer Institute
City
Buffalo
State/Province
New York
ZIP/Postal Code
14263-0001
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Adoptive Cell Therapy With (LN-145) in Combination With Pembrolizumab in Treating Patients With Unresectable or Metastatic Transitional Cell Cancer Who Have Failed Cisplatin-Based Chemotherapy

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