B7H3 CAR T Cell Immunotherapy for Recurrent/Refractory Solid Tumors in Children and Young Adults
Primary Purpose
Pediatric Solid Tumor, Germ Cell Tumor, Retinoblastoma
Status
Active
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
second generation 4-1BBζ B7H3-EGFRt-DHFR
second generation 4-1BBζ B7H3-EGFRt-DHFR(selected) and a second generation 4-1BBζ CD19-Her2tG
Pembrolizumab
Sponsored by
About this trial
This is an interventional treatment trial for Pediatric Solid Tumor focused on measuring CAR T cell, Pediatric, Young adults, Non-CNS solid tumor
Eligibility Criteria
Inclusion Criteria:
- Participants age ≤ 26 years at the time of consent for study participation; the first 2 participants enrolled and treated with CAR T cells in both Arms A and B will be ≥ 15 years. and ≤ 26 years at time of consent for study participation
- Histologically diagnosed malignant, non-primary CNS solid tumor
- Evidence of refractory or recurrent disease
- Lansky or Karnofsky score ≥ 50
- Life expectancy ≥ 8 weeks
- Recovered from significant acute toxic effects of all prior chemotherapy, immunotherapy and radiotherapy
- If no apheresis product or usable T cell product is available, all chemotherapy has been discontinued ≥ 7 days prior to enrollment
- If no apheresis or usable T cell product is available, all biologic therapy has been discontinued ≥ 7 days prior to enrollment
- If no apheresis product or T cell product is available, all systemic corticosteroid therapy has been discontinued ≥ 7 days prior to enrollment (physiologic replacement dosing is allowed)
- If no apheresis product or usable T cell product is available, at least 3 half-lives or 30 days (whichever is shorter) from time of last dose of anti-tumor directed antibody therapy (including checkpoint inhibitor) at time of enrollment
- If no apheresis product or usable T cell product is available, at least 6 weeks post last dose of myeloablative therapy and autologous and/or allogeneic stem cell transplant, or non-myeloablative therapy and allogeneic stem cell transplant (all timed from stem cell infusion). Participants who receive autologous stem cell infusion following non-myeloablative therapy are eligible once all other eligibility requirements are met.
- If no apheresis product or usable T cell product is available, participants who have received genetically modified cell therapy must be at least 30 days from most recent cell infusion prior to enrollment
- If no apheresis product or usable T cell product is available, participants with neuroblastoma must be at least 12 weeks from I131 MIBG therapy.
- Adequate organ function
- Adequate laboratory values
- Participant is able to tolerate apheresis (including placement of temporary apheresis catheter, if necessary), or already has an apheresis product available for use in manufacturing.
- Participants of childbearing potential must agree to use highly effective contraception
Exclusion Criteria:
- Presence of active malignancy other than primary malignant solid tumor diagnosis
- Current relevant CNS pathology
- Receiving external beam radiation therapy at time of enrollment
- Presence of active GVHD, or receiving immunosuppressive therapy for treatment or prevention of GVHD within 4 weeks prior to enrollment
- Participant is pregnant or breastfeeding
- Participant has presence of active severe infection
- Participant has presence of any condition that, in the option of an investigator, would prohibit the participant from undergoing treatment under this protocol
- Participant has primary immunodeficiency syndrome
- Unwilling or unable to provide consent/assent for participation in the study and 15 year follow up period
Sites / Locations
- Seattle Children's Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm Type
Experimental
Experimental
Experimental
Arm Label
SCRI-CARB7H3(s)
SCRI-CARB7H3(s)x19
SCRI-CARB7H3(s)x19 plus pembrolizumab
Arm Description
Autologous CD4+ and CD8+ T-cells genetically modified to express an B7H3-specific CAR
Autologous CD4+ and CD8+ T-cells genetically modified to a bispecific B7H3xCD19 CAR
Autologous CD4+ and CD8+ T-cells genetically modified to express a bispecific B7H3xCD19 CAR given in combination with pembrolizumab
Outcomes
Primary Outcome Measures
Assess the safety and tolerability of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express B7H3-specific CAR (Arm A)
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Assess the safety and tolerability of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express a bispecific B7H3xCD19 CAR (Arm B)
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
To assess the safety and tolerability of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express a bispecific B7H3xCD19 CAR given in combination with pembrolizumab (Arm C)
Type, frequency, severity, and duration of adverse events will be tabulated and summarized to determine maximal tolerated dose
To determine the maximum tolerated dose (MTD) of B7H3-specific CAR (Arm A)
Type, frequency, severity, and duration of adverse events will be tabulated and summarized to determine maximal tolerated dose
To determine the maximum tolerated dose of bispecific B7H3xCD19 CAR (Arm B)
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
To determine the feasibility of administration of pembrolizumab in combination with bispecific B7H3xCD19 CAR (Arm C)
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
To assess the dose limiting toxicities (DLTs) and describe the full toxicity profile for each study arm
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
To assess the feasibility of manufacturing B7H3 specific CARs from patient-derived lymphocytes
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
To assess the feasibility of manufacturing B7H3xCD19 bispecific CARs from patient-derived lymphocytes
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Secondary Outcome Measures
Determine the duration of in vivo persistence of adoptively transferred T cells in the peripheral blood and compare engraftment between T cell products and treatment arms
Presence of CAR T cells in the peripheral blood will be assessed
Determine the magnitude of in vivo persistence of adoptively transferred T cells in the peripheral blood and compare engraftment between T cell products
Number of CAR T cells in the peripheral blood will be assessed
Quantitate anti-tumor responses by measuring changes in tumor burden using disease-specific evaluations
Presence of CAR T cells in the peripheral blood will be assessed
Describe the relative expansion and persistence of the CAR T cell product and retention of function for B7H3xCD19 bispecific CARs determined by maintenance of B cell aplasia (BCA) with and without pembrolizumab
Presence of CAR T cells in the peripheral blood will be assessed
Full Information
NCT ID
NCT04483778
First Posted
July 14, 2020
Last Updated
July 6, 2023
Sponsor
Seattle Children's Hospital
1. Study Identification
Unique Protocol Identification Number
NCT04483778
Brief Title
B7H3 CAR T Cell Immunotherapy for Recurrent/Refractory Solid Tumors in Children and Young Adults
Official Title
Phase I Study of B7H3 CAR T Cell Immunotherapy for Recurrent/Refractory Solid Tumors in Children and Young Adults
Study Type
Interventional
2. Study Status
Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 13, 2020 (Actual)
Primary Completion Date
December 2025 (Anticipated)
Study Completion Date
December 2040 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Seattle Children's Hospital
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 is a phase I, open-label, non-randomized study that will enroll pediatric and young adult research participants with relapsed or refractory non-CNS solid tumors to evaluate the safety, feasibility, and efficacy of administering T cell products derived from the research participant's blood that have been genetically modified to express a B7H3-specific receptor (chimeric antigen receptor, or CAR) that will target and kill solid tumors that express B7H3. On Arm A of the study, research participants will receive B7H3-specific CAR T cells only. On Arm B of the study, research participants will receive CAR T cells directed at B7H3 and CD19, a marker on the surface of B lymphocytes, following the hypothesis that CD19+ B cells serving in their normal role as antigen presenting cells to T cells will promote the expansion and persistence of the CAR T cells. Arm A CAR T cells include the protein EGFRt and Arm B CAR T cells include the protein HER2tG. These proteins can be used to both track and destroy the CAR T cells in case of undue toxicity. The primary objectives of the study will be to determine the feasibility of manufacturing the cell products, the safety of the T cell product infusion, to determine the maximum tolerated dose of the CAR T cells products, to describe the full toxicity profile of each product, and determine the persistence of the modified cell in the participant's body on each arm. Participants will receive a single dose of T cells comprised of two different subtypes of T cells (CD4 and CD8 T cells) felt to benefit one another once administered to the research participants for improved potential therapeutic effect. The secondary objectives of this protocol are to study the number of modified cells in the patients and the duration they continue to be at detectable levels. The investigators will also quantitate anti-tumor efficacy on each arm. Participants who experience significant and potentially life-threatening toxicities (other than clinically manageable toxicities related to T cells working, called cytokine release syndrome) will receive infusions of cetuximab (an antibody commercially available that targets EGFRt) or trastuzumab (an antibody commercially available that targets HER2tG) to assess the ability of the EGFRt on the T cells to be an effective suicide mechanism for the elimination of the transferred T cell products.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pediatric Solid Tumor, Germ Cell Tumor, Retinoblastoma, Hepatoblastoma, Wilms Tumor, Rhabdoid Tumor, Carcinoma, Osteosarcoma, Ewing Sarcoma, Rhabdomyosarcoma, Synovial Sarcoma, Clear Cell Sarcoma, Malignant Peripheral Nerve Sheath Tumors, Desmoplastic Small Round Cell Tumor, Soft Tissue Sarcoma, Neuroblastoma, Melanoma
Keywords
CAR T cell, Pediatric, Young adults, Non-CNS solid tumor
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
68 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
SCRI-CARB7H3(s)
Arm Type
Experimental
Arm Description
Autologous CD4+ and CD8+ T-cells genetically modified to express an B7H3-specific CAR
Arm Title
SCRI-CARB7H3(s)x19
Arm Type
Experimental
Arm Description
Autologous CD4+ and CD8+ T-cells genetically modified to a bispecific B7H3xCD19 CAR
Arm Title
SCRI-CARB7H3(s)x19 plus pembrolizumab
Arm Type
Experimental
Arm Description
Autologous CD4+ and CD8+ T-cells genetically modified to express a bispecific B7H3xCD19 CAR given in combination with pembrolizumab
Intervention Type
Biological
Intervention Name(s)
second generation 4-1BBζ B7H3-EGFRt-DHFR
Intervention Description
Autologous CD4+ and CD8+ T-cells lentivirally transduced to express a second generation 4-1BBζ B7H3-EGFRt-DHFR
Intervention Type
Biological
Intervention Name(s)
second generation 4-1BBζ B7H3-EGFRt-DHFR(selected) and a second generation 4-1BBζ CD19-Her2tG
Intervention Description
Autologous CD4+ and CD8+ T-cells lentivirally transduced to express a second generation 4-1BBζ B7H3-EGFRt-DHFR(selected) and a second generation 4-1BBζ CD19-Her2tG
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Intervention Description
SCRI-CARB7H3(s)x19 plus pembrolizumab
Primary Outcome Measure Information:
Title
Assess the safety and tolerability of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express B7H3-specific CAR (Arm A)
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Title
Assess the safety and tolerability of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express a bispecific B7H3xCD19 CAR (Arm B)
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Title
To assess the safety and tolerability of cellular immunotherapy utilizing ex-vivo expanded autologous T cells genetically modified to express a bispecific B7H3xCD19 CAR given in combination with pembrolizumab (Arm C)
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized to determine maximal tolerated dose
Time Frame
28 days
Title
To determine the maximum tolerated dose (MTD) of B7H3-specific CAR (Arm A)
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized to determine maximal tolerated dose
Time Frame
28 days
Title
To determine the maximum tolerated dose of bispecific B7H3xCD19 CAR (Arm B)
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Title
To determine the feasibility of administration of pembrolizumab in combination with bispecific B7H3xCD19 CAR (Arm C)
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Title
To assess the dose limiting toxicities (DLTs) and describe the full toxicity profile for each study arm
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Title
To assess the feasibility of manufacturing B7H3 specific CARs from patient-derived lymphocytes
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Title
To assess the feasibility of manufacturing B7H3xCD19 bispecific CARs from patient-derived lymphocytes
Description
Type, frequency, severity, and duration of adverse events will be tabulated and summarized
Time Frame
28 days
Secondary Outcome Measure Information:
Title
Determine the duration of in vivo persistence of adoptively transferred T cells in the peripheral blood and compare engraftment between T cell products and treatment arms
Description
Presence of CAR T cells in the peripheral blood will be assessed
Time Frame
84 days
Title
Determine the magnitude of in vivo persistence of adoptively transferred T cells in the peripheral blood and compare engraftment between T cell products
Description
Number of CAR T cells in the peripheral blood will be assessed
Time Frame
84 days
Title
Quantitate anti-tumor responses by measuring changes in tumor burden using disease-specific evaluations
Description
Presence of CAR T cells in the peripheral blood will be assessed
Time Frame
84 days
Title
Describe the relative expansion and persistence of the CAR T cell product and retention of function for B7H3xCD19 bispecific CARs determined by maintenance of B cell aplasia (BCA) with and without pembrolizumab
Description
Presence of CAR T cells in the peripheral blood will be assessed
Time Frame
84 days
Other Pre-specified Outcome Measures:
Title
Evaluate for the presence of B7H3 CAR T cells in tumor tissue and/or normal tissue if a tissue biopsy, tumor biopsy, or resection is clinically indicated post-treatment
Description
Tumor tissue, when obtained, will be assessed for the presence of adoptively transferred CAR T cells
Time Frame
84 days
Title
Evaluate B7H3 antigen expression in tumor tissue and/or normal tissue if a tissue biopsy, tumor biopsy, or resection is available
Description
Tumor tissue, when obtained, will be assessed for the presence of B7H3 antigen
Time Frame
84 days
Title
Analyze blood, bone marrow, CSF, normal tissue, and/or tumor tissue for biomarkers of safety and/or anti-tumor activity
Description
If a tissue biopsy, tumor biopsy, or resection is clinically indicated post-treatment, pathology will be assessed for the presence of B7H3 CAR T cells
Time Frame
84 days
Title
Assess the efficacy of infusional cetuximab and/or trastuzumab in ablating transferred T cells and ameliorating acute toxicities in treated participants
Description
Biologic specimens, when obtained, will be assessed for biomarkers of safety and/or anti-tumor efficacy
Time Frame
84 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
0 Years
Maximum Age & Unit of Time
26 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Participants age ≤ 26 years at the time of consent for study participation; the first 2 participants enrolled and treated with CAR T cells in both Arms A and B will be ≥ 15 years. and ≤ 26 years at time of consent for study participation
Histologically diagnosed malignant, non-primary CNS solid tumor
Evidence of refractory or recurrent disease
Lansky or Karnofsky score ≥ 50
Life expectancy ≥ 8 weeks
Recovered from significant acute toxic effects of all prior chemotherapy, immunotherapy and radiotherapy
If no apheresis product or usable T cell product is available, all chemotherapy has been discontinued ≥ 7 days prior to enrollment
If no apheresis or usable T cell product is available, all biologic therapy has been discontinued ≥ 7 days prior to enrollment
If no apheresis product or T cell product is available, all systemic corticosteroid therapy has been discontinued ≥ 7 days prior to enrollment (physiologic replacement dosing is allowed)
If no apheresis product or usable T cell product is available, at least 3 half-lives or 30 days (whichever is shorter) from time of last dose of anti-tumor directed antibody therapy (including checkpoint inhibitor) at time of enrollment
If no apheresis product or usable T cell product is available, at least 6 weeks post last dose of myeloablative therapy and autologous and/or allogeneic stem cell transplant, or non-myeloablative therapy and allogeneic stem cell transplant (all timed from stem cell infusion). Participants who receive autologous stem cell infusion following non-myeloablative therapy are eligible once all other eligibility requirements are met.
If no apheresis product or usable T cell product is available, participants who have received genetically modified cell therapy must be at least 30 days from most recent cell infusion prior to enrollment
If no apheresis product or usable T cell product is available, participants with neuroblastoma must be at least 12 weeks from I131 MIBG therapy.
Adequate organ function
Adequate laboratory values
Participant is able to tolerate apheresis (including placement of temporary apheresis catheter, if necessary), or already has an apheresis product available for use in manufacturing.
Participants of childbearing potential must agree to use highly effective contraception
Exclusion Criteria:
Presence of active malignancy other than primary malignant solid tumor diagnosis
Current relevant CNS pathology
Receiving external beam radiation therapy at time of enrollment
Presence of active GVHD, or receiving immunosuppressive therapy for treatment or prevention of GVHD within 4 weeks prior to enrollment
Participant is pregnant or breastfeeding
Participant has presence of active severe infection
Participant has presence of any condition that, in the option of an investigator, would prohibit the participant from undergoing treatment under this protocol
Participant has primary immunodeficiency syndrome
Unwilling or unable to provide consent/assent for participation in the study and 15 year follow up period
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Navin Pinto, MD
Organizational Affiliation
Seattle Children's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Seattle Children's Hospital
City
Seattle
State/Province
Washington
ZIP/Postal Code
98105
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
B7H3 CAR T Cell Immunotherapy for Recurrent/Refractory Solid Tumors in Children and Young Adults
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