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Antigen-specific T Cell Therapy for Patients With Relapsed Refractory Multiple Myeloma

Primary Purpose

Relapsed Refractory Multiple Myeloma

Status
Suspended
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
NEXI-002 T Cells
Sponsored by
NexImmune Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Relapsed Refractory Multiple Myeloma

Eligibility Criteria

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

Inclusion Criteria:

  1. Ability to provide informed consent and documentation of informed consent prior to initiation of any study-related tests or procedures that are not part of standard-of-care for the patient's disease. Patients must also be willing and able to comply with study procedures, including the acquisition of specified research specimens
  2. Age ≥ 18 years old & life expectancy > 3 months
  3. Expression of HLA-A*0201 as determined by high resolution sequence-based typing method
  4. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 with exception of ECOG > 1 if related to recent bone fracture
  5. Patients must have confirmed diagnosis of MM
  6. Have identified relapsed/refractory disease which includes:

    1. Previous therapy consisting of at least three (3) standard regimens, including a proteasome inhibitor, IMiD, or anti-CD38 targeting therapy.

      Note: Induction therapy, autologous stem cell transplantation (ASCT) & maintenance therapy if given sequentially without intervening progressive disease (PD) are considered one 'regimen'

    2. Refractory MM may be defined as disease that is refractory to treatment while on therapy or that shows progression within 60 days of the last therapy.
  7. Have measurable disease as defined by:

    1. Serum M protein ≥ 0.5 g/dL
    2. Urine M protein ≥ 200 mg/24hr
    3. Serum free light chains (FLC) ≥ 10 mg/dL with abnormal FLC ratio Note: Patients with IgA MM in whom serum protein electrophoresis (sPEP) is deemed unreliable, due to co-migration of normal serum proteins with the paraprotein in the β region, may be considered eligible as long as total serum IgA level is > normal range.
  8. Acceptable laboratory parameters as follows:

    1. AST/ALT ≤ 2.5 × ULN
    2. Total bilirubin ≤ 1.5 × ULN, except patients with Gilbert's syndrome, who may enroll if the conjugated bilirubin is within normal limits
    3. Serum creatinine ≤ 2.5 mg/dL or estimated creatinine clearance (CL) ≥ 30 mL/min & not dialysis-dependent
    4. ALC > 1000 cells/µL
  9. Recovery to Grade 1 or baseline of non-hematologic toxicities from prior treatments, excluding alopecia & Grade 2 peripheral neuropathy
  10. Female patients of childbearing potential must test negative for pregnancy at enrollment and during the study. Sexually active women of child-bearing potential, unless surgically sterile, must be willing to use a highly effective method of birth control defined as those which result in a low failure rate (i.e., less than 1% per year) such as implants, injectables, combined oral contraceptives, intra-uterine devices (IUDs) or vasectomized partner
  11. Male patients with partners of childbearing potential must be either vasectomized or agree to use a condom in addition to having their partners use another method of contraception resulting in a highly effective method of birth control defined as those which result in a low failure rate (i.e., less than 1% per year) such as implants, injectables, combined oral contraceptives, or IUDs. Patients should not have sexual intercourse with females who are either pregnant or lactating without double-barrier contraception • Is not pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the prescreening or screening visit through one year from administration of NEXI-002 T cells

Exclusion Criteria:

  1. Have active cerebral or meningeal disease related to the underlying malignancy
  2. Have hemolytic anemia, plasma cell leukemia, Waldenstrom's macroglobulinemia, POEMS syndrome, amyloidosis, plasmacytoma, significant autoimmune or other malignant disease
  3. History of allogeneic hematopoietic stem cell transplantation
  4. Have active or uncontrolled infections with positive cultures and/or requiring treatment with IV anti-infective agents
  5. Echocardiogram or MUGA with left ventricular ejection fraction < 45%
  6. History of clinically significant cardiovascular disease including but not limited to:

    1. Myocardial infarction or unstable angina within the 6 months prior to the initiation of study
    2. Stroke or transient ischemic attack within 6 months prior to initiation of study
    3. Clinically significant cardiac arrhythmia
    4. Uncontrolled hypertension: systolic blood pressure (SBP) > 180 mmHg, diastolic blood pressure (DBP) > 100 mmHg
    5. Congestive heart failure (New York Heart Association [NYHA] class III-IV)
    6. Pericarditis or clinically significant pericardial effusion
    7. Myocarditis
  7. Clinically significant pulmonary compromise, including a requirement for supplemental oxygen use to maintain adequate oxygenation
  8. Eligible patients will not be on any steroids ≥10 mg per day prednisone or equivalent or other immunosuppressants such as tacrolimus, cyclosporine, etc.

    a. Intermittent topical, inhaled or intranasal corticosteroids are allowed

  9. History of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) requiring systemic anticoagulation within 6 months before enrollment
  10. History of autoimmune disease (e.g., Crohn's, rheumatoid arthritis, systemic lupus erythematosus, etc.) resulting in end organ injury or requiring systemic immunosuppression / systemic disease modifying agents within the last 2 year prior to enrollment. Subjects with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone and subjects with controlled Type 1 diabetes mellitus on a stable insulin regimen may be eligible for the study
  11. Human immunodeficiency virus (HIV) seropositive; HIV testing within 2 years of enrollment
  12. Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV). Patients who are hepatitis B surface antigen (HBsAg) negative and HBV viral DNA negative are eligible

    1. Patients who had HBV but have received an antiviral treatment and show non-detectable viral DNA for 6 months are eligible
    2. Patients who are seropositive because of HBV vaccine are eligible
  13. Seropositive for and with active viral infection with hepatitis C virus (HCV)

    a. Patients who had HCV but have received an antiviral treatment and show no detectable HCV viral DNA for 6 months are eligible

  14. Second primary invasive malignancy that has not been in remission for more than 2 years. Exceptions that do not require a 2-year remission include: non-melanoma skin cancer; carcinoma in situ (cervix, bladder, breast, etc.) or squamous intraepithelial lesion on Pap smear; localized prostate cancer (Gleason score < 6); or resected melanoma in situ
  15. History of trauma or major surgery within 4 weeks prior to the initiation of study
  16. Any serious underlying medical or psychiatric condition that would impair the ability of the patient to receive or tolerate the planned treatment and follow up
  17. Known hypersensitivity to any component of NEXI-002 T cells, cyclophosphamide, fludarabine or tocilizumab
  18. Vaccination with any live virus vaccine within 6 weeks prior to the initiation of study treatment. Inactivated annual influenza vaccination is allowed
  19. Dementia or altered mental status that would preclude understanding and rendering of informed consent
  20. History of seizures, aphasia, psychosis or other chronic clinically significant neurologic disorders

    a. Patients with remote history of seizures that are well controlled on anti-seizure medications and without any seizure episode for 6 months are eligible

  21. Any issue that in the opinion of the investigator, would contraindicate the patient's participation in the study or confound the results of the study

Sites / Locations

  • City of Hope Comprehensive Cancer Center
  • Advent Health Medical Group Blood & Marrow Transplant
  • Dana-Farber Cancer Institute
  • Karmanos Cancer Institute
  • David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center
  • MD Anderson Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Safety Evaluation Phase

Dose Expansion Phase

Arm Description

Treatment with NEXI-002 T cells, derived from PBMCs of the patient

Dose Expansion Phase to further define the safety, tolerability and initial anti-tumor efficacy of the NEXI- 002 T cell product at the dose established from the Safety Evaluation Phase.

Outcomes

Primary Outcome Measures

Adverse Events of Special Interest (AESIs) events
1) Dose Limiting Toxicities (DLTs).
Progressive Free Survival
Median Progressive free Survival (PFS)
Overall Response Survival (Rate)
Overall Response Rate (ORR)
Survival
Overall Survival (OS)
Adverse events (AEs) Reporting
Incidence of TEAEs leading to study withdrawal
Adverse Events of Special Interest (AESIs) events (AEs) Reporting
Cytokine Release Syndrome (CRS)
Adverse Events of Special Interest (AESIs)events (AEs) Reporting (ICANS)
Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS)
Adverse Events of Special Interest (AESIs)events (AEs) Reporting-TEAEs
For Incidence of TEAEs and serious TEAEs (Treatment-emergent adverse events (TEAEs) are defined as those AEs that started on or after LD therapy or that worsened after LD therapy.
Adverse Events of Special Interest (AESIs)events (AEs) Reporting-Infusion Reactions
Infusion Related Reactions (IRR)

Secondary Outcome Measures

Full Information

First Posted
August 5, 2020
Last Updated
December 13, 2022
Sponsor
NexImmune Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04505813
Brief Title
Antigen-specific T Cell Therapy for Patients With Relapsed Refractory Multiple Myeloma
Official Title
A Phase 1 / 2 Study to Evaluate the Safety and Tolerability of Adoptively Transferred Autologous T Cells in Patients With Relapsed Refractory Multiple Myeloma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Suspended
Why Stopped
Lack of accrual
Study Start Date
August 17, 2020 (Actual)
Primary Completion Date
November 30, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
NexImmune 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 Research study is being done to characterize the safety, tolerability, and preliminary antitumor activity of the NEXI-002 T cell product (a new experimental therapy), which contains populations of CD8+ T cells targeting multiple Myeloma associated antigen peptides in patients with relapsed refractory multiple myeloma (MM). The study will enroll patients with MM who have relapsed or are refractory to standard lines of treatment. The enrolled patients will undergo bridging therapy for the purposes of disease control while the NEXI-002 T cell product is being manufactured. Choice of bridging therapy administered will be per the Investigator's discretion, but is limited to acceptable agents as specified in the protocol. Bridging therapy will be administered prior to lymphodepleting (LD) therapy, with the last dose of the bridging therapy administered ≥ 14 days prior to initiation of LD therapy. Within 72 hours after completing LD therapy, patients will receive a single IV infusion of the NEXI-002 T cell product.
Detailed Description
The NEXI-002 is an adoptive cellular therapy product which contains populations of antigen-specific CD8+ T cells. The antigen-specific CD8+ T cells in the NEXI-002 T cell product are derived from Peripheral Blood Mononuclear Cells (PBMC) obtained from the patient. During the manufacturing process, these cells are primed and expanded ex vivo using nano-size artificial Antigen Presenting Cells (aAPC) loaded with five leukemia associated antigen peptides in combination with a proprietary T cell enrichment and expansion process. The NEXI-002 T cell product is restricted to patients that are HLA-A2.01 allele positive for this study. There are two parts to this study, a Safety Evaluation Phase and a Dose Expansion Phase. The Safety Evaluation Phase will determine the safety and tolerability of a single dose of NEXI-002 T cell product, and will consist of Dose Escalation at two dose levels - each with cohorts of three patients. When all three patients at Dose Level 1 have dosed and cleared the DLT period, three additional patients will be enrolled at Dose Level 2. When three patients have cleared the DLT period at the highest dose level, that dose will be advanced to the Dose Expansion Phase. The Dose Expansion Phase will enroll up to 16 additional patients to further define the safety and evaluate the initial anti-tumor efficacy of the NEXI- 002 T cell product at the dose established from the Safety Evaluation Phase. All patients will enter a Post-Treatment Follow-Up period after infusion of the NEXI- 002 T cell product. During this phase, all patients will be monitored for AEs and followed for anti-leukemia response until the end of study visit is complete (up to one year). Additional assessments for safety, disease status, and other secondary and exploratory endpoints will also be monitored during the follow-up period. All patients will be followed for overall survival (OS) from time of disease progression until the last visit of the last patient. During this time, patients will be followed via telephone or other electronic contact at 12 week intervals for monitoring of OS.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Relapsed Refractory Multiple Myeloma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
9 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Safety Evaluation Phase
Arm Type
Experimental
Arm Description
Treatment with NEXI-002 T cells, derived from PBMCs of the patient
Arm Title
Dose Expansion Phase
Arm Type
Experimental
Arm Description
Dose Expansion Phase to further define the safety, tolerability and initial anti-tumor efficacy of the NEXI- 002 T cell product at the dose established from the Safety Evaluation Phase.
Intervention Type
Biological
Intervention Name(s)
NEXI-002 T Cells
Intervention Description
The NEXI-001 T cell product will be administered as a single IV infusion to patients within 72 hours after completing LD therapy.
Primary Outcome Measure Information:
Title
Adverse Events of Special Interest (AESIs) events
Description
1) Dose Limiting Toxicities (DLTs).
Time Frame
1 year
Title
Progressive Free Survival
Description
Median Progressive free Survival (PFS)
Time Frame
At 12 months
Title
Overall Response Survival (Rate)
Description
Overall Response Rate (ORR)
Time Frame
At 12 months
Title
Survival
Description
Overall Survival (OS)
Time Frame
At 12 months
Title
Adverse events (AEs) Reporting
Description
Incidence of TEAEs leading to study withdrawal
Time Frame
At year 1
Title
Adverse Events of Special Interest (AESIs) events (AEs) Reporting
Description
Cytokine Release Syndrome (CRS)
Time Frame
at year 1
Title
Adverse Events of Special Interest (AESIs)events (AEs) Reporting (ICANS)
Description
Immune effector Cell-Associated Neurotoxicity Syndrome (ICANS)
Time Frame
at year 1
Title
Adverse Events of Special Interest (AESIs)events (AEs) Reporting-TEAEs
Description
For Incidence of TEAEs and serious TEAEs (Treatment-emergent adverse events (TEAEs) are defined as those AEs that started on or after LD therapy or that worsened after LD therapy.
Time Frame
At year 1
Title
Adverse Events of Special Interest (AESIs)events (AEs) Reporting-Infusion Reactions
Description
Infusion Related Reactions (IRR)
Time Frame
At year 1

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability to provide informed consent and documentation of informed consent prior to initiation of any study-related tests or procedures that are not part of standard-of-care for the patient's disease. Patients must also be willing and able to comply with study procedures, including the acquisition of specified research specimens Age ≥ 18 years old & life expectancy > 3 months Expression of HLA-A*0201 as determined by high resolution sequence-based typing method Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 with exception of ECOG > 1 if related to recent bone fracture Patients must have confirmed diagnosis of MM Have identified relapsed/refractory disease which includes: Previous therapy consisting of at least three (3) standard regimens, including a proteasome inhibitor, IMiD, or anti-CD38 targeting therapy. Note: Induction therapy, autologous stem cell transplantation (ASCT) & maintenance therapy if given sequentially without intervening progressive disease (PD) are considered one 'regimen' Refractory MM may be defined as disease that is refractory to treatment while on therapy or that shows progression within 60 days of the last therapy. Have measurable disease as defined by: Serum M protein ≥ 0.5 g/dL Urine M protein ≥ 200 mg/24hr Serum free light chains (FLC) ≥ 10 mg/dL with abnormal FLC ratio Note: Patients with IgA MM in whom serum protein electrophoresis (sPEP) is deemed unreliable, due to co-migration of normal serum proteins with the paraprotein in the β region, may be considered eligible as long as total serum IgA level is > normal range. Acceptable laboratory parameters as follows: AST/ALT ≤ 2.5 × ULN Total bilirubin ≤ 1.5 × ULN, except patients with Gilbert's syndrome, who may enroll if the conjugated bilirubin is within normal limits Serum creatinine ≤ 2.5 mg/dL or estimated creatinine clearance (CL) ≥ 30 mL/min & not dialysis-dependent ALC > 1000 cells/µL Recovery to Grade 1 or baseline of non-hematologic toxicities from prior treatments, excluding alopecia & Grade 2 peripheral neuropathy Female patients of childbearing potential must test negative for pregnancy at enrollment and during the study. Sexually active women of child-bearing potential, unless surgically sterile, must be willing to use a highly effective method of birth control defined as those which result in a low failure rate (i.e., less than 1% per year) such as implants, injectables, combined oral contraceptives, intra-uterine devices (IUDs) or vasectomized partner Male patients with partners of childbearing potential must be either vasectomized or agree to use a condom in addition to having their partners use another method of contraception resulting in a highly effective method of birth control defined as those which result in a low failure rate (i.e., less than 1% per year) such as implants, injectables, combined oral contraceptives, or IUDs. Patients should not have sexual intercourse with females who are either pregnant or lactating without double-barrier contraception • Is not pregnant or breastfeeding, or expecting to conceive or father children within the projected duration of the trial, starting with the prescreening or screening visit through one year from administration of NEXI-002 T cells Exclusion Criteria: Have active cerebral or meningeal disease related to the underlying malignancy Have hemolytic anemia, plasma cell leukemia, Waldenstrom's macroglobulinemia, POEMS syndrome, amyloidosis, plasmacytoma, significant autoimmune or other malignant disease History of allogeneic hematopoietic stem cell transplantation Have active or uncontrolled infections with positive cultures and/or requiring treatment with IV anti-infective agents Echocardiogram or MUGA with left ventricular ejection fraction < 45% History of clinically significant cardiovascular disease including but not limited to: Myocardial infarction or unstable angina within the 6 months prior to the initiation of study Stroke or transient ischemic attack within 6 months prior to initiation of study Clinically significant cardiac arrhythmia Uncontrolled hypertension: systolic blood pressure (SBP) > 180 mmHg, diastolic blood pressure (DBP) > 100 mmHg Congestive heart failure (New York Heart Association [NYHA] class III-IV) Pericarditis or clinically significant pericardial effusion Myocarditis Clinically significant pulmonary compromise, including a requirement for supplemental oxygen use to maintain adequate oxygenation Eligible patients will not be on any steroids ≥10 mg per day prednisone or equivalent or other immunosuppressants such as tacrolimus, cyclosporine, etc. a. Intermittent topical, inhaled or intranasal corticosteroids are allowed History of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) requiring systemic anticoagulation within 6 months before enrollment History of autoimmune disease (e.g., Crohn's, rheumatoid arthritis, systemic lupus erythematosus, etc.) resulting in end organ injury or requiring systemic immunosuppression / systemic disease modifying agents within the last 2 year prior to enrollment. Subjects with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone and subjects with controlled Type 1 diabetes mellitus on a stable insulin regimen may be eligible for the study Human immunodeficiency virus (HIV) seropositive; HIV testing within 2 years of enrollment Seropositive for and with evidence of active viral infection with hepatitis B virus (HBV). Patients who are hepatitis B surface antigen (HBsAg) negative and HBV viral DNA negative are eligible Patients who had HBV but have received an antiviral treatment and show non-detectable viral DNA for 6 months are eligible Patients who are seropositive because of HBV vaccine are eligible Seropositive for and with active viral infection with hepatitis C virus (HCV) a. Patients who had HCV but have received an antiviral treatment and show no detectable HCV viral DNA for 6 months are eligible Second primary invasive malignancy that has not been in remission for more than 2 years. Exceptions that do not require a 2-year remission include: non-melanoma skin cancer; carcinoma in situ (cervix, bladder, breast, etc.) or squamous intraepithelial lesion on Pap smear; localized prostate cancer (Gleason score < 6); or resected melanoma in situ History of trauma or major surgery within 4 weeks prior to the initiation of study Any serious underlying medical or psychiatric condition that would impair the ability of the patient to receive or tolerate the planned treatment and follow up Known hypersensitivity to any component of NEXI-002 T cells, cyclophosphamide, fludarabine or tocilizumab Vaccination with any live virus vaccine within 6 weeks prior to the initiation of study treatment. Inactivated annual influenza vaccination is allowed Dementia or altered mental status that would preclude understanding and rendering of informed consent History of seizures, aphasia, psychosis or other chronic clinically significant neurologic disorders a. Patients with remote history of seizures that are well controlled on anti-seizure medications and without any seizure episode for 6 months are eligible Any issue that in the opinion of the investigator, would contraindicate the patient's participation in the study or confound the results of the study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Robert Knight, MD
Organizational Affiliation
NexImmune
Official's Role
Study Chair
Facility Information:
Facility Name
City of Hope Comprehensive Cancer Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Facility Name
Advent Health Medical Group Blood & Marrow Transplant
City
Orlando
State/Province
Florida
ZIP/Postal Code
32804
Country
United States
Facility Name
Dana-Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10021
Country
United States
Facility Name
MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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Antigen-specific T Cell Therapy for Patients With Relapsed Refractory Multiple Myeloma

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