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4SCAR-T Therapy Targeting GD2, PSMA and CD276 for Treating Neuroblastoma

Primary Purpose

Neuroblastoma

Status
Recruiting
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
GD2, PSMA and CD276 CAR-T cells
Sponsored by
Shenzhen Geno-Immune Medical Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Neuroblastoma focused on measuring CART, chimeric antigen receptor, adoptive T cell transfer, GD2, PSMA, CD276, B7-H3

Eligibility Criteria

1 Year - 65 Years (Child, Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients with tumors have received standard first-line therapy and been judged to be non-resectable, metastatic, progressive or recurrent.
  • The expression status of GD2, PSMA and CD276 antigens of the tumor will be determined for eligibility. Positive expression is defined by GD2, PMSA and CD276 antibody staining results based on immunohistochemistry or flow cytometry analyses.
  • Body weight greater than or equal to 10 kg.
  • Age: ≥1 year and ≤ 65 years of age at the time of enrollment.
  • Life expectancy: at least 8 weeks.
  • Prior Therapy:

    1. There is no limit to the number of prior treatment regimens. Any grade 3 or 4 non-hematologic toxicity of any previous therapy must have resolved to grade 2 or less.
    2. Participant must not have received hematopoietic growth factors for at least 1 week prior to mononuclear cells collection.
    3. At least 7 days must have elapsed since the completion of therapy with a biologic agent, targeted agent, tyrosine kinase inhibitor or a metronomic non-myelosuppressive regimen.
    4. At least 4 weeks must have elapsed since prior therapy that included a monoclonal antibody.
    5. At least 1 week since any radiation therapy at the time of study entry.
  • Karnofsky/jansky score of 60% or greater.
  • Cardiac function: Left ventricular ejection fraction greater than or equal to 40/55 percent.
  • Pulse Ox greater than or equal to 90% on room air.
  • Liver function: defined as alanine transaminase (ALT) <3x upper limit of normal (ULN), aspartate aminotransferase (AST) <3x ULN; serum bilirubin and alkaline phosphatase <2x ULN.
  • Renal function: Patients must have serum creatinine less than 3 times upper limit of normal.
  • Marrow function: White blood cell count ≥1000/ul, Absolute neutrophil count ≥500/ul, Absolute lymphocyte count ≥500/ul, Platelet count ≥25,000/ul (not achieved by transfusion).
  • Patients with known bone marrow metastatic disease will be eligible for study as long as they meet hematologic function criteria, and the marrow disease not evaluable for hematologic toxicity.
  • For all patients enrolled in this study, their parents or legal guardians must sign an informed consent and assent.

Exclusion Criteria:

  • Existing severe illness (e.g. significant cardiac, pulmonary, hepatic diseases, etc.) or major organ dysfunction, with the exception of grade 3 hematologic toxicity.
  • Untreated central nervous system (CNS) metastasis: Patients with previous CNS tumor involvement that has been treated and is stable for at least 6 weeks following completion of therapy are eligible.
  • Previous treatment with other genetically engineered GD2, PSMA and CD276 CART cells.
  • Active HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) infection or uncontrolled infection.
  • Patients who require systemic corticosteroid or other immunosuppressive therapy.
  • Evidence of tumor potentially causing airway obstruction.
  • Inability to comply with protocol requirements.
  • Insufficient CART cells availability.

Sites / Locations

  • Guangdong Zhujiang Hospital of Southern Medical UniversityRecruiting
  • Shenzhen Children's HospitalRecruiting
  • Shenzhen Geno-Immune Medical InstituteRecruiting
  • Shandong Cancer HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

effectiveness of CAR-T cells targeting GD2, PSMA and CD276

Arm Description

Gene-modified T cells are designed to kill tumor cells through specific recognition of GD2, PSMA and CD276. This study will evaluate the side effects and effective doses of GD2, PSMA and CD276 CAR-T cells in treating refractory and recurrent NB

Outcomes

Primary Outcome Measures

Number of patients with adverse events
Determine the toxicity profile the GD2, PSMA and CD276 4SCAR-T cells with Common Toxicity Criteria for Adverse Effects version 4.0

Secondary Outcome Measures

Anti-tumor effects
Complete response/remission (CR), Very good partial response/remission (VGPR) will be assessed by the image scan
The expansion of CAR-T cells
The investigators will monitor the expansion of GD2, PSMA and CD276 CAR-T cells in the peripheral blood of patients and the correlation with antitumor effects.
The anti-tumor activity after CAR-T infusions
The anti-tumor activity of lymphocytes will be assessed
The cytokine secretion profile after CAR-T infusions
The cytokine secretion profile of lymphocytes will be assessed.
Survival time of the patients
The overall survival time of the patients treated with CAR-T cells

Full Information

First Posted
October 16, 2020
Last Updated
November 18, 2020
Sponsor
Shenzhen Geno-Immune Medical Institute
Collaborators
Shenzhen Children's Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT04637503
Brief Title
4SCAR-T Therapy Targeting GD2, PSMA and CD276 for Treating Neuroblastoma
Official Title
Multi-center Phase I/II Clinical Trial of 4SCAR-T Therapy Targeting GD2, PSMA and CD276 for Treating Neuroblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
November 2020
Overall Recruitment Status
Recruiting
Study Start Date
November 18, 2020 (Anticipated)
Primary Completion Date
November 19, 2020 (Actual)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shenzhen Geno-Immune Medical Institute
Collaborators
Shenzhen Children's Hospital

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this clinical trial is to assess the feasibility, safety and efficacy of multiple 4SCAR-T cell therapy which targets GD2, PSMA and CD276 surface antigens in patients with relapsed and refractory neuroblastoma (NB). Another goal of the study is to understand the function of the multi-CAR-T cells and their persistency in the patients.
Detailed Description
Neuroblastoma is one of the most aggressive childhood tumors arising from neural crest cells. Nearly 50% of patients with high risk disease have poor long-term survival even after multimodal treatments. Novel immunotherapy targeting tumor-specific antigens has been developed to meet the desperate need. Disialoganglioside (GD2) is a well-studied tumor associated antigen which is expressed uniformly in NB but restrictedly in normal tissue. Over the past few years, CAR-T therapy against GD2 in NB has achieved encouraging but modest outcomes. Only a fraction of patients achieved measurable responses. Like for many other solid tumors, CAR-T therapy for NB is not as effective as for hematologic malignancies. In this study, the investigators use "multiple targeting" approach as the strategy to overcome the challenge in treating NB. Prostate-specific membrane antigen (PSMA) is expressed in normal prostate but is upregulated in prostate tumor. However, PSMA expression is not restricted to prostate cancer. By immunohistochemistry (IHC) staining, the investigators confirmed that PSMA is expressed in a variety of solid tumors, including brain tumor, neuroblastoma and some lymphoma tumor tissues. Therefore, PSMA could potentially serve as a promising target for antigen-specific immunotherapy in patients with NB. In addition, CD276 (B7-H3) is an immune checkpoint molecule highly expressed on many solid tumors including NB. CD276 has been characterized to be involved in tumor evasion and thus its expression is correlated with poor prognosis. These characteristics make CD276 an attractive candidate for immunotherapy. Given the significant variation of tumor antigen expression among patients, the investigators aim to examine GD2, PSMA and CD276 expression in each patient's tumor sections by IHC staining, and combine two or three highly-expressed targets for the 4SCAR-T therapy. This individualized and multi-antigen-targeted approach is a new strategy to overcome the limited clinical outcome in the 4SCAR-T therapy against NB. The purpose of this clinical study is to assess the feasibility, safety and efficacy of the combinational GD2, PSMA and CD276 4SCAR-T cell therapy against NB. Another goal of the study is to learn more about the function of the multi-4SCAR-T cells and their persistency in the patients.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Neuroblastoma
Keywords
CART, chimeric antigen receptor, adoptive T cell transfer, GD2, PSMA, CD276, B7-H3

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
effectiveness of CAR-T cells targeting GD2, PSMA and CD276
Arm Type
Experimental
Arm Description
Gene-modified T cells are designed to kill tumor cells through specific recognition of GD2, PSMA and CD276. This study will evaluate the side effects and effective doses of GD2, PSMA and CD276 CAR-T cells in treating refractory and recurrent NB
Intervention Type
Biological
Intervention Name(s)
GD2, PSMA and CD276 CAR-T cells
Intervention Description
infusion, for 1x10^6~1x10^7 cells/kg via IV
Primary Outcome Measure Information:
Title
Number of patients with adverse events
Description
Determine the toxicity profile the GD2, PSMA and CD276 4SCAR-T cells with Common Toxicity Criteria for Adverse Effects version 4.0
Time Frame
3 year
Secondary Outcome Measure Information:
Title
Anti-tumor effects
Description
Complete response/remission (CR), Very good partial response/remission (VGPR) will be assessed by the image scan
Time Frame
3 year
Title
The expansion of CAR-T cells
Description
The investigators will monitor the expansion of GD2, PSMA and CD276 CAR-T cells in the peripheral blood of patients and the correlation with antitumor effects.
Time Frame
3 year
Title
The anti-tumor activity after CAR-T infusions
Description
The anti-tumor activity of lymphocytes will be assessed
Time Frame
1 year
Title
The cytokine secretion profile after CAR-T infusions
Description
The cytokine secretion profile of lymphocytes will be assessed.
Time Frame
1 year
Title
Survival time of the patients
Description
The overall survival time of the patients treated with CAR-T cells
Time Frame
3 year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
1 Year
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with tumors have received standard first-line therapy and been judged to be non-resectable, metastatic, progressive or recurrent. The expression status of GD2, PSMA and CD276 antigens of the tumor will be determined for eligibility. Positive expression is defined by GD2, PMSA and CD276 antibody staining results based on immunohistochemistry or flow cytometry analyses. Body weight greater than or equal to 10 kg. Age: ≥1 year and ≤ 65 years of age at the time of enrollment. Life expectancy: at least 8 weeks. Prior Therapy: There is no limit to the number of prior treatment regimens. Any grade 3 or 4 non-hematologic toxicity of any previous therapy must have resolved to grade 2 or less. Participant must not have received hematopoietic growth factors for at least 1 week prior to mononuclear cells collection. At least 7 days must have elapsed since the completion of therapy with a biologic agent, targeted agent, tyrosine kinase inhibitor or a metronomic non-myelosuppressive regimen. At least 4 weeks must have elapsed since prior therapy that included a monoclonal antibody. At least 1 week since any radiation therapy at the time of study entry. Karnofsky/jansky score of 60% or greater. Cardiac function: Left ventricular ejection fraction greater than or equal to 40/55 percent. Pulse Ox greater than or equal to 90% on room air. Liver function: defined as alanine transaminase (ALT) <3x upper limit of normal (ULN), aspartate aminotransferase (AST) <3x ULN; serum bilirubin and alkaline phosphatase <2x ULN. Renal function: Patients must have serum creatinine less than 3 times upper limit of normal. Marrow function: White blood cell count ≥1000/ul, Absolute neutrophil count ≥500/ul, Absolute lymphocyte count ≥500/ul, Platelet count ≥25,000/ul (not achieved by transfusion). Patients with known bone marrow metastatic disease will be eligible for study as long as they meet hematologic function criteria, and the marrow disease not evaluable for hematologic toxicity. For all patients enrolled in this study, their parents or legal guardians must sign an informed consent and assent. Exclusion Criteria: Existing severe illness (e.g. significant cardiac, pulmonary, hepatic diseases, etc.) or major organ dysfunction, with the exception of grade 3 hematologic toxicity. Untreated central nervous system (CNS) metastasis: Patients with previous CNS tumor involvement that has been treated and is stable for at least 6 weeks following completion of therapy are eligible. Previous treatment with other genetically engineered GD2, PSMA and CD276 CART cells. Active HIV, Hepatitis B virus (HBV), Hepatitis C virus (HCV) infection or uncontrolled infection. Patients who require systemic corticosteroid or other immunosuppressive therapy. Evidence of tumor potentially causing airway obstruction. Inability to comply with protocol requirements. Insufficient CART cells availability.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lung-Ji Chang, PhD
Phone
+86-8672-5195
Email
c@szgimi.org
Facility Information:
Facility Name
Guangdong Zhujiang Hospital of Southern Medical University
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510282
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lihua Yang, M.D, PhD
Phone
86-13580532469
Email
dryanglihua@163.com
First Name & Middle Initial & Last Name & Degree
Lihua Yu, M.D
Phone
86-13414125621
Email
eveylhyu@gmail.com
Facility Name
Shenzhen Children's Hospital
City
Shenzhen
State/Province
Guangdong
ZIP/Postal Code
518000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Xiuli Yuan, M.D
Phone
86-18938690212
Email
18938690212@163.com
Facility Name
Shenzhen Geno-Immune Medical Institute
City
Shenzhen
State/Province
Guangzhou
ZIP/Postal Code
518000
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lung-Ji Chang, PhD
Phone
+86-13671121909
Email
c@szgimi.org
Facility Name
Shandong Cancer Hospital
City
Jinan
State/Province
Shandong
ZIP/Postal Code
250022
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jingfu Wang, M.D, Ph.D
Phone
86-13821271562
Email
wangjingfu666@163.com

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

4SCAR-T Therapy Targeting GD2, PSMA and CD276 for Treating Neuroblastoma

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