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Combination of CAR-DC Vaccine and ICIs in Malignant Tumors

Primary Purpose

Solid Tumor, Adult, Lymphoma, EphA2 Overexpression

Status
Recruiting
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
TP53-EphA-2-CAR-DC
Abraxane
Cyclophosphamide
anti-PD-1 antibody
Anti-CTLA4 Monoclonal Antibody
Sponsored by
Chinese PLA General Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Solid Tumor, Adult focused on measuring Local Advanced/Metastatic, Relapsed/refractory

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Age 18-75 (inclusive). ECOG performance status ≤2 and Estimated life expectancy of more than 3 months. Local advanced/metastatic solid tumors or R/R lymphomas confirmed by histopathology or cytology with documentation of tumor EphA2 positive (≥20%) and TP53 mutation (R273H or R175H or R248Q or R249S) within 6 months prior to screening. The second malignancy is allowed. No clinical response to standard frontline therapy or no standard therapy exists for solid tumors. Relapse after treatment with ≥2 lines systemic therapy or refractory disease for lymphomas. Patients who have declined standard therapy or have no access to standard therapy may be enrolled and the reasons for a lack of access need to be documented. Previous treatment with anti-PD-1/PD-L1 antibodies or anti-CTLA4 antibody are allowed, regardless of the level of PD-1/PD-L1 expression, dMMR and TMB. At least one measurable lesion at baseline per RECIST version 1.1 or Lugano response criteria 2014. Adequate organ function as defined by the following criteria: ANC ≥1000 cells/μL; Platelet count ≥80,000/μL; Hemoglobin ≥8.0 g/dL (hemocytopenia caused by lymphoma invasion of bone marrow is not subject to conditions); Serum AST and serum ALT, ≤3.0 x ULN (≤5 x ULN for patients with liver metastases); Total serum bilirubin ≤3.0 x ULN); Serum creatinine ≤2 x ULN or creatinine clearance of ≥45 mL/min. Willing to undergo either excised or large-needle lymph node or tissue biopsy, or provide formalin-fixed paraffin-embedded (FFPE) tumor tissue block or freshly cut unstained slides. Willing to complete all scheduled visits and assessments at the institution administering the therapy. Able to read, understand and provide written informed consent. Exclusion Criteria: Having TP53 (R273H or R175H or R248Q or R249S) germline mutation. Active central nervous system disease involvement (but allow patients with prior brain metastases treated at least 4 weeks prior to enrollment that are clinically stable and do not require intervention), or prior history of NCI CTCAE Grade ≥3 drug-related CNS toxicity. Prior organ allograft transplantations or allogeneic hematopoietic stem cell transplantation. Evidence of active uncontrolled viral, bacterial, or systemic fungal infection. Known positive test result for human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Active infection of hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients with history (within the last 5 years) or risk of autoimmune disease who have immunosuppressive medications or immunosuppressive doses of systemic corticosteroids (>10 mg/day prednisone or equivalent) within 28 days prior to enrollment. However, patients who received a short course of corticosteroids (eg, premedication prior to antibody drug) will be eligible for study entry. Major trauma or major surgery within 4 weeks prior to enrollment. Previous treatment involving TP53 mutant (R273H or R175H or R248Q or R249S) and EphA2. Systemic chemotherapy and other intervene within 2 weeks prior to vaccination. Being participating or withdrew any other trials within 4 weeks. Any serious underlying medical (eg, pulmonary, renal, hepatic, gastrointestinal, or neurological) or psychiatric condition or any issue that would limit compliance with study requirements. Vaccination within 30 days of study enrollment. Pregnant, lactating, or breastfeeding females. Researchers believe that other reasons are not suitable for clinical trials.

Sites / Locations

  • Biotherapeutic Department of Chinsese PLA Gereral HospitalRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

TP53-EphA-2-CAR-DC plus anti-PD-1 antibody/anti-CTLA4 antibody

Arm Description

In the priming phase, a conditioning chemotherapy regimen of Abraxane and cyclophosphamide is administered three days before vaccination, and TP53-EphA-2-CAR-DC vaccine is infused on Day 0 and Day 7 in Week 1. In the boost phase, TP53-EphA-2-CAR-DC vaccine is infused one dose every 8 weeks since Week 5. Anti-PD-1 antibody and anti-CTLA4 antibody are administered 2 days after the first dose of TP53-EphA-2-CAR-DC vaccine in the boost phase (Day 3 in Week 5) and every 3 weeks afterwards for four doses, followed by anti-PD-1 antibody once every 3 weeks, until: 1. Unacceptable toxicity occurred or disease progression; or 2. Reactive T cells are undetected repeatedly after the last vaccine dose; or 3. Vaccine exhaustion.

Outcomes

Primary Outcome Measures

Incidence of treatment related adverse events (AEs)
Determining the safety profile following the initiation of treatment and grading these toxicities by CTCAE v5.0. AEs such as cytokine release syndrome (CRS) and immune cell-associated neurotoxicity syndrome (ICANS) were graded according to American Society for Transplantation and Cellular Therapy (ASTCT) criteria.
Clinical Response
Clinical Response will be determined by iRECIST criteria. Response rate is the proportion of patients that achieve CR or PR.
Immune Response
Immune response will be evaluated by phenotype and functional analysis of vaccine-reactive T cells and Neoantigen-reactive T cells as well as other immune cells in peripheral blood and tumor samples. Response is defined by ≥3 folds increase relative to pre-vaccination.

Secondary Outcome Measures

Progression Free Survival (PFS)
PFS is defined as the time from TP53-EphA-2-CAR-DCs infusion to documented disease progression or death.
Overall Survival (OS)
OS is defined as the time from TP53-EphA-2-CAR-DCs infusion to the date of death.
Time to response (TTR)
TTR is defined as the time from TP53-EphA-2-CAR-DCs infusion to first assessed CR or PR by investigators and based on the iRECIST criteria.
Duration of response (DOR)
DOR is defined as the time from objective response (OR) until documented tumor progression date among responders.
Number and copy number of TP53-EphA-2-CAR-DCs
Number and copy number of TP53-EphA-2-CAR-DCs were assessed by the number in peripheral blood and tumor tissue.
The level of cytokines in serum
The cytokines mainly include IL-1, IL-2, IL-6, IL-8, IL-10, IL-12 (p70), TNF-α

Full Information

First Posted
November 21, 2022
Last Updated
August 24, 2023
Sponsor
Chinese PLA General Hospital
Collaborators
Zhejiang University
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1. Study Identification

Unique Protocol Identification Number
NCT05631886
Brief Title
Combination of CAR-DC Vaccine and ICIs in Malignant Tumors
Official Title
A Pilot Clinical Trial of Autologous EphA-2-Targeting Chimeric Antigen Receptor Dendritic Cell Vaccine Loaded With TP53 Mutant Peptide Plus ICIs for Local Advanced/Metastatic Solid Tumors or Relapsed/Refractory Lymphomas.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 4, 2023 (Actual)
Primary Completion Date
December 30, 2025 (Anticipated)
Study Completion Date
December 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Chinese PLA General Hospital
Collaborators
Zhejiang University

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 pilot clinical trial for subjects with local advanced/metastatic solid tumors or relapsed/refractory (R/R) lymphomas to determine the safety, efficacy and immune response of autologous EphA2-targeting CAR-DC vaccine loaded with TP53 mutant peptide (TP53-EphA-2-CAR-DC) in combination with ICIs. It aims to: assess the safety and antitumor effects of TP53-EphA-2-CAR-DC vaccine; detect T cell response against TP53 mutant peptide and tumor neoepitopes after the treatment with TP53-EphA-2-CAR-DC vaccine and ICIs.
Detailed Description
Therapeutic cancer vaccines, especially DC-based vaccines, are extensively pursued immune approaches in addition to immune checkpoint blockade antibodies and chimeric antigen receptor T cells. DCs can engulf, process and present tumor antigens to T cells, thereby initiating a potent and tumor-specific immune response. However, clinical outcomes of therapeutic cancer vaccines still remain poor, with objective response rates that rarely exceed ~15%. The maturation and activation of DCs are necessary steps to trigger the antitumor responses. However, it is increasingly clear that tumor-infiltrating dendritic cells (TIDCs) usually have an immature or tolerated phenotype that plays central roles in developing tumor microenvironment (TME). As a consequence, malfunction of TIDCs could suppress the infiltration and function of tumor infiltrating T cells and convert them into immune suppressive regulatory T cells. In our previous research, we constructed novel CAR-DCs (Chimeric antigen receptor engineered dendritic cells) containing a scFv domain targeting EphA2 antigen, CD8a transmembrane, tandem DC-specific activation domains. The engineered CAR-DCs were activated when contacting with tumor targets in TME, and consequently, augmented the cytotoxicity of antigen specific T cells in immune system humanized solid tumor mouse models. Our design of CAR-DCs provides an effective vaccine strategy for malignant tumors. Therefore, we designed an autologous CAR-DC vaccine engineered with anti-EphA2 CAR and TP53 mutant peptide (TP53-EphA-2-CAR-DC), which can suppress the growth of tumors expressing the correlated TP53 mutant in animal models. In addition, the combination of the immune checkpoint inhibitors could further reverse immunosuppressive TME and globally activate T cell responses. In this pilot study, we aim to assess the safety, efficacy and immune response of TP53-EphA-2-CAR-DC combined with anti-PD-1 antibody/anti-CTLA4 antibody in patients with local advanced/metastatic solid tumors or R/R lymphomas.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Solid Tumor, Adult, Lymphoma, EphA2 Overexpression, TP53 R273H, TP53 R175H, TP53 R248Q, TP53 R249S
Keywords
Local Advanced/Metastatic, Relapsed/refractory

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
TP53-EphA-2-CAR-DC plus anti-PD-1 antibody/anti-CTLA4 antibody
Arm Type
Experimental
Arm Description
In the priming phase, a conditioning chemotherapy regimen of Abraxane and cyclophosphamide is administered three days before vaccination, and TP53-EphA-2-CAR-DC vaccine is infused on Day 0 and Day 7 in Week 1. In the boost phase, TP53-EphA-2-CAR-DC vaccine is infused one dose every 8 weeks since Week 5. Anti-PD-1 antibody and anti-CTLA4 antibody are administered 2 days after the first dose of TP53-EphA-2-CAR-DC vaccine in the boost phase (Day 3 in Week 5) and every 3 weeks afterwards for four doses, followed by anti-PD-1 antibody once every 3 weeks, until: 1. Unacceptable toxicity occurred or disease progression; or 2. Reactive T cells are undetected repeatedly after the last vaccine dose; or 3. Vaccine exhaustion.
Intervention Type
Biological
Intervention Name(s)
TP53-EphA-2-CAR-DC
Intervention Description
5~10 × 10^6 CAR DCs per dose will be administered by intravenous injection.
Intervention Type
Drug
Intervention Name(s)
Abraxane
Other Intervention Name(s)
Abraxane Injectable Product
Intervention Description
Intravenous abraxane 125 mg/m^2/day on day-5.
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
Cyclophosphamide for Injection
Intervention Description
Intravenous cyclophosphamide 300 mg/m^2/day on day -4.
Intervention Type
Drug
Intervention Name(s)
anti-PD-1 antibody
Other Intervention Name(s)
PD-1 blocking antibody
Intervention Description
Intravenous anti-PD-1 antibody 200 mg/day.
Intervention Type
Drug
Intervention Name(s)
Anti-CTLA4 Monoclonal Antibody
Other Intervention Name(s)
Ipilimumab
Intervention Description
Intravenous anti-CTLA4 antibody 1 mg/kg/day
Primary Outcome Measure Information:
Title
Incidence of treatment related adverse events (AEs)
Description
Determining the safety profile following the initiation of treatment and grading these toxicities by CTCAE v5.0. AEs such as cytokine release syndrome (CRS) and immune cell-associated neurotoxicity syndrome (ICANS) were graded according to American Society for Transplantation and Cellular Therapy (ASTCT) criteria.
Time Frame
2 years
Title
Clinical Response
Description
Clinical Response will be determined by iRECIST criteria. Response rate is the proportion of patients that achieve CR or PR.
Time Frame
2 years
Title
Immune Response
Description
Immune response will be evaluated by phenotype and functional analysis of vaccine-reactive T cells and Neoantigen-reactive T cells as well as other immune cells in peripheral blood and tumor samples. Response is defined by ≥3 folds increase relative to pre-vaccination.
Time Frame
Peripheral blood: baseline, weekly before Week 9, prior to each vaccination after Week 9 until last vaccine and 1 year after last vaccine. Tumor tissue: baseline, Week 3, and following timing will be performed according to subject's condition.
Secondary Outcome Measure Information:
Title
Progression Free Survival (PFS)
Description
PFS is defined as the time from TP53-EphA-2-CAR-DCs infusion to documented disease progression or death.
Time Frame
2 years
Title
Overall Survival (OS)
Description
OS is defined as the time from TP53-EphA-2-CAR-DCs infusion to the date of death.
Time Frame
2 years
Title
Time to response (TTR)
Description
TTR is defined as the time from TP53-EphA-2-CAR-DCs infusion to first assessed CR or PR by investigators and based on the iRECIST criteria.
Time Frame
2 years
Title
Duration of response (DOR)
Description
DOR is defined as the time from objective response (OR) until documented tumor progression date among responders.
Time Frame
2 years
Title
Number and copy number of TP53-EphA-2-CAR-DCs
Description
Number and copy number of TP53-EphA-2-CAR-DCs were assessed by the number in peripheral blood and tumor tissue.
Time Frame
Peripheral blood samples are collected on days 0, 3, 7, 10, 22, the day before each vaccination until last vaccination and 1 year after last vaccine. Tumor tissues are collected at baseline, the day before Week 5, and after combination.
Title
The level of cytokines in serum
Description
The cytokines mainly include IL-1, IL-2, IL-6, IL-8, IL-10, IL-12 (p70), TNF-α
Time Frame
Peripheral blood samples are collected on days 0, 3, 7, 10, 22, the days before each vaccination until last vaccination and 1 year after last vaccine. Tumor tissues are collected at baseline, the day before Week 5, and after combination.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18-75 (inclusive). ECOG performance status ≤2 and Estimated life expectancy of more than 3 months. Local advanced/metastatic solid tumors or R/R lymphomas confirmed by histopathology or cytology with documentation of tumor EphA2 positive (≥20%) and TP53 mutation (R273H or R175H or R248Q or R249S) within 6 months prior to screening. The second malignancy is allowed. No clinical response to standard frontline therapy or no standard therapy exists for solid tumors. Relapse after treatment with ≥2 lines systemic therapy or refractory disease for lymphomas. Patients who have declined standard therapy or have no access to standard therapy may be enrolled and the reasons for a lack of access need to be documented. Previous treatment with anti-PD-1/PD-L1 antibodies or anti-CTLA4 antibody are allowed, regardless of the level of PD-1/PD-L1 expression, dMMR and TMB. At least one measurable lesion at baseline per RECIST version 1.1 or Lugano response criteria 2014. Adequate organ function as defined by the following criteria: ANC ≥1000 cells/μL; Platelet count ≥80,000/μL; Hemoglobin ≥8.0 g/dL (hemocytopenia caused by lymphoma invasion of bone marrow is not subject to conditions); Serum AST and serum ALT, ≤3.0 x ULN (≤5 x ULN for patients with liver metastases); Total serum bilirubin ≤3.0 x ULN); Serum creatinine ≤2 x ULN or creatinine clearance of ≥45 mL/min. Willing to undergo either excised or large-needle lymph node or tissue biopsy, or provide formalin-fixed paraffin-embedded (FFPE) tumor tissue block or freshly cut unstained slides. Willing to complete all scheduled visits and assessments at the institution administering the therapy. Able to read, understand and provide written informed consent. Exclusion Criteria: Having TP53 (R273H or R175H or R248Q or R249S) germline mutation. Active central nervous system disease involvement (but allow patients with prior brain metastases treated at least 4 weeks prior to enrollment that are clinically stable and do not require intervention), or prior history of NCI CTCAE Grade ≥3 drug-related CNS toxicity. Prior organ allograft transplantations or allogeneic hematopoietic stem cell transplantation. Evidence of active uncontrolled viral, bacterial, or systemic fungal infection. Known positive test result for human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS). Active infection of hepatitis B virus (HBV), or hepatitis C virus (HCV). Patients with history (within the last 5 years) or risk of autoimmune disease who have immunosuppressive medications or immunosuppressive doses of systemic corticosteroids (>10 mg/day prednisone or equivalent) within 28 days prior to enrollment. However, patients who received a short course of corticosteroids (eg, premedication prior to antibody drug) will be eligible for study entry. Major trauma or major surgery within 4 weeks prior to enrollment. Previous treatment involving TP53 mutant (R273H or R175H or R248Q or R249S) and EphA2. Systemic chemotherapy and other intervene within 2 weeks prior to vaccination. Being participating or withdrew any other trials within 4 weeks. Any serious underlying medical (eg, pulmonary, renal, hepatic, gastrointestinal, or neurological) or psychiatric condition or any issue that would limit compliance with study requirements. Vaccination within 30 days of study enrollment. Pregnant, lactating, or breastfeeding females. Researchers believe that other reasons are not suitable for clinical trials.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Weidong Han, Ph.D
Phone
010-66937231
Ext
+86
Email
hanwdrsw@sina.com
First Name & Middle Initial & Last Name or Official Title & Degree
Yang Liu, M.D
Phone
010-66939460
Ext
+86
Email
liuyang301blood@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yang Xu, Ph.D
Organizational Affiliation
Zhejiang University
Official's Role
Study Director
Facility Information:
Facility Name
Biotherapeutic Department of Chinsese PLA Gereral Hospital
City
Beijing
State/Province
Beijing
ZIP/Postal Code
100853
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Weidong Han
Phone
+86-010-66937463
Email
hanwdrsw69@yahoo.com

12. IPD Sharing Statement

Learn more about this trial

Combination of CAR-DC Vaccine and ICIs in Malignant Tumors

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