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FKC288 for Relapsed or Refractory Systemic Light Chain (AL) Amyloidosis

Primary Purpose

Light Chain Amyloidosis

Status
Not yet recruiting
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
FKC288
Sponsored by
Nanjing University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Light Chain Amyloidosis focused on measuring AL Amyloidosis, BCMA/CD19-CAR-T cell

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: The subject must personally sign a written informed consent form approved by the ethics committee before the start of the study; The subject's age is ≥18 years old and <70 years old; The subject must be diagnosed with light chain amyloidosis by pathological examination, with at least one major organ involved (heart, kidney, or liver); The subject with recurrent/refractory light chain amyloidosis that achieved no response with conventional treatment; dFLC > 50mg/L; Expected survival ≥ 12 weeks; ECOG score ≤ 2 points; Female subjects with fertility should agree to practice an effective method of contraception from the day of signing the ICF until 365 days after the infusion. An effective method of contraception is defined as abstinence or contraceptive methods with an annual failure rate of <1% specified in the plan. Before enrollment, the subject must have appropriate organ function and meet all the following criteria: 1) Absolute neutrophil count ≥ 1.0×109/L (use of granulocyte colony-stimulating factor (G-CSF) support is allowed, but must be without supportive treatment within 7 days before the examination); 2) Platelet count ≥ 75×109/L (no transfusion support [including component transfusion] or treatments aimed at raising platelets such as thrombopoietin [TPO] should be received within 7 days before the examination); 3) Hemoglobin ≥ 9 g/dl (no transfusion support [including component transfusion] should be received within 7 days before the examination); 4) Bilirubin value ≤ 1.5× upper limit of normal (ULN) (except bile duct obstruction caused by tumor compression); 5) Creatinine clearance rate ≥ 40 ml/min; 6) ALT or AST ≤ 2.5× ULN (≤5 times the upper limit of normal in patients with liver involvement); 7) Echocardiography results indicate left ventricular ejection fraction ≥ 50% with no significant pericardial effusion; 8) NTproBNP < 1800pg/ml, TNT < 0.06ng/ml; 9) Stable coagulation function: INR ≤ 1.5, APTT ≤ 1.2× ULN (excluding tumor-related anticoagulant therapy); 10) >95% basic blood oxygen saturation in the natural indoor air environments. Exclusion Criteria: Subjects who have received any of the following treatments prior to enrollment: 1) Subjects who have received gene therapy before enrollment; 2) Subjects who have received live vaccines within 4 weeks prior to enrollment; 3) Subjects has received other interventional clinical research drugs within 12 weeks before apheresis. Subjects with central metastasis or complete intestinal obstruction. Subject with moderate or more severe hydrothorax and ascites which are hard to control by conventional treatment and require continuous catheter drainage. With an active malignant tumor in the past 5 years, unless it is a curable tumor and has been obviously cured. Subjects who are positive for hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) and have abnormal peripheral blood HBV DNA test results (HBV DNA test abnormality is defined as HBV DNA quantitative detection is higher than the detection center's detection lower limit or higher than the detection center's normal reference range or HBV DNA qualitative detection is positive); hepatitis C virus (HCV) antibody positive and peripheral blood hepatitis C virus (HCV) RNA positive; human immunodeficiency virus (HIV) antibody positive; the cytomegalovirus (CMV) DNA positive; syphilis testing RPR positive. Presence of uncontrollable active infections (excluding <CTCAE grade 2 urinary and respiratory tract infections). Severe cardiovascular diseases, including but not limited to unstable angina pectoris, myocardial infarction (within 6 months prior to screening), congestive heart failure (New York Heart Association [NYHA] classification ≥ III), and severe arrhythmias. Subjects with hypertension that cannot be controlled by medication. Toxicity reactions that have not been relieved to baseline or ≤ grade 1 (NCI-CTCAE version 5.0, except for hair loss and laboratory test abnormalities without clinical significance) from past treatments. Major surgery within 2 weeks before enrollment, or has a surgery planned during the time the subject is expected to be infused with FKC288 or within 12 weeks after FKC288 infusion (except planned surgery under local anesthesia). Subject who has a solid organ transplant. Women who are pregnant or breastfeeding. Subjects with previous central nervous system diseases (such as cerebral aneurysm, epilepsy, stroke, dementia, psychosis, etc.) or conscious disorders. Other systemic diseases that the investigator judges as unstable, including but not limited to severe liver, kidney, or metabolic diseases that require medication. Known life-threatening allergic reactions, hypersensitivity reactions, or intolerance to FKC288 cell preparations or their components. Subjects judged by the investigator to have bleeding or severe thrombosis, or have inherited/acquired bleeding and severe thrombosis (including hemophilia, coagulation dysfunction, thrombocytopenia, splenomegaly, etc.), or are receiving thrombolysis or anticoagulation therapy. Other situations deemed inappropriate for inclusion by the investigator.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Treatment arm

    Arm Description

    Outcomes

    Primary Outcome Measures

    The proportion of subjects with dose-limiting toxicity
    The number of participants with dose limiting toxicity in each dose group and the type of dose limiting toxicity that occurred.
    The proportion of subjects with adverse events
    All adverse events were evaluated according to NCI-CTCAE v5.0 criteria.

    Secondary Outcome Measures

    Proportion of subjects achieving hematologic response
    The proportion of subjects who achieve any type of hematologic response according to the 2023 National Comprehensive Cancer Network (NCCN) systemic light-chain amyloidosis guidelines within 6 months after receiving FKC288 infusion.
    Proportion of subjects achieving organ response
    The proportion of subjects who achieve any type of organ response according to the 2023 National Comprehensive Cancer Network (NCCN) systemic light-chain amyloidosis guidelines within 2 years after receiving FKC288 infusion.
    Progression-free survival (PFS) of all subjects
    Time from the first FKC288 infusion to the first assessment of disease progression/relapse or death from any cause.
    Overall survival (OS) of all subjects
    Time from the first FKC288 infusion to death from any cause.

    Full Information

    First Posted
    May 7, 2023
    Last Updated
    July 30, 2023
    Sponsor
    Nanjing University School of Medicine
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05978661
    Brief Title
    FKC288 for Relapsed or Refractory Systemic Light Chain (AL) Amyloidosis
    Official Title
    A Single-Center Exploratory Study to Evaluate the Safety and Efficacy of FKC288 in Subjects With Relapsed or Refractory Systemic Light Chain (AL) Amyloidosis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2023
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    August 2023 (Anticipated)
    Primary Completion Date
    June 2025 (Anticipated)
    Study Completion Date
    June 2026 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Nanjing University School of Medicine

    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 study is a single-center exploratory clinical trial. It is estimated that 6-12 subjects will be enrolled. The "BOIN" dose escalation design is adopted. The main purpose is to evaluate the safety of FKC288 in the treatment of subjects with relapsed or refractory AL amyloidosis and explore the recommended phase II dose of FKC288 in the treatment of patients with relapsed/refractory systemic Light Chain (AL) amyloidosis.
    Detailed Description
    A leukapheresis procedure will be performed to manufacture FKC288 chimeric antigen receptor (CAR) modified T cells. Bridging therapy is allowed between PBMC collection and lymphodepletion. Lymphodepletion with fludarabine and cyclophosphamide was performed for three consecutive days. After 1-day rest, subjects will receive a single dose infusion of FKC288 at 0.1, 0.3, 1.0, or 3.0x 10^6 CAR+ T cells/Kg. Subjects will be followed in the study for a minimum of 2 years after FKC288 infusion.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Light Chain Amyloidosis
    Keywords
    AL Amyloidosis, BCMA/CD19-CAR-T cell

    7. Study Design

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

    8. Arms, Groups, and Interventions

    Arm Title
    Treatment arm
    Arm Type
    Experimental
    Intervention Type
    Drug
    Intervention Name(s)
    FKC288
    Intervention Description
    Administration of FKC288 Four dose groups of 0.1×10^6 CAR-T/kg, 0.3×10^6 CAR-T/kg, 1.0×10^6 CAR-T/kg, and 3.0×10^6 CAR-T/kg FKC288 are designed in this study. 3 to 6 subjects are expected to be enrolled in each dose group according to observed DLT.
    Primary Outcome Measure Information:
    Title
    The proportion of subjects with dose-limiting toxicity
    Description
    The number of participants with dose limiting toxicity in each dose group and the type of dose limiting toxicity that occurred.
    Time Frame
    Within 28 days after FKC288 injection infusion
    Title
    The proportion of subjects with adverse events
    Description
    All adverse events were evaluated according to NCI-CTCAE v5.0 criteria.
    Time Frame
    Within 24 weeks after FKC288 injection infusion
    Secondary Outcome Measure Information:
    Title
    Proportion of subjects achieving hematologic response
    Description
    The proportion of subjects who achieve any type of hematologic response according to the 2023 National Comprehensive Cancer Network (NCCN) systemic light-chain amyloidosis guidelines within 6 months after receiving FKC288 infusion.
    Time Frame
    Within 6 months after FKC288 injection infusion
    Title
    Proportion of subjects achieving organ response
    Description
    The proportion of subjects who achieve any type of organ response according to the 2023 National Comprehensive Cancer Network (NCCN) systemic light-chain amyloidosis guidelines within 2 years after receiving FKC288 infusion.
    Time Frame
    Within 2 years after FKC288 injection infusion
    Title
    Progression-free survival (PFS) of all subjects
    Description
    Time from the first FKC288 infusion to the first assessment of disease progression/relapse or death from any cause.
    Time Frame
    Within 2 years after FKC288 injection infusion
    Title
    Overall survival (OS) of all subjects
    Description
    Time from the first FKC288 infusion to death from any cause.
    Time Frame
    Within 2 years after FKC288 injection infusion

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    70 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: The subject must personally sign a written informed consent form approved by the ethics committee before the start of the study; The subject's age is ≥18 years old and <70 years old; The subject must be diagnosed with light chain amyloidosis by pathological examination, with at least one major organ involved (heart, kidney, or liver); The subject with recurrent/refractory light chain amyloidosis that achieved no response with conventional treatment; dFLC > 50mg/L; Expected survival ≥ 12 weeks; ECOG score ≤ 2 points; Female subjects with fertility should agree to practice an effective method of contraception from the day of signing the ICF until 365 days after the infusion. An effective method of contraception is defined as abstinence or contraceptive methods with an annual failure rate of <1% specified in the plan. Before enrollment, the subject must have appropriate organ function and meet all the following criteria: 1) Absolute neutrophil count ≥ 1.0×109/L (use of granulocyte colony-stimulating factor (G-CSF) support is allowed, but must be without supportive treatment within 7 days before the examination); 2) Platelet count ≥ 75×109/L (no transfusion support [including component transfusion] or treatments aimed at raising platelets such as thrombopoietin [TPO] should be received within 7 days before the examination); 3) Hemoglobin ≥ 9 g/dl (no transfusion support [including component transfusion] should be received within 7 days before the examination); 4) Bilirubin value ≤ 1.5× upper limit of normal (ULN) (except bile duct obstruction caused by tumor compression); 5) Creatinine clearance rate ≥ 40 ml/min; 6) ALT or AST ≤ 2.5× ULN (≤5 times the upper limit of normal in patients with liver involvement); 7) Echocardiography results indicate left ventricular ejection fraction ≥ 50% with no significant pericardial effusion; 8) NTproBNP < 1800pg/ml, TNT < 0.06ng/ml; 9) Stable coagulation function: INR ≤ 1.5, APTT ≤ 1.2× ULN (excluding tumor-related anticoagulant therapy); 10) >95% basic blood oxygen saturation in the natural indoor air environments. Exclusion Criteria: Subjects who have received any of the following treatments prior to enrollment: 1) Subjects who have received gene therapy before enrollment; 2) Subjects who have received live vaccines within 4 weeks prior to enrollment; 3) Subjects has received other interventional clinical research drugs within 12 weeks before apheresis. Subjects with central metastasis or complete intestinal obstruction. Subject with moderate or more severe hydrothorax and ascites which are hard to control by conventional treatment and require continuous catheter drainage. With an active malignant tumor in the past 5 years, unless it is a curable tumor and has been obviously cured. Subjects who are positive for hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) and have abnormal peripheral blood HBV DNA test results (HBV DNA test abnormality is defined as HBV DNA quantitative detection is higher than the detection center's detection lower limit or higher than the detection center's normal reference range or HBV DNA qualitative detection is positive); hepatitis C virus (HCV) antibody positive and peripheral blood hepatitis C virus (HCV) RNA positive; human immunodeficiency virus (HIV) antibody positive; the cytomegalovirus (CMV) DNA positive; syphilis testing RPR positive. Presence of uncontrollable active infections (excluding <CTCAE grade 2 urinary and respiratory tract infections). Severe cardiovascular diseases, including but not limited to unstable angina pectoris, myocardial infarction (within 6 months prior to screening), congestive heart failure (New York Heart Association [NYHA] classification ≥ III), and severe arrhythmias. Subjects with hypertension that cannot be controlled by medication. Toxicity reactions that have not been relieved to baseline or ≤ grade 1 (NCI-CTCAE version 5.0, except for hair loss and laboratory test abnormalities without clinical significance) from past treatments. Major surgery within 2 weeks before enrollment, or has a surgery planned during the time the subject is expected to be infused with FKC288 or within 12 weeks after FKC288 infusion (except planned surgery under local anesthesia). Subject who has a solid organ transplant. Women who are pregnant or breastfeeding. Subjects with previous central nervous system diseases (such as cerebral aneurysm, epilepsy, stroke, dementia, psychosis, etc.) or conscious disorders. Other systemic diseases that the investigator judges as unstable, including but not limited to severe liver, kidney, or metabolic diseases that require medication. Known life-threatening allergic reactions, hypersensitivity reactions, or intolerance to FKC288 cell preparations or their components. Subjects judged by the investigator to have bleeding or severe thrombosis, or have inherited/acquired bleeding and severe thrombosis (including hemophilia, coagulation dysfunction, thrombocytopenia, splenomegaly, etc.), or are receiving thrombolysis or anticoagulation therapy. Other situations deemed inappropriate for inclusion by the investigator.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Xianghua Huang, MD
    Phone
    86-25-80862002
    Email
    hxhszb@163.com

    12. IPD Sharing Statement

    Plan to Share IPD
    No

    Learn more about this trial

    FKC288 for Relapsed or Refractory Systemic Light Chain (AL) Amyloidosis

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