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A Phase I/II Trial of ALETA-001 for the Treatment of Participants With B-cell Malignancies

Primary Purpose

Lymphoma, Non-Hodgkin, Lymphoma, Large B-Cell, Diffuse, Lymphoma, Mantle-Cell

Status
Not yet recruiting
Phase
Phase 1
Locations
United Kingdom
Study Type
Interventional
Intervention
ALETA-001
Sponsored by
Cancer Research UK
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Lymphoma, Non-Hodgkin focused on measuring Neoplasms, Immunotherapy, Adoptive, Receptors, Chimeric Antigen, Receptors, Antigen, T-Cell, Antigens, CD19

Eligibility Criteria

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

Inclusion Criteria: Aged 16 years or over. Written informed consent and capable of co-operating with ALETA-001 administration and follow-up. Confirmed diagnosis of NHL according to World Health Organization (WHO) 2016 criteria. Received an approved anti-CD19 CAR T-cell therapy. Objectively evaluable or measurable disease at 4 weeks post CAR T, which demonstrates inadequate or incomplete response or progressive disease if there is a reasonable expectation of deriving benefit from trial treatment, or- initial response followed by relapse within 9 months assessed according to Lugano criteria. Eastern Cooperative Oncology Group performance status of 0, 1 or 2 following anti-CD19 CAR T-cell treatment. Haematological and biochemical indices within protocol specified ranges. Exclusion Criteria: Concurrent radiotherapy (except for palliative reasons). Potential participants who experienced any of the following because of the initial CAR T-cell treatment: Grade 4 ICANs, Grade >=3 ICANs persisting beyond 7 days and despite optimal supportive therapy. Grade 4 CRS, Grade 3 CRS persisting beyond 7 days and despite optimal supportive therapy, any Grade 2 ICANs or CRS must be fully resolved. Any ongoing toxic manifestation of previous anti-cancer treatment that, in the opinion of the Investigator, should exclude the participant. Active or previous malignancies of other types that, in the opinion of the Investigator, should exclude the participant. Exceptions include adequately treated cone biopsied in situ carcinoma of the cervix uteri and basal or squamous cell carcinoma of the skin and patients with asymptomatic prostate cancer without known metastatic disease and with no requirement for therapy or who require only hormonal therapy and have had normal prostate specific antigen for >1 year prior to the start of therapy. Cancer survivors, who have undergone potentially curative therapy for a prior malignancy, have no evidence of that disease for 2 years or more and are deemed at negligible risk for recurrence, are eligible for the trial. Ongoing need for systemic immunosuppressive therapy other than replacement dose of corticosteroids. Intermittent topical, inhaled or intra-nasal corticosteroids are permitted. Presence of active infections and/ or inflammatory disease requiring active management. Documented current central nervous system involvement by lymphoma. Women of childbearing potential (or are already pregnant or lactating) unless willing to adhere to protocol-defined contraceptive requirements. Male patients with partners of childbearing potential unless willing to adhere to protocol-defined contraceptive requirements. Major thoracic or abdominal surgery from which the participant has not yet recovered. At high medical risk because of non-malignant systemic disease including active uncontrolled infection. Hypersensitivity to any of the ingredients/excipients in ALETA-001 Participation in another interventional clinical trial, whilst taking part in this trial of ALETA-001. Participation in an observational trial or interventional clinical trial that does not involve administration of an IMP and that would not place an unacceptable burden on the participant, in the opinion of the Investigator and CDD, would be acceptable. Participants with any congenital or acquired immunodeficiency syndrome or who are receiving immunosuppressive therapy (including any dose of systemic corticosteroids), or who are immunosuppressed post organ transplant. However, participants receiving inhaled corticosteroids and participants with a history of allergy (other than anaphylaxis) are eligible, as are participants with a history of autoimmune disease. Any other condition that, in the Investigator's opinion, would mean that the trial is not in the best interests of the participant.

Sites / Locations

  • University Hospital Birmingham NHS Foundation Trust
  • University Hospitals Bristol and Weston
  • Cambridge University Hospitals
  • Kings College Hospital
  • University Hospital London Hospital
  • The Christie Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Safety Lead-In Phase

Dose Expansion Phase

Arm Description

Outcomes

Primary Outcome Measures

Dose level of ALETA-001 for use in Dose Expansion (Safety Lead-in Phase).
Determine a dose level that is deemed tolerable based on available safety and pharmacodynamic data.
Number of Participants who experience dose limiting toxicities (DLTs).
DLTs will be assessed up to Day 28 and are defined as toxicities that meet pre-defined severity criteria and assessed as having a suspected relationship to study drug, and unrelated to disease, disease progression, intercurrent illness, or concomitant medications that occurs within the 28 days of the first dose of ALETA-001.
Number of Participants who experience Grade 3, 4 or 5 related adverse event (AEs).
Related AEs are those considered by the investigator to be possibly, probably or highly probably related to ALETA-001. Events of cytokine release syndrome (CRS) and immune effector cell mediated neurotoxicity (ICANS) are graded according to the American Society for Transplantation and Cellular Therapy grading criteria. All other AEs are graded according to the Common Terminology Criteria for AEs (CTCAE) Version 5.0.
Best Overall Response (Dose Expansion Phase).
Best Overall Response according to Lugano criteria (Cheson, Journal of Clinical Oncology, 2014), the number of participants taking part in the Dose Expansion Phase with best overall response of complete response (CR), partial response (PR), no response or stable disease (SD/NR), and progressive disease (PD).
Progression-Free Survival (PFS) (Dose Expansion Phase).
Median PFS measured from first dose of ALETA-001 to date of progression according to Lugano criteria or date of death without a previous progression recorded.
Time to Progression (TTP) (Dose Expansion Phase).
Median TTP measured from first dose of ALETA-001 to date of progression according to Lugano criteria. Participants who die without recorded progression will be censored.
Overall Survival (OS) (Dose Expansion Phase).
Median OS measured from first dose of ALETA-001 to date of death due to any cause or to the date of censoring at the last time the participant was known to be alive.

Secondary Outcome Measures

Best Overall Response (Safety Lead-in Phase).
Best Overall Response according to Lugano criteria, the number of participants taking part in the Safety Lead-in Phase with best overall response of complete response (CR), partial response (PR), no response or stable disease (SD), and progressive disease (PD).
Progression-Free Survival (PFS) (Safety Lead-in Phase).
Median PFS measured from first dose of ALETA-001 to date of progression according to Lugano criteria or date of death without a previous progression recorded.
Time to Progression (TTP) (Safety Lead-in Phase).
Median TTP measured from first dose of ALETA-001 to date of progression according to Lugano criteria. Participants who die without recorded progression will be censored.
Overall Survival (OS) (Safety Lead-in Phase).
Median OS measured from first dose of ALETA-001 to date of death due to any cause or to the date of censoring at the last time the participant was known to be alive.
Maximum observed plasma concentration (Cmax) of ALETA-001.
Measurement of Cmax of ALETA-001 as appropriate.
Terminal elimination half-life (t1/2) of ALETA-001.
Measurement of t1/2 of ALETA-001 as appropriate.
Area under the concentration-time curve (AUC) of ALETA-001.
Measurement of AUC of ALETA-001 as appropriate.
Volume of distribution (Vss) of ALETA-001.
Measurement of Vss of ALETA-001 as appropriate.
Clearance (CL) of ALETA-001.
Measurement of CL of ALETA-001 as appropriate.

Full Information

First Posted
August 15, 2023
Last Updated
October 18, 2023
Sponsor
Cancer Research UK
Collaborators
Aleta BioTherapeutics
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1. Study Identification

Unique Protocol Identification Number
NCT06045910
Brief Title
A Phase I/II Trial of ALETA-001 for the Treatment of Participants With B-cell Malignancies
Official Title
A Cancer Research Phase I/ II Trial of ALETA-001 in Participants Who Do Not Achieve or Maintain an Optimal Response to Anti-CD19 CAR T-cell Therapy for the Treatment of B-cell Malignancies
Study Type
Interventional

2. Study Status

Record Verification Date
October 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
November 2023 (Anticipated)
Primary Completion Date
December 2027 (Anticipated)
Study Completion Date
December 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Cancer Research UK
Collaborators
Aleta BioTherapeutics

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
This is a Phase I/II multicentre, open-label trial designed to evaluate the efficacy, safety, tolerability and pharmacokinetics (PK) of a novel chimeric antigen receptor (CAR) T-cell engager, ALETA-001, administered by intravenous (IV) infusion as a single agent every 2 weeks in patients with relapsed non-Hodgkin lymphoma (NHL) who have failed to optimally respond to prior treatment with anti-CD19 CAR T-cell therapy. This first in human study is divided into 2 parts: a safety lead-in phase (Phase I) and a dose expansion phase (Phase II). Different dose levels of ALETA-001 will be evaluated in Phase I in order to define a recommended dosing level and schedule for Phase II. Phase II will further evaluate the safety, PK and therapeutic activity of ALETA-001.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lymphoma, Non-Hodgkin, Lymphoma, Large B-Cell, Diffuse, Lymphoma, Mantle-Cell, Lymphoma, Follicular, Lymphoma, B-Cell
Keywords
Neoplasms, Immunotherapy, Adoptive, Receptors, Chimeric Antigen, Receptors, Antigen, T-Cell, Antigens, CD19

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
72 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Safety Lead-In Phase
Arm Type
Experimental
Arm Title
Dose Expansion Phase
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
ALETA-001
Intervention Description
ALETA-001 will be administered intravenously (IV) every two weeks.
Primary Outcome Measure Information:
Title
Dose level of ALETA-001 for use in Dose Expansion (Safety Lead-in Phase).
Description
Determine a dose level that is deemed tolerable based on available safety and pharmacodynamic data.
Time Frame
Day 1 to Day 28.
Title
Number of Participants who experience dose limiting toxicities (DLTs).
Description
DLTs will be assessed up to Day 28 and are defined as toxicities that meet pre-defined severity criteria and assessed as having a suspected relationship to study drug, and unrelated to disease, disease progression, intercurrent illness, or concomitant medications that occurs within the 28 days of the first dose of ALETA-001.
Time Frame
Up to Day 28.
Title
Number of Participants who experience Grade 3, 4 or 5 related adverse event (AEs).
Description
Related AEs are those considered by the investigator to be possibly, probably or highly probably related to ALETA-001. Events of cytokine release syndrome (CRS) and immune effector cell mediated neurotoxicity (ICANS) are graded according to the American Society for Transplantation and Cellular Therapy grading criteria. All other AEs are graded according to the Common Terminology Criteria for AEs (CTCAE) Version 5.0.
Time Frame
Safety data will be collected from the time of informed consent until 95 days after the last dose of ALETA-001. The average time from consent to the end of follow up will be presented.
Title
Best Overall Response (Dose Expansion Phase).
Description
Best Overall Response according to Lugano criteria (Cheson, Journal of Clinical Oncology, 2014), the number of participants taking part in the Dose Expansion Phase with best overall response of complete response (CR), partial response (PR), no response or stable disease (SD/NR), and progressive disease (PD).
Time Frame
Radiological assessment from within 28 days before starting ALETA-001 and up to 12 months after.
Title
Progression-Free Survival (PFS) (Dose Expansion Phase).
Description
Median PFS measured from first dose of ALETA-001 to date of progression according to Lugano criteria or date of death without a previous progression recorded.
Time Frame
From date of first dose of ALETA-001 up to 12 months.
Title
Time to Progression (TTP) (Dose Expansion Phase).
Description
Median TTP measured from first dose of ALETA-001 to date of progression according to Lugano criteria. Participants who die without recorded progression will be censored.
Time Frame
From date of first dose of ALETA-001 up to 12 months.
Title
Overall Survival (OS) (Dose Expansion Phase).
Description
Median OS measured from first dose of ALETA-001 to date of death due to any cause or to the date of censoring at the last time the participant was known to be alive.
Time Frame
Follow-up until end of trial, estimated to be up to 48 months.
Secondary Outcome Measure Information:
Title
Best Overall Response (Safety Lead-in Phase).
Description
Best Overall Response according to Lugano criteria, the number of participants taking part in the Safety Lead-in Phase with best overall response of complete response (CR), partial response (PR), no response or stable disease (SD), and progressive disease (PD).
Time Frame
Radiological assessment from within 28 days before starting ALETA-001 and up to 12 months after.
Title
Progression-Free Survival (PFS) (Safety Lead-in Phase).
Description
Median PFS measured from first dose of ALETA-001 to date of progression according to Lugano criteria or date of death without a previous progression recorded.
Time Frame
From date of first dose of ALETA-001 up to 12 months.
Title
Time to Progression (TTP) (Safety Lead-in Phase).
Description
Median TTP measured from first dose of ALETA-001 to date of progression according to Lugano criteria. Participants who die without recorded progression will be censored.
Time Frame
From date of first dose of ALETA-001 up to 12 months.
Title
Overall Survival (OS) (Safety Lead-in Phase).
Description
Median OS measured from first dose of ALETA-001 to date of death due to any cause or to the date of censoring at the last time the participant was known to be alive.
Time Frame
Follow-up until end of trial, estimated to be up to 48 months.
Title
Maximum observed plasma concentration (Cmax) of ALETA-001.
Description
Measurement of Cmax of ALETA-001 as appropriate.
Time Frame
Day 1 to Day 7.
Title
Terminal elimination half-life (t1/2) of ALETA-001.
Description
Measurement of t1/2 of ALETA-001 as appropriate.
Time Frame
Day 1 to Day 7.
Title
Area under the concentration-time curve (AUC) of ALETA-001.
Description
Measurement of AUC of ALETA-001 as appropriate.
Time Frame
Day 1 to Day 7.
Title
Volume of distribution (Vss) of ALETA-001.
Description
Measurement of Vss of ALETA-001 as appropriate.
Time Frame
Day 1 (before first ALETA-001 infusion) to Day 7.
Title
Clearance (CL) of ALETA-001.
Description
Measurement of CL of ALETA-001 as appropriate.
Time Frame
Day 1 to Day 7.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
16 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Aged 16 years or over. Written informed consent and capable of co-operating with ALETA-001 administration and follow-up. Confirmed diagnosis of NHL according to World Health Organization (WHO) 2016 criteria. Received an approved anti-CD19 CAR T-cell therapy. Objectively evaluable or measurable disease at 4 weeks post CAR T, which demonstrates inadequate or incomplete response or progressive disease if there is a reasonable expectation of deriving benefit from trial treatment, or- initial response followed by relapse within 9 months assessed according to Lugano criteria. Eastern Cooperative Oncology Group performance status of 0, 1 or 2 following anti-CD19 CAR T-cell treatment. Haematological and biochemical indices within protocol specified ranges. Exclusion Criteria: Concurrent radiotherapy (except for palliative reasons). Potential participants who experienced any of the following because of the initial CAR T-cell treatment: Grade 4 ICANs, Grade >=3 ICANs persisting beyond 7 days and despite optimal supportive therapy. Grade 4 CRS, Grade 3 CRS persisting beyond 7 days and despite optimal supportive therapy, any Grade 2 ICANs or CRS must be fully resolved. Any ongoing toxic manifestation of previous anti-cancer treatment that, in the opinion of the Investigator, should exclude the participant. Active or previous malignancies of other types that, in the opinion of the Investigator, should exclude the participant. Exceptions include adequately treated cone biopsied in situ carcinoma of the cervix uteri and basal or squamous cell carcinoma of the skin and patients with asymptomatic prostate cancer without known metastatic disease and with no requirement for therapy or who require only hormonal therapy and have had normal prostate specific antigen for >1 year prior to the start of therapy. Cancer survivors, who have undergone potentially curative therapy for a prior malignancy, have no evidence of that disease for 2 years or more and are deemed at negligible risk for recurrence, are eligible for the trial. Ongoing need for systemic immunosuppressive therapy other than replacement dose of corticosteroids. Intermittent topical, inhaled or intra-nasal corticosteroids are permitted. Presence of active infections and/ or inflammatory disease requiring active management. Documented current central nervous system involvement by lymphoma. Women of childbearing potential (or are already pregnant or lactating) unless willing to adhere to protocol-defined contraceptive requirements. Male patients with partners of childbearing potential unless willing to adhere to protocol-defined contraceptive requirements. Major thoracic or abdominal surgery from which the participant has not yet recovered. At high medical risk because of non-malignant systemic disease including active uncontrolled infection. Hypersensitivity to any of the ingredients/excipients in ALETA-001 Participation in another interventional clinical trial, whilst taking part in this trial of ALETA-001. Participation in an observational trial or interventional clinical trial that does not involve administration of an IMP and that would not place an unacceptable burden on the participant, in the opinion of the Investigator and CDD, would be acceptable. Participants with any congenital or acquired immunodeficiency syndrome or who are receiving immunosuppressive therapy (including any dose of systemic corticosteroids), or who are immunosuppressed post organ transplant. However, participants receiving inhaled corticosteroids and participants with a history of allergy (other than anaphylaxis) are eligible, as are participants with a history of autoimmune disease. Any other condition that, in the Investigator's opinion, would mean that the trial is not in the best interests of the participant.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Emma Ingleson
Phone
0203 469 6897
Email
aleta@cancer.org.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sridhar Chaganti, Dr
Organizational Affiliation
University Hospital Birmingham NHS Foundation Trust
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Birmingham NHS Foundation Trust
City
Birmingham
Country
United Kingdom
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sridhar Chaganti, Dr
Email
sridhar.chaganti@uhb.nhs.uk
Facility Name
University Hospitals Bristol and Weston
City
Bristol
Country
United Kingdom
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rajesh Alajangi, Dr
Email
Rajesh.Alajangi@uhbw.nhs.uk
Facility Name
Cambridge University Hospitals
City
Cambridge
Country
United Kingdom
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ram Malladi, Dr
Email
Ram.malladi@nhs.net
Facility Name
Kings College Hospital
City
London
Country
United Kingdom
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Robin Sanderson, Dr
Email
Robinsanderson1@nhs.net
Facility Name
University Hospital London Hospital
City
London
Country
United Kingdom
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maeve O'Reilly, Dr
Email
maeve.o'reilly@nhs.net
Facility Name
The Christie Hospital
City
Manchester
Country
United Kingdom
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Adam Gibb, Dr
Email
adam.gibb@nhs.net

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Individual de-identified patient data that underlie the results reported will be shared with researchers whose proposed use of the data is approved by a review committee of the Sponsor.
IPD Sharing Time Frame
All requests made within 5 years from the end of trial will be considered; requests made subsequently will be considered where possible.
IPD Sharing Access Criteria
When a request has been approved, Cancer Research UK will provide access to the de-identified individual patient-level data and appropriate supporting information. A signed Data Sharing Agreement must be in place before accessing requested information. Requests should be submitted to drugdev@cancer.org.uk.
Links:
URL
https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-aleta-001-b-cell-lymphoma
Description
Simple Summary of the trial on Cancer Research UK database.

Learn more about this trial

A Phase I/II Trial of ALETA-001 for the Treatment of Participants With B-cell Malignancies

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