决定异体 CAR T 细胞排斥与扩增的细胞和分子机制
Cellular and molecular mechanisms determining allogeneic CAR T cell rejection and expansion.
我们评估了11例接受单一批次cemacabtagene ansegedleucel(cema-cel)治疗的大B细胞淋巴瘤患者,cemacabtagene ansegedleucel是一种异体抗CD19 CAR T产品。
英文原题:Dual-targeting HER2 and PD-L1 CAR-T for Solid Tumors
⚠ 该试验的登记信息已有 23 个月未更新, 页面上显示的「招募中」可能已经失效。联系研究中心之前,建议先到 ClinicalTrials.gov 核对登记原文的最新状态与联系方式。
这是一项早期 I 期注册临床试验,评估 HER2CAR-T 细胞治疗相关疾病的安全性、可行性及初步疗效。当前状态:招募中。计划入组 18 例。试验地点:中国 · 成都(共 1 个中心,其中中国 1 个)。登记号:NCT04684459。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 男女均可,年龄18–75岁;超过75岁的受试者由研究者根据基础健康状况判断是否入组。胸腔/腹腔回输CAR-T的受试者不设年龄上限; 2. 研究者判断预期生存期≥3个月; 3. ECOG体能状态评分0–2分; 4. 确诊卵巢癌、非小细胞肺癌、乳腺癌、胃癌、头颈部肿瘤、胰腺癌、结直肠癌、移行细胞癌、子宫内膜癌、肉瘤、胶质母细胞瘤、胆管癌等,已接受标准全身治疗,存在全身转移/浆膜腔转移或不能耐受标准治疗; 5. 原发肿瘤或浆膜腔转移细胞中HER2表达>20%,由免疫组化(IHC)或荧光原位杂交(FISH)证实; 6. 中性粒细胞绝对计数≥1×10⁹/L,血小板≥75×10⁹/L,淋巴细胞绝对计数≥0.5×10⁸/L,血红蛋白≥8.0 g/dL; 7. 肌酐清除率≥60 mL/min,血清ALT/AST≤正常值的2.5倍,总胆红素≤正常值的1.5倍; 8. 心脏射血分数≥50%,且无心包积液; 9. 无其他严重疾病(自身免疫性疾病、免疫缺陷病或其他需要免疫抑制治疗的疾病); 10. 治疗开始前至少3周停止化疗和靶向治疗; 11. 入组前、研究期间及CAR-T输注后1年内采取可靠避孕措施,具体方式由主要研究者或指定人员确定; 12. 自愿参加研究,理解并签署知情同意书; 13. 既往抗肿瘤治疗副作用已降至≤1级,脱发除外。 排除标准: 1. 对细胞因子过敏; 2. 活动性感染未得到控制; 3. 急性或慢性移植物抗宿主病(GVHD); 4. 合并其他未控制的恶性肿瘤; 5. 活动期乙型或丙型肝炎,或HIV感染水平达到/超过正常值上限; 6. 患有冠心病、心绞痛、心肌梗死、心律失常、脑血栓、脑出血等严重疾病; 7. 2–3级或控制不佳的高血压; 8. 有难以控制的精神疾病史; 9. 器官移植后长期使用免疫抑制剂(近期或目前吸入性皮质类固醇治疗除外); 10. 既往病史、精神状态或实验室异常可能增加参加研究或使用研究药物的相关风险; 11. 入组前6个月内发生不稳定肺栓塞、深静脉血栓或其他重大动静脉血栓栓塞事件;正在接受抗凝治疗者亦排除; 12. 妊娠期或哺乳期女性,或计划在治疗期间或治疗结束后1年内妊娠者; 13. 患有影响签署书面知情同意或遵守研究程序的疾病,或不愿/不能遵守研究要求。
Inclusion Criteria: 1. Male or female, Age 18-75 years old; If the subjects are over 75 years old, the researchers will determine whether to enroll according to the basic health conditions of the subjects, regardless of gender. No upper age limit was set for chest/abdominal reinfusion CAR-T subjects. 2. Estimated life expectancy ≥ 3 months (according to investigator's judgement); 3. The Eastern Cooperative Oncology Group (ECOG) performance status score is 0-2; 4. Patients diagnosed as ovarian cancer, non-small cell lung cancer, breast cancer, gastric cancer, head and neck cancer, pancreatic cancer, colorectal cancer, transitional cell carcinoma, endometrial carcinoma, sarcoma, glioblastoma, cholangiocarcinoma, etc. have received standard systemic treatment, have systemic metastasis/serosal cavity metastasis or are not tolerated; 5. Expressing HER2 \>20% of primary tumors or metastatic cells in the serous cavity by immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH); 6. Absolute neutrophil count ≥ 1×10\^9/L, platelet count ≥ 75×10\^9/L, absolute lymphocyte count ≥0.5×10\^8/L, hemoglobin ≥ 8.0 g/dl; 7. Creatinine clearance rate ≥60ml/min, Serum ALT/AST≤2.5 times of the normal level, and total bilirubin≤1.5 times of the normal level; 8. Cardiac ejection fraction ≥50%, no pericardial effusion; 9. No other serious diseases (autoimmune diseases or any immune deficiency disease or other disease in need of immunosuppressive therapy); 10. Patients must stop chemotherapy and targeted therapy for at least 3 weeks before starting treatment; 11. Patients must take reliable contraceptive measures before entering the trial, during the research process until 1 year after CAR-T infusion; reliable contraceptive measures will be determined by the main investigator or designated personnel; 12. Voluntarily participate in the research, understand and sign the informed consent; 13. The side effect of the last anti-tumor treatment was reduced to ≤1 grade, except for hair loss. Exclusion Criteria: 1. Allergic to cytokines; 2. Uncontrolled activity infection; 3. Acute or chronic (graft-versus-host disease) GVHD; 4. Accompanied by other uncontrolled malignant tumors; 5. Patient with hepatitis B or C active period, HIV infection ≥ the upper limit of the normal level; 6. Suffer from serious diseases such as coronary heart disease, angina pectoris, myocardial infarction, arrhythmia, cerebral thrombosis, cerebral hemorrhage, etc.; 7. Patients with grade 2-3 hypertension or poorly controlled; 8. History of mental illness that is difficult to control; 9. Patients have used immunosuppressive agents for a long time after organ transplantation, except for recent or current inhaled corticosteroid therapy; 10. The existing medical history or mental state history or laboratory abnormalities may increase the risk associated with participating in the study or the administration of the study drug; 11. Unstable pulmonary embolism, deep venous embolism or other major arterial/venous thromboembolic events occurred within 6 months before enrollment. If receiving anticoagulant therapy; 12. Pregnant or nursing women, or plan to become pregnant during the treatment period or within 1 year after the treatment ends; 13. Patient suffering from diseases that have signed written informed consent or comply with research procedures; or are unwilling or unable to comply with research requirements.
以上为辅助阅读译文。是否适合入组须由主治医生判断,最终以登记平台与研究者确认为准。
主要终点:Incidence of Treatment-Related Adverse Events · AE during the first 28 days after CAR-T cell administration · 12 months;Dose-limiting toxicity (DLT) · Baseline up to 28 days after CAR-T cells infusion · 12 months
次要终点:ORR(objective response rate);DOR (duration of response)
HER2和PD-L1双靶向CAR-T细胞治疗。
近年来CAR-T疗法在血液系统肿瘤中取得突破,但其治疗实体瘤仍面临挑战。HER2常见于乳腺癌、卵巢癌、肺癌、胃癌等恶性肿瘤。本研究拟在肿瘤微环境中将PD-L1抑制信号转化为激活信号,以增强CAR-T细胞的杀伤活性和存活能力,并在HER2阳性实体瘤患者中评估HER2/PD-L1双靶向CAR-T细胞。所有入组受试者将通过静脉或胸腔/腹腔途径接受细胞输注。
CAR-T therapy has achieved unprecedented success in hematological tumors in recent years, but the progress of CAR-T cells in the treatment of solid tumors is facing difficulties. HER-2 is frequently expressed in breast cancer, ovarian cancer, lung cancer, gastric cancer and other malignant tumors. In this study, the PD-L1 inhibitory signal was transformed into an activation signal in the tumor microenvironment, and enhanced the killing activity and survival ability of CAR-T cells. The HER-2/PD-L1 dual-targeting CAR-T will be investigated in patients with HER2-positive solid tumors, and all enrolled subjects will receive HER2/PD-L1 CAR T cells via intravenous or thoracic/peritoneal cavity infusion.
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