单细胞追踪揭示黑色素瘤 TIL 治疗过程中肿瘤反应性 T 细胞的可塑性
Single-cell tracking reveals tumor-reactive T cell plasticity during melanoma TIL therapy.
TIL(肿瘤浸润淋巴细胞)过继细胞治疗可在转移性黑色素瘤中诱导持久缓解,然而在体外扩增过程中及回输后,调控肿瘤反应性T细胞命运的克隆和转录动态仍知之甚少。
英文原题:A Study of GC101 TIL in Advanced Solid Tumors (TR)
这是一项早期 I 期注册临床试验,评估TIL(肿瘤浸润淋巴细胞)治疗晚期实体瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 20 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT04967833。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 年龄18至75岁。 2. 组织学确诊为原发、复发或转移性恶性肿瘤。 3. 预期生存期超过3个月。 4. Karnofsky体能状态评分≥60%,或ECOG评分0–2分。 5. 标准治疗方案无效,或无可用标准治疗方案。 6. 有适合活检或切除的肿瘤部位,或有可分离TIL的恶性体液。 7. 至少有1个可评估肿瘤病灶。 8. 入组前7天内血液学及生化指标符合以下要求:白细胞绝对计数≥2.5×10⁹/L;中性粒细胞绝对计数≥1.5×10⁹/L;淋巴细胞绝对计数≥0.7×10⁹/L;血小板≥100×10⁹/L;血红蛋白≥90 g/L;活化部分凝血活酶时间(APTT)≤1.5倍ULN(此前3天内接受抗凝治疗者除外);国际标准化比值(INR)≤1.5倍ULN(此前3天内接受抗凝治疗者除外);血清肌酐≤1.5 mg/dL(或≤132.6 μmol/L),或肌酐清除率≥50 mL/min;血清ALT/AST≤3倍ULN;总胆红素≤1.5倍ULN。 9. 无手术或活检的绝对或相对禁忌证。 10. 有生育能力者须同意自签署知情同意书起采用经认可的高效避孕方法,并持续至淋巴细胞清除治疗完成后1年。 11. 任何针对恶性肿瘤的治疗,包括放疗、化疗和生物制剂治疗,须在采集TIL前至少28天停止。 12. 能理解并签署知情同意书。 13. 能遵守随访计划及研究协议的其他要求。 排除标准: 1. 需要使用糖皮质激素且每日泼尼松剂量超过15 mg(或等效激素剂量),或患有需要免疫调节治疗的自身免疫性疾病。 2. FEV1<2 L,或校正的DLCO<40%。 3. 存在显著心血管异常,包括NYHA心功能III或IV级充血性心力衰竭、有临床意义的低血压、未控制的症状性冠状动脉疾病、射血分数<35%;或严重心律/传导异常,如需临床干预的室性心律失常、二度或三度房室传导阻滞等。 4. HIV感染或抗HIV抗体阳性、活动性HBV或HCV感染(HBsAg阳性和/或抗HCV阳性)、梅毒感染或梅毒螺旋体抗体阳性。 5. 患有严重躯体或精神疾病。 6. 存在需要治疗的全身活动性感染,或血培养阳性/影像学提示感染。 7. 入组前1个月内接受过其他药物、其他生物治疗、化疗或放疗,或目前正在接受上述治疗。 8. 对与细胞治疗类似的化学或生物化合物有过敏史。 9. 接受免疫治疗后发生超过3级的irAE。 10. 既往抗肿瘤治疗相关不良事件尚未恢复至CTCAE 5.0版1级或以下;研究者认为不构成安全问题的毒性(如脱发)除外。 11. 妊娠期或哺乳期女性。 12. 有器官移植、异基因造血干细胞移植或肾脏替代治疗史。 13. 研究者认为受试者有其他严重全身性疾病史,或存在其他不适合参加本研究的原因。
Inclusion Criteria: 1. Age: 18 years to 75 years; 2. Histologically diagnosed as primary/relapsed/metastasized malignant tumors; 3. Expected life-span more than 3 months; 4. Karnofsky≥60% or ECOG score 0-2; 5. Test subjects have failed standard treatment regimens, or there are no standard treatment regimens available. 6. Test subjects must have tumor regions eligible for biopsy or resection, or malignant body fluid where TILs can be isolated; 7. At least 1 evaluable tumor lesion; 8. Hematology and Chemistry(within 7 days prior to enrollment): * Absolute count of white blood cells≥2.5×10\^9/L; * Absolute count of neutropils≥1.5×10\^9/L; * Absolute count of lymphocytes ≥0.7×109/L; * Platelet count≥100×10\^9; * hemoglobin≥90 g/L; * Activated partial thromboplastin time (APTT) ≤1.5xULN (Unless received anticoagulant therapy within the previous 3 days); * International normalized ratio (INR) ≤1.5xULN (Unless received anticoagulant therapy within the previous 3 days); * Serum creatinine ≤1.5mg/dL(or ≤132.6μmol/L), or clearance rate≥50mL/min; * Serum ALT/AST ≤3×ULN(subjects with liver metastasis ≤3×ULN); * Totol bilirubin≤1.5×ULN; 9. No absolute or relative contraindications to operation or biopsy; 10. Test subjects with child-bearing potential must be willing to practice approved highly effective methods of contraception at the time of informed consent, and continue within 1 year after the completion of lymphodepletion; 11. Any malignant tumor-targeting therapies, including radiotherapy, chemotherapy and biologics must cease 28 days before obtaining TILs; 12. Be able to understand and sign the informed consent document; 13. Be able to stick to follow-up visit plan and other requirements in the agreement. Exclusion Criteria: 1. Need glucocorticoid treatment, and daily dose of Prednisone greater than 15mg (or equivalent doses of hormones) or outoimmune diseases requiring immunomodulatory treatment; 2. Forced expiratory volume in one second (FEV1) less than 2L, diffusing capacity of the lung for carbon monoxide (DLCO) (calibrated) less than 40%; 3. Significant cardiovascular anomalies according to any of the following definition: New York Heart Association (NYHA) Grade III or IV congestive heart failure, clinically significant low blood pressure, uncontrollable symptomatic coronary artery diseases, or ejection fraction less than 35%; Severe cardiac rhythm and conduction anomaly, such as ventricular arrhythmia requiring clinical intervention, second-third degree atrio-ventricular conductive block, etc. 4. Human immunodeficiency virus (HIV) infection or anti-HIV antibody positive, active HBV or HCV infection (HBsAg positive and/or anti-HCV positive), syphilis infection or Treponema pallidum antibody positive; 5. Severe physical or mental diseases; 6. Have a systemic active infection requiring treatment, or have positive blood cultures(or imaging evidence of infection); 7. Having been treated within a month or being treated now with other medicines, or other biologic therapy, chemo-or radiotherapy; 8. History of allergy to chemical compound consisting of chemical and biologic substances resembling cell therapy; 9. Having received immunotherapy and developed irAE level greater than Level 3; 10. Previous anti-tumor treatment AE did not return to CTCAE5.0 version grade 1 or below (toxicity considered by the investigator as non-safety concerns like alopecia excluded); 11. Females in pregnancy or lactation; 12. History of organ transplantation, allogeneic stem cell transplantation, and renal replacement therapy; 13. Researchers considering the test subject as having a history of other severe systemic diseases, or other reasons inappropriate for the clinical study.
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:Adverse Events(AE) · To characterize the safety profile of GC101 TIL in patients with recurrent, metastatic, or persistent solid tumor as assessed by incidence of adverse events. · 6 month;Objective Response Rate (ORR) · Proportion of patients with response per Response Evaluation Criteria in Solid Tumors (RECIST v1.1):
ORR (proportion of patients) = # with CR + # with PR / # with CR + # with PR + # with SD + # with PD.
( Except baseline evaluation within 28 days before GC101 TIL infusion,PET/CT scan will be performed at 6 weeks after TIL infusion, and than every 6 weeks for 6 months, and then every 6 months after that for up to 3 years) · Up to 36 months
次要终点:Disease Control Rate (DCR);Duration of Response (DOR);Progression-Free Survival (PFS);Overall Survival (OS)
将体外扩增的自体TIL(1×10⁹–5×10¹⁰个)静脉输注给晚期实体瘤患者;输注前采用羟氯喹(单次600 mg)和环磷酰胺进行非清髓性淋巴细胞清除预处理。
本研究旨在评估TIL疗法治疗晚期恶性实体瘤患者的安全性和疗效。研究将从肿瘤切除组织或活检标本中扩增自体TIL,经羟氯喹(单次600 mg)和环磷酰胺进行非清髓性淋巴细胞清除预处理后,将细胞静脉输注给患者。
This study is to investigate the safety and efficacy of tumor infiltrating lymphocyte (TIL) therapy in patients with Advanced malignant solid tumors.Autologous TILs are expanded from tumor resections or biopsies and infused i.v. into the patient after NMA lymphodepletion treatment with hydroxychloroquine(600mg,single-dose) and cyclophosphamide.
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