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 GC201 TIL in Advanced Gynecologic Tumors (10hospital)
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)治疗多发性骨髓瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 50 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT05098171。
仅女性 · ≥ 18 Years 且 ≤ 75 Years
纳入标准:年龄18–75岁;组织学确诊原发、复发或转移性妇科肿瘤;预计生存期>3个月;Karnofsky评分≥60%或ECOG 0–2;标准治疗失败或无标准治疗方案;有适合活检/切除并可分离TIL的肿瘤部位,或有可分离TIL的恶性体液;至少1个可评估肿瘤病灶。入组前7天内血液及生化检查须满足:白细胞≥2.5×10⁹/L、中性粒细胞≥1.5×10⁹/L、淋巴细胞≥0.7×10⁹/L、血小板≥100×10⁹/L、血红蛋白≥90 g/L;APTT≤1.5×ULN(过去3天接受抗凝治疗者除外),INR≤1.5×ULN(同上);血清肌酐≤1.5 mg/dL(或≤132.6 μmol/L)或肌酐清除率≥50 mL/min;ALT/AST≤3×ULN;总胆红素≤1.5×ULN。无手术或活检的绝对/相对禁忌;有生育能力者同意从签署知情同意起采取获批的高效避孕措施,并持续至淋巴清除完成后1年;针对肿瘤的放疗、化疗、生物治疗须在获取TIL前停止28天;能够理解并签署知情同意书,且能够遵守随访计划及研究要求。 排除标准:需接受泼尼松>15 mg/日(或等效剂量糖皮质激素)治疗,或有需免疫调节治疗的自身免疫病;FEV1<2 L或校正DLCO<40%;显著心血管异常,包括NYHA III/IV级心衰、有临床意义的低血压、未控制且有症状的冠状动脉疾病、射血分数<35%,或需临床干预的室性心律失常、二至三度房室传导阻滞等严重心律/传导异常;HIV感染或抗体阳性、活动性乙肝/丙肝(HBsAg和/或抗HCV阳性)、梅毒感染或梅毒螺旋体抗体阳性;严重躯体或精神疾病;需治疗的全身活动性感染、血培养阳性或影像学提示感染;过去1个月内接受或当前接受其他药物、生物治疗、化疗或放疗;对类似细胞治疗所含化学或生物成分有过敏史;免疫治疗后发生>3级免疫相关不良事件;既往抗肿瘤治疗不良事件未恢复至CTCAE 5.0版≤1级(研究者认为无安全性影响的脱发等毒性除外);妊娠或哺乳;既往器官移植、异基因干细胞移植或肾脏替代治疗;研究者认为有其他严重系统性疾病或不适合参加研究的原因。
Inclusion Criteria: 1. Age: 18 years to 75 years; 2. Histologically diagnosed as primary/relapsed/metastasized Gynecological 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 Signal Switch Receptor Modified TIL (GC201 TIL) in patients with advanced gynecologic tumors as assessed by incidence of adverse events related to GC201 TIL infusion. · Up to 6 months;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 TIL infusion,PET/CT scan will be performed at 6 weeks after GC201 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;Disease Control Rate (DCR) · Percentage of patients that meet CR, PR and SD criteria set in this study according to RECIST v1.1: DCR (proportion of patients) = # with CR + # with PR + # with SD / # with CR + # with PR + # with SD + # with PD. · Up to 36 months;Duration of Response (DOR) · The time length between the first confirmed objective response per RECIST 1.1 to the treatment and the subsequent disease progression per RECIST 1.1 · Up to 36 months ];Progression-Free Survival (PFS) · The time length between GC201 TIL infusion and confirmed subsequent disease progression according to RECIST 1.1 · Up to 36 months;Overall Survival (OS) · The length of time from the date of the start of GC201 TIL treatment that the patients are still alive · Up to 36 months ]
次要终点:Change in Quality of Life
输注2×10⁸–1×10¹⁰个体外扩增的自体PD-1或TGF-β信号转换受体修饰TIL(GC201 TIL)。晚期妇科肿瘤患者先接受羟氯喹(单次600 mg)和环磷酰胺进行非清髓性淋巴清除,再静脉输注细胞。
本研究评估信号转换受体修饰TIL(GC201 TIL)治疗晚期妇科肿瘤的安全性和疗效。研究者从肿瘤切除或活检组织中获取自体TIL,经基因修饰(改造TGF-β受体或PD-1,使肿瘤微环境的抑制信号转为持续的T细胞激活信号)并扩增;患者接受羟氯喹(单次600 mg)和环磷酰胺进行非清髓性淋巴清除后静脉输注。
This study is to investigate the safety and efficacy of signal switch receptor modified TIL (GC201 TIL) in patients with advanced gynecologic tumors. Autologous TILs from tumor resections or biopsies are first gene modified(TGF-β receptor or PD-1 gene modified TILs which could transfer the suppression signal surrounding the microenvironment of tumor bed into persistent T cell activation signal) and than expanded before i.v. infusion into the patient after NMA lymphodepletion treatment with hydroxychloroquine(600mg,single-dose) and cyclophosphamide.
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