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 Melanoma (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)治疗黑色素瘤、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:NCT05098184。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 年龄18–75岁。 2. 组织学诊断为原发性、复发性或转移性黑色素瘤。 3. 预期生存期>3个月。 4. Karnofsky评分≥60%或ECOG评分0–2。 5. 标准治疗方案失败,或无可用标准治疗方案。 6. 有可供活检/切除并分离TIL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天内血液学和生化检查符合:白细胞≥2.5×10^9/L;中性粒细胞≥1.5×10^9/L;淋巴细胞≥0.7×10^9/L;血小板≥100×10^9/L;血红蛋白≥90 g/L;活化部分凝血活酶时间(APTT)≤ULN的1.5倍(过去3天内接受抗凝治疗者除外);国际标准化比值(INR)≤ULN的1.5倍(过去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≤ULN的3倍(肝转移患者亦≤ULN的3倍);总胆红素≤ULN的1.5倍。 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从签署知情同意书时起至淋巴细胞清除结束后1年采取认可的高效避孕方法。 11. 包括放疗、化疗和生物制剂在内的所有抗肿瘤治疗须在采集TIL前28天停止。 12. 能够理解并签署知情同意书。 13. 能遵守随访访视安排及知情同意书中规定的其他要求。 排除标准: 1. 需要糖皮质激素治疗且泼尼松日剂量>15 mg(或等效剂量),或患有需免疫调节治疗的自身免疫病。 2. FEV1<2 L,或校正后的DLCO<40%。 3. 存在以下有临床意义的心血管异常:NYHA III/IV级充血性心力衰竭、有临床意义的低血压、症状性冠状动脉疾病无法控制、射血分数<35%;或严重心律失常/传导异常,如需临床干预的室性心律失常、二/三度房室传导阻滞等。 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. 严重躯体或精神疾病。 6. 存在需治疗的活动性全身感染、血培养阳性或影像学感染证据。 7. 过去1个月内接受过其他药物治疗,或当前接受其他药物、生物治疗、化疗或放疗。 8. 对化学或生物组成与细胞疗法类似的化合物有过敏史。 9. 既往接受免疫治疗后发生>3级免疫相关不良事件(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;研究者认为不涉及安全性的毒性(如脱发)除外。 11. 妊娠或哺乳期女性。 12. 有器官移植、异基因干细胞移植或肾脏替代治疗史。 13. 研究者认为有其他严重全身性疾病或其他不适合参加临床研究的原因。
Inclusion Criteria: 1. Age: 18 years to 75 years; 2. Histologically diagnosed as primary/relapsed/metastasized melanoma; 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 advanced melanoma as assessed by incidence of adverse events. · 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 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;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 GC101 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 GC101 TIL treatment that the patients are still alive · Up to 36 months
次要终点:Change in Quality of Life
患者接受1×10^9–5×10^10个体外扩增的自体TIL。输注前接受非清髓性淋巴细胞清除预处理,使用羟氯喹(600 mg,单次给药)和环磷酰胺,随后经静脉输注TIL。
本研究旨在评估肿瘤浸润淋巴细胞(TIL)治疗晚期黑色素瘤患者的安全性和疗效。自体TIL从肿瘤切除或活检标本中扩增,在非清髓性(NMA)淋巴细胞清除预处理后(羟氯喹600 mg单次给药及环磷酰胺),经静脉回输患者。
This study is to investigate the safety and efficacy of tumor infiltrating lymphocyte (TIL) therapy in patients with advanced melanoma. 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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