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 Hepatobiliary-Pancreatic Cancers (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)治疗肝癌、多发性骨髓瘤、胰腺癌的安全性、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:NCT05098197。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 年龄18–75岁。 2. 组织学确诊原发、复发或转移性肝胆癌或胰腺癌。 3. 预期生存期>3个月。 4. Karnofsky评分≥60%或ECOG 0–2分。 5. 标准治疗失败或无可用标准治疗。 6. 有可活检/切除并获取TIL的肿瘤区域,或有可分离TIL的恶性体液;至少有1个可评估病灶。 7. 入组前7天内血液学和生化指标符合:白细胞≥2.5×10⁹/L、ANC≥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≤ULN的1.5倍(过去3天接受抗凝者除外);INR≤ULN的1.5倍(过去3天接受抗凝者除外);肌酐≤1.5 mg/dL(132.6 μmol/L)或清除率≥50 mL/min;ALT/AST≤ULN的3倍;总胆红素≤ULN的1.5倍。 8. 无手术或活检的绝对/相对禁忌证。 9. 有生育能力者同意采用获批的高效避孕方式,知情同意时开始并持续至淋巴清除结束后1年。 10. 放疗、化疗、生物制剂等抗肿瘤治疗须在获取TIL前停止至少28天。 11. 能理解并签署知情同意书,且能遵守随访和协议要求。 排除标准: 1. 需要泼尼松>15 mg/日(或等效剂量)糖皮质激素治疗,或自身免疫病需免疫调节治疗。 2. FEV1<2 L或校正DLCO<40%。 3. 有显著心血管异常,包括NYHA心功能Ⅲ/Ⅳ级心力衰竭、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%,或需临床干预的室性心律失常、二/三度房室传导阻滞等严重心律/传导异常。 4. HIV感染或抗HIV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。 5. 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有感染证据。 6. 过去1个月内接受过其他药物、生物治疗、化疗或放疗,或目前正在接受上述治疗。 7. 对与细胞治疗相似的化学/生物物质有过敏史。 8. 既往免疫治疗发生>3级免疫相关不良事件(irAE)。 9. 既往抗肿瘤治疗不良事件尚未恢复至CTCAE 5.0版≤1级;研究者认为无安全性影响的毒性(如脱发)除外。 10. 妊娠或哺乳期;有器官移植、异体造血干细胞移植或肾脏替代治疗史。 11. 研究者认为有其他严重全身性疾病史或其他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 hepatobiliary cancer or pancreatic cancers; 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 hepatobiliary-pancreatic cancers as assessed by incidence of adverse events. · 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 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 GC101 TIL 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
非清髓性淋巴清除后,静脉输注1×10⁹–5×10¹⁰个体外扩增的自体TIL;预处理包括羟氯喹单次600 mg及环磷酰胺。
本研究评估肿瘤浸润淋巴细胞(TIL)治疗晚期肝胆胰癌的安全性和疗效。自体TIL从肿瘤切除或活检组织中扩增,患者接受羟氯喹(单次600 mg)和环磷酰胺非清髓性淋巴清除后,将TIL静脉输注回患者体内。
This study is to investigate the safety and efficacy of tumor infiltrating lymphocyte (TIL) therapy in patients with advanced hepatobiliary-pancreatic cancers. 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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