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:Safety and Efficacy Study of Anti-B7-H3 CAR-T Cell Therapy for Recurrent Glioblastoma
这是一项 I 期注册临床试验,评估 CAR-T 细胞治疗胶质母细胞瘤的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 30 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT05241392。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: 1. 男性或女性,年龄18–75岁(含18岁和75岁)。 2. 经正电子发射断层显像(PET)或组织病理学确认的复发性胶质母细胞瘤。 3. 免疫化学法检测原发或复发肿瘤组织中B7-H3染色范围≥30%。 4. Karnofsky评分≥50。 5. 可采集外周血单个核细胞(PBMC)。 6. 实验室检查及器官功能充分。 7. 有生育/受孕能力者同意使用高效避孕方法。 排除标准: 1. 妊娠或哺乳期女性。 2. 贝伐珠单抗禁忌证。 3. CAR-T输注前5天内接受全身类固醇,泼尼松剂量>10 mg/日或其他类固醇等效剂量;吸入性皮质类固醇除外。 4. 合并其他未控制的恶性肿瘤。 5. 活动性HIV、乙肝、丙肝或结核感染。 6. 入组前6个月内植入卡莫司汀缓释片。 7. 自身免疫性疾病。 8. 器官移植后长期接受免疫抑制治疗。 9. 严重或未控制的精神疾病,或可能增加不良事件/干扰疗效评价的状况。 10. 既往治疗的毒性或副作用尚未恢复。 11. 入组前1个月内参加其他干预性试验,或既往接受其他CAR-T/基因修饰细胞治疗。 12. 存在影响签署书面知情同意书或遵守研究程序的医学状况,包括但不限于心脑血管疾病、肾功能障碍/衰竭、肺栓塞、凝血障碍、活动性全身感染或未控制感染;或患者不愿/无法遵守研究程序。 13. 研究者认为会妨碍受试者参加试验的其他情况。
Inclusion Criteria: 1. Male or female, aged 18-75 years (including 18 and 75 years old); 2. Patients with relapsed glioblastoma, as confirmed by positron emission tomography (PET) or histologic pathology; 3. A \>= 30% staining extent of B7-H3 in his/her primary/recurrent tumor tissue by the immunochemical method; 4. Karnofsky scale score\>=50 5. Availability in collecting peripheral blood mononuclear cells (PBMCs) ; 6. Adequate laboratory values and adequate organ function; 7. Patients with childbearing/fathering potential must agree to use highly effective contraception; Exclusion Criteria: 1. Pregnant or breastfeeding females; 2. Contraindication to bevacizumab; 3. Within 5 days before the CAR-T cell infusion, subjects receiving systemic administration of steroids with dosage more than 10mg/d prednisone or the equivalent doses of other steroids ( not including inhaled corticosteroid); 4. Comorbid with Other uncontrolled malignancy; 5. Active immunodeficiency virus (HIV) or hepatitis B virus or hepatitis C virus or tuberculosis infection; 6. Subjects receiving the placement of a carmustine slow-release wafer within 6 months before the enrollment; 7. Autoimmune diseases; 8. Receiving long-term immunosuppressive treatment after organ transplantation; 9. Severe or uncontrolled psychiatric diseases or condition that could increase adverse events or interfere the evaluation of outcomes; 10. Not recovered from the toxicities or side effects by previous treatment; 11. Subjects who have participated the other interventional trial within one month before the enrollment, or have received other CAR-T cell therapies or gene-modified cell therapy before enrollment. 12. Subjects with medical conditions that affect signing the written informed consent or complying with the research procedures, the medical conditions including, but not limited to cardio-cerebral vascular diseases, renal dysfunction/failure, pulmonary embolism, coagulation disorders, active systemic infection, uncontrolled infection et. al; or patients who are unwilling or unable to comply with the research procedures; these 13. Subjects with other conditions that would interfere trial participation at the investigator's discretion.
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 Dose Limiting Toxicity (DLT) · To evaluate the DLT incidence occurred within three months after B7-H3 CAR-T cells infusion · three months post CAR-T cells infusion;Safety:Incidence and severity of adverse events · To evaluate the possible adverse events occurred within three months after B7-H3 CAR-T cell infusion, including the incidence and severity of symptoms such as cytokine release syndrome and neurotoxicity · three months post CAR-T cells infusion
次要终点:Efficacy:Overall survival rate at 12 months;Efficacy:objective remission rate;pharmacokinetics:Cmax;pharmacokinetics:Tmax;pharmacokinetics:AUC
剂量递增阶段采用“3+3”设计确定MTD和RP2D。自体抗B7-H3 CAR-T细胞每2周给药一次,每个疗程4个周期。每周期剂量递增如下:剂量1为2000万个细胞,共3名患者;剂量2为6000万个细胞,共3名;剂量3为1.5亿个细胞,共3名;剂量4为4.5亿个细胞,共3名;剂量5为9亿个细胞,共3名。RP2D确认阶段根据剂量递增结果确定RP2D,另有12名患者每2周接受RP2D剂量的自体抗B7-H3 CAR-T细胞,以进一步确认其安全性。若各剂量阶段患者耐受治疗且有应答,主要研究者可酌情安排多个疗程。
这是一项开放标签、单臂、剂量递增、多剂量研究,评估靶向B7-H3的嵌合抗原受体T细胞(CAR-T)治疗复发性胶质母细胞瘤患者的安全性、耐受性和初步疗效。研究还将探索最大耐受剂量(MTD)并确定推荐Ⅱ期剂量(RP2D)。
This is an open, single-arm, dose-escalation and multiple-dose study to evaluate the safety, tolerability and preliminary effectiveness of B7-H3-targeting Chimeric Antigen Receptor-T (CAR-T) cell therapy on patients with recurrent glioblastomas. The study also plan to explore the Maximum Tolerated Dose (MTD) and determine the Recommended Phase II Dose (RP2D) of the CAR-T cell therapy.
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