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:Clinical Study on the EBV CAR-T /TCR-T Cells in the Treatment of Nasopharyngeal Carcinoma
这是一项早期 I 期注册临床试验,评估细胞治疗用于鼻咽癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 24 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT05587543。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: * 自愿签署书面知情同意书; * 年龄≥18岁且≤75岁,男女均可; * 预期生存期≥3个月; * 东部肿瘤协作组(ECOG)体能状态评分为0–2分; * 通过EBER原位杂交(EBER-FISH)确诊EBV阳性鼻咽癌; * 知情同意签署前5年内的病理石蜡切片检测结果; * 至少有一个符合实体瘤RECIST 1.1标准的可测量病灶; * 既往接受过二线或以上全身治疗且治疗失败的复发/转移性鼻咽癌患者; * 可建立单采或静脉通路,且无其他血细胞采集禁忌证; * 既往抗肿瘤治疗(放疗、化疗、靶向治疗等)所致不良反应已恢复至CTCAE 5.0的1级以下; * 研究期间及给药结束后6个月内,有生育能力的受试者(男女均包括)须采取有效医学避孕措施。育龄女性须在首次给药前72小时内进行妊娠检测,结果须为阴性。 排除标准: * 活动性中枢神经系统转移(治疗后稳定者除外); * HIV阳性、HBsAg阳性且HBV DNA阳性(定量检测≥1000 CPS/ml),或HCV抗体阳性且HCV RNA阳性; * 存在精神或心理障碍,无法配合治疗及疗效评估; * 患有严重自身免疫性疾病或长期使用免疫抑制剂; * 入组前14天内存在需要全身治疗的活动性或未控制感染; * 存在任何不稳定的全身性疾病; * 合并肺、脑、肾等重要器官功能障碍; * 细胞治疗前4周内接受过大手术或遭受严重创伤,或预计研究期间需要接受大手术; * 细胞治疗前4周内接受过最后一次放疗或抗肿瘤治疗; * 目前患有或曾患有其他癌症,且治愈时间不足3年;宫颈原位癌、皮肤基底细胞癌,以及无病生存超过5年的其他癌症除外; * 6个月内接受过嵌合抗原受体T细胞治疗; * 存在移植物抗宿主病(GVHD); * 筛查前正在接受全身性类固醇治疗,且研究者认为治疗期间需要长期全身使用类固醇(吸入或局部用药除外);或细胞回输前72小时内接受过全身性类固醇治疗(吸入或局部用药除外); * 有严重过敏或过敏史; * 需要接受抗凝治疗; * 妊娠期或哺乳期女性,或计划在6个月内妊娠者(男女均适用); * 研究者认为存在其他不适合参加研究的原因。
Inclusion Criteria: * Voluntary written informed consent; * Age ≥18 years old, ≤75 years old, male and female; * Expected survival ≥3 months; * The Eastern Cooperative Oncology Group (ECOG) physical fitness score was 0-2; * Ebv-positive nasopharyngeal carcinoma was diagnosed by in situ hybridization with Ebers (Eber-fish) . * Pathological Paraffin section testing (within 5 years before signing the informed consent form) ; * At least one measurable lesion according to RECIST v1.1 criteria for solid tumors; * Recurrent/metastatic nasopharyngeal carcinoma patients who had previously failed second-line or more systemic therapy; * An apheresis or venous access can be established and there are no other contraindications to blood cell isolation; * CTCAE 5.0 was lower than grade 1 in the side effects of previous anti-tumor therapy (radiotherapy, chemotherapy, targeted therapy, etc.) * During the study period and up to 6 months after the end of the administration, fertile subjects -LRB-both male and female) were required to use effective medical contraception. For women of reproductive age, a pregnancy test should be performed within 72 hours before the first dose, and the results were negative. Exclusion Criteria: * Active central nervous system metastases (except those that are stable after treatment); * HIV positive, HBsAg positive and HBV DNA copy number positive (quantitative detection ≥1000 CPS/ml) , HCV antibody positive and HCV RNA positive; * Patients with mental or psychological disorders who can not cooperate with the treatment and evaluation of the curative effect; * Subjects with severe autoimmune disease and long-term use of immunosuppressants; * Active or uncontrolled infection requiring systemic therapy was present within 14 days prior to enrollment; * Any unstable systemic disease; * Complicated with dysfunction of important organs such as lung, brain and kidney. * Subjects had undergone major surgery or severe trauma within 4 weeks before receiving cell therapy, or were expected to undergo major surgery during the study period. * Participants received their last dose of radiation or anti-tumor therapy within 4 weeks of receiving the cell therapy. * Participants had or had had other cancers that were incurable for up to 3 years, except for cervical cancer in situ or skin basal-cell carcinoma, and other cancers that had disease-free survival of more than 5 years. * Treated with Chimeric antigen receptor t-cell therapy within six months. * Graft-versus-host disease (GVHD); * Subjects who were receiving systemic steroid therapy before screening and who required long-term systemic steroid therapy during treatment as determined by the investigator (with the exception of inhaled or topical use) ; And subjects treated with systemic steroids within 72 hours before cell reinfusion (except for inhalation or topical use) . * Severe allergies or a history of allergies; * Subjects requiring anticoagulant therapy; * Pregnant or lactating women, or a six-month pregnancy plan (for both men and women); * Researchers believe there are other reasons not to include people in treatment.
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:Dose Limiting Toxicities · Analysis based on clinical trial data of subjects · one year;MTD or the best effective dose · Analysis based on clinical trial data of subjects · one year;Incidence of AE、SAE、AESI · Analysis based on clinical trial data of subjects · one year
次要终点:PK parameter:Cmax;PK parameter:Tmax;ORR;DCR;DOR;PFS
靶点A阳性的受试者分配至CAR-T细胞治疗组。
靶点A阴性、靶点B阳性且靶点C阳性的受试者分配至TCR-T细胞治疗组。
这是一项单臂、开放标签、采用“3+3”剂量递增设计的探索性研究。受试者分为EBV TCR-T细胞组和EBV CAR-T细胞组。EBV CAR-T组接受三个递增剂量水平的治疗:3.0×10⁶、9.0×10⁶和1.5×10⁷个细胞/kg;EBV TCR-T组接受三个递增剂量:5.0×10⁶、1.5×10⁷和3.0×10⁷个细胞/kg。
This study was a single-arm, open-label, "3 + 3" dose-escalation Exploratory research. The patients were divided into two groups: EBV TCR-T-cell Group and EBV CAR-T-cell group. The EBV CAR-T-treated group received three progressively increasing dose levels (3.0 × 106 cells/kg, 9.0 × 106 cells/kg, 1.5 × 107 cells/kg) of EBV CAR-T-cell therapy; The EBV TCR-T-cell group received three progressively increasing doses (5.0 × 106 cells/kg, 1.5 × 107 cells/kg, 3.0 × 107 cells/kg) of EBV TCR-T-cell therapy.
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