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LB2102(DLL3 CAR-T)治疗小细胞肺癌:I 期临床试验

英文原题:DLL3-Directed Chimeric Antigen Receptor T-cells in Subjects With Extensive Stage Small Cell Lung Cancer

ClinicalTrials.gov 2023/01/11(首次登记) I 期注册临床试验 · 进行中(不再招募)

简要介绍

这是一项 I 期注册临床试验,评估细胞治疗用于小细胞肺癌的安全性、可行性及初步疗效。当前状态:进行中(不再招募)。计划入组 41 例。试验地点:美国 · 坦帕、列克星敦、波士顿、纽约(共 4 个中心)。登记号:NCT05680922。

入组条件决定能不能参加

不限性别 · ≥ 18 Years

纳入标准:

• 年龄≥18岁,愿意并能够提供书面知情同意。
• 按2021年WHO标准,经组织学/细胞学确诊为不可切除小细胞肺癌(SCLC)、肺大细胞神经内分泌癌(LCNEC)、混合型SCLC或混合型LCNEC。
• 至少接受过一线标准治疗,之后疾病进展或应答不足;且标准治疗不可耐受、不太可能带来显著临床获益、已无效,或受试者拒绝继续标准治疗。
• 入组前有可用的福尔马林固定石蜡包埋肿瘤样本(组织块或连续未染色切片),并附病理报告;须提供存档样本或新鲜活检组织。
• 按实体瘤疗效评价标准(RECIST)1.1版,至少存在一个影像学可测量病灶。
• ECOG体能状态0或1。
• 预期寿命至少4个月。
• 器官功能充分。
• 有生育能力女性须在筛查时接受高灵敏度血清妊娠试验(β-hCG),结果为阴性。
• 所有受试者均须同意从签署知情同意书(ICF)起至LB2102输注后1年采取高效避孕措施(持续且正确使用时年失败率<1%)。
• 女性和男性分别须同意在LB2102输注后至少1年内不捐献卵子(卵子/卵母细胞)或精子。

排除标准:

• 既往接受过细胞免疫治疗(如CAR-T)或基因治疗产品。
• 既往接受过DLL3靶向治疗。
• 既往发生过检查点抑制剂相关肺炎。
• 存在具有临床意义的腹水、胸腔积液或腹膜腔积液。
• 已知存在获得性或遗传性免疫缺陷,且无法通过医疗手段控制或恢复正常。
• 已知软脑膜转移。
• 活动性或有症状的脑转移。已治疗的脑转移患者可入组,但须至少在入组前2周完成根治性治疗,且有记录证实病情稳定,并已停用超生理剂量类固醇至少7天;另须满足方案规定的其他条件。
• 筛查前正在接受免疫调节治疗(如环孢素或大剂量全身类固醇)的活动性自身免疫性疾病;相关治疗须停用至少2周或5个半衰期(以较长者为准)。近期或当前使用生理替代剂量类固醇或吸入类固醇者不排除。
• 心功能受损或药物无法控制的具有临床意义的心脏病,包括:白细胞单采前6个月内有不稳定型心绞痛或心肌梗死;既往心肌病且超声心动图或MUGA扫描评估LVEF<45%。
• 既往或同时存在其他恶性肿瘤,方案规定的例外情形除外。
• 研究者判断存在严重和/或未控制的疾病,可能造成不可接受的安全风险、干扰研究操作或结果,或损害方案依从性,例如:活动性且未控制的病毒、细菌或全身性真菌感染;需要补充氧气才能维持血氧饱和度;有痴呆或意识状态改变的临床证据;医学状况未控制,或筛查前6个月内急性事件恢复不充分。
• 已知存在HIV、乙肝和/或丙肝活动性感染者不符合条件,除非满足方案规定的其他要求。HIV感染者须接受有效抗逆转录病毒治疗并稳定控制至少4周,且入组前HIV病毒载量<400 copies/mL。活动性HBV患者须在入组前接受抑制性抗病毒治疗。有既往HBV感染且血清学证据提示感染已缓解者,须评估HBV再激活风险,并在入组前仔细判断是否需要抗HBV预防治疗。未经治疗的HCV感染者若病情稳定、无肝功能失代偿风险,且研究性抗癌治疗预计不会加重HCV感染,可考虑入组。
• 对LB2102辅料(如二甲基亚砜)、氟达拉滨、环磷酰胺或托珠单抗存在禁忌,或有危及生命的过敏、超敏反应或不耐受。
• 既往抗癌治疗导致器官功能毒性尚未恢复至≤1级(脱发除外)。
• 白细胞单采前4周内接受过重大手术,或计划在LB2102给药后4周内接受重大手术。
• 妊娠或哺乳。
• 计划在LB2102输注后1年内怀孕、哺乳或使他人受孕。
• 既往接受过异基因造血干细胞移植(HSCT)或器官移植。
核对登记原文(英文)
Inclusion Criteria:

* Be at least 18 years of age and willing and able to provide a written informed consent
* Have histologically/cytologically confirmed unresectable small cell lung carcinoma (SCLC), large cell neuroendocrine lung carcinoma (LCNEC), combined SCLC, or combined LCNEC as per WHO 2021 criteria
* Subjects who have at least one prior line of standard treatment, and have progressed after or have had an insufficient response, and for whom standard treatment is intolerable, unlikely to confer significant clinical benefit, is no longer effective, or the subject declines further standard treatment
* Have available formalin-fixed, paraffin-embedded tumor specimen in a tissue block or unstained serial slides accompanied by an associated pathology report prior to enrollment. Archival or fresh biopsy tissue is required
* Presence of ≥ 1 radiologically measurable lesion per Response Evaluation Criteria In Solid Tumors (RECIST) Version 1.1
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
* Life expectancy of at least 4 months
* Have adequate organ function
* Women of childbearing potential must have a negative pregnancy test at screening using a highly sensitive serum pregnancy test (β-human chorionic gonadotropin \[β-hCG\])
* All subjects must agree to practice a highly effective method of contraception (failure rate of \<1% per year when used consistently and correctly) from the time of signing the informed consent form (ICF) to 1 year after receiving a LB2102 infusion
* Women and men must agree not to donate eggs (ova, oocytes) or sperm, respectively, until at least 1 year after receiving a LB2102 infusion

Exclusion Criteria:

* Prior treatment with cellular immunotherapy (e.g., CAR-T) or gene therapy product
* Prior treatment with DLL3-targeted therapy
* Prior history of checkpoint inhibitor associated pneumonitis
* Clinically significant ascites, pleural or peritoneal effusions
* Known status of acquired or inherited immunodeficiency without the ability of medical control or normalization.
* Known leptomeningeal metastases
* Active or symptomatic brain metastasis. Subjects with treated brain metastasis are allowed provided definitive therapy was completed at least 2 weeks prior to enrollment with at least documented stable disease and the subject is off supraphysiologic doses of steroid for at least 7 days. Additional requirements are met per protocol.
* Active autoimmune disease receiving immunomodulatory treatments (e.g., cyclosporine or high dose systemic steroids) prior to screening as follows:

  * Within 2 weeks or 5 half-lives, whichever is longer
  * Those with steroid replacement at physiologic doses and inhaled steroids recently or currently are not excluded.
* Impaired cardiac function or clinically significant cardiac disease not controlled by medications including:
* Unstable angina or myocardial infraction within 6 months prior to apheresis.
* History of cardiomyopathy with left ventricular ejection fraction (LVEF)\<45% as assessed by ECHO and MUGA scan.
* Previous or concurrent malignancy, excluding certain exceptions.
* Serious and /or uncontrolled medical condition that, in the Investigator's judgment, would cause unacceptable safety risk, interfere with study procedures or results, or compromise compliance with the protocol, such as:
* Active, uncontrolled, viral bacterial or systemic fungal infections.
* Requirement if supplemental oxygen to maintain oxygen saturation.
* Clinical evidence of dementia or altered mental status.
* Medically uncontrolled condition or insufficient recovery from an acute event within 6 months of screening.
* Subjects with known active infection with HIV, hepatitis B, and/or hepatitis C virus (HBV/HCV) are not eligible unless additional protocol requirements are met.
* subjects with HIV must be controlled on effective antiretroviral therapy for at least four weeks and have HIV viral load of less than 400 copies/mL prior to enrollment.
* subjects with active HBV must be on suppressive antiviral therapy prior to enrollment in the study.
* For subject with history of HBV and with serologic evidence of a resolved prior infection, the risk of HBV reactivation must be considered, and the need for anti-HBV prophylaxis must be carefully assessed prior to enrollment in the study.
* Subjects with untreated HCV infection may be eligible if the HCV is stable, the subject is not at risk for hepatic decompensation and the investigational cancer treatment is not expected to exacerbate the HCV infection.
* Contraindications or life-threatening allergies, hypersensitivity, or intolerance to LB2102 excipients, such as dimethyl sulfoxide; or to fludarabine, cyclophosphamide, or tocilizumab
* Ongoing toxicity of organ functions from previous anticancer therapy that has not resolved to Grade 1 or less, except for alopecia
* Major surgery within 4 weeks prior to apheresis, or planned within 4 weeks after LB2102 administration
* Pregnant or breast-feeding
* Plans to become pregnant or breastfeed, or father a child within 1 year after receiving a LB2102 infusion
* Previous history of allogeneic hematopoietic (HSCT), organ transplant.

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。

研究终点衡量什么算有效

  • 主要终点描述LB2102的安全性和耐受性,并确定扩展推荐剂量(RDE)28天
  • 主要终点进一步描述采用剂量递增阶段确定的RDE时LB2102的安全性和耐受性,并确定II期推荐剂量(RP2D)90天
  • 次要终点评估LB2102的初步疗效
  • 次要终点描述LB2102在血液中的药代动力学
  • 次要终点评估LB2102的免疫原性
核对登记原文(英文)

主要终点:To characterize the safety and tolerability of LB2102 and determine recommended dose for expansion (RDE) · Multiple doses will be tested to establish a recommended dose · 28 days;To further characterize the safety and tolerability of LB2102 with the RDE identified in the dose-escalation and determine the recommended Phase 2 dose (RP2D) · Treatment of additional patients at the recommended dose as identified in the initial dose escalation part of the study · 90 days
次要终点:To evaluate the preliminary efficacy of LB2102;To characterize the pharmacokinetics of LB2102 in blood;To evaluate the immunogenicity of LB2102

研究设计怎么做的

研究类型
干预性研究
入组人数
41 人(预计)
分组方式
不适用(单臂)
  • LB2102试验治疗组试验组

    DLL3靶向嵌合抗原受体T细胞(CAR-T)治疗。

核对分组登记原文(英文)
  • Experimental LB2102 · EXPERIMENTAL · DLL3-Directed Chimeric Antigen Receptor T-cells (CAR T)

关键日期

开始日期
2023-07-26
主要完成日期
2027-12
全部完成日期
2027-12
登记状态核实于
2026-03

联系与责任方

申办方
Legend Biotech USA Inc

登记简述

这是一项I期、首次人体、开放标签、多中心剂量递增及队列扩展研究,评估DLL3靶向嵌合抗原受体T细胞治疗广泛期小细胞肺癌或肺大细胞神经内分泌癌患者。

核对登记原文(英文)

This is a phase 1, first-in-human, open-label, multicenter, dose escalation and expansion study of DLL3-targeted chimeric antigen receptor T-cells in subjects with extensive stage small cell lung cancer or large cell neuroendocrine lung cancer.

登记原文与核验信息

试验登记号
NCT05680922
试验期别
I 期
试验状态
进行中(不再招募)
试验中心
Moffitt Cancer Center · 坦帕 · 美国 | University of Kentucky - Markey Cancer Center · 列克星敦 · 美国 | Dana-Farber Cancer Institute · 波士顿 · 美国 | Memorial Sloan Kettering Cancer Center · 纽约 · 美国
适应症(原文)
Small Cell Lung Cancer Extensive Stage; Large Cell Neuroendocrine Carcinoma of the Lung
干预方式(原文)
LB2102