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:Locoregional Administration of TIL and Lymphodepletion in Patients With Melanoma and Liver Metastases
这是一项 I 期注册临床试验,评估自体TIL(肿瘤浸润淋巴细胞)治疗黑色素瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 6 例。登记号:NCT05903937。
不限性别 · ≥ 18 Years
纳入标准: • 愿意并能够提供书面知情同意,且遵守研究程序;在开始任何方案特定程序前须签署并注明知情同意日期。 • 组织学/细胞学确诊以下任一种: • IV期葡萄膜黑色素瘤,既往是否接受过全身治疗均可;或 • IV期皮肤黑色素瘤,至少接受过一种既往全身治疗(包括程序性细胞死亡蛋白1〔PD-1〕抑制剂,可联合或不联合CTLA-4抑制剂)后疾病进展;如有BRAF V600突变,还须接受过BRAF抑制剂或BRAF抑制剂联合MEK抑制剂治疗。 • CT按RECIST 1.1显示可测量疾病,至少有一个肝脏靶病灶,且研究者判断转移主要累及肝脏。 • 肝脏至少有一个可切除病灶(或病灶合计),切除后直径至少0.5 cm,可用于生成TIL。 • ECOG体能状态评分0至1。 排除标准: • 预期生存期<3个月。 • 肾功能下降:血清肌酐≥正常值上限(ULN)的1.5倍,或按Cockcroft-Gault公式计算的肌酐清除率<40 mL/min。 • 肝功能下降(ASAT、ALAT或胆红素>ULN的3倍,或凝血酶原时间国际标准化比值>1.5),或有肝硬化/门静脉高压病史。 • 血红蛋白<90 g/L、血小板<100×10^9/L或中性粒细胞<1.5×10^9/L。 • 研究开始前或开始后4周内使用活疫苗。 • HIV/AIDS、乙型肝炎或丙型肝炎感染。 • 活动性自身免疫性疾病。 • 研究药物给药前14天内需全身性皮质类固醇(泼尼松等效剂量>10 mg/日)或其他免疫抑制药物治疗。无活动性自身免疫性疾病者可使用吸入或局部类固醇及肾上腺替代剂量。 • 同时接受其他抗癌治疗、患有需使用免疫抑制药物的合并疾病,或使用其他试验药物。 • 已知存在其他正在进展或需要积极治疗的恶性肿瘤。 • 研究者认为可能混淆结果、妨碍患者完成全程研究,或不符合患者最佳利益的任何病史、当前状况、治疗或实验室异常。
Inclusion Criteria: * Patient is willing and able to provide written informed consent and comply with study procedures. Written informed consent must be signed and dated before the start of specific protocol procedures. * Patient must have a histologically/cytologically confirmed diagnosis of: * stage IV uveal melanoma with or without any previous systemic therapy OR * stage IV cutaneous melanoma with confirmed progression following at least one or two prior systemic therapies including a programmed cell death protein-1 (PD-1) inhibitor with or without a CTLA-4 inhibitor; and if BRAF V600 mutation-positive, also a BRAF inhibitor or a BRAF inhibitor in combination with a MEK inhibitor. * Measurable disease by computed tomography (CT) per RECIST 1.1 criteria with at least one target lesion identified in the liver and where the distribution pattern of metastasis is predominantly engaging the liver as judged by the investigator. * At least one resectable lesion in the liver (or aggregate of lesions resected) of a minimum size of 0.5 cm in diameter post- resection to generate TILs. * ECOG performance status of 0 - 1. Exclusion Criteria: * Life expectancy of less than 3 months. * Reduced renal function defined as S-Creatinine \>=1.5xULN or Creatinine Clearance \< 40 mL/min, calculated using the Cockroft and Gault formula. * Reduced hepatic function (defined as ASAT, ALAT, bilirubin \> 3\*ULN and PK- INR \> 1.5) or medical history of liver cirrhosis or portal hypertension. * Hemoglobin \<90 g/L or platelets \<100x109/L or neutrophils \<1.5x109/L * Use of live vaccines four weeks before or after the start of study. * Infection of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), hepatitis B or hepatitis C. * Active autoimmune disease. * A condition requiring systemic treatment with either corticosteroids (\>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses \>10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease. * Concomitant therapy with any other anti- cancer therapy, concurrent medical conditions requiring use of immunosuppressive medications or use of other investigational drugs. * Has a known additional malignancy of other diagnosis that is progressing or requires active treatment. * A history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate, in the opinion of the treating Investigator
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 and severity of adverse events · Graded according to Common Terminology Criteria for Adverse Events version 5.0 · 5 years
次要终点:Objective response rate;Progression-free survival;hepatic Progression-free survival;Duration of response;Overall survival;Evaluation of Tolerability
本研究评估自体肿瘤浸润淋巴细胞(TIL)经肝动脉输注,并采用经皮肝灌注进行预处理,用于肝转移(不限于此)恶性黑色素瘤患者的安全性和耐受性。
Evaluate the safety and tolerability of treatment with autologous tumor infiltrating lymphocytes (TIL) administered via hepatic arterial infusion and preconditioning with percutaneous hepatic perfusion in patients with liver metastases (but not restricted to) of malignant melanoma
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