为肝细胞癌武装 GPC3 CAR T 细胞:多少才足够,下一步是什么?
Armouring GPC3 CAR T cells for hepatocellular carcinoma: how much is enough and what comes next?
英文原题:Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Advanced Liver Cancer
⚠ 该试验的登记信息已有 13 个月未更新, 页面上显示的「招募中」可能已经失效。联系研究中心之前,建议先到 ClinicalTrials.gov 核对登记原文的最新状态与联系方式。
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)治疗肝癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 16 例。试验地点:中国 · 武汉(共 1 个中心,其中中国 1 个)。登记号:NCT06084299。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
入选标准 • 受试者已在研究前获知试验信息,并自愿签署书面知情同意书。 • 年龄18至70岁。 • 组织学确诊晚期肝癌。 • ECOG体能状态0至1。 • PET-CT、CT、MRI和/或术中探查证实转移灶>3处,且至少有一处可获取肿瘤浸润淋巴细胞(TIL)的转移灶。 • 除上述病灶外,至少另有一个符合RECIST 1.1标准的可测量肿瘤病灶。 • 至少接受过两线标准治疗后疾病进展,且无有效治疗选择。 • 骨髓及重要器官功能充分:中性粒细胞绝对计数≥1×10^9/L,白细胞≥3×10^9/L,血小板≥75×10^9/L,血红蛋白≥80 g/L;AST、ALT≤ULN的2倍;血清肌酐≤1.5×ULN;血清总胆红素≤1.5×ULN。 • 有生育能力女性在细胞回输前7天内尿或血清HCG妊娠试验阴性。 • 提供至少1 g新鲜肿瘤组织及10 mL外周血,用于全外显子组测序及TIL分离培养。 • 预期生存期≥3个月。 • 细胞回输前7天内Child-Pugh肝功能为A级。 排除标准 • 既往或同时患有其他活动性肿瘤;已治愈且5年内未复发的原位癌,或经充分治疗可治愈者除外。 • 中枢神经系统或脑转移。 • 既往接受器官移植。 • 首次给药前4周内接受重大肝脏手术(肝转移活检除外)。 • 首次给药前4周内接受肝脏或其他部位局部治疗,包括经导管肝动脉化疗栓塞(TACE)、经导管动脉栓塞(TAE)、肝动脉灌注(HAI)、放疗、放射栓塞或消融。索拉非尼或含奥沙利铂方案末次给药至首次研究给药期间如接受上述治疗,也不符合入组条件。 • CT血管造影显示严重动脉栓塞或肝动脉血管变异。 • APTT或PT≥5×ULN(原登记写作“5 UNL”),或过去2个月内有出血证据,或临床研究前有任何严重程度的出血史。 • 接受全身抗生素治疗后7天内仍有活动性炎症。 • 入组前4周内接受剖腹、开胸、腹腔镜器官切除等重大手术,或发生严重创伤。 • 活动性冠状动脉疾病、严重或不稳定型心绞痛,或临床研究前12个月内新诊断心绞痛或心肌梗死。 • 临床研究前12个月内发生血栓或栓塞事件,如脑血管意外(包括短暂性脑缺血发作)或肺栓塞。 • NYHA心衰分级≥II级。 • HIV感染或已知获得性免疫缺陷综合征(AIDS);未治疗的活动性肝炎(乙肝定义为HBV DNA≥500 IU/mL;丙肝定义为HCV RNA高于检测方法检出限);或乙肝、丙肝合并感染。 • 活动性、已知或疑似自身免疫病。病情稳定且无需全身免疫抑制治疗者可入组,例如1型糖尿病、仅需激素替代治疗的甲状腺功能减退,以及无需全身治疗的皮肤病(如白癜风、银屑病和脱发)。 • 任何间质性肺病、非感染性肺部炎症,或未控制的全身性疾病(如糖尿病、肺纤维化或急性肺炎)。 • 既往治疗引起的CTCAE v5.0≥2级不良事件;贫血、脱发和皮肤色素沉着除外。 • 妊娠或哺乳,或首次注射前妊娠试验阳性。 • 研究者认为存在不适合参加本研究的临床/实验室异常或依从性问题。 • 严重心理或精神异常。 • 本研究开始前4周内参加其他临床试验。 • 对环磷酰胺或氟达拉滨有超敏反应史。 • 研究者认为不适合入组的其他情况。
Inclusion Criteria: * The subjects must be informed of the study before the test and voluntarily sign a written informed consent. * Age of the patients was between 18\~70 years * Eligible patients have histologically proven advanced liver cancer * Eastern Cooperative Oncology Group (ECOG) performance status was 0-1 * Metastatic lesions are confirmed by PET-CT, CT, MR and/or intraoperative exploration (more than 3, at least one accessible metastasis to procure for TILs) * Patients have at least one separate additional measurable tumour lesion according to RECIST version 1.1 standard. * The disease has progressed after at least two previous lines of standard treatment and there is no effective treatment option available * Adequate normal organ and marrow function were present, including absolute neutrophil count ≥ 1×10\^9/L, leukocyte count ≥ 3×10\^9/L, platelet count ≥ 75×10\^9/L, hemoglobin ≥ 80 g/L, AST and ALT ≤ 2× of upper limit of normal, Serum creatinine ≤ 1.5× upper normal limits, Serum total bilirubin ≤ 1.5× upper normal limits * Female subjects of childbearing age must have a negative urine or serum HCG test within 7 days before cell reinfusion * Provide at least one gram of fresh tumor tissue and 10ml of peripheral blood for whole exome sequencing and TIL isolation and culture. * Expected survival was at least 3 months * Child-Push liver function score grade is A within seven days before the cell reinfusion. Exclusion Criteria: * With previous or concurrent other active cancer (except carcinoma in situ that has been cured without onset within 5 years, or those that can be cured by adequate treatment) * Patients with metastasis to Central Nervous System or brain * Have received organ transplantation in the past * Received major liver surgery within 4 weeks before the first administration (except liver metastases biopsy). * Received local treatment of the liver or other parts within 4 weeks before the first administration (transcatheter arterial chemoembolization \[TACE\], transcatheter arterial embolization \[TAE\], hepatic artery infusion \[HAI\], radiotherapy, radioembolization or ablation). Subjects are not eligible to participate in the study if the above-mentioned treatment is carried out between the last dose of sorafenib or oxaliplatin-containing regimen and the first study administration. * After CT angiography examination, there is severe arterial embolism or hepatic artery vascular variation. * APTT or PT \>= 5 UNL, or with bleeding evidence in two months or bleeding history in prior to the clinical study, no matter how serious it is * Active inflammation within 7 days after systemic antibiotics treatment * Subjects who have undergone major surgery or severe trauma such as laparotomy, thoracotomy, and laparoscopic organ removal within 4 weeks before enrollment. * Active coronary artery disease, serious or unstable angina pectoris, or newly diagnosed angina pectoris or myocardial infarction within 12 months prior to the clinical study * Thrombosis or embolism event within 12 months prior to the clinical study, such as cerebrovascular accident ( including TIA) or pulmonary embolism * Congestive heart failure of NYHA \>= Class II * Human immunodeficiency virus (HIV) infection or known acquired immunodeficiency syndrome (AIDS), untreated active hepatitis (hepatitis B, defined as HBV-DNA ≥ 500 IU/ml C Hepatitis, defined as HCV-RNA higher than the detection limit of the analytical method) or co-infection with hepatitis B and hepatitis C. * Presence of any active, known or suspected autoimmune disease. Subjects in a stable state who do not require systemic immunosuppressive therapy are allowed, such as: type 1 diabetes mellitus, hypothyroidism requiring only hormone replacement therapy, and skin diseases that do not require systemic therapy (e.g., vitiligo, psoriasis disease and hair loss). * Any interstitial lung disease, noninfectious causes of lung inflammation, or uncontrolled systemic disease (e.g. diabetes, pulmonary fibrosis, or acute pneumonia) * Any adverse event of CTCAE (Ver 5.0) grade 2 or higher induced by previous treatment, except anemia, hair loss, and skin pigmentation * Pregnant or lactating women or those who are positive in pregnancy test before 1st injection * The investigator believes that the subject has any clinical or laboratory abnormalities or compliance problems and is not suitable for participating in this clinical study. * With serious psychological or mental abnormalities * Joined other clinical trials in four weeks prior to this study * Patients who have a history of hypersensitivity to cyclophosphamide and fludarabine. * Other researchers think that they are not suitable for enrollment.
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:Types and incidence of Dose-limiting toxicity (DLT) [Safety and Tolerability] · Dose-limiting toxicity (DLT) will be collected and graded according to CTCAE v5.0 · 1 month;Types and incidence of adverse events (AEs) ,serious adverse events (SAEs) [Safety and Tolerability] · AE will be collected and graded according to CTCAE v5.0 · Up to 24 months;Maximum tolerated dose [Safety and Tolerability] · Evaluate the maximum tolerated dose of TILs in patients with advanced liver cancer · 1 month
次要终点:Progression-free Survival (PFS);Disease Control Rate (DCR);Objective response rate (ORR);Overall Survival (OS)
经非清髓性(NMA)淋巴清除预处理后,回输患者自体肿瘤浸润淋巴细胞(TIL),随后给予白细胞介素-2(IL-2)。
这是一项单臂、开放标签干预性研究,评估晚期肝癌患者接受自体肿瘤浸润淋巴细胞(TIL)输注及后续IL-2治疗的效果。治疗前采用非清髓性淋巴清除预处理方案。
Single-arm, open-label, interventional study evaluating adoptive cell therapy (ACT) with autologous tumor-infiltrating lymphocytes (TIL) infusion followed by IL-2 after a non-myeloablative(NMA) lymphodepletion preparative regimen for the treatment of patients with advanced liver cancer.
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