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:Exploratory Study of MSLN-CAR T Cells Secreting PD1/CTLA-4 Nanoantibody for the Treatment of Advanced Solid Tumors
⚠ 该试验的登记信息已有 32 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。
这是一项早期 I 期注册临床试验,评估 CAR-T 细胞治疗实体瘤的安全性、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 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT06248697。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: • 组织学或细胞学确诊晚期实体瘤,如非小细胞肺癌或间皮瘤;既往标准抗癌治疗失败;签署知情同意当天年龄18–70岁(含),预期生存期≥3个月,ECOG 0–1分。 • 肿瘤组织中>50%细胞MSLN染色阳性且有明确膜表达,PD-L1阳性;筛选所用活检组织采集时间距入组≤3年。按RECIST 1.1有可测量病灶;理解试验并愿意签署知情同意。 • 骨髓功能足以接受淋巴细胞清除化疗:ANC≥1.5×10⁹/L、淋巴细胞≥0.5×10⁹/L、血小板≥90×10⁹/L、血红蛋白≥90 g/L;前7天未输血或依赖促红细胞生成素。总胆红素≤机构ULN的2倍;ALT/AST≤ULN的2.5倍(肝转移时亦为≤2.5倍)。肌酐≤ULN的1.5倍或eGFR≥60 mL/min/1.73m²。INR或PT≤ULN的1.5倍。呼吸困难≤CTCAE 1级且SaO₂≥91%。入组前1个月内超声心动图/MUGA示LVEF≥50%。 • 男女受试者同意研究期间及细胞输注后至少12个月使用获批避孕方法,并持续至连续两次PCR检测确认不再检出CAR-T细胞。 排除标准: • 既往接受MSLN靶向治疗或细胞治疗;既往接受任何基因治疗(包括CAR-T)或国内外任何T细胞治疗。 • 活动性细菌、病毒或真菌感染且抗感染治疗后未控制(输注前≤72小时血液检查阳性)。梅毒、HIV、活动性乙肝(HBsAg阳性)或丙肝(HCV RNA可检出)阳性。 • 自身免疫病或器官移植等需要长期全身激素/其他免疫抑制剂治疗的情况。过去6个月严重心肺疾病,包括药物不能控制的高血压,以及NYHA≥III级心衰、冠脉成形/支架、心肌梗死、不稳定型心绞痛或其他临床显著心脏病。 • 临床相关CNS转移,或癫痫/发作、脑缺血/出血、痴呆、小脑疾病或累及CNS的自身免疫病。研究者认为可能混淆结果、妨碍全程参与或不符合患者最佳利益的神经、精神、免疫、代谢、感染性疾病、治疗或实验室异常。 • 血液系统恶性肿瘤史,或同时存在其他原发实体瘤;宫颈/乳腺原位癌经根治治疗且无病≥3年者,或原位癌成功根治切除且无病≥5年者除外。 • 研究开始前2周内接受化疗、放射性治疗、小分子药物、生物抗癌治疗、免疫治疗或其他研究药物。妊娠或哺乳。研究者判断会妨碍全程参加或不适合入组的其他情况。
Inclusion Criteria: * Patients must have a histological or cytological diagnosis of advanced solid tumors, such as non-small-cell lung cancer and mesothelioma; * Patients must have failed established standard medical anti-cancer therapies; * Greater than or equal to 18 years of age and less than or equal to 70 years of age on day of signing informed consent; * Life expectancy ≥3 months; * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1; * Staining of MSLN must be greater than 50% of the cells in the tumor tissue and with apparent expression in the membrane. PD-L1 expression must be positive. Tissue obtained for the biopsy must be ≤3 year prior to enrollment for screening; * Satisfactory organ and bone marrow function as defined by the following: 1. Adequate bone marrow function in the opinion of the Investigator for lymphocyte-depleting chemotherapy: absolute neutrophil count must be greater than ≥ 1.5×10\^9/L, lymphocyte count must be greater than ≥ 0.5×10\^9/L, platelets must be greater than ≥ 90×10\^9/L, hemoglobin must be greater than ≥ 90g/L without transfusion within 7 days or dependency on EPO; 2. Total bilirubin must be less than or equal to two times (≤2.0x) the institutional normal upper limit; transaminases, serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST), must be less than or equal to 2.5 times (≤2.5x) the institutional normal upper limit (≤2.5x if there is hepatic metastasis); 3. Creatinine must be less than or equal to one and one half times (≤ 1.5x) the institutional normal upper limit or eGFR ≥ 60ml/min/1.73m\^2 \[eGFR=186×(age)-0.203×SCr-1.154(mg/dl),for female the eGFR shoud be timed by 0.742\]; 4. International normalized ratio (INR) or the PT is not greater than one and one half times (≤ 1.5) the upper limit of normal; 5. Lung function: ≤ CTCAE grade 1 dyspnea and SaO2≥ 91%; 6. Cardiac function: cardiac ejection fraction (LVEF) must be greater than fifty percent (≥50%) by echocardiogram or MUGA one month before enrollment. * Subjects must have measureable disease as defined by RECIST 1.1 criteria; * Subjects sufficiently understand the trial and willingly sign the informed consent; * Male and Female subjects agree to use approved contraceptive methods (e.g. birth control pills, barrier device, intrauterine device, abstinence) during the study and for at least 12 months following the last dose of the study cell infusion and until no CAR-T cells can be detected after two consecutive PCR tests. Exclusion Criteria: * Prior therapy with targeted therapy or cell therapy against MSLN; * Prior therapy with any gene therapy (including CAR-T cell therapy) or any T cell therapy home and abroad; * Active bacteria, viral or fungal infection, and not contained after anti-infective therapy (positive results in the blood ≤72 hours before infusion); * Patient is positive for Syphilis, Human Immunodeficiency Virus (HIV) , active Hepatitis B (HBsAg reactive) or Hepatitis C (HCV RNA (qualitative) is detected); * Patient has a medical condition such as autoimmune disease or organ transplantation that requires chronic systemic steroid therapy or requires any other form of immunosuppressive medication; * History of severe cardiac or pulmonary disease, including hypertension that cannot be controlled by medication, and any of the conditions occurred within the past 6 months: congestive heart failure (New York Heart Association functional classification ≥3), cardiac angioplasty and stents, myocardial infarction, unstable angina, or other clinically significant heart disease; * Detectable clinically relevant central nervous system (CNS) metastases and/or pathology such as epilepsy/seizure, brain Ischemia/ hemorrhage, dementia, cerebellar disease, or autoimmune disease affecting central nervous system; * Patient has a history or current evidence of any condition such as neurotic, psychiatric, immune, metabolic and infectious disease, on any 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; * Patient has a known history of a hematologic malignancy, or of another malignant primary solid tumor concurrently, with the exception of : 1. Patients with in situ cervical cancer or breast cancer with no evidence of disease for ≥ 3 years after curative treatments; 2. Patients who underwent successful definitive resection of in situ cancer with no evidence of disease for ≥5 years; * Has had chemotherapy, radioactive, small molecules, biological cancer therapy, immunotherapy or other investigational drugs within 2 weeks prior to the initiation of the study; * Pregnant or breastfeeding women; * Investigators think that patient has 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 and cooperation with the requirements of the trial, uncontrolled medical, psychological, familial, sociological, or geographical conditions, or is not in the best interest of the patient to participate.
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 toxicity(DLT) · Safety · 28 days
次要终点:Maximum tolerated dose (MTD);Objective response rate (ORR);Progression-free survival (PFS);Peak Plasma Concentration (Cmax);AUC;Pharmacodynamics (PD)
αPD1/CTLA4-MSLN-CAR T细胞。
本单组、开放标签剂量递增研究,评估自体间皮素(MSLN)靶向嵌合抗原受体T细胞(CAR-T)在患者体内分泌PD-1及CTLA-4纳米抗体(αPD1/CTLA-4-MSLN-CAR T细胞)治疗实体瘤的安全性和耐受性。
This is a single arm, open-label, dose escalation clinical study to evaluate the safety and tolerability of autologous mesothelin (MSLN)-targeted chimeric antigen receptor (MSLN-CAR) T cells secreting PD-1 and CTLA-4 nanobodies (αPD1/CTLA-4-MSLN-CAR T cells) in patients with solid tumors.
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