γδ T 细胞调节小细胞肺癌中的抗肿瘤免疫
γδ T cells modulate anti-tumor immunity in small cell lung cancer.
我们的发现表明,活化的γδ T细胞可能是SCLC治疗的有价值靶点。
英文原题:A Phase Ib Study of GC101 in NSCLC
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)治疗非小细胞肺癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 20 例。试验地点:中国 · 上海(共 1 个中心,其中中国 1 个)。登记号:NCT06473961。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: * 1. 已签署知情同意书(ICF),且能够遵守方案规定的访视及相关程序; * 2. 年龄≥18岁且≤70岁,性别不限; * 3. 驱动基因阳性的不可切除的晚期、复发或转移性非小细胞肺癌患者,且经靶向及含铂双药化疗治疗失败; * 4. 可从手术可切除的肿瘤区域分离出TILs:组织体积必须>150mm3,且病灶未接受过局部治疗(如放疗、射频消融、溶瘤病毒等)或局部治疗后进展; * 5. 即使在TIL采样并切除手术可切除组织后,仍至少有1个可测量病灶(根据RECIST1.1标准[见附录4]); * 6. ECOG体能状态评分0-1; * 7. 预期生存时间>3个月; * 8. 具有以下实验室检查结果所定义的足够的血液学和终末器官功能,检查结果必须在肿瘤组织采集前7天内完成并出具: * 白细胞(WBC)≥2.5×10^9/L# * 中性粒细胞绝对计数(ANC)≥1.5×10^9/L; * 淋巴细胞绝对计数(ALC)≥0.7×10^9/L; * 血小板≥100×10^9/L# * 国际标准化比值#INR#≤1.5×ULN; * 活化部分凝血活酶时间#APTT#≤1.5×ULN; * 血清肌酐(Scr)≤1.5mg/dL(或132.6μmol/L)或肌酐 * 清除率≥60mL/min * 尿液分析:尿蛋白低于2+,或24小时尿蛋白<1g; * 丙氨酸氨基转移酶(AST/SGOT)≤3×ULN; * 丙氨酸氨基转移酶(ALT/SGPT)≤3×ULN; * 总胆红素(TBIL)≤1.5×ULN# * 9. * 未接受过绝育手术的绝经前女性必须同意从研究治疗(预处理)开始至细胞输注后一年内采取有效的避孕措施,且筛选期的血清妊娠试验必须为阴性;*未接受过绝育手术的男性必须同意从研究治疗(预处理)开始至细胞输注后一年内采取有效的避孕措施; * 10. 无手术的绝对或相对禁忌证; * 11. 任何黑色素瘤治疗方法,包括放疗、化疗、内分泌治疗、靶向治疗、免疫治疗、肿瘤栓塞或具有抗肿瘤适应症的中药/草药治疗,必须在输注前28天停止。如果既往治疗中使用了小分子靶向药物,洗脱时间可缩短至所用药物的5个半衰期; * 12. 依从性良好,能够坚持研究访视计划及其他协议要求。 排除标准: * 1. 筛选期前3年内已使用超过5线系统性治疗。 * 2. 在输注前28天内参加了另一项药物或生物疗法的临床试验,或接受了类似的细胞治疗; * 3. 合并2种或以上恶性肿瘤,但以下情况除外:在研究入组前已根治且无活动性≥5年且复发风险极低的恶性肿瘤;充分治疗的非黑色素瘤皮肤癌或恶性雀斑样痣且无疾病复发证据;充分治疗的原位癌且无疾病复发证据; * 4. 签署知情同意后接受过减毒活疫苗接种,或计划在研究期间接受此类疫苗; * 5. 既往手术或治疗相关不良反应未恢复至≤1级NCI CTCAE 5.0(脱发等经研究者判断无安全风险的毒性除外); * 6. 已知对链霉素、环丙沙星或米卡芬净过敏,或对输注产品制剂的任何成分过敏; * 7. 未控制的合并症,包括但不限于:即使经过标准化治疗仍无法控制的高血压(收缩压≥160 mmHg和/或舒张压≥100 mmHg),或入组前6个月内的任何不稳定心血管疾病,包括短暂性脑缺血发作、脑血管意外、心肌梗死、不稳定型心绞痛;纽约心脏协会(NYHA)III级或IV级充血性心力衰竭伴射血分数<50%;或需要临床干预的严重心律失常或传导异常,如室性心律失常、II-III度房室传导阻滞等;ECG结果显示具有临床意义的异常或QTcF≥450ms(若首次检测异常,可至少间隔5分钟复测两次,以综合结果/平均值判定合格性); * 8. 需要立即干预(如套扎或硬化治疗)的食管或胃静脉曲张患者,或根据研究者意见或经消化科或肝病科会诊认为出血风险高、有门静脉高压证据(包括影像学检查发现的脾肿大)、或既往有静脉曲张出血史的患者,必须在入组前3个月内接受过内镜评估; * 9. 未控制的代谢紊乱,如已知未控制的糖尿病,或其他非恶性器官或全身性疾病或癌症继发反应,且可能导致更高的医疗风险和/或生存评估的不确定性; * 10. 肝性脑病、肝肾综合征或Child-Pugh B级或更严重的肝硬化、肝衰竭; * 11. 合并其他严重器质性或精神性疾病; * 12. 存在需要治疗的活动性全身感染,血培养阳性或影像学有感染证据,包括但不限于活动性结核; * 13. 为HIV阳性,梅毒血清学检测阳性,或患有临床活动性甲型、乙型或丙型肝炎,包括病毒携带者:乙型肝炎,不包括HBsAg阳性者;丙型肝炎,不包括HCVAb阳性者; * 14. 筛选期间仍需要全身性类固醇激素或其他免疫抑制药物的活动性自身免疫性疾病(泼尼松大于10 mg/天或其他激素的等效剂量); * 15. 既往任何免疫治疗期间出现任何nci ctcae5.0免疫相关不良效应(irae)≥3级; * 16. 器官同种移植、异基因干细胞移植和肾脏替代治疗史;异基因t细胞和nk细胞治疗史; * 17. 肺纤维化、间质性肺病(既往史和现病史)、急性肺病;肺功能FEV1(第1秒用力呼气容积)≤70%的阻塞性或限制性肺病患者; * 18. 临床无法控制的第三间隙积液,如入组前无法通过引流或其他方式控制的胸膜腔和腹腔积液; * 19. 有临床中枢神经系统转移症状的患者(如脑水肿、需要激素干预或脑转移进展)。既往接受过脑转移治疗,如临床稳定(mri)已维持至少2个月,且已停用全身激素治疗(剂量>10 mg/天泼尼松或其他等效激素)>4周的患者可纳入; * 20. 妊娠或哺乳期女性; * 21. 研究者认为其他情况不适合入组。
Inclusion Criteria: * 1\. Signed the informed consent form (ICF) and able to comply with the visits and related procedures specified in the protocol; * 2\. Aged ≥18 years and ≤70 years, regardless of gender; * 3\. Patients with unresectable advanced, recurrent, or metastatic non-small cell lung cancer who are positive for driver genes and have failed after targeted and platinum-containing dual chemotherapy; * 4\. TILs can be isolated from a surgically resectable tumor region: the tissue volume must be \>150mm3, and the lesion has not received local treatment (such as radiotherapy, radiofrequency ablation, oncolytic virus, etc.) or progressed after local treatment; * 5\. There are still at least 1 measurable lesion (according to RECIST1.1 criteria \[see Appendix 4\]) even after TIL sampling and resection of surgically resectable tissue; * 6\. ECOG performance status 0-1; * 7\. Expected survival time \>3 months; * 8\. With sufficient hematology and end-organ function as defined by the following laboratory test results, the test results must be completed and issued within 7 days before tumor tissue collection: * White Blood Cell (WBC)≥2.5×10\^9/L# * Absolute Lymphocyte Count (ANC)≥1.5×10\^9/L; * Absolute Lymphocyte Count(ALC)≥0.7×10\^9/L; * Platelet≥100×10\^9/L# * International Normalized Ratio#INR#≤1.5×ULN; * Activated Partial Thromboplastin Time#APTT#≤1.5×ULN; * Serum Creatinine (Scr)≤1.5mg/dL (or 132.6μmol/L) or Creatinine * Clearance≥60mL/min * Urinalysis: urine protein less than 2+, or 24-hour urine protein \<1g; * Alanine aminotransferase(AST/SGOT) ≤3×ULN; * Alanine aminotransferase (ALT/SGPT) ≤3×ULN; * Total Bilirubin(TBIL)≤1.5×ULN# * 9\. \* Premenopausal women who have not undergone sterilization surgery must agree to use effective contraception measures from the start of study treatment (preconditioning) to one year after cell infusion, and the serum pregnancy test during the screening period must be negative; \*Men who have not undergone sterilization surgery must agree to use effective contraception measures from the start of study treatment (preconditioning) until one year after cell infusion; * 10\. No absolute or relative contraindications for surgery; * 11\. Any melanoma treatment methods, including radiotherapy, chemotherapy, endocrine therapy, targeted therapy, immunotherapy, tumor embolization, or traditional Chinese medicine/herbal medicine treatment with anti-tumor indications, must be stopped 28 days before infusion. If a small molecular targeted drug was used in the previous treatment, the withdrawal time can be shortened to 5 half-lives of the drug used; * 12\. Good compliance and able to adhere to the study visit plan and other agreement requirements. Exclusion Criteria: * 1\. More than 5-line system therapy had been used in previous 3 years before screening period. * 2\. Participation in a clinical trial of another drug or biologic therapy or receipt of a comparable cellular therapy within 28 days prior to infusion; * 3\. Combination of 2 or more malignant tumors, except: Eradicated malignant tumors that have been inactive for ≥5 years prior to study entry and are at minimal risk of recurrence; adequately treated non-melanoma skin cancer or malignant nevus of freckle-like nevus without evidence of disease recurrence; adequately treated carcinoma in situ without evidence of disease recurrence; * 4\. Has received live attenuated vaccination after signing informed consent or is scheduled to receive it during the study; * 5\. Has not recovered from a prior procedure or treatment-related adverse reaction to ≤ grade 1 nci ctcae 5.0 (except for toxicities such as alopecia, etc., which in the judgment of the investigator pose no safety risk); * 6\. Known history of allergy to streptomycin, ciprofloxacin, or micafungin or allergy to any component of the infused product formulation; * 7\. Uncontrolled co-morbidities including, but not limited to, uncontrolled arterial hypertension (systolic blood pressure ≥160 mmhg and/or diastolic blood pressure ≥100 mmhg) even with standardized treatment or any unstable cardiovascular disease including transient ischemic attack, cerebrovascular accident, myocardial infarction, unstable angina pectoris within 6 months prior to enrollment; new york heart association ( nyha class iii or iv congestive heart failure with an ejection fraction \<50%; or severe cardiac rhythm or conduction abnormalities, such as ventricular arrhythmias, degree ii-iii atrioventricular block, etc., requiring clinical intervention; ecg results showing clinically significant abnormalities or a qtcf ≥450ms (if the first test is abnormal, it may be retested at least 5 minutes apart twice and the combined result/mean value to determine eligibility) ; * 8\. Patients with esophageal or gastric varices that require immediate intervention (e.g., taping or sclerotherapy) or are considered to be at high risk for bleeding based on the opinion of the investigator or consultation with a gastroenterologist or hepatologist, have evidence of portal hypertension (including splenomegaly detected on imaging), or have a prior history of variceal bleeding must have undergone endoscopic evaluation within 3 months prior to enrollment; * 9\. Uncontrolled metabolic disorders, such as diabetes mellitus known to be uncontrolled, or other non-malignant organ or systemic diseases or secondary reactions to cancer, and which can lead to higher medical risk and/or uncertainty in survival evaluation; * 10\. Hepatic encephalopathy, hepatorenal syndrome or child-pugh class b or more severe cirrhosis, liver failure; * 11\. Comorbidity with other serious organic or psychiatric disease; * 12\. Have an active systemic infection requiring treatment with positive blood cultures or imaging evidence of infection, including but not limited to active tuberculosis; * 13\. Be hiv-positive, have a positive serologic test for syphilis, or have clinically active hepatitis a, b, or c, including viral carriers: Hepatitis b, excluding those who are HBsAg-positive; hepatitis c, excluding those who are HCVAb-positive; * 14\. Active autoimmune diseases that still require systemic steroid hormones or other immunosuppressive drugs during the screening period (greater than 10 mg/ day of prednisone or equivalent doses of other hormones); * 15\. Any nci ctcae5.0 immune-related adverse effect (irae) grade ≥ 3 during any prior period of immunotherapy receipt; * 16\. History of organ allograft, allogeneic stem cell transplantation and renal replacement therapy; History of allogeneic t-cell and nk-cell therapy; * 17\. Pulmonary fibrosis, interstitial lung disease (both past history and current), and acute lung disease; Patients with obstructive or restrictive lung disease with FEV1(forced expiratory volume in 1 second) of lung function ≤70%; * 18\. Clinically uncontrollable third space effusions, such as pleural and abdominal effusions that cannot be controlled by drainage or other means prior to enrollment; * 19\. Patients with clinically symptomatic central nervous system metastases (e.g., cerebral edema, need for hormonal intervention, or progression of brain metastases). Patients with prior treatment for brain metastases, such as clinical stability (mri) that has been maintained for at least 2 months and who have discontinued systemic hormone therapy (dose \>10 mg/day prednisone or other equipotent hormone) for \>4 weeks may be included; * 20\. Women who are pregnant or breastfeeding; * 21\. If the investigator believes that other circumstances 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:Adverse Events · Incidence of adverse events associated with GC101 TIL retransfusion · Up to Day 28;Objective Response Rate · Proportion of subjects in total cases in complete or partial response (RECIST v1.1 criteria) · 18 weeks
次要终点:Adverse Events;Objective Response Rate;Best overall response;Disease Control Rate;Progression-Free Survival;Duration of Response;overall survival
使用冷冻保存的GC101 TIL的晚期NSCLC受试者
预计将入组20名受试者参加Ib期临床试验,该试验预计在36个月内完成。
20 participants are expected to be enrolled for the Phase Ib clinical trial,this trail is expected to be finished in 36 months.
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