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细胞治疗用于软组织肉瘤:I 期临床试验(M.D. Anderson)

英文原题:T Cell Membrane-Anchored Tumor-Targeted IL12 -Modified TIL Cell Therapy (attIL12-TIL) for Advanced/Metastatic Soft Tissue and Bone Sarcoma Patients.

ClinicalTrials.gov 2024/06/26(首次登记) I 期注册临床试验 · 招募中

简要介绍

这是一项 I 期注册临床试验,评估细胞治疗用于软组织肉瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 40 例。试验地点:美国 · 休斯顿(共 1 个中心)。登记号:NCT06474676。

入组条件决定能不能参加

不限性别 · ≥ 12 Years

纳入标准:

1. 年龄≥12岁。
2. 经组织学确诊为局部晚期或转移性软组织肉瘤或骨肉瘤,并计划按标准医疗程序接受切除或活检。
3. 脂肪肉瘤扩展队列:经组织学确诊为不可切除、复发/转移性脂肪肉瘤,并计划按标准医疗程序接受切除或活检。
4. 接受切除手术的受试者须另有可测量病灶,或经研究者评估认为12个月内复发风险高,并事先获得主要研究者(PI)批准。
5. 在输注attIL12-TIL前,须有符合RECIST 1.1标准的可测量疾病。若唯一可测量病灶即为本研究活检病灶,其最大径须至少为2 cm。
6. 受试者须既往至少接受过1线肉瘤全身治疗;特定肉瘤亚型没有标准治疗方案者除外。
7. 肿瘤组织采集前,末次细胞毒性化疗或免疫治疗须已结束至少3周。靶向治疗须在肿瘤组织采集前停药至少4个半衰期或3周(以较短者为准)。采集肿瘤组织后、开始环磷酰胺前,允许接受标准抗癌治疗作为桥接治疗;但开始环磷酰胺前,末次细胞毒性化疗或免疫治疗须至少间隔3周,靶向治疗须至少间隔4个半衰期或3周(以较短者为准)。不允许接受研究性抗癌治疗。
8. 除指定用于组织采集的肿瘤部位外,其他肿瘤部位接受姑息性放疗后须至少间隔2周。
9. 受试者须有以下器官和骨髓功能:

   * 中性粒细胞绝对计数(ANC)>1 K/µL;血红蛋白>9 g/dL;血小板>100 K/mm³;
   * 血清肌酐≤2 mg/dL,或肌酐清除率>50 mL/min;
   * 天冬氨酸氨基转移酶(AST)≤正常值上限(ULN)的1.5倍;丙氨酸氨基转移酶(ALT)≤ULN的1.5倍;胆红素≤ULN的1.5倍。

10. 有生育能力的女性(WOCBP)须同意采取一种高效避孕方法或两种公认的有效避孕方法,以尽量降低研究期间妊娠风险。建议至少在治疗前1个月开始采取预防措施,并在研究期间持续使用,直至T细胞输注后3个月。WOCBP指已初潮、未接受成功手术绝育(子宫切除术、双侧输卵管结扎术或双侧卵巢切除术)且未绝经的女性。
11. 若男性受试者的性伴侣为WOCBP,须愿意且能够在给药期间及研究药物(T细胞输注)给药结束后至少3个月内采用可接受的避孕方法,如乳胶避孕套。
12. 已签署知情同意书;如适用,儿童受试者还须签署知情同意表示书。

排除标准:

1. 已知对环磷酰胺和/或研究药物敏感。
2. 过去2年内患有活动性或有记录的自身免疫性疾病(包括炎症性肠病、乳糜泻、韦格纳肉芽肿)。儿童期特应性疾病或哮喘、白癜风、脱发、桥本甲状腺炎、Graves病,或过去2年内不需要全身治疗的银屑病患者不排除。
3. 未治疗的中枢神经系统转移、软脑膜疾病或脊髓压迫。既往接受治疗的CNS转移患者若影像学和神经系统状况稳定至少6周,且attIL12-TIL细胞首次给药前至少14天未因症状控制而使用任何剂量的糖皮质激素,则可入组。
4. 肿瘤组织采集或attIL12 TIL细胞输注时,正在接受任何用于癌症治疗的化疗、免疫治疗、生物治疗或激素治疗;曾对用于attIL12 TIL制备的肿瘤采集部位进行放疗;或过去2周内对任何肿瘤部位进行姑息性放疗。允许在采集肿瘤组织后、开始环磷酰胺前接受标准抗癌治疗作为桥接治疗(见方案5.5节)。因非癌症原因合并使用激素(如糖尿病患者使用胰岛素或接受激素替代治疗)可以接受。
5. 既往抗癌治疗毒性尚未消退至美国国家癌症研究所不良事件通用术语标准(NCI CTCAE)5版0级或1级;脱发及纳入标准中列出的实验室指标除外。经与PI讨论后,预计不会因任何研究性产品而加重的不可逆毒性(如听力损失)可允许入组。
6. 有原发性免疫缺陷、实体器官移植史或既往临床诊断的结核病史。
7. 研究性产品首次给药前28天内接种过减毒活疫苗。
8. 治疗首次给药前4周内接受过重大手术(由研究者界定)。按研究方案进行的活检允许。
9. 存在未控制的并发疾病,包括但不限于持续或活动性感染、未愈合伤口、有症状的充血性心力衰竭、未控制的高血压、不稳定型心绞痛、心律失常、活动性消化性溃疡或胃炎,或会妨碍遵循研究要求、显著增加研究药物相关不良事件风险或影响受试者提供书面知情同意能力的精神疾病/社会处境。认知障碍者(包括唐氏综合征或类似状况的成人)并非一概排除,前提是由父母或法定监护人适当签署书面知情同意,且受试者能够配合研究方案要求及治疗。
10. 合并活动性第二种恶性肿瘤。
11. 妊娠或哺乳期女性。
12. 乙型或丙型肝炎病毒检测阳性,提示急性或慢性感染。
13. 已知HIV检测阳性史或已知患有获得性免疫缺陷综合征(AIDS)。
核对登记原文(英文)
Inclusion Criteria:

1. Age ≥ 12 years old
2. Histologically-confirmed locally advanced or metastatic soft tissue or bone sarcoma scheduled to undergo resection or biopsy as part of standard of care
3. Liposarcoma expansion cohort: histologically confirmed unresectable recurrent/metastatic liposarcoma scheduled to undergo resection or biopsy as part of standard of care
4. Participants undergoing resection should have other measurable disease or be high risk for recurrence within 12 month per investigator assessment and has prior approval by PI.
5. Measurable disease according to RECIST 1.1 present prior to infusion of attIL12-TIL. If the only measurable disease is the same as the lesion biopsied for the study, it needs to be at least 2 cm in largest diameter.
6. Participants must have received at least 1 prior line of systemic therapy for the treatment of sarcoma, unless no standard therapy exists for a specific sarcoma subtype.
7. At least 3 weeks must have elapsed since the last cytotoxic chemotherapy or immunotherapy prior to tumor tissue collection. For targeted therapies, at least 4 half-lives or 3 weeks must have elapsed prior to tumor tissue collection (whichever is shorter). Standard of care anti- cancer therapy will be permitted following tumor tissue collection but prior to initiation of cyclophosphamide such that at least 3 weeks must have elapsed since last cytotoxic chemotherapy or immunotherapy prior to starting treatment with cyclophosphamide. For targeted therapies, at least 4 half-lives or 3 weeks must have elapsed prior to initiation of treatment with cyclophosphamide (whichever is shorter). Investigational anti-cancer therapy will not be permitted.
8. At least 2 weeks must have elapsed for palliative radiation to any tumor site other than the tumor site identified for tissue collection
9. Participants must have organ and marrow function as defined below
10. Absolute neutrophil count (ANC) \> 1 K/uL, Hemoglobin \> 9 g/dL, Platelets \> 100 K/mm3
11. Serum creatinine \</= 2 mg/dL OR creatinine clearance \> 50 mL/min
12. Aspartic transaminase (AST) . 1.5 x upper limit of normal (ULN), Alanine transaminase (ALT) \</= 1.5 x ULN, Bilirubin ≤ 1.5 x ULN
13. Women of childbearing potential (WOCBP) must agree to use method(s) of contraception: at least one highly effective or two effective accepted methods of contraception to avoid conception throughout the study in such a manner that the risk of pregnancy is minimized. Suggested precautions should be used to minimize the risk or pregnancy for at least 1 month before start of therapy, and while women are on study for up to 3 months after T cell infusion.

    WOCBP include any female who has experienced menarche and who has not undergone successful surgical sterilization (hysterectomy, bilateral tubal ligation or bilateral oophorectomy) or is not postmenopausal
14. Men must be willing and able to use an acceptable method of birth control such as latex condom during the dosing period and for at least 3 months after completion of the study agent administration (T cell infusion) if their sexual partners are WOCBP.
15. Signed Informed Consent and if applicable, pediatric assent

Exclusion Criteria:

1. Known sensitivity to cyclophosphamide and/or study agents
2. Active or prior documented autoimmune disease (including inflammatory bowel disease, celiac disease, Wegener syndrome) within the past 2 years. Participants with childhood atopy or asthma, vitiligo, alopecia, Hashimoto syndrome, Grave's disease, or psoriasis not requiring systemic treatment (within the past 2 years) are not excluded
3. Untreated central nervous system metastatic disease, leptomeningeal disease, or cord compression. Participants previously treated central nervous system metastases that are radiographically and neurologically stable for at least 6 weeks and do not require corticosteroids (of any dose) for symptomatic management for at least 14 days prior to first dose of attIL12-TIL cells are permitted to enroll.
4. Any concurrent chemotherapy, immunotherapy, or biologic or hormonal therapy for cancer treatment at the time of tumor tissue collection or attIL12 TIL cell infusion. Any prior radiation to the tumor site that is being collected for attIL12 TIL production. Palliative radiation to any tumor site within the past 2 weeks. Standard of care anti-cancer therapy will be permitted following tumor tissue collection but prior to initiation of cyclophosphamide as bridging therapy (per section 5.5). Concurrent use of hormones for non-cancer-related conditions (eg, insulin for diabetes and hormone replacement therapy) is acceptable.
5. Unresolved toxicities from prior anticancer therapy, defined as having not resolved to NCI CTCAE v5 Grade 0 or 1 with the exception of alopecia and laboratory values listed per the inclusion criteria. Subjects with irreversible toxicity that is not reasonably expected to be exacerbated by any of the investigational products may be included (eg, hearing loss) after consultation with the PI.
6. History of primary immunodeficiency, solid organ transplantation, or previous clinical diagnosis of tuberculosis.
7. Receipt of live, attenuated vaccine within 28 days prior to the first dose of investigational products.
8. Major surgery (as defined by the investigator) within 4 weeks prior to first dose of treatment. Biopsy as per study protocol is allowed
9. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, unhealed wound, symptomatic congestive heart failure, uncontrolled hypertension, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease or gastritis, or psychiatric illness/social situations that would limit compliance with study requirement, substantially increase risk of incurring AEs from the study agents, or compromise the ability of the participant to give written informed consent. Participants with cognitive impairment, including adults with cognitive impairment such as trisomy 21 or similar conditions are not specifically excluded from participation, such that appropriate written informed consent is obtained from the parent or legal guardian and they are able to complete with the study protocol requirements and treatment.
10. Active concurrent second malignancy
11. Pregnant or lactating women
12. Any positive test result for hepatitis B or C virus indicating acute or chronic infection
13. Known history of testing positive for human immunodeficiency virus or known acquired immunodeficiency syndrome

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

  • 主要终点安全性和不良事件(AE)研究完成前,平均约1年
核对登记原文(英文)

主要终点:Safety and adverse events (AEs) · Incidence of Adverse Events, Graded According to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version (v) 5.0 · Through study completion; an average of 1 year

研究设计怎么做的

研究类型
干预性研究
入组人数
40 人(预计)
分组方式
非随机分组
  • A部分试验组

    A部分受试者接受的attIL2-TIL细胞治疗剂量取决于其入组时间。首组受试者接受最低剂量。若未观察到不可耐受的副作用,后续每组将接受高于前一组的剂量,并持续递增,直至确定attIL2-TIL细胞治疗的最高耐受剂量。

  • B部分试验组

    B部分受试者接受A部分确定的推荐剂量attIL2-TIL细胞治疗。

核对分组登记原文(英文)
  • Part A, · EXPERIMENTAL · Participants enrolled in Part A, the dose of attIL2-TIL cell therapy a participant receive will depend on when the participant joins this study. The first group of participants will receive the lowest dose level of attIL2-TIL cell therapy. Each new group will receive a higher dose of attIL2-TIL cell therapy than the group before it, if no intolerable side effects were seen. This will continue until the highest tolerable dose of attIL2-TIL cell therapy is found.
  • Part B · EXPERIMENTAL · Participants enrolled in Part B, will receive attIL2-TIL cell therapy at the recommended dose that was found in Part A.

关键日期

开始日期
2025-09-29
主要完成日期
2030-12-31
全部完成日期
2032-12-31
登记状态核实于
2026-08

联系与责任方

申办方
M.D. Anderson Cancer Center
联系邮箱
nsomaiah@mdanderson.org
联系电话
(713) 792-3626

登记简述

本研究旨在为复发或转移性肉瘤患者确定可使用的attIL2-TIL细胞治疗推荐剂量。 研究还将进一步测试A部分确定的剂量,评估其是否有助于控制脂肪肉瘤生长。

核对登记原文(英文)

To find a recommended dose of attIL2-TIL cell therapy that can be given to participant with either relapsed or metastatic sarcomas (has come back or spread to other parts of the body, respectively). To further test the dose found in Part A to see if it can help to control liposarcoma growth.

登记原文与核验信息

试验登记号
NCT06474676
试验期别
I 期
试验状态
招募中
试验中心
MD Anderson Cancer Center · 休斯顿 · 美国
适应症(原文)
Metastatic Soft-tissue Sarcoma
干预方式(原文)
Cyclophosphamide; T Cell Membrane-Anchored Tumor-Targeted IL12 -Modified TIL Cell Therapy