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:Anti-HER2 CAR-T Cell Injection in Patients With HER2-positive Advanced Malignant Solid Tumors
这是一项分期未标注的注册临床试验,评估 HER2CAR-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 30 例。试验地点:中国 · 郑州(共 1 个中心,其中中国 1 个)。登记号:NCT06658951。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: 1. 年龄18–70岁(含界值),不限性别。 2. 组织学确诊的恶性实体瘤,经标准治疗后难治或复发,包括但不限于胃癌、胆道肿瘤、膀胱癌、卵巢癌、子宫内膜癌、宫颈癌、结直肠癌、乳腺癌、肺癌和食管癌。 3. 至少有1个符合RECIST 1.1的可测量病灶。 4. 肿瘤组织样本经免疫组化证实HER2阳性。 5. ECOG体能状态评分0或1。 6. 预期生存期≥3个月。 7. 器官功能符合方案要求。 8. 有生育能力女性须接受妊娠检测且结果阴性。有生育能力女性,以及性伴侣有生育能力的男性参与者,须愿意从筛查期至输注后至少1年采取有效避孕措施。 9. 能理解研究方案,自愿参加并签署知情同意书,且能够遵守研究和随访程序。 排除标准: 1. 妊娠或哺乳期女性。 2. HBsAg阳性;HBcAb阳性且外周血HBV DNA高于检测下限;HCV抗体阳性且外周血HCV DNA高于检测下限;HIV抗体或梅毒抗体阳性。 3. 既往治疗(手术、化疗、放疗、靶向治疗、免疫治疗等)所致毒性尚未恢复至CTCAE 1级;脱发和周围感觉神经障碍除外。 4. 曾接受任何异体组织/器官移植(包括骨髓、干细胞、肝脏、肾脏移植);无需免疫抑制治疗的移植(如角膜或毛发移植)除外。 5. 曾接受抗HER2 CAR-T细胞治疗。 6. 签署知情同意前4周内接受过重大手术且严重创伤尚未恢复,或计划在细胞治疗后12周内接受重大手术。 7. 已知中枢神经系统转移者排除,但以下情况可纳入:无症状脑转移;临床稳定(单采前4周内影像学无进展,神经症状恢复至基线),且脑转移无需皮质类固醇或其他治疗已≥4周。 8. 研究者评估存在会影响治疗耐受性或显著增加并发症风险的临床显著全身性疾病,如严重活动性感染或显著心、肺、肝、神经系统及其他器官功能障碍。 9. 对研究所用药物/成分(氟达拉滨、环磷酰胺、二甲基亚砜、低分子右旋糖酐、人血清白蛋白等)有严重全身超敏反应史。 10. 签署知情同意前4周内接种减毒活疫苗。 11. 签署知情同意前4周内参加其他临床试验。 12. 过去5年内有其他恶性肿瘤史;充分治疗的非黑色素瘤皮肤癌、膀胱/胃/结肠/宫颈原位癌或不典型增生、黑色素瘤或乳腺癌除外。 13. 依据ICD-11诊断或研究者评估患有神经精神疾病,包括但不限于癫痫、精神分裂症、痴呆、药物或酒精成瘾。 14. 研究者认为不适合参加本研究的其他原因。
Inclusion Criteria: * 1\. 18 to 70 years old (including cut-off value), gender is not limited. 2\. Solid tumors that histological diagnosis of malignancy refractory to, or relapsing after standard therapy, including but not limited to gastric cancer, biliary system tumors, bladder cancer, ovarian cancer, endometrial cancer, cervical cancer, colorectal cancer, breast cancer, lung cancer, esophageal cancer, etc. 3\. At least one measurable lesion according to RECIST v1.1. 4\. HER2 should be positive confirmed by Immunohistochemistry in tumor tissue samples. 5\. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. 6\. Life expectancy ≥ 3 months. 7\. The organ function must meet the protocol requirements. 8\. Female participants of childbearing potential must undergo a pregnancy test and the results must be negative. Female participants of childbearing potential or male participants whose sex partner has childbearing potential must be willing to use effective methods of contraception from screening period to at least 1 year after infusion. 9\. Participants must be able to understand the protocol and be willing to enroll the study, sign the informed consent, and be able to comply with the study and follow-up procedures. Exclusion Criteria: * 1\. Pregnant or lactating women. 2\. Patients with hepatitis B surface antigen (HBsAg) positive. Patients who is hepatitis B core antibody (HBcAb) positive and the quantification of HBV DNA in peripheral blood is higher than the lower limit of detection. Patients who is hepatitis C virus (HCV) antibody positive and quantification of HCV DNA in peripheral blood is higher than the lower limit of detection. Patients with human immunodeficiency virus (HIV) antibody positive, or syphilis antibody positive. 3\. The toxicities caused by the prior therapy (surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, etc.) have not recovered to grade 1 according to CTCAE, except for hair loss and peripheral sensory nerve disorders. 4\. Have received any allogeneic tissue/organ transplantation (including bone marrow transplantation, stem cell transplantation, liver transplantation, kidney transplantation), except for the transplantation that does not require immunosuppressive therapy (such as: corneal transplantation, hair transplantation.) 5\. Patients have received anti-HER2 CAR-T cell therapy. 6\. Patients who have history of major surgery and unrecovered severe trauma within 4 weeks prior to signing informed consent; or plan to have major surgery within 12 weeks of cell therapy. 7\. Presence of known central nervous system metastases, but the following patients will be allowed: a) Asymptomatic brain metastases; b) Clinically stable (no radiographic progression within 4 weeks before apheresis and return of any neurologic symptoms to baseline), and with no need for corticosteroids or other treatment for brain metastases for ≥ 4 weeks. 8\. Patients with clinically significant systemic disease (such as: severe active infection or significant cardiac, pulmonary, hepatic, nervous system, or other organ dysfunction) that evaluated by the investigator would impair the patients' ability to tolerate the treatments used in this study or significantly increase the risk of complications. 9\. History of severe systemic hypersensitivity reaction to the drugs/ingredients \[fludarabine, cyclophosphamide, dimethyl sulfoxide (DMSO), low molecular dextran, human serum albumin (HSA), etc.\] used in this study. 10\. Patients have received attenuated vaccine within 4 weeks prior to signing informed consent. 11\. Patients have received other clinical trials within 4 weeks prior to signing informed consent. 12\. History of another malignancy tumor within the previous five years, except for adequately treated non-melanoma skin cancer, carcinoma in situ of bladder, stomach, colon, cervix/dysplasia, melanoma, or breast. 13\. History of neuropsychiatric diseases diagnosed by the ICD-11 criteria or evaluated by investigator, including but not limited to epilepsy, schizophrenia, dementia, drug and alcohol addictions. 14\. For any other reasons, the patients are believed not suitable for participation in this study by investigators.
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:Identification of Maximum Tolerated Dose (MTD) & Incidence of Dose-limiting Toxicities (DLTs) · Incidence and severity of dose-limiting toxicities (DLTs) following infusion of CAR-T cell injection, at each dose level tested in dose escalation phase. · 4 weeks after the CAR-T cells infusion;Adverse Events (AEs) · Incidence and severity of adverse events. · 2 years
次要终点:Objective Response Rate (ORR);Disease Control Rate (DCR);Progression-Free Survival (PFS);Overall Survival (OS)
所有符合条件的参与者先接受氟达拉滨、环磷酰胺和ABRAXANE预处理化疗,随后接受抗HER2 CAR-T细胞注射。
这是一项单臂、开放标签探索性临床研究,评估抗HER2 CAR-T细胞注射治疗HER2阳性晚期恶性实体瘤患者的安全性和初步疗效。
This is a single-arm, open-label, exploratory clinical study to evaluate the safety and preliminary efficacy of Anti-HER2 CAR-T cell injection in patients with HER2-positive advanced malignant solid tumors.
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