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:Clinical Trial of Autologous CD19 CAR-T Cells (CNCT19) Therapy for Advanced Hepatocellular Carcinoma
这是一项 I 期注册临床试验,评估抗 CD19CAR-T 细胞治疗肝细胞癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 12 例。试验地点:中国 · 杭州(共 2 个中心,其中中国 2 个)。登记号:NCT06676982。
不限性别 · ≥ 18 Years 且 ≤ 80 Years
纳入标准: * 年龄18至80岁,男性或女性; * 受试者自愿参加研究,并由本人或监护人签署知情同意书(ICF); * 经病理学诊断为肝细胞癌,中国肝癌分期(CNLC)II-III期患者; * 不适合手术切除或局部治疗(包括消融治疗、介入治疗和放射治疗),或在手术和/或局部治疗后出现复发或进展,且既往至少接受过二线系统标准化治疗并进展或不耐受的HCC患者; * 根据RECIST 1.1标准,至少有一个可测量的肿瘤病灶; * 2年内符合要求的肿瘤样本(蜡块或未染色切片,数量满足本研究规定的检测要求),且经免疫组化或免疫荧光检测出CD19/CD68双阳性细胞; * Child-Pugh ≤ 7且无肝性脑病史; * ECOG 0-1; * 预期生存期 ≥ 12周; * 既往治疗引起的毒性已稳定或恢复至 ≤ 1级(研究者判断临床无显著意义的情况除外) 排除标准: * 活动性脑转移; * 已接受或正在等待器官移植的患者; * 过去2年内需要全身免疫抑制治疗的活动性自身免疫性疾病,如系统性红斑狼疮、类风湿关节炎、溃疡性结肠炎等; * 研究者评估肝内肿瘤占比大于整个肝脏的50%;或可能存在门静脉主干癌栓形成,或癌栓侵犯肠系膜静脉/下腔静脉; * 在细胞采集前规定时间内使用以下任何药物或治疗方法:a. 细胞采集前4周内针对研究疾病接受过手术干预、放射治疗、消融等局部治疗;b. 细胞采集前4周内接受过大手术或重大创伤,或预期在研究期间接受大手术的患者;c. 细胞采集前一周内接受过抗PD-1和PD-L1等免疫治疗;d. 细胞采集前2周内接受过化疗药物或索拉非尼、瑞戈非尼、仑伐替尼等靶向治疗;e. 细胞采集前3天内使用过治疗剂量的皮质类固醇,但允许使用局部和吸入性皮质类固醇; * 过去5年内或同时患有其他无法治愈的恶性肿瘤,但宫颈原位癌、皮肤基底细胞癌和乳腺导管原位癌除外; * 既往接受过其他细胞治疗或基因修饰细胞治疗的个体; * 既往或筛选期有临床意义的中枢神经系统疾病,如癫痫、癫痫发作、脑血管疾病(缺血/出血/脑梗死)、脑水肿、可逆性后部白质脑病、瘫痪、失语、卒中、严重脑损伤、痴呆、帕金森病、小脑疾病、器质性脑综合征或精神疾病; * 存在慢性阻塞性肺疾病、间质性肺病,以及肺功能检查具有临床意义的异常; * 经研究者评估,受试者存在大量无法控制的浆液性积液(如胸腔积液、腹腔积液、心包积液)。
Inclusion Criteria: * Aged 18 to 80 years, male or female; * Subjects voluntarily participated in the research and signed the Informed Consent Form (ICF) by themselves or their guardians; * Pathologically diagnosed with hepatocellular carcinoma, patients with China liver Cancer Staging (CNLC) stageII-III.; * HCC patients who are not suitable for surgical resection or local treatment (including ablation therapy, interventional therapy, and radiation therapy), or who experience recurrence or progression after surgery and/or local treatment, and who have previously received at least second-line systematic standardized treatment and have progressed or are intolerant to it; * According to RECIST 1.1 standard, there should be at least one measurable tumor lesion; * Tumor samples that meet the requirements (paraffin blocks or unstained sections with a quantity that meets the testing requirements specified in this study) within 2 years, and have CD19/CD68 double positive cells detected by immunohistochemistry or immunofluorescence; * Child-Pugh ≤ 7 and no history of hepatic encephalopathy; * ECOG 0-1; * Expected survival period ≥ 12 weeks; * The toxicity caused by previous treatment has stabilized or recovered to ≤ level 1 (except for cases judged by the researcher to be clinically insignificant) Exclusion Criteria: * Active brain metastasis; * Patients who have received or are waiting for organ transplantation; * Active autoimmune diseases that require systemic immunosuppressive therapy within the past 2 years, such as systemic lupus erythematosus, rheumatoid arthritis, ulcerative colitis, etc; * Researchers evaluated that the proportion of intrahepatic tumors is greater than 50% of the entire liver; Or there may be tumor thrombus formation in the main portal vein, or tumor thrombus invasion into the mesenteric vein/inferior vena cava; * Use any of the following drugs or treatment methods within the specified time before cell collection: a Received local treatments such as surgical intervention, radiation therapy, ablation, etc. for the studied disease within 4 weeks prior to cell collection; b. Patients who have undergone major surgical procedures or significant trauma within 4 weeks prior to cell collection, or who are expected to undergo major surgery during the study period; c. Received immunotherapy such as anti-PD-1 and PD-L1 within one week prior to cell collection; d. Received chemotherapy drugs or targeted therapy such as sorafenib, regorafenib, lenvatinib within 2 weeks prior to cell collection; e. Used therapeutic doses of corticosteroids within 3 days prior to cell collection, but allowed to use topical and inhaled corticosteroids; * Within the past 5 years or simultaneously with other incurable malignant tumors, except for cervical cancer in situ, basal cell carcinoma of the skin, and ductal carcinoma in situ of the breast; * Individuals who have received other cell therapies or gene modified cell therapies in the past; * Central nervous system diseases that have clinical significance in the past or screening, such as epilepsy, epileptic seizures, cerebrovascular disease (ischemia/hemorrhage/cerebral infarction), cerebral edema, reversible posterior white matter encephalopathy, paralysis, aphasia, stroke, severe brain injury, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome or psychiatric disorders; * There are chronic obstructive pulmonary disease, interstitial lung disease, and clinically significant abnormalities in lung function tests; * After evaluation by the researchers, it was found that the subject had a large amount of uncontrollable serous fluid accumulation (such as pleural effusion, abdominal effusion, pericardial effusion).
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) · Describe the adverse events of limiting further increases in the dose of CNCT19. · Within 28 days of CNCT19infusion;Adverse events · Describe adverse events (AEs) and serious adverse events (SAEs) that are "likely" or "definitely" related to the studytreatment that occur at any time of 24 months after treatment. · Within 24 months after the treatment;Maximum tolerated dose · Determine the optimal agent for CNCT19 at maximum tolerated dose. · From enrollment of the first subject to completion of follow-up of the last subject (up to 3 years)
次要终点:Effectiveness evaluation;Effectiveness evaluation;Effectiveness evaluation;Effectiveness evaluation;Effectiveness evaluation;Pharmacokinetic evaluation;Pharmacokinetic evaluation
CNCT19
一项关于CNCT19 CAR T细胞疗法在晚期肝细胞癌患者中的安全性、耐受性和有效性的I期临床研究。
A phase I clinical study of the safety and tolerability, efficacy of CNCT19 CAR T-cell therapy in patients with advanced hepatocellular carcinoma hepatocellular carcinoma.
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