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:Allogeneic B7H3 CAR-γδT Cell Therapy for Advanced Solid Tumors
⚠ 该试验的登记信息已有 20 个月未更新, 页面上显示的「尚未开始招募」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 细胞治疗晚期实体瘤、卵巢癌、恶性肿瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 18 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT06825455。
不限性别 · ≥ 18 Years
纳入标准: 1. 年龄≥18岁,性别不限; 2. 预计生存时间≥3个月; 3. ECOG评分0~1; 4. 符合临床诊断标准,经病理确诊为标准治疗失败的恶性实体瘤患者; 5. 经免疫组化(IHC)染色或流式检测B7H3阳性的肿瘤组织样本(建议一年内的标本); 6. 根据RECIST V1.1至少有一个可评估病灶; 7. 开腹组患者肿瘤局限于腹膜(转移)和卵巢癌; 8. 骨髓储备功能基本正常,肝肾功能正常(首次细胞注射液治疗前需完成实验室检查): 血液:白细胞计数(WBC)≥3E9/L,淋巴细胞计数(LY)≥0.8E9/L,血红蛋白(Hb)≥80g/L,血小板(PLT)≥75E9/L;肝脏:ALT ≤ 3 × ULN;AST ≤ 3 × ULN;总胆红素 ≤ 3.0 × ULN;肾脏:血清肌酐 ≤ 1.5 × 正常范围上限(ULN);心脏:超声心动图左心室射血分数≥50%;肺:不吸氧状态下血氧饱和度正常。 9. 育龄期女性妊娠试验应为阴性,且男女双方同意在治疗期间及此后1年内采取有效避孕措施; 10. 能够理解试验的要求和事项,并愿意按要求参加临床研究; 11. 签署试验知情同意书。 排除标准: 1. 已知对细胞输注或研究中可能使用的任何药物成分过敏、变态反应、不耐受或禁忌,包括氟达拉滨和环磷酰胺; 2. 细胞输注前1个月内持续使用免疫抑制药物的患者; 3. 签署知情同意书前6个月内发生脑血管意外或癫痫发作; 4. 有症状的脑转移; 5. 已知的精神疾病或药物滥用障碍,会干扰对试验要求的配合; 6. 乙型肝炎表面抗原(HBsAg)阳性或乙型肝炎核心抗体(HBcAb)阳性且外周血乙型肝炎病毒(HBV)DNA滴度不在正常参考范围内;丙型肝炎病毒(HCV)抗体阳性且外周血丙型肝炎病毒(HCV)RNA阳性;人类免疫缺陷病毒(HIV)抗体阳性;梅毒阳性; 7. 严重心脏疾病:包括但不限于不稳定型心绞痛、心肌梗死(筛选前6个月内发生)、充血性心力衰竭(NYHA分级≥III级)及严重心律失常; 8. 存在需要全身治疗的活动的或未控制的感染(轻度泌尿生殖道和上呼吸道感染除外); 9. 未从既往治疗的急性毒性效应中恢复(既往治疗引起的血液学或器官毒性≥2级,与研究疾病和病史相关的异常除外); 10. 确诊为免疫缺陷病 11. 患有需要全身治疗的活性感染; 12. 有生育潜力的女性受试者计划在细胞输注后2年内怀孕;或其伴侣计划在细胞输注后2年内怀孕的男性受试者; 13. 筛选前1个月内参加过其他创新药物的临床研究;
Inclusion Criteria: 1. Age ≥18 years old, gender is not limited; 2. Expected survival time ≥3 months; 3. ECOG score 0\~1; 4. Patients who meet the clinical diagnostic criteria and have a clear pathological diagnosis of malignant solid tumors that have failed standard treatment; 5. Tumor tissue samples (specimens within one year are recommended) positive for B7H3 by immunohistochemical (IHC) staining or flow assay; 6. Presence of at least one evaluable lesion according to RECIST V1.1; 7. Tumors limited to peritoneal (metastatic) and ovarian cancer in patients in the laparotomy group; 8. Substantially normal bone marrow reserve function and normal liver and renal function (laboratory tests need to be fulfilled before the first treatment with cell injection): Blood: white blood cell count (WBC) ≥3E9/L, lymphocyte count (LY) ≥0.8E9/L, hemoglobin (Hb) ≥80g/L, platelet (PLT) ≥75E9/L; Liver: ALT ≤ 3 × ULN; AST ≤ 3 × ULN; total bilirubin ≤ 3.0 × ULN; Kidney: serum creatinine ≤ 1.5 × upper limit of normal range (ULN); Heart: left ventricular ejection fraction ≥50% on echocardiography; lung: normal oxygen saturation without oxygen. 9. Pregnancy test should be negative for women of childbearing potential and both men and women agree to use effective contraception during treatment and for 1 year thereafter; 10. Be able to understand the requirements and matters of the trial and be willing to participate in the clinical study as required; 11. Sign the trial informed consent form. Exclusion Criteria: 1. Known hypersensitivity, allergy, intolerance, or contraindication to cell infusion or any of the drug components that may be used in the study, including fludarabine and cyclophosphamide; 2. Patients who have been continuously using immunosuppressive drugs within 1 month prior to cell infusion; 3. Cerebrovascular accident or seizure within 6 months prior to signing the informed consent form; 4. Symptomatic brain metastases; 5. a known psychiatric or substance abuse disorder that would interfere with cooperation with the trial requirements; 6. Hepatitis B surface antigen (HBsAg) positivity or hepatitis B core antibody (HBcAb) positivity and a peripheral blood test for hepatitis B virus (HBV) DNA titer that is not within the normal reference range; hepatitis C virus (HCV) antibody positivity and peripheral blood hepatitis C virus (HCV) RNA positivity; human immunodeficiency virus (HIV) antibody positivity; syphilis Positive for syphilis; 7. Serious cardiac disease: including, but not limited to, unstable angina pectoris, myocardial infarction (occurring within 6 months prior to screening), congestive heart failure (NYHA classification ≥ III), and severe arrhythmias; 8. Presence of active or uncontrolled infections requiring systemic therapy (except for mild genitourinary and upper respiratory tract infections); 9. has not recovered from acute toxic effects of prior therapy (prior therapy-induced hematologic or organ toxicity ≥ Grade 2, except for abnormalities related to study disease and medical history); 10. have a confirmed diagnosis of an immunodeficiency 11. suffering from an active infection requiring systemic therapy; 12. a female subject of childbearing potential who plans to become pregnant within 2 years of cell infusion; or a male subject whose partner plans to become pregnant within 2 years of cell infusion; 13. Participation in a clinical study of another innovative drug within 1 month prior to screening;
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:Incidence of Adverse Events (AEs) · AE is defined as any adverse medical event from the date of randomization to 12 months after B7H3 CAR-γδT cells infusion. Among them, cytokine release syndrome (CRS) and immune cell-associated neurotoxicity syndrome (ICANS) were graded according to American Society for Transplantation and Cellular Therapy (ASTCT) criteria, graft-versushost disease (GVHD) according to criteria defined by the Mount Sinai Acute GVHD International Consortium. Other AEs were graded according to common terminology criteria for adverse events (CTCAE) v5.0. · 12 months
次要终点:Best objective Response Rate;Duration of Response (DOR);Progression Free Survival (PFS);Overall Survival (OS);Immunogenicity: Proportion of subjects with anti drug antibody (ADA);Pharmacodynamics;Pharmacokinetics
晚期实体瘤患者。将先给予氟达拉滨和环磷酰胺的清淋化疗方案,随后进行试验性治疗,即异体靶向B7H3嵌合抗原受体γδT细胞。
卵巢癌或腹膜(转移性)癌患者。在细胞注射前,对于有明显腹水的受试者,应通过腹膜穿刺尽可能将腹水抽吸干净,然后在进行细胞输注前用生理盐水冲洗腹腔。
γδT细胞能够直接识别非肽类肿瘤抗原,如IPP磷酸化代谢物,而不依赖于特定的主要组织相容性复合体(MHC)。这一独特特性导致移植物抗宿主病(GVHD)的风险较低。γδT细胞在同种异体肿瘤治疗中的临床安全性已多次得到验证,突显了其在开发通用CAR-T细胞疗法方面的巨大潜力。 B7H3(CD276)是B7负性共刺激分子家族的一员,在正常组织中表达极低或缺失,但在多种肿瘤组织中高表达。因此,B7H3被视为一种极具前景的肿瘤相关抗原和具有重大治疗潜力的通用药物靶点。 利用γδT细胞作为载体细胞,开发针对晚期实体瘤的通用B7H3 CAR-γδT细胞注射液,可以有效解决自体细胞制备失败和治疗延误等风险。这一创新方法为实体瘤治疗提供了一种高效解决方案,并有望推动该领域的免疫治疗进展。
γδT cells can directly recognize non-peptide tumor antigens, such as IPP phosphorylated metabolites, without relying on specific major histocompatibility complexes (MHCs). This unique characteristic leads to a lower risk of graft-versus-host disease (GVHD). The clinical safety of γδT cells in allogeneic tumor therapies has been validated multiple times, highlighting their significant potential in developing universal CAR-T cell therapies. B7H3 (CD276), a member of the B7 negative co-stimulatory molecule family, is minimally expressed or absent in normal tissues but highly expressed in various tumor tissues. As a result, B7H3 is regarded as a highly promising tumor-associated antigen and a universal drug target with substantial therapeutic potential. By utilizing γδT cells as carrier cells, the development of universal B7H3 CAR-γδT cell injections for advanced solid tumors can effectively address risks such as autologous cell preparation failure and treatment delays. This innovative approach offers a highly efficient solution for solid tumor treatment and holds great promise for advancing immunotherapy in this field
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