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:CDH17 CAR-T Therapy in Advanced Malignant Solid Tumors
这是一项早期 I 期注册临床试验,评估 CAR-T 细胞治疗胆管癌、结直肠癌、胃癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 36 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT06937567。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: * 经组织病理学确诊的恶性实体瘤,包括但不限于结直肠癌、胃癌、胰腺癌和胆道肿瘤。 * 标准治疗失败、对标准治疗不耐受,或缺乏有效治疗选择。 * 至少有一个符合RECIST 1.1版标准的可测量病灶。 * 有既往肿瘤活检组织,或能够提供新的肿瘤组织标本。 * 免疫组化(IHC)或免疫细胞化学(ICC)染色确认肿瘤组织为CDH17阳性。 * 东部肿瘤协作组(ECOG)体能状态评分0–1。 * 预期生存期≥3个月。 * 器官功能适当:血液学方面,中性粒细胞绝对计数(ANC)≥1.5×10^9/L,淋巴细胞绝对计数(ALC)≥0.5×10^9/L,血红蛋白(HGB)≥80 g/L,血小板计数(PLT)≥75×10^9/L。肝功能方面,天冬氨酸氨基转移酶(AST/SGOT)和丙氨酸氨基转移酶(ALT/SGPT)≤正常值上限(ULN)的3.0倍(原发性肝肿瘤或肝转移患者≤ULN的5.0倍);总胆红素≤ULN的1.5倍(原发性肝肿瘤或肝转移患者≤ULN的3.0倍;Gilbert综合征患者≤ULN的3倍且直接胆红素≤ULN的1.5倍)。凝血功能方面,国际标准化比值(INR)≤ULN的1.5倍(接受治疗性抗凝药者除外);活化部分凝血活酶时间(APTT)≤ULN的1.5倍(接受治疗性抗凝药者除外)。肾功能方面,血清肌酐(Cr)≤ULN的1.5倍,或按Cockcroft–Gault公式计算的肌酐清除率≥60 mL/min。心功能方面,超声心动图确认左心室射血分数(LVEF)≥50%。肺功能方面,不吸氧时静息血氧饱和度(SpO₂)>92%。 * 有生育能力的女性须妊娠试验阴性。 * 有生育能力的女性或伴侣有生育能力的男性受试者,须同意在研究期间及末次细胞输注后1年内采取有效避孕措施。 * 愿意签署知情同意书,表明理解研究内容并同意遵守研究程序。 排除标准: * 妊娠或哺乳期女性。 * 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HBV DNA高于检测下限。 * 丙型肝炎病毒(HCV)抗体阳性且外周血HCV RNA高于检测下限。 * HIV抗体阳性。 * 梅毒特异性及非特异性抗体检测阳性。 * 既往治疗(手术、化疗、放疗、靶向治疗、免疫治疗等)所致的非血液学毒性尚未恢复至≤CTCAE 1级,脱发和周围感觉神经病变除外。 * 既往接受过异基因组织或器官移植(包括骨髓、干细胞、肝、肾等),不需要免疫抑制治疗的移植(如角膜或毛发移植)除外。 * 既往接受过CDH17 CAR-T治疗者;在本研究中接受CAR-T输注者除外。 * 签署知情同意书前4周内接受过重大手术且尚未完全恢复,或有尚未痊愈的严重创伤史。 * 已知存在中枢神经系统(CNS)转移(无症状脑转移或临床症状稳定者除外)。 * 签署知情同意书前6个月内存在需要全身性皮质类固醇治疗的严重活动性感染或肺部疾病。 * 有症状的充血性心力衰竭(NYHA II–IV级)、严重主动脉瓣狭窄或有症状的二尖瓣狭窄。 * 心电图显示QTc>450 ms,或合并束支传导阻滞时QTc>480 ms。 * 未控制的高血压(收缩压≥160 mmHg和/或舒张压≥100 mmHg)。 * 签署知情同意书前6个月内发生脑血管意外。 * 活动性、慢性或复发性严重自身免疫性疾病,且需要免疫抑制治疗(符合例外情况者除外)。 * 任何形式的原发性或继发性免疫缺陷。 * 研究者判断存在器官穿孔或出血风险。 * 对研究药物/成分发生严重全身性超敏反应。 * 签署知情同意书前4周内接种过减毒活疫苗。 * 签署知情同意书前4周内参加过其他临床研究。 * 过去5年内有其他恶性肿瘤史,已充分治疗的非黑色素瘤皮肤癌或原位癌除外。 * 诊断为神经精神疾病,或研究者认为不适合参加研究的任何情况。
Inclusion Criteria: * Histopathologically confirmed malignant solid tumors, including but not limited to colorectal cancer, gastric cancer, pancreatic cancer, and biliary tract tumors. * Patients must have failed standard treatments, be intolerant to standard treatments, or lack effective treatment options. * At least one measurable lesion as defined by RECIST v1.1 criteria. * Tumor tissue must be available either from prior tumor biopsy or by providing new tumor specimens. * Tumor specimens must be confirmed as CDH17-positive by immunohistochemistry (IHC) or immunocytochemistry (ICC) staining. * Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. * Expected survival time ≥ 3 months. * Appropriate organ function: hematological: Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L; Absolute lymphocyte count (ALC) ≥ 0.5 × 10⁹/L. Hemoglobin (HGB) ≥ 80 g/L; Platelet count (PLT) ≥ 75 × 10⁹/L. Liver Function: aspartate aminotransferase (AST/SGOT) and alanine aminotransferase (ALT/SGPT) ≤ 3.0 × ULN (≤ 5.0 × ULN for patients with primary liver tumors or liver metastases); total bilirubin ≤ 1.5 × ULN (≤ 3.0 × ULN for patients with primary liver tumors or liver metastases; ≤ 3 × ULN for Gilbert's syndrome with direct bilirubin ≤ 1.5 × ULN). Coagulation: international normalized ratio (INR) ≤ 1.5 × ULN (unless on therapeutic anticoagulants); activated partial thromboplastin time (APTT) ≤ 1.5 × ULN (unless on therapeutic anticoagulants). Renal Function: serum creatinine (Cr) ≤ 1.5 × ULN or creatinine clearance rate ≥ 60 mL/min (based on Cockcroft-Gault formula). Cardiac Function: left ventricular ejection fraction (LVEF) ≥ 50% (confirmed by echocardiography). Pulmonary Function: resting oxygen saturation (SpO₂) \> 92% without supplemental oxygen. * Female participants of childbearing potential must have a negative pregnancy test. * Female participants of childbearing potential or male participants with partners of childbearing potential must agree to use effective contraception during the study and for 1 year after the final cell infusion. * Willingness to sign the informed consent form, demonstrating understanding of the study and agreement to comply with study procedures. Exclusion Criteria: * Women who are pregnant or breastfeeding. * Positive hepatitis B surface antigen (HBsAg), or hepatitis B core antibody (HBcAb) with peripheral HBV DNA levels above the lower limit of detection. * Positive hepatitis C virus (HCV) antibody with peripheral HCV RNA levels above the lower limit of detection. * Positive HIV antibody. * Positive syphilis-specific and non-specific antibody tests. * Non-hematological toxicity from prior treatment (surgery, chemotherapy, radiotherapy, targeted therapy, immunotherapy, etc.) has not resolved to ≤ CTCAE grade 1 (except for hair loss and peripheral sensory neuropathy). * Prior allogeneic tissue or organ transplant (including bone marrow, stem cell, liver, kidney, etc.), except for transplants not requiring immunosuppression (e.g., corneal or hair transplantation). * Patients who have previously received CDH17 CAR-T therapy, except those who received CAR-T infusion within this study. * Underwent major surgery within 4 weeks prior to signing informed consent and has not fully recovered, or has a history of serious unresolved trauma. * Known central nervous system (CNS) metastases (with exceptions for asymptomatic brain metastases or stable clinical symptoms). * Severe active infections or pulmonary diseases requiring systemic corticosteroid treatment within 6 months prior to signing informed consent. * Symptomatic congestive heart failure (NYHA class II-IV), severe aortic stenosis, or symptomatic mitral stenosis. * ECG showing QTc \> 450 ms or QTc \> 480 ms with bundle branch block. * Uncontrolled hypertension (SBP ≥ 160 mmHg and/or DBP ≥ 100 mmHg). * Cerebrovascular accidents within 6 months prior to signing informed consent. * Active, chronic, or recurrent severe autoimmune diseases requiring immunosuppressive treatment (with exceptions). * Any form of primary or secondary immunodeficiency. * Risk of organ perforation or bleeding as judged by the investigator. * Severe systemic hypersensitivity reactions to study drugs/components. - Received live attenuated vaccines within 4 weeks prior to signing informed consent. * Participated in another clinical study within 4 weeks prior to signing informed consent. * History of another malignancy within the past 5 years, except for adequately treated non-melanoma skin cancer or in situ cancers. * Diagnosed with neuropsychiatric disorders or any condition deemed by the investigator as unsuitable for participation.
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:The safety of UCLH801 cells in patients with advanced malignant solid tumors with positive expression of CDH17 · The number and severity of dose-limiting toxicity (DLT) events and all adverse events occurring in subjects following the infusion of UCLH801 cells; The determination of the recommended Phase II dose (RP2D). Periodic analysis may be conducted during the dose esclation stage, including subgroup analysis, such as CDH17 expression strength, prior therapy lines and tumor burden. · 28 days after the CAR-T cells infusion
次要终点:Evaluate the preliminary response rate of UCLH801 cells in patients with advanced malignant solid tumors expressing CDH17.;Evaluate the pharmacodynamic (PD) characteristics of UCLH801 cells in subjects;Evaluate the concentration of anti-UCLH801 cell antibodies in serum;Evaluate the preliminary response rate of UCLH801 cells in patients with advanced malignant solid tumors expressing CDH17.;Evaluate the peak plasma concentration (Cmax) of UCLH801 cells;Evaluate the long-time area under the curve (AUC) of UCLH801 cells.;Evaluate the area under the plasma concentration versus time curve (AUC) of UCLH801 cells
本研究将CDH17阳性晚期恶性实体瘤患者纳入传统“3+3”剂量递增试验。研究中细胞治疗起始剂量设为1.0×10^6/kg,最高剂量设为6.0×10^6/kg。
通过静脉输注给予两个剂量水平的FAST LACO-Stim CDH17 CAR-T细胞。本研究将CDH17阳性晚期恶性实体瘤患者纳入升级版FAST LACO-Stim CDH17 CAR-T治疗,采用改良的“3+3”剂量递增设计。细胞治疗起始剂量设为3.0×10^4/kg,最高剂量设为1.0×10^5/kg。剂量递增期间,研究者可依据累积的人体安全性和耐受性、药代动力学及药效学数据酌情调整剂量水平。
本研究所用研究产品UCLH801细胞是一种特异性靶向CDH17的CAR-T细胞疗法。拟治疗人群为CDH17阳性的晚期实体瘤,包括但不限于结直肠癌、胃癌、胰腺癌、胆道肿瘤、神经内分泌肿瘤、卵巢癌和肺癌。本研究主要目标是评估UCLH801细胞治疗CDH17阳性晚期恶性实体瘤患者的安全性和耐受性。次要目标包括评估UCLH801细胞的初步疗效、体内药代动力学和药效学特征,以及免疫原性。 本研究将观察输注UCLH801细胞对患者身体的影响,包括任何不适或实验室检查结果变化;还将评估UCLH801细胞是否对肿瘤产生作用。此外,研究将考察UCLH801细胞如何代谢、发挥作用的机制,以及机体是否会对UCLH801细胞产生免疫反应或排斥反应。
The investigational product used in this study, UCLH801 cells, is a CAR-T cell therapy specifically targeting CDH17. The proposed indication includes CDH17-positive advanced solid tumors, such as but not limited to colorectal cancer, gastric cancer, pancreatic cancer, biliary tract tumors, neuroendocrine tumors, ovarian cancer, and lung cancer. The primary objective of this study is to evaluate the safety and tolerability of UCLH801 cells in patients with CDH17-positive advanced malignant solid tumors. The secondary objectives include assessing the preliminary efficacy of UCLH801 cells, their pharmacokinetics and pharmacodynamics in the body, and their immunogenicity. This study aims to observe how the infusion of UCLH801 cells affects patients 's body, including any discomfort or changes in laboratory test results. Additionally, it will evaluate whether UCLH801 cells have any effect on tumor. Furthermore, the study will investigate how UCLH801 cells are metabolized; the mechanisms through which they exert their effects, and how to develops any immune response or rejection against UCLH801 cells.
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