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 Study of Combined EphA2-targeted CAR-DC and CAR-T Cell Therapy for Non-small Cell Lung Cancer
⚠ 该试验的登记信息已有 17 个月未更新, 页面上显示的「招募中」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 I 期注册临床试验,评估 CAR-T 细胞治疗非小细胞肺癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 18 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT06972576。
不限性别 · ≥ 18 Years 且 ≤ 70 Years
纳入标准: 1. 病理确诊Ⅳ期非小细胞肺癌,至少有1个符合RECIST 1.1的可测量病灶(螺旋CT上最长径≥10 mm的病灶,或短轴≥15 mm的淋巴结)。 2. 肿瘤组织免疫组化检测EphA2阳性,表达比例≥20%。 3. 标准治疗后疾病进展或无可用标准治疗;既往至少接受过2线全身治疗,包括但不限于化疗和免疫检查点抑制剂。有可靶向驱动基因突变者须已接受相应靶向治疗且治疗失败。 4. ECOG体能状态0–1分;预期生存期≥6个月。 5. 既往抗肿瘤治疗相关毒性已恢复至基线或≤1级;残留脱发除外,≤2级神经毒性可接受。洗脱期:化疗和免疫治疗4周,靶向治疗2周。 6. 器官功能充分:ANC≥1.5×10⁹/L、血小板≥75×10⁹/L、血红蛋白≥9 g/dL。血液检查前14天内不得输血或使用G-CSF、促血小板生成素、促红细胞生成素。总胆红素<ULN的1.5倍,AST和ALT<ULN的2.5倍;Gilbert综合征患者总胆红素<2倍,肝转移患者AST和ALT<5倍。肌酐≤ULN的1.5倍;若肌酐>1.5倍,则按Cockcroft-Gault公式计算的肌酐清除率须≥60 mL/min。凝血酶原时间和活化部分凝血活酶时间<ULN的1.5倍;国际标准化比值<1.5,接受抗凝治疗者须在目标范围内。 7. 有生育能力者愿意采取有效避孕措施。 8. 能理解并自愿签署知情同意书。 9. 愿意遵守计划访视、治疗方案、实验室检查及其他研究程序。 排除标准: 1. 病理证实为混合组织学类型,例如肺腺鳞癌。 2. 存在需紧急处理的肿瘤相关危急情况,例如恶性心包积液或心脏压塞、上腔静脉综合征、脊髓压迫。 3. 有显著心血管疾病,包括过去6个月内发生心肌梗死、心绞痛、心力衰竭、严重心律失常,或接受血管成形术、支架置入、冠状动脉旁路移植术;或有临床意义的QT/QTcF延长(女性>470 ms、男性>450 ms)。 4. 有临床意义的出血倾向或凝血障碍,如血友病。 5. HIV或梅毒感染、活动性乙肝或丙肝;乙肝患者HBV DNA≥1,000 IU/mL,或丙肝患者HCV RNA阳性且肝功能异常。 6. 曾因精神疾病被非自愿收治,或研究者认为其他心理状况不适合接受治疗。 7. 合并其他自身免疫病,或长期使用免疫抑制剂/糖皮质激素。 8. 服药依从性差。 9. 研究者认为不宜入组的其他情况。
Inclusion Criteria: 1. Pathologically confirmed stage IV non-small cell lung cancer (NSCLC) with at least one measurable lesion according to RECIST 1.1 criteria (i.e., a lesion with the longest diameter ≥10 mm on spiral CT scan or a lymph node with a short axis ≥15 mm). 2. Tumor tissue tested positive for EphA2 expression by immunohistochemistry (≥20%). 3. Disease progression after standard treatment or no available standard treatment (patients must have received at least two prior systemic therapies, including but not limited to chemotherapy and immune checkpoint inhibitors; patients with actionable driver mutations must have failed targeted therapy). 4. ECOG performance status: 0-1. 5. Expected survival ≥6 months. 6. Toxicities related to prior anti-tumor treatments must have resolved to baseline levels or ≤ Grade 1 (excluding residual alopecia); Grade ≤2 neurotoxicity is acceptable. Washout periods: 4 weeks for chemotherapy and immunotherapy, 2 weeks for targeted therapy. 7. Adequate organ function, including: * Adequate hematologic function: Absolute neutrophil count (ANC) ≥1.5×10\^9/L, platelet count ≥75×10\^9/L, hemoglobin ≥9 g/dL. No transfusions, granulocyte colony-stimulating factor (G-CSF), thrombopoietin, or erythropoietin allowed within 14 days before blood tests. * Adequate hepatic function: Total bilirubin (TBIL) \<1.5× upper limit of normal (ULN); AST and ALT \<2.5×ULN. For patients with Gilbert's syndrome, TBIL \<2×ULN; if liver metastases are present, AST and ALT \<5×ULN. * Adequate renal function: Serum creatinine (Cr) ≤1.5×ULN, or if Cr \>1.5×ULN, creatinine clearance (CrCl) ≥60 mL/min calculated using the Cockcroft-Gault formula. * Adequate coagulation function: Prothrombin time (PT) and activated partial thromboplastin time (APTT) \<1.5×ULN; international normalized ratio (INR) \<1.5 or within the target range if on anticoagulant therapy. 8. Subjects of reproductive potential must be willing to use effective contraception. 9. Ability to understand and voluntarily sign the informed consent form. 10. Willingness to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures. Exclusion Criteria: 1. Pathologically confirmed mixed histology, such as adenosquamous carcinoma of the lung. 2. Tumor-related emergencies requiring urgent treatment, such as malignant pericardial effusion or cardiac tamponade, superior vena cava syndrome, or spinal cord compression. 3. Significant cardiovascular diseases, including: * Documented cardiovascular events within the past 6 months, such as myocardial infarction, angina, heart failure, severe arrhythmia, or having undergone angioplasty, stent implantation, or coronary artery bypass surgery. * Clinically significant QT/QTcF prolongation (QT/QTcF \> 470 ms in females or \> 450 ms in males). 4. Clinically significant bleeding tendency or coagulation disorders, such as hemophilia. 5. HIV or syphilis infection; active hepatitis B or C: * Hepatitis B: HBV-DNA ≥ 1000 IU/mL. * Hepatitis C: Positive HCV RNA with abnormal liver function. 6. History of involuntary commitment due to psychiatric disorders or other psychological conditions deemed unsuitable for treatment by the investigator. 7. Presence of other autoimmune diseases, or long-term use of immunosuppressive agents or corticosteroids. 8. Poor medication compliance. 9. Any other condition that the investigator considers grounds for exclusion.
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:Safety: Incidence and severity of adverse events · To evaluate adverse events occurring within the first three months following infusion of EphA2-targeted CAR- T cells and CAR-DCs. The assessment includes incidence and severity of treatment-related symptoms such as neurological toxicity, hematological abnormalities, infections, autoimmune reactions, and secondary malignancies. · First 3 month post CAR-T cells and CAR-DCs infusion;Efficacy: Remission Rate · To evaluate the proportion of participants who achieve an objective tumor response, including complete remission (CR) and partial remission (PR) · 3 months post CAR-T cells and CAR-DCs infusion
次要终点:Progression-Free Survival;Overall Survival;Relapse Rate;Duration of Response;In Vivo Persistence of CAR-T cells and CAR-DCs and Cytokine Profile Monitoring;Objective Response Rate in Participants Receiving Different Doses of CAR-DCs;Incidence and Severity of Treatment-Related Adverse Events in Participants Receiving Different Doses of CAR-DCs
依次给予两种生物治疗:先给予EphA2靶向CAR-DC,随后输注EphA2靶向CAR-T细胞。
本开放标签、单臂临床研究旨在评估EphA2靶向CAR-DC联合CAR-T细胞治疗非小细胞肺癌患者的安全性和初步疗效。
This is an open-label, single-arm clinical study designed to evaluate the safety and preliminary efficacy of EphA2-targeted CAR-DC combined with CAR-T cell therapy in patients with non-small cell lung cancer.
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