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:A Study of CEA-Targeted CAR-T Therapy in Patients With CEA-Positive Advanced Solid Tumors
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、乳腺癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 48 例。试验地点:中国 · 杭州(共 1 个中心,其中中国 1 个)。登记号:NCT07250386。
不限性别 · ≥ 18 Years
纳入标准:男女不限,年龄≥18岁;组织学或细胞学确诊晚期、转移性或复发性实体瘤,包括非小细胞肺癌和乳腺癌;至少接受二线标准治疗后疾病进展或不耐受,既往治疗可包括手术、化疗、放疗、靶向或免疫治疗;筛查前3个月内肿瘤样本免疫组化证实CEA阳性(明确膜染色,阳性比例≥10%);若免疫组化结果距筛查超过3个月,血清CEA须>10 ng/mL。至少有1个按RECIST 1.1可评估病灶:非淋巴结病灶最长径≥10 mm,淋巴结病灶短径≥15 mm;胸腔灌注亚组可接受恶性胸腔积液,须通过CT或MRI准确评估积液量,并由细胞学或胸腔镜活检确认其为恶性。ECOG 0–2;预期生存期≥12周;无严重精神疾病。除非另有说明,器官功能须满足:白细胞>2.0×10⁹/L、中性粒细胞>1.0×10⁹/L、淋巴细胞>0.5×10⁹/L、血小板>50×10⁹/L、血红蛋白>80 g/L;超声心动图射血分数≥50%,心电图无显著异常;血清肌酐≤2.0×ULN;ALT及AST≤3.0×ULN(肝肿瘤浸润者≤5.0×ULN);总胆红素≤2.0×ULN;不吸氧时血氧饱和度>92%。适合单采或静脉采血且无细胞采集禁忌;同意CAR-T输注后1年内采用可靠有效的避孕措施(安全期法除外);受试者或授权监护人同意参加并签署知情同意书,确认理解研究目的和程序。 排除标准:筛查时有中枢神经系统或脑膜转移症状,或研究者判断相关转移未控制;筛查前4周内参加其他临床试验;筛查前4周内接种减毒活疫苗;筛查前14天内或5个半衰期内(取较短者)接受化疗、靶向治疗或其他试验药物;需全身治疗的活动性或未控制感染;肿瘤压迫气管或大血管且研究者认为风险显著;有NYHA III/IV级心衰、筛查前6个月内心肌梗死或冠状动脉搭桥、具有临床意义的室性心律失常或无法解释的晕厥(血管迷走性或脱水所致除外)、严重非缺血性心肌病史;活动性自身免疫病或需长期免疫抑制治疗的其他情况;过去3年内有既往或同期未治疗恶性肿瘤(皮肤基底细胞癌或宫颈原位癌除外);HBsAg阳性,或HBcAb阳性且HBV DNA高于正常范围;HCV抗体阳性且HCV RNA高于正常范围;HIV抗体或梅毒阳性;妊娠或哺乳;研究者认为不适合参加的其他情况。
Inclusion Criteria:
1. Aged 18 years or older, of any gender.
2. Histologically or cytologically confirmed advanced, metastatic, or recurrent solid tumors, including non-small cell lung cancer and breast cancer.
3. Disease progression or intolerance after at least second-line standard therapy, including but not limited to surgery, chemotherapy, radiotherapy, targeted therapy, or immunotherapy.
4. CEA positivity confirmed by immunohistochemistry (IHC) in tumor samples within 3 months of screening (clear membrane staining, with positivity rate ≥10%). If the IHC result is more than 3 months old, serum CEA must be above 10 ng/mL.
5. At least one evaluable lesion according to RECIST 1.1, with a longest diameter of ≥10 mm for non-lymph node lesions and a shortest diameter of ≥15 mm for lymph node lesions. Malignant pleural effusion is acceptable for the chest infusion subgroup.
6. For patients with malignant pleural effusion, accurate volume assessment of pleural effusion by imaging (CT or MRI) and cytological or thoracoscopic biopsy confirmation of malignant pleural effusion.
7. ECOG performance status of 0-2.
8. Life expectancy of 12 weeks or more.
9. No serious psychiatric disorders.
10. The following organ function criteria should be met unless otherwise specified:
1. Hematology: White blood cell count \>2.0×10\^9/L, neutrophils \>1.0×10\^9/L, lymphocytes \>0.5×10\^9/L, platelets \>50×10\^9/L, hemoglobin \>80 g/L.
2. Cardiac function: Echocardiography showing ejection fraction ≥50%, with no significant abnormalities on ECG.
3. Renal function: Serum creatinine ≤2.0×ULN.
4. Liver function: ALT and AST ≤3.0×ULN (≤5.0×ULN for those with liver tumor infiltration).
5. Total bilirubin ≤2.0×ULN.
6. Oxygen saturation \>92% without supplemental oxygen.
11. Eligible for single or venous blood collection with no contraindications to cell collection.
12. Consent to use a reliable and effective method of contraception for 1 year after CAR-T cell infusion (excluding the rhythm method).
13. The participant or their authorized guardian agrees to participate in the clinical trial and signs the informed consent form (ICF), indicating an understanding of the trial's purpose and procedures.
Exclusion Criteria:
1. Clinical symptoms of CNS metastasis or meningeal metastasis at screening, or other evidence suggesting that CNS metastasis or meningeal metastasis is uncontrolled, as determined by the investigator.
2. Participation in other clinical trials within 4 weeks prior to screening.
3. Receipt of a live attenuated vaccine within 4 weeks prior to screening.
4. Receipt of chemotherapy, targeted therapy, or other experimental drugs within 14 days or at least 5 half-lives (whichever is shorter) prior to screening.
5. Active or uncontrolled infection requiring systemic treatment.
6. Tumor compression of the trachea or major blood vessels, with significant risk as assessed by the investigator.
7. History of any of the following cardiac diseases:
1. New York Heart Association (NYHA) Class III or IV congestive heart failure.
2. Myocardial infarction or coronary artery bypass grafting (CABG) within 6 months prior to screening.
3. Clinically significant ventricular arrhythmias or unexplained syncope (except those caused by vasovagal or dehydration).
4. History of severe non-ischemic cardiomyopathy.
8. Active autoimmune disease or other conditions requiring long-term immunosuppressive therapy.
9. History of or concurrent untreated malignancies within 3 years, except for basal cell carcinoma or in situ cervical cancer.
10. Positive for HBsAg or HBcAb with HBV DNA levels above the normal range, HCV antibody positive with HCV RNA levels above the normal range, HIV antibody positive, or positive for syphilis.
11. Pregnant or breastfeeding women.
12. Any other condition that the investigator deems unsuitable for participation in the study.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:To evaluate the safety of CAR-T cell preparations in the treatment of CEA-positive advanced malignancies [Safety and Tolerability] · Incidence of adverse events during the study, evaluated per the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and American Society for Transplantation and Cellular Therapy (ASTCT) criteria · From infusion through Month 3;Obtained the recommended dose and infusion regimen of CAR-T cells for the treatment of patients with CEA-positive advanced malignancies [Safety and Tolerability] · Dose-limiting toxicity after CEA CAR-T cell infusion · From infusion through Month 3
次要终点:Assessing disease control(DCR) rates of CAR-T cell preparations in CEA-positive advanced malignancies [Effectiveness];Objective response rate (ORR) of CEA CAR-T treatment in patients with CEA-positive advanced malignancies [Effectiveness];Duration of Response (DOR) of CEA CAR-T treatment in patients with CEA-positive advanced malignancies [Effectiveness];Progress-free survival(PFS) of CEA CAR-T treatment in patients with CEA-positive advanced malignancies [Effectiveness];Overall survival(OS)of CEA CAR-T treatment in patients with CEA-positive advanced malignancies [Effectiveness];To evaluate the efficacy of CAR-T cell preparations in CEA-positive advanced malignancies【Effectiveness】;To characterize the in-vivo cellular kinetics of CAR-T cells【pharmacokinetics】;To characterize the in-vivo cellular kinetics of CAR-T cells【pharmacokinetics】
按2–6×10⁵个细胞/kg剂量静脉输注CEA靶向CAR-T细胞。
按2–6×10⁵个细胞/kg剂量胸腔内输注CEA靶向CAR-T细胞。
这是一项单臂、开放标签、剂量递增并扩展的临床研究,旨在评估CEA靶向CAR-T细胞制剂治疗CEA阳性晚期恶性肿瘤的安全性和疗效,初步观察其药代动力学特征,并确定推荐剂量及输注方案。
This study is a single-arm, open-label, dose-escalating + dose-expansion clinical study, aiming to evaluate the safety and efficacy of CEA-targeted CAR-T cell preparations, and to preliminarily observe the study drug in CEA-positive advanced malignant tumors. The pharmacokinetic characteristics of CAR-T cell preparations for the treatment of patients with CEA-positive advanced malignancies were obtained and the recommended dose and infusion schedule.
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