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:CAR-T for Claudin18.2 Positive Solid Tumors
这是一项早期 I 期注册临床试验,评估 Claudin18.2CAR-T 细胞治疗晚期实体瘤的安全性、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 · 成都(共 1 个中心,其中中国 1 个)。登记号:NCT07266311。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准: * 签署知情同意书(ICF)时年龄18至75岁。 * 经病理学确诊的晚期实体瘤,且患者至少接受过2线既往系统性治疗失败;或晚期胰腺癌患者至少接受过1线既往系统性治疗失败。 * 肿瘤组织检测符合要求:免疫组化(IHC)染色显示Claudin 18.2(CLDN18.2)阳性。 * 从筛选时起预计生存期≥ 12周。 * 根据实体瘤疗效评价标准(RECIST)1.1版,存在可测量肿瘤病灶。 * 筛选时、单采前24小时内及基线时,美国东部肿瘤协作组(ECOG)体能状态评分为0、1或2分。 * 具有足够的静脉通路,能够成功采集外周血单个核细胞(PBMC)。 * 筛选时和治疗前符合规定的实验室检查标准(详细参数见附录)。对于不符合标准的异常实验室检查结果,允许在1周内复测;若复测仍不符合标准,则判定该患者筛选不合格。 * 有生育能力的女性患者在筛选时和治疗前血清妊娠试验必须为阴性。她们必须同意在末次研究治疗结束后1年内采用高效可靠的避孕方法。 * 与有生育能力的女性有性生活的男性患者必须同意在研究期间及末次研究治疗结束后1年内采用屏障避孕(除非已接受输精管切除术)。 * 自愿同意参加临床试验,已充分了解研究详情,签署ICF,并愿意遵守且能够完成所有研究程序。 排除标准: * 妊娠或哺乳期女性。 * 人类免疫缺陷病毒(HIV)、梅毒螺旋体或丙型肝炎病毒(HCV)血清学阳性;或EB病毒(EBV)-DNA、巨细胞病毒(CMV)-DNA或严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸检测阳性。 * 存在任何未控制的的活动性感染,包括但不限于活动性结核病和活动性乙型肝炎病毒(HBV)感染(定义为HBsAg阳性且HBV-DNA可检测到)。 * 既往抗肿瘤治疗导致的持续性毒性未恢复至常见不良事件评价标准(CTCAE)≤ 1级,但研究者判断可耐受的事件(如脱发)除外。 * 已知有活动性自身免疫性疾病病史(包括但不限于银屑病、类风湿关节炎)或其他需要长期免疫抑制治疗的情况。 * 对免疫治疗药物或相关药物有过敏史、严重过敏史,或对CAR-T注射液任何成分过敏。 * 存在脑转移或与脑转移相关的症状。 * 存在高出血或穿孔风险的患者(例如,活动性胃溃疡、3个月内有近期胃肠道出血)。 * 需要抗凝治疗的患者。 * 需要持续抗血小板治疗的患者。 * 有器官移植史或等待器官移植的患者。 * 在单采前4周内有重大手术史或严重创伤史,或计划在研究期间进行重大手术。 * 存在其他可能限制患者参与研究的严重既往疾病(例如,严重的心脏、肝脏或肾脏功能障碍)。 * 研究者评估为无法或不愿意遵守研究方案要求。 * 存在临床显著的中枢神经系统(CNS)疾病体征或异常显著的神经系统检查结果。 * 当前诊断或过去3年内有其他不可治愈的恶性肿瘤病史,但原位宫颈癌或皮肤基底细胞癌(经适当治疗后被认为已治愈)除外。
Inclusion Criteria: * Aged 18 to 75 years at the time of signing the the informed consent form (ICF). * Pathologically confirmed advanced solid tumor and patients have failed at least 2 prior lines of systemic therapy; or patients with advanced pancreatic cancer who have failed at least 1 prior line of systemic therapy. * Tumor tissue testing meets the requirement: Positive for Claudin 18.2 (CLDN18.2) by immunohistochemistry (IHC) staining. * Estimated life expectancy ≥ 12 weeks from the time of screening. * Presence of measurable tumor lesions in accordance with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. * Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1 or 2 at screening, within 24 hours prior to apheresis, and at baseline. * Has adequate venous access to allow successful collection of peripheral blood mononuclear cells (PBMCs). * Meets the specified laboratory test criteria at screening and pre-treatment (see Appendix for detailed parameters). For abnormal laboratory results that do not meet the criteria, a retest is permitted within 1 week; if the retest still fails to meet the criteria, the patient is deemed ineligible for screening. * Female patients of childbearing potential must have a negative serum pregnancy test at screening and pre-treatment. They must agree to use a highly effective and reliable contraceptive method for 1 year after the last study treatment. * Male patients who are sexually active with women of childbearing potential must agree to use barrier contraception (unless they have undergone vasectomy) during the study and for 1 year after the last study treatment. * Voluntarily agrees to participate in the clinical trial, has been fully informed of the study details, signs the ICF, and is willing to comply with and capable of completing all study procedures. Exclusion Criteria: * Pregnant or lactating women. * Serologically positive for human immunodeficiency virus (HIV), Treponema pallidum, or hepatitis C virus (HCV); or positive for Epstein-Barr virus (EBV)-DNA, cytomegalovirus (CMV)-DNA, or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. * Presence of any uncontrolled active infection, including but not limited to active tuberculosis and active hepatitis B virus (HBV) infection (defined as HBsAg positive with detectable HBV-DNA). * Persistent toxicities from prior anti-tumor therapy that have not resolved to Common Terminology Criteria for Adverse Events (CTCAE) grade ≤ 1, except for tolerable events such as alopecia as determined by the investigator. * Known history of active autoimmune diseases (including but not limited to psoriasis, rheumatoid arthritis) or other conditions requiring long-term immunosuppressive therapy. * History of hypersensitivity to immunotherapeutic agents or related drugs, history of severe allergies, or hypersensitivity to any component of CAR-T injection. * Presence of brain metastases or symptoms related to brain metastases. * Patients at high risk of bleeding or perforation (e.g., active gastrointestinal ulcer, recent gastrointestinal bleeding within 3 months). * Patients requiring anticoagulant therapy. * Patients requiring continuous antiplatelet therapy. * History of organ transplantation or awaiting organ transplantation. * History of major surgery or significant trauma within 4 weeks prior to apheresis, or planned major surgery during the study period. * Presence of other serious pre-existing medical conditions that may limit the patient's participation in the study (e.g., severe cardiac, hepatic, or renal dysfunction). * Assessed by the investigator as unable or unwilling to comply with the study protocol requirements. * Presence of clinically significant central nervous system (CNS) disease signs or abnormally significant neurological test results. * Current diagnosis or history of other incurable malignant tumors within the past 3 years, except for in situ cervical cancer or basal cell carcinoma of the skin (which are considered cured after appropriate treatment).
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 incidence rate of CAR-T-related adverse events · up to 3 months after CAR-T injection
次要终点:objective response rate (ORR);Progression-free survival (PFS);Duration of response (DOR);Overall Survival (OS)
本临床试验的目的是了解自体claudin18.2靶向嵌合抗原受体T细胞(CAR-T)疗法能否用于治疗成人claudin18.2阳性实体瘤。同时还将了解自体claudin18.2 CAR-T细胞产品的安全性和有效性。 其主要旨在回答的问题包括: 1. 自体CAR-T细胞输注后3个月内会发生哪些CAR-T相关不良事件(AE)? 2. 客观缓解率(ORR)、无进展生存期(PFS)、缓解持续时间(DOR)和总生存期(OS)如何? 参与者将: 1. 接受白细胞分离术,以采集自体T细胞用于CAR-T细胞制备。 2. 如临床需要,可能接受连续3天的淋巴细胞清除化疗(氟达拉滨联合环磷酰胺)。 3. 如实施淋巴细胞清除化疗,则在第-2天和第-1天休息2天。 4. 在第0天接受自体CAR-T细胞输注。 5. 输注后住院至少7天以进行密切安全性监测,并在至少28天内保持在治疗机构2小时范围内。 6. 在CAR-T细胞输注后第14天、第28天到门诊就诊,之后每月一次,持续至多12个月,并继续进行长期随访以评估安全性和持续性。
The purpose of this clinical trial is to learn if autologous claudin18.2-directed chimeric antigen receptor T-cell (CAR-T) therapy works to treat claudin18.2 positive solid tumors in adults. It will also learn about the safety and efficacy of the autologous claudin18.2 CAR-T cell product. The main questions it aims to answer are: 1. What CAR-T-related adverse events (AEs) occur within 3 months after the autologous CAR-T cell infusion? 2. What is the Objective Response Rate (ORR), Progression-free survival (PFS), duration of response (DOR), and overall survival (OS)? Participants will: 1. Undergo leukapheresis for collection of autologous T cells for CAR-T cell manufacturing. 2. May receive lymphodepletion chemotherapy (fludarabine plus cyclophosphamide) for 3 consecutive days if clinically needed. 3. If lymphodepletion chemotherapy is administered, rest for 2 days on Day -2 and Day -1. 4. Receive autologous CAR-T cells infusion on Day 0. 5. Be hospitalized for at least 7 days post-infusion for close safety monitoring and remain within 2 hours of the treatment facility for at least 28 days. 6. Visit the clinic at Day 14, Day 28, then monthly for up to 12 months after CAR-T cells infusion, with continued long-term follow-up for safety and persistence.
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