单细胞追踪揭示黑色素瘤 TIL 治疗过程中肿瘤反应性 T 细胞的可塑性
Single-cell tracking reveals tumor-reactive T cell plasticity during melanoma TIL therapy.
TIL(肿瘤浸润淋巴细胞)过继细胞治疗可在转移性黑色素瘤中诱导持久缓解,然而在体外扩增过程中及回输后,调控肿瘤反应性T细胞命运的克隆和转录动态仍知之甚少。
英文原题:Safety and Efficacy of Metabolically Armed Tumor-Infiltrating Lymphocytes (Meta10-TIL) for the Treatment of Advanced Solid Tumors
这是一项早期 I 期注册临床试验,评估TIL(肿瘤浸润淋巴细胞)治疗晚期实体瘤的安全性、可行性及初步疗效。当前状态:招募中。计划入组 36 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT07349160。
不限性别 · ≥ 19 Years 且 ≤ 70 Years
纳入标准: • 患者或监护人自愿签署知情同意书。 • 年龄>18岁且≤70岁,男女不限。 • 组织病理学或细胞学确诊晚期实体瘤;既往标准治疗因疾病进展或毒性不耐受而失败,目前无标准治疗选择,或因其他原因无法耐受现行标准治疗。 • 有适合切除(≥1.5 cm)或活检取材的残余病灶,用于制备肿瘤浸润淋巴细胞(TIL)。粗针活检须使用16G针至少取4针,或18G针至少取6针。宫颈癌患者肿瘤组织直径≥0.5 cm或体积≥400 mm³亦可。建议优先从近端转移淋巴结或肿瘤病灶边缘采集新鲜组织。取样病灶未接受局部治疗(如放疗、射频消融、溶瘤病毒等),或局部治疗已完成≥3个月且治疗后病灶进展。 • 预期生存期≥3个月。肿瘤切除/穿刺后,至少仍有1个符合RECIST 1.1的可测量病灶用于疗效评估。 • ECOG体能状态0–1;稳定脑转移者由研究者评估。 • 器官功能充分:单采/采血前24小时内评估血液学指标;入组前7天内未输血、输注血小板或使用生长因子(重组促红细胞生成素除外):ANC≥1×10⁹/L、血小板≥80×10⁹/L、血红蛋白≥90 g/L。按Cockcroft-Gault公式估算肌酐清除率≥40 mL/min;ALT及AST≤3×ULN(肝转移者可≤5×ULN);总胆红素≤2 mg/dL,Gilbert-Meulengracht综合征患者≤3 mg/dL。肺储备充分:呼吸困难≤1级,室内空气血氧饱和度>91%。超声心动图或MUGA示LVEF≥45%,血流动力学稳定。 • 研究者判断既往抗癌治疗毒性已恢复至≤1级,且适合接受淋巴清除预处理化疗和TIL治疗;研究者认为短期内不可逆的特定≤2级毒性(如脱发)除外。 • 既往免疫检查点抑制剂治疗导致≥2级腹泻或结肠炎者,肿瘤切除前须无症状≥6个月,且免疫治疗后结肠镜(肉眼评估)正常;结直肠癌患者除外。 • 免疫相关内分泌疾病(如甲状腺功能减退)患者,若病情稳定≥6周并通过非糖皮质激素类激素替代治疗控制,可入组。 • 有生育能力女性及所有男性受试者同意自签署知情同意起至Meta10-TIL输注后1年采用高效避孕方法。 排除标准: • 活动性中枢神经系统转移;稳定脑转移且≥3个月无需药物治疗或糖皮质激素者除外。 • 预处理前1周内使用具有抗肿瘤适应证的中草药或植物药。 • 预处理前2周内接受全身糖皮质激素(泼尼松≥10 mg/日或等效剂量)或其他免疫抑制剂;吸入、局部或生理替代治疗除外。 • 入组前4周内接受重大手术,或研究期间计划接受重大手术;Meta10-TIL制备所需的计划手术除外。重大手术按中国《医疗技术临床应用管理办法》(2009年5月1日起施行)定义为3级或4级手术,是否构成重大手术由研究者评估。 • 筛选前3年内有其他恶性肿瘤史或同时患有其他恶性肿瘤;局部治疗后复发风险≥1年的恶性肿瘤(如非黑色素瘤皮肤癌、膀胱癌)除外。 • 原发性免疫缺陷(如重症联合免疫缺陷或获得性免疫缺陷综合征);器官移植史。 • 活动性乙肝(HBsAg阳性,或抗HBc阳性且HBV DNA>1,000 copies/mL)或丙肝(HCV RNA阳性);抗HIV抗体或抗梅毒抗体阳性。 • 未控制的急性危及生命的细菌、病毒或真菌感染(如Meta10-TIL输注前≤72小时血培养阳性)。 • 预处理前4周内接种活疫苗或减毒疫苗。 • 签署知情同意前6个月内不稳定型心绞痛和/或心肌梗死;前12个月内未控制的血栓事件、严重出血或深静脉血栓。 • 神经系统或精神疾病史,包括癫痫或痴呆。 • 对药物过敏史(如环磷酰胺、氟达拉滨、IL-2、Meta10-TIL成分、庆大霉素等)。 • 研究者评估出血风险高,包括但不限于肿瘤包绕/浸润大血管(如颈动脉、颈静脉、支气管动脉);其他高风险特征(如瘘管、空洞性病灶或既往≤60天内出血)。 • 签署知情同意前30天内接受其他研究性治疗。 • 研究者认为不适合参加的其他情况,如既往免疫治疗相关≥3级不良事件。
Inclusion Criteria:
* The patient or his/her guardian voluntarily signed the informed consent;
* Age \>18 years and ≤70 years, male or female;
* Patients with advanced solid tumors who have been confirmed by histopathology or cytology:
Patients with advanced solid tumors who have failed prior standard treatments (due to disease progression or intolerance to toxicity), currently have no standard treatment options, or are unable to tolerate the current standard treatment for other reasons;
* The subject has residual lesions suitable for surgical resection (≥1.5 cm) or biopsy (core needle biopsy specimens: ≥4 passes with 16G needle or ≥6 passes with 18G needle) to generate tumor-infiltrating lymphocytes (TILs). For cervical cancer subjects, tumor tissue meeting either ≥0.5 cm in diameter or ≥400 mm³ in volume is acceptable. Fresh tumor tissue for TIL production should preferably be obtained from proximal metastatic lymph nodes or the periphery of tumor lesions. The sampled lesion has not received local therapy (e.g., radiotherapy, radiofrequency ablation, oncolytic virus, etc.) or such interventions have occurred ≥3 months prior and the lesion has progressed after local treatment;
* Expected life expectancy ≥3 months;
* After tumor resection/puncture, the subject must have at least one measurable lesion according to Response Evaluation Criteria in Solid Tumors (RECIST v1.1) for efficacy evaluation;
* Eastern Cooperative Oncology Group (ECOG) performance status was 0-1 (subjects with stable brain metastases require investigator assessment);
* Adequate organ function:
1. Hematological (must meet the following criteria within 24 hours before apheresis/blood collection; no transfusions, platelet infusions, or growth factor support \[except recombinant erythropoietin\] within 7 days prior to enrollment):
1. Absolute neutrophil count (ANC) ≥1 × 10⁹/L;
2. Platelet count (PLT) ≥80 × 10⁹/L;
3. Hemoglobin (Hb) ≥90.0 g/L;
2. Blood chemistry:
1. Estimated creatinine clearance ≥40 mL/min (calculated by Cockcroft-Gault formula);
2. Alanine aminotransferase (ALT) ≤3 × upper limit of normal (ULN);
3. Aspartate aminotransferase (AST) ≤3 × ULN;
4. Total bilirubin (TBIL) ≤2 mg/dL (subjects with Gilbert-Meulengracht syndrome ≤3 mg/dL);
3. Serum AST and ALT ≤5 × ULN (subjects with liver metastasis);
4. Adequate pulmonary reserve defined as ≤Grade 1 dyspnea and oxygen saturation \>91% on room air;
5. Left ventricular ejection fraction (LVEF) ≥45% by echocardiography or multigated acquisition (MUGA) scan, with hemodynamic stability;
* In the investigator's judgment, the subject must have recovered from prior anticancer therapy toxicities to Grade 1 or lower (except for specific Grade 2 or lower toxicities deemed irreversible in a short period of time as judged by the investigator, e.g., alopecia) and be eligible for preconditioning chemotherapy and TIL therapy;
* Subjects with documented ≥Grade 2 diarrhea or colitis from prior immune checkpoint inhibitor therapy must be asymptomatic for ≥6 months before tumor resection, with normal colonoscopy (visual assessment) post-immunotherapy (excluding colorectal cancer patients);
* Subjects with immune-related endocrinopathies (e.g., hypothyroidism) may enroll if stable for ≥6 weeks and controlled with hormone replacement therapy (non-corticosteroid);
* Women of childbearing potential and all male subjects must agree to use highly effective methods of contraception at the time of informed consent, and continue within 1 year after Meta10-TILs infusion.
Exclusion Criteria:
* Active central nervous system (CNS) metastases (except for stable brain metastases not requiring medication or steroid dependence for ≥3 months).
* Use of Chinese herbal medicine or botanical drugs with antitumor indications within 1 week before preconditioning.
* Systemic corticosteroid therapy (≥10 mg/day prednisone or equivalent) or other immunosuppressive drugs within 2 weeks before preconditioning (excluding inhaled, topical, or physiological replacement therapy).
* Subjects who have undergone major surgery within 4 weeks before enrollment (as assessed by the investigator) or planned major surgery during the study (excluding scheduled surgery for Meta10-TILs preparation);Major surgery refers to Grade 3 \& 4 surgeries as defined by China's Administrative Measures for Clinical Application of Medical Technology (effective on May 1, 2009).
* History of other malignancies within 3 years before screening or concurrent malignancies (except for locally treated malignancies with no recurrence risk for ≥1 year, e.g., non-melanoma skin cancer, bladder cancer).
* Any form of primary immunodeficiency disorder (e.g., severe combined immunodeficiency \[SCID\] or acquired immunodeficiency syndrome \[AIDS\]).
* History of organ transplantation.
* Active hepatitis B (HBsAg positive or anti-HBc positive with HBV-DNA \>1000 copies/mL) or hepatitis C (HCV-RNA positive).
* Anti-HIV antibody positive or anti-syphilis antibody positive.
* Uncontrolled acute life-threatening bacterial, viral, or fungal infections (e.g., positive blood culture ≤72 hours before Meta10-TILs infusion).
* Patients who have received a live or attenuated vaccination within 4 weeks before preconditioning.
* Unstable angina and/or myocardial infarction within 6 months before signing informed consent;Uncontrolled thrombotic events, severe bleeding, or deep vein thrombosis (DVT) within 12 months before signing informed consent.
* History of neurological or psychiatric disorders, including epilepsy or dementia.
* History of hypersensitivity to drugs (e.g., cyclophosphamide, fludarabine, IL-2, Meta10-TILs components, gentamicin, etc.).
* High bleeding risk per investigator assessment, including but not limited to: tumor encasement/infiltration of major blood vessels (e.g., carotid artery, jugular vein, bronchial artery);other high-risk features (e.g., fistula, cavitary lesions, history of previous bleeding \[≤60 days\]).
* Patients who have received other investigational therapies within 30 days before signing informed consent.
* Other conditions deemed ineligible for the study by the investigator (e.g., Grade ≥3 adverse events in previous immunotherapy).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:Adverse Events (AEs) · To characterize the safety profile of Meta10-TIL in patients with advanced solid tumor as assessed by incidence of adverse events. Adverse events will be graded by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0. · 1 year post Meta10-TIL infusion.
次要终点:Objective response rate (ORR);Duration of Response (DOR);Overall survival (OS);Progression-free survival (PFS)
输注TIL细胞前,患者接受环磷酰胺和氟达拉滨非清髓性淋巴清除化疗。第0天输注Meta10-TIL细胞。
本研究评估代谢增强型肿瘤浸润淋巴细胞(Meta10-TIL)治疗晚期实体瘤患者的安全性和疗效。
A Study of Metabolically Armed Tumor-Infiltrating Lymphocytes (Meta10-TIL) Therapy for Patients With Advanced Solid Tumors
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