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 First-in-human (FIH), Phase 1 Study of ML261, an Autologous Potency Enhanced Anti-DLL3 CAR T Cell Therapy, in Participants With R/R SCLC or Select NECs (SPECTRAL-1)
这是一项 I 期注册临床试验,评估细胞治疗用于小细胞肺癌、前列腺癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 110 例。试验地点:美国 · 圣路易斯、哈肯萨克、纽约、纳什维尔(共 6 个中心)。登记号:NCT07488923。
不限性别 · ≥ 18 Years
纳入标准 * 在签署ICF时年龄≥18岁 * 既往已针对其相应癌症适应症接受过至少一线全身性标准治疗(SOC)抗癌治疗。适合根治性切除的局部晚期疾病受试者将被排除。 * 在最近一线抗癌治疗期间或之后,有记录的影像学疾病进展/复发,且影像学评估显示存在可测量病灶,依据RECIST v1.1评估 * 经组织学和/或细胞学确诊为以下一种选定晚期或转移性R/R实体瘤恶性肿瘤:R/R SCLC、R/R GEP-NEC、R/R高级别NEPC、R/R epNEC,且经当地或中心评估,存档组织或新鲜活检记录有DLL3表达。CNS NEC被排除。对于上述任何适应症,如果小细胞/神经内分泌肿瘤细胞百分比> 50%,则混合组织学受试者符合资格,但高级别NEPC除外,其神经内分泌成分必须> 20%。 * 美国东部肿瘤协作组(ECOG)体能状态评分(PS)为0或1 * 预期寿命≥12周 * 具有足够的血液学和终末器官功能 排除标准: * 在方案规定的时间范围内接受过既往全身性抗癌治疗。 * 既往接受过DLL3靶向CAR T治疗或任何其他基因工程过继性T细胞治疗。 * 既往接受过同种异体器官移植(包括同种异体骨髓移植)。 * 在任何研究药物首次给药前4周内接受过大手术,或预期在研究过程中需要接受大手术。 * 受试者存在(因既往抗癌治疗导致的)毒性,且未恢复至基线或CTCAE v5.0 <2级,但被认为不太可能构成安全性风险的不良事件(AE)除外:(例如,脱发、神经病变、无临床相关意义的实验室异常)。 * 需要间歇性引流的症状性腹水或积液(胸腔或心包)。 * 已知有其他活动性恶性肿瘤病史,但以下情况除外:完全切除的原位宫颈上皮内瘤变、非黑色素瘤皮肤癌、导管原位癌、已充分治疗的早期前列腺癌,以及受试者已无病生存3年或更长时间的其他癌症,或不需要治疗且经研究者与医学监查员讨论后认为不太可能影响患者预期寿命。 * 符合以下一项或多项心脏标准:不稳定型心绞痛、筛选前6个月内发生心肌梗死、纽约心脏病协会III至IV级心力衰竭、静息ECG节律、传导或形态学存在临床重要异常(例如,完全性左束支传导阻滞或三度心脏传导阻滞) * 急性静脉血栓栓塞症(VTE)。无血流动力学障碍的VTE,接受稳定剂量抗凝治疗者允许入组。 * 存在具有临床意义的中枢神经系统病变: * 癫痫发作性疾病、失语症、卒中、严重脑损伤、痴呆、帕金森病或小脑疾病。有上述疾病史者需与医学监查员讨论。 * 存在临床活动性精神病。 * 已知脑转移,除非无症状且在任何研究药物首次给药前至少2周内不需要类固醇治疗。 * 活动性系统性自身免疫性疾病或任何其他需要或预计需要全身性类固醇或其他全身性免疫抑制剂治疗的情况,或在白细胞分离术和ML261给药前4周内接受过此类药物的受试者(更多详情见方案正文)。 * 有间质性肺病(如特发性肺纤维化)证据或任何病因的活动性肺炎需要治疗。 * 在白细胞分离术前14天内有任何需要全身治疗的细菌、病毒、真菌或未知病因的活动性感染(定义为症状、体征或影像学)。有临床和/或实验室证据表明存在持续性感染的受试者将排除。 * 研究者或申办方认为,存在会干扰受试者参与或影响研究目标的不受控制的医学、心理/精神或社会状况。
Inclusion Criteria * ≥18 years of age at the time of signing the ICF * Have been previously treated with at least one line of systemic standard of care (SOC) anti-cancer therapy for their respective cancer indication. Participants with locally advanced disease who are eligible for curative resection will be excluded. * Have documented radiological disease progression/relapse during or after their most recent line of anti-cancer therapy with measurable disease on imaging, as assessed by RECIST v1.1 * Have histologically and/or cytologically confirmed diagnosis of select advanced or metastatic R/R solid tumor malignancy in one of the following: R/R SCLC, R/R GEP-NEC, R/R high-grade NEPC, R/R epNEC with biopsy-documented DLL3 expression on archival tissue or fresh biopsy by local or central assessment. CNS NEC is excluded. Participants with mixed histologies for any of these indications qualify if the small cell/neuroendocrine tumor cell percentage is \> 50%, except for high-grade NEPC where neuroendocrine component must be \> 20%. * Eastern Cooperative Oncology Group (ECOG) Performance Score (PS) 0 or 1 * Life expectancy ≥12 weeks * Have adequate hematologic and end-organ function Exclusion Criteria: * Previous systemic anti-cancer therapies within the timeframes, as specified in the protocol. * Prior exposure/treatment with DLL3-targeted CAR T therapy or any other genetically engineered adoptive T cell therapy. * Prior allogeneic organ transplant (including allogeneic bone marrow transplant). * Major surgical procedure within 4 weeks of the first dose of any study drug administration or anticipated to be in need of a major surgical procedure during the course of study. * Participants with toxicities (as a result of prior anti-cancer therapy) which have not recovered to baseline or CTCAE v5.0 \<Grade 2, except for adverse events (AEs) not considered a likely safety risk: (e.g., alopecia, neuropathy, non-clinically relevant laboratory abnormalities). * Symptomatic ascites or effusions (pleural or pericardial) requiring intermittent drainage. * History of any other malignancy known to be active, with the exception of completely removed in situ cervical intra-epithelial neoplasia, non-melanoma skin cancer, ductal carcinoma in situ, early-stage prostate cancer that has been adequately treated, and other cancers from which the participant has been disease free for 3 years or longer or does not require treatment and in the opinion of investigator after discussion with the medical monitor are not likely to impact the patient's life expectancy. * One or more of the following cardiac criteria: Unstable angina, Myocardial infarction within 6 months prior to Screening, New York Heart Association Class III to IV heart failure, clinically important abnormalities in rhythm, conduction, or morphology of resting ECG (e.g., complete left bundle branch block or third-degree heart block) * Acute venous thromboembolism (VTE). VTEs without hemodynamic compromise, treated with stable doses of anticoagulants are allowed. * Presence of clinically significant CNS pathology: * seizure disorder, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, or cerebellar disease. History of these disorders requires discussion with the medical monitor. * Presence of clinically active psychosis. * Known brain metastases unless asymptomatic and not requiring steroids for at least 2 weeks prior to the first dose of any study drug administration. * Active systemic autoimmune disease or any other condition that requires, or is anticipated to require, systemic treatment with steroids or other systemic immunosuppressive agents, or participants who have received such agents within 4 weeks of leukapheresis and ML261 administration (further details provided in protocol body). * Evidence of interstitial lung disease (such as idiopathic pulmonary fibrosis) or active pneumonitis of any etiology requiring treatment. * Any active infection (defined as symptoms, signs, or radiographic) of bacterial, viral, or fungal or unknown etiology requiring systemic therapy within 14 days of leukapheresis. Participants with clinical and/or laboratory evidence of persistent infection will be excluded. * Uncontrolled medical, psychological/psychiatric, or social condition that would interfere with the participant's participation or compromise the objectives of the study in the opinion of the Investigator and/or the Sponsor.
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:Incidence of dose-limiting toxicities (DLTs) listed during the DLT observation period · Graded according to Common Terminology Criteria for Adverse Events (CTCAE) or American Society for Transplantation and Cell Therapy (ASTCT) criteria · 28 days
次要终点:Incidence of treatment-emergent AEs (TEAEs), Grade ≥3 TEAEs, serious AEs (SAEs), and AEs of special interest (AESIs). Clinically significant laboratory abnormalities / changes from baseline in safety laboratory test results;Characterize the molecular pharmacokinetic (PK) profile of ML261 after dosing;Evaluate the preliminary efficacy of ML261 after dosing
靶向DLL3的嵌合抗原受体T细胞(CAR T)
这是一项首次人体(FIH)、开放标签、1期研究,旨在评估ML261(一种自体效力增强的抗DLL3 CAR T细胞疗法)在R/R SCLC或特定NEC受试者中的安全性、药代动力学(PK)和初步疗效。
This is a first-in-human (FIH), open-label, Phase 1 study designed to evaluate the safety, pharmacokinetics (PK), and preliminary efficacy of ML261, an autologous potency enhanced anti-DLL3 CAR T cell therapy, in participants with R/R SCLC or select NECs
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