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:The Safety and Efficacy of Allogeneic CD70 CAR-T Therapy in Unresectable or Metastatic Clear Cell Renal Cell Carcinoma
这是一项早期 I 期注册临床试验,评估 CAR-T 细胞治疗肾细胞癌的安全性、可行性及初步疗效。当前状态:招募中。计划入组 30 例。试验地点:中国 · 北京(共 3 个中心,其中中国 3 个)。登记号:NCT07645690。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
主要纳入标准: 1. 年龄18至75岁(含),性别不限。 2. 经组织病理学和/或细胞学确诊为不可切除或转移性透明细胞肾细胞癌。 3. 至少接受过二线治疗(包括至少一种免疫检查点抑制剂[ICI]和至少一种血管内皮生长因子酪氨酸激酶抑制剂[VEGF TKI])后出现局部进展或转移。 4. 愿意接受肿瘤组织采样,或提供既往肿瘤组织样本以检测CD70表达水平。 5. 肿瘤组织免疫组化(IHC)显示CD70表达阳性(阳性细胞比例≥10%)。 6. 根据RECIST v1.1标准至少有一个可测量病灶。 7. Karnofsky体能状态(KPS)评分≥70%。 8. 器官功能须符合以下标准: 1. 血常规(血液检查前1周内未使用G-CSF,或前2周内未使用聚乙二醇化G-CSF):中性粒细胞绝对计数(ANC)≥1.0×10⁹/L;血小板(PLT)≥100×10⁹/L;血红蛋白≥80 g/L(淋巴瘤骨髓浸润所致骨髓抑制除外)。 2. 凝血功能:国际标准化比值(INR)≤正常值上限(ULN)的1.5倍,活化部分凝血活酶时间(APTT)≤ULN的1.5倍。 3. 肝功能:血清天冬氨酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)≤ULN的3倍;如有肝转移,则AST和ALT≤ULN的5倍;总胆红素≤ULN的1.5倍。 4. 肾功能:血清肌酐≤ULN的1.5倍,或按Cockcroft-Gault公式计算的肌酐清除率≥60 mL/min。 5. 心功能:超声心动图(ECHO)左心室射血分数(LVEF)≥50%,无心包积液;12导联心电图(ECG)无具有临床意义的异常。 6. 肺功能:未吸氧、室内空气下末梢血氧饱和度≥92%;无具有临床意义的胸腔积液。 9. 有生育能力的受试者及/或其伴侣同意在整个治疗期间和治疗后52周采取有效避孕措施,并且在此期间不捐献用于辅助生殖的卵子/精子。有生育能力的女性(已接受绝育手术或绝经≥12个月者不视为有生育能力)筛选时妊娠试验须为阴性,并同意在整个研究期间有效避孕。 10. 愿意遵守所有研究程序,自愿参加研究并签署知情同意书(ICF)。 主要排除标准: 1. 预计生存期<3个月。 2. 既往或当前存在活动性恶性肿瘤,但已治愈或至少3年无复发的宫颈原位癌、非浸润性皮肤基底细胞癌或鳞状细胞癌、已接受根治性治疗的局部晚期前列腺癌,或根治性手术后的乳腺导管原位癌除外。 3. 既往接受过CD70靶向治疗。 4. 既往接受过CAR-T或任何其他基因工程细胞治疗。 5. 有中枢神经系统(CNS)疾病史或有临床意义的CNS功能障碍,如脑缺血/出血、痴呆、小脑疾病、癫痫、失语等。 6. 有重大器官移植(如心、肺、肾、肝)或造血干细胞/骨髓移植史。 7. 筛选前12个月内发生过心肌梗死、心脏血管成形术或支架植入、不稳定型心绞痛,或其他具有临床意义的心脏疾病。 8. 存在CNS转移或CNS转移症状。 9. 既往治疗毒性尚未恢复至CTCAE≤1级;无安全风险的不良事件(如脱发)除外。 10. 计划接受ET-970输注前,既往抗肿瘤治疗的洗脱时间尚未达到5个半衰期。 11. 存在未控制的活动性细菌、真菌或病毒感染,或研究者认为不适合参加研究的其他感染。 12. HIV抗体阳性、梅毒螺旋体抗体阳性、乙型肝炎表面抗原(HBsAg)阳性,或乙型肝炎核心抗体(HBcAb)阳性且外周血可检出HBV DNA,或丙型肝炎病毒(HCV)抗体阳性且可检出HCV RNA;研究者判断可通过药物预防或控制的感染除外。 13. 有需要免疫抑制治疗的其他自身免疫性疾病史。 14. 已知对研究药物或其任何成分严重过敏。 15. 妊娠或哺乳期女性。 16. 淋巴清除预处理前6周内使用过任何针对感染性疾病的活疫苗。 17. 签署ICF前3个月内参加过其他干预性临床研究并接受过活性研究药物;或计划在整个研究期间参加其他临床试验,或在方案外接受自身免疫性疾病治疗。 18. 患有伴抑郁或自杀倾向的精神障碍。 19. 存在任何可能影响研究药物安全性和疗效评价的其他疾病。 20. 研究者认为患者不适合参加研究的其他因素。
Key Inclusion Criteria: 1.Age 18-75 years (inclusive), any gender. 2.Confirmed by histopathology and/or cytology as unresectable or metastatic clear cell renal cell carcinoma; 3.Local progression or metastasis after receiving at least second line therapy \[including at least one immune checkpoint inhibitor (ICI) and at least one vascular endothelial growth factor tyrosine kinase inhibitor (VEGF TKI)\]; 4.Willing to undergo tumor tissue sample collection or provide previous tumor tissue samples for CD70 expression level testing; 5.Positive CD70 expression by immunohistochemical (IHC) staining of tumor tissue (percentage of positive cells ≥ 10%); 6.At least one measurable lesion according to RECIST v1.1 criteria. 7.Karnofsky Performance Status (KPS) ≥ 70%. 8.Organ function must meet the following criteria: 1. Complete blood count (no G-CSF within 1 week prior to blood count testing. or no pegylated G-CSF within 2 weeks prior to blood count testing): Absolute neutrophil count (ANC) ≥ 1.0×10⁹/L. platelet count (PLT) ≥ 100×10⁹/L. hemoglobin ≥ 80 g/L (excluding bone marrow suppression caused by lymphoma involvement of the bone marrow). 2. Coagulation function: International normalized ratio (INR) ≤ 1.5×ULN, and activated partial thromboplastin time (APTT) ≤ 1.5×ULN. 3. Liver function: Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3×ULN (if with liver metastasis, AST and ALT ≤ 5×ULN). total bilirubin ≤ 1.5×ULN. 4. Renal function: Serum creatinine ≤ 1.5×ULN or creatinine clearance (Cockcroft-Gault formula) ≥ 60 mL/min. 5. Cardiac function: Left ventricular ejection fraction (LVEF) on echocardiography (ECHO) ≥ 50%, no pericardial effusion. no clinically significant abnormalities on 12-lead electrocardiogram (ECG). 6. Pulmonary function: End-blood oxygen saturation ≥ 92% while breathing room air without supplemental oxygen. no clinically significant pleural effusion. 9.Subjects and/or their partners of childbearing potential agree to use effective contraceptive measures throughout the entire treatment period and for 52 weeks after treatment, and during this period they must not donate eggs/sperm for assisted reproduction; Female participants of childbearing potential (women who have undergone sterilization surgery or have been postmenopausal for ≥12 months are not considered to have childbearing potential) must present a negative pregnancy test at screening and agree to use effective contraception throughout the study period. 10.Willing to comply with all study procedures and voluntarily participate in this study and sign the informed consent form (ICF). Key Exclusion Criteria: 1. Expected survival \< 3 months. 2. Prior or concurrent active malignancy, with the exception of cured or recurrence-free for at least 3 years of cervical carcinoma in situ, non-invasive basal cell or squamous cell skin cancer, or locally advanced prostate cancer that has received curative treatment, or ductal carcinoma in situ after radical surgery. 3. Prior use of CD70-targeted therapy. 4. Previous treatment with CAR-T or any other genetically engineered cell therapy. 5. History of central nervous system (CNS) disease or clinically significant CNS dysfunction, such as cerebral ischemia/hemorrhage, dementia, cerebellar disease, epilepsy, aphasia, dementia, etc. 6. History of major organ transplantation (e.g., heart, lung, kidney, liver) or hematopoietic stem cell/bone marrow transplantation. 7. Occurrence of myocardial infarction, cardiac angioplasty or stent implantation, unstable angina, or other clinically significant cardiac diseases within 12 months prior to screening. 8. Presence of CNS metastasis or symptoms of CNS metastasis. 9. Toxicities from prior therapy have not recovered to CTCAE grade ≤ 1, except for adverse events without safety risks (e.g., alopecia). 10. The anti-tumor therapy received is still within 5 half-lives prior to the planned ET-970 infusion. 11. Presence of uncontrolled active bacterial, fungal, or viral infections, or other infections deemed by the investigator as unsuitable for study participation. 12. Positive for human immunodeficiency virus (HIV) antibody, positive for Treponema pallidum antibody, positive for hepatitis B surface antigen (HBsAg) or positive for hepatitis B core antibody (HBcAb) with detectable peripheral blood HBV DNA, positive for hepatitis C virus (HCV) antibody with detectable HCV RNA; except for infections that can be prevented or controlled with medication as judged by the investigator. 13. History of other autoimmune diseases requiring immunosuppressive therapy. 14. Known severe allergy to the study drug or any of its components. 15. Pregnant or breastfeeding women. 16. Use of any live vaccines against infectious disease within 6 weeks before lymphodepletion conditioning. 17. Participation in another interventional clinical study and receipt of an active investigational drug within 3 months prior to signing the ICF, or intention to participate in another clinical trial or receive treatment for autoimmune diseases outside the protocol during the entire study period. 18. Psychiatric disorders with depression or suicidal tendencies. 19. Presence of any other medical condition that may affect the evaluation of the safety and efficacy of the study drug. 20. Other factors due to which the patient is deemed unsuitable for participation by the investigator.
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:Dose limited toxicity (DLT) · DLT is defined as any of the following adverse events (AEs) related to ET-970 occurring within 28 days after ET-970 infusion (CRS and ICANS will be graded according to the ASTCT 2019 criteria, and other AEs will be evaluated using CTCAE v6.0) · Within 28 days post-infusion;Incidence and severity of AEs and serious adverse events (SAEs) · AEs refer to any adverse medical events occurring in subjects from the initiation of ET-970 administration during clinical trials. SAEs denote events involving death, life-threatening conditions, significant disability/incapacity, hospitalization or prolonged hospitalization arising after ET-970 administration in subjects. · Within 52 weeks post-infusion;Incidence and severity of AESIs · AESI including grade ≥3 Cytokine Release Syndrome (CRS), Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), and GvHD. · Within 52 weeks post-infusion
次要终点:Disease control rate (DCR);Objective Response Rate (ORR);Duration of Response (DOR);Progression-Free Survival (PFS);Overall Survival (OS);CAR-positive T cells;CAR gene copy number;Number of CD70 positive cells
通过静脉输注给药。
CLEAR CAR-T细胞注射液(ET-970)是一种经过工程化改造、靶向CD70的异基因嵌合抗原受体T细胞(CAR-T)产品。本研究是一项多中心、单臂、开放标签的早期探索性临床研究,旨在评估ET-970用于不可切除或转移性透明细胞肾细胞癌患者时的安全性和初步疗效。
CLEAR CAR-T cell injection (ET-970) is an engineered CD70-targeting allogeneic Chimeric Antigen Receptor T-Cell (CAR-T cell). This is a multi-center, single-arm, open-label, early exploratory clinical study. The objective of this study is to evaluate the safety and preliminary efficacy of ET-970 in unresectable or metastatic clear cell renal cell carcinoma.
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