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:CIB In Vivo CAR-T Lentiviral Injection in Patients With Advanced Malignant Tumors
这是一项 I 期注册临床试验,评估体内 CAR-T 细胞治疗实体瘤的安全性、可行性及初步疗效。当前状态:尚未开始招募。计划入组 91 例。试验地点:中国 · 北京(共 1 个中心,其中中国 1 个)。登记号:NCT07657585。
不限性别 · ≥ 18 Years 且 ≤ 75 Years
纳入标准:年龄18–75岁;筛查时按RECIST 1.1至少有1个可测量靶病灶;组织学或细胞学确诊晚期/转移性恶性肿瘤,且经验证方法确认靶抗原表达阳性;既往标准全身治疗(包括但不限于VEGF靶向酪氨酸激酶抑制剂和/或免疫检查点抑制剂)失败或不耐受;ECOG 0–1;研究者评估预计生存期≥3个月。基线器官功能充分,且筛查前14天内未使用生长因子或输血支持:骨髓功能ANC≥1.5×10⁹/L、血红蛋白≥90 g/L、血小板≥75×10⁹/L;肝功能ALT/AST≤2.5×ULN(肝转移者≤5×ULN),总胆红素≤1.5×ULN;肾功能血清肌酐≤ULN或肌酐清除率≥80 mL/min。有生育能力女性入组前7天内血清β-HCG阴性;同意自签署知情同意至研究结束后至少90天有效避孕;自愿签署知情同意并能理解、遵守方案要求。 排除标准:无症状且未治疗的脑转移;有症状CNS转移或癌性脑膜炎;或研究者认为不适合入组的未控制CNS/脑膜转移证据。基线有可能增加风险或影响安全性评估的临床显著心血管、肺部、神经系统或全身性疾病。严重慢性/活动性感染,包括活动性乙肝(HBsAg阳性且HBV DNA>ULN)、活动性丙肝(抗HCV阳性且HCV RNA可检出)、HIV病史或检测阳性,或首次给药前4周内需全身抗感染治疗(包括感染住院、菌血症、重症肺炎或活动性结核)。活动性自身免疫病(如SLE、类风湿关节炎、血管炎),或首次给药前4周内长期使用全身糖皮质激素(泼尼松>10 mg/日或等效剂量)或其他免疫抑制剂。既往异基因组织/实体器官移植;严重免疫缺陷(如SCID)或并发机会性感染;既往使用慢病毒或逆转录病毒载体进行基因治疗;既往接受靶向相同抗原的药物;需要且无法在给药前停用治疗性抗凝。严重心血管疾病史,包括NYHA≥II级心衰、LVEF<50%、QTcF>470 ms或长QT综合征、首次给药前6个月内急性冠脉综合征/主动脉夹层/严重心律失常/卒中或其他≥3级心血管事件、未控制高血压。抗肿瘤治疗洗脱期不足:首次给药前4周或5个半衰期内(取较长者)接受化疗、放疗、生物治疗、内分泌或免疫治疗;2周或5个半衰期内(取较长者)口服小分子靶向药;14天内姑息放疗;4周内参加其他抗肿瘤临床试验;2周内使用任何抗肿瘤中药。妊娠、哺乳或有生育能力女性拒绝研究期间有效避孕;以及研究者认为不适合参加的其他疾病或实验室异常。
Inclusion Criteria:
1. Age ≥ 18 years and ≤ 75 years.
2. At least one measurable target lesion according to RECIST version 1.1 at screening.
3. Histologically or cytologically confirmed advanced or metastatic malignant tumor, with positive target expression confirmed by validated assay methods.
4. Patients who have failed prior standard systemic therapy (including but not limited to VEGF-targeted tyrosine kinase inhibitors and/or immune checkpoint inhibitors), or are intolerant to standard therapy.
5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
6. Expected survival time ≥ 3 months as assessed by the investigator.
7. Adequate organ function at baseline (no growth factor support or transfusion within 14 days prior to screening):
a. Bone marrow function: i. Absolute neutrophil count (ANC) ≥ 1.5 × 10⁹/L; ii. Hemoglobin (Hb) ≥ 90 g/L; iii. Platelet count (PLT) ≥ 75 × 10⁹/L. b. Liver function: Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 2.5 × upper limit of normal (ULN); if liver metastases are present, ALT and AST ≤ 5 × ULN; total bilirubin (TBIL) ≤ 1.5 × ULN.
c. Renal function: Serum creatinine ≤ ULN or creatinine clearance rate ≥ 80 mL/min.
8. For female patients of childbearing potential, serum β-HCG test result must be negative within 7 days prior to enrollment.
9. Patients must agree to use effective contraception from the signing of the informed consent form (ICF) until at least 90 days after the end of the study.
10. Voluntarily sign the informed consent form (ICF) and be able to understand and comply with the requirements of the study protocol.
Exclusion Criteria:
1. Asymptomatic untreated brain metastases; symptomatic central nervous system (CNS) metastases or carcinomatous meningitis; or other evidence of uncontrolled CNS/meningeal metastases that are considered unsuitable for enrollment by the investigator.
2. Presence of clinically significant cardiovascular, pulmonary, neurological, or systemic disease at baseline that may increase study participation risk or interfere with safety assessments.
3. Presence of severe chronic or active infection at baseline, including:
1. Active hepatitis B (HBsAg positive with HBV DNA \> ULN);
2. Active hepatitis C (anti-HCV positive with detectable HCV RNA);
3. Known history of or positive test for human immunodeficiency virus (HIV);
4. Systemic anti-infective therapy required within 4 weeks prior to first administration, including hospitalization for infectious complications, bacteremia, severe pneumonia, or active tuberculosis.
4. History of active autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis, vasculitis) or receipt of long-term systemic corticosteroids (prednisone \> 10 mg/day or equivalent) or other immunosuppressive agents within 4 weeks prior to first administration.
5. Prior allogeneic tissue or solid organ transplantation.
6. Evidence of severe immunodeficiency, such as primary immunodeficiency (e.g., severe combined immunodeficiency, SCID) or concurrent opportunistic infections.
7. Prior gene therapy using lentiviral or retroviral vectors.
8. Prior treatment with drugs targeting the same antigen.
9. Requiring therapeutic anticoagulation that cannot be discontinued prior to administration.
10. History of severe cardiovascular disease, including:
1. NYHA class ≥ II congestive heart failure;
2. Left ventricular ejection fraction (LVEF) \< 50%;
3. Corrected QT interval (QTcF) \> 470 ms or long QT syndrome;
4. Acute coronary syndrome, aortic dissection, severe arrhythmia, stroke, or other grade ≥ 3 cardiovascular events within 6 months prior to first administration;
5. Uncontrolled hypertension.
11. Prior anti-tumor therapy within 4 weeks or 5 half-lives (whichever is longer) prior to first administration, including chemotherapy, radiotherapy, biotherapy, endocrine therapy, immunotherapy; prior oral small-molecule targeted therapy within 2 weeks or 5 half-lives (whichever is longer); prior palliative radiotherapy within 14 days; prior participation in other anti-tumor clinical trials within 4 weeks; prior use of any anti-tumor traditional Chinese medicine within 2 weeks.
12. Pregnant or breastfeeding women, or women of childbearing potential who refuse to use effective contraception during the study period.
13. Any other disease or laboratory abnormality that, in the investigator's opinion, makes the patient unsuitable for participation in this 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:Incidence of Dose-Limiting Toxicities (DLTs) and Determination of Maximum Tolerated Dose (MTD) · To evaluate the incidence of dose-limiting toxicities (DLTs) within 28 days after administration, and to determine the maximum tolerated dose (MTD) or recommended Phase 2 dose (RP2D) of CIB in vivo CAR-T lentiviral injection. · 28 days after administration
次要终点:Incidence and Frequency of Adverse Events (AEs) and Serious Adverse Events (SAEs);Objective Response Rate (ORR);Disease Control Rate (DCR);Duration of Response (DoR);Progression-Free Survival (PFS);Dynamic Changes in Peripheral Blood CAR-Positive T Cell Proportion;Dynamic Changes in Peripheral Blood Lentiviral Vector Copy Number;Changes in Plasma Cytokine Levels
单药静脉给予CIB体内CAR-T慢病毒注射。计划剂量水平为1×10⁵、3×10⁵、1×10⁶、3×10⁶、1×10⁷及3×10⁷ TU/kg。
这是一项开放标签、单臂I期剂量递增研究,评估CIB体内CAR-T慢病毒注射治疗晚期恶性肿瘤的安全性、耐受性、药代动力学及初步疗效。计划按“3+3”设计递增剂量:1×10⁵、3×10⁵、1×10⁶、3×10⁶、1×10⁷和3×10⁷ TU/kg。主要目标是根据给药后28天内的剂量限制性毒性(DLT)确定最大耐受剂量(MTD)或II期推荐剂量(RP2D);次要目标包括不良事件、ORR、DCR、PFS、OS及药代动力学指标。
This is an open-label, single-arm, phase 1 dose-escalation study to evaluate the safety, tolerability, pharmacokinetics, and preliminary efficacy of CIB in vivo CAR-T lentiviral injection in patients with advanced malignant tumors. The study will enroll patients with histologically or cytologically confirmed advanced solid tumors that have progressed on or are intolerant to standard therapies. A "3+3" dose-escalation design will be used, with planned dose levels including 1×10⁵ TU/kg, 3×10⁵ TU/kg, 1×10⁶ TU/kg, 3×10⁶ TU/kg, 1×10⁷ TU/kg, and 3×10⁷ TU/kg. The primary objective is to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) based on dose-limiting toxicities (DLTs) observed within 28 days after administration. Secondary objectives include evaluating adverse events, objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and pharmacokinetic parameters of the study drug.
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