Modified Immune Cells (NYCE T Cells) in Treating Patients with Recurrent or Refractory Multiple Myeloma, Melanoma, Synovial Sarcoma, or Myxoid/Round Cell Liposarcoma
This phase I trial studies the side effects of NYCE T cells in treating patients with multiple myeloma, melanoma, synovial sarcoma, or myxoid/round cell liposarcoma that has come back (recurrent) or does not respond to treatment (refractory). NYCE T cells are gene-modified using a lentiviral vector, which works by inserting genetic material into the cells, which may allow them to identify and possibly kill cancer cells.
Inclusion Criteria
- Subjects with a confirmed diagnosis of relapsed refractory multiple myeloma, melanoma, synovial sarcoma, or myxoid/round cell liposarcoma (MRCL) as follows: * Multiple myeloma ** Subjects must have a confirmed prior diagnosis of active multiple myeloma (MM) as defined by the International Myeloma Working Group (IMWG) criteria ** Subjects must have relapsed or refractory disease after either one of the following: *** At least 3 prior regimens, which must have contained an alkylating agent, proteasome inhibitor, and immunomodulatory agent (IMiD) OR *** At least 2 prior regimens if “double-refractory” to a proteasome inhibitor and IMiD, defined as progression on or within 60 days of treatment with these agents **** Note: Induction therapy, stem cell transplant, and maintenance therapy, if given sequentially without intervening progression, should be considered as 1 “regimen”. ** Subjects must be at least 90 days since autologous stem cell transplant, if performed ** Toxicities from prior therapies, with the exception of alopecia or peripheral neuropathy attributable to bortezomib, must have recovered to grade =< 2 according to the Common Toxicity Criteria (CTC) 4.03 criteria or to the subject’s prior baseline ** Subjects must have measurable disease per IMWG criteria on study entry, which must include at least 1 of the following: *** Serum M-spike >= 0.5 g/dL **** Patients with IgA myeloma in whom serum protein electrophoresis is deemed unreliable, due to co-migration of normal serum proteins with the paraprotein in the beta region, may be considered eligible as long as total serum IgA level is elevated above normal range *** 24 hour (hr) urine M-spike >= 200 mg *** Involved serum free light chain (FLC) >= 50 mg/L with abnormal ratio *** Measurable plasmacytoma on exam or imaging *** Bone marrow plasma cells >= 20% * Melanoma ** Subjects must have a confirmed prior diagnosis of melanoma ** Progressed after at least 2 therapy lines ** Subjects with BRAF mutant tumors should have received and progressed through, or are intolerant to, BRAF/MEK inhibitor therapy prior to enrollment ** Patients must have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 in order to allow assessment of an anti-tumor response * Synovial sarcoma or myxoid/round cell liposarcoma (MRCL) ** Subjects must have a confirmed prior diagnosis of synovial sarcoma or MRCL ** Patients with proven metastatic disease or surgically inoperable local recurrence that have failed first line treatment ** Patients must have measurable disease per RECIST 1.1 in order to allow assessment of an anti-tumor response
- Provides written, informed consent
- Eastern Cooperative Oncology Group (ECOG) performance status of 0-2
- Documented NY-ESO-1 and/or LAGE-1 expression on tumor tissue
- HLA-A*201 positive
- Subjects of reproductive potential must agree to use acceptable birth control methods
- Serum creatinine =< 2.5 or estimated creatinine clearance >= 30 ml/min and not dialysis-dependent
- Absolute neutrophil count >= 1000/ul
- Platelet count >= 50,000/ul (>= 30,000/ul if bone marrow plasma cells are >= 50% of cellularity for MM patients)
- Serum glutamic-oxaloacetic transaminase (SGOT) =< 3x the upper limit of normal
- Total bilirubin =< 2.0 mg/dl (except for patients in whom hyperbilirubinemia is attributed to Gilbert’s syndrome)
- Left ventricular ejection fraction (LVEF) >= 45%. LVEF assessment must have been performed within 8 weeks of eligibility confirmation by physician-investigator
Exclusion Criteria
- Pregnant or nursing (lactating) women
- Have inadequate venous access for or contraindications to leukapheresis
- Have any active and uncontrolled infection
- Active hepatitis B or hepatitis C
- Human immunodeficiency virus (HIV) infection
- Any uncontrolled medical or psychiatric disorder that would preclude participation
- New York Heart Association (NYHA) class III or IV heart failure, unstable angina, or a history of recent (within 6 months) myocardial infarction or sustained (> 30 seconds) ventricular tachyarrhythmias
- Received prior gene therapy or gene-modified cellular immunotherapy. Subject may have received, however, non-gene-modified autologous T-cells in association with an anti-myeloma vaccine (e.g., hTERT or MAGEA3) or vaccination against infectious agents (e.g., influenza or pneumococcus) as was performed on our previous studies
- Active auto-immune disease, including connective tissue disease, uveitis, sarcoidosis, inflammatory bowel disease, or multiple sclerosis, or have a history of severe (as judged by the principal investigator) autoimmune disease requiring prolonged immunosuppressive therapy
- Prior allogeneic stem cell transplant
- Prior or active central nervous system (CNS) involvement (e.g. leptomeningeal disease, parenchymal masses) with myeloma. Screening for this (e.g. with lumbar puncture) is not required unless suspicious symptoms or radiographic findings are present. Subjects with calvarial disease that extends intracranially and involves the dura will be excluded, even if cerebrospinal fluid (CSF) is negative for myeloma
Additional locations may be listed on ClinicalTrials.gov for NCT03399448.
See trial information on ClinicalTrials.gov for a list of participating sites.
PRIMARY OBJECTIVES:
I. Determine safety profile of a single infusion of autologous NY-ESO-1-redirected CRISPR-edited T cells (NYCE T cells).
II. Evaluate manufacturing feasibility of NYCE T cells.
SECONDARY CLINICAL OBJECTIVES:
I. Describe anti-tumor responses and survival after infusion.
SECONDARY EXPLORATORY OBJECTIVES:
I. Characterize NYCE T cells with respect to their expansion, persistence, trafficking, phenotype and function.
II. Describe the incidence of immunogenicity.
III. Evaluate bioactivity of NYCE T cells.
IV. Follow dynamics of T cells repertoire to identify clonal outgrowth as a potential biomarker of cell transformation.
OUTLINE:
Patients receive cyclophosphamide intravenously (IV) and fludarabine IV on days -5, -4, and -3, and then receive autologous NY-ESO-1-redirected CRISPR-edited T cells IV on day 0.
After completion of study treatment, patients are followed up at days 1, 3, 7, 10, 14, 21, and 28, then every month up to 6 months, every 3 months up to 2 years, every 6 months up to 5 years, and then yearly up to 10 years.
Trial PhasePhase I
Trial Typetreatment
Lead OrganizationUniversity of Pennsylvania/Abramson Cancer Center
Principal InvestigatorEdward A. Stadtmauer
- Primary IDUPCC 25416
- Secondary IDsNCI-2019-04201
- ClinicalTrials.gov IDNCT03399448