Genetically Engineered Cells (ATLCAR.CD30 T Cells) for the Treatment of Relapsed or Refractory CD30 Positive Peripheral T Cell Lymphoma
This phase II trial studies how well genetically engineered cells (ATLCAR.CD30 T cells) work in treating patients with CD30 positive peripheral T cell lymphoma that has come back (recurrent) or does not respond to treatment (refractory). T cells are special types of blood cells. They can find and destroy other cells that may cause disease or cancer. However, sometimes cancer cells can hide from T cells and grow into tumors. Genes make up the chemical structure carrying information that may determine human characteristics (i.e., eye color, height and sex). In this study, a gene that makes an antibody called anti-CD30 is put inside T cells, which may make T cells better at recognizing and destroying CD30 positive peripheral T cell lymphoma cancer cells.
Inclusion Criteria
- Written informed consent to undergo cell procurement and Health Insurance Portability and Accountability Act (HIPAA) authorization for release of personal health information explained to, understood by and signed by the subject or legally authorized representative
- Age >= 18 years at the time of consent
- Karnofsky score of > 60%
- Histological or cytological evidence/confirmation of CD30+ peripheral T-cell lymphoma per the 2017 World Health Organization Classification of Hematopoietic and Lymphoid Tissues
- CD30+ disease determined via archival tissue after the subject’s most recent anti-CD30 therapy prior to ATLCAR.CD30 (result can be pending at the time of cell procurement, but must be confirmed prior to treatment with the first infusion of ATLCAR.CD30 cells). NOTE: CD30+ disease requires documented CD30 expression by immunohistochemistry based on the institutional hematopathology standard
- Any subject with relapsed or refractory lymphoma after at least one prior line of therapy as long as prior therapy included brentuximab vedotin (unless they were not candidates for brentuximab vedotin)
- Subjects relapsed after allogeneic stem cell transplant are eligible provided the patient is ≥ 180 days from transplant, not on immunosuppressive therapy to treat/prevent graft-versus-host disease, and has no evidence of active graft-versus-host disease
- Subjects with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- Female subjects of childbearing potential must have a negative serum pregnancy test within 72 hours prior to cell procurement. Note: Females are considered of childbearing potential unless they are surgically sterile (have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are naturally postmenopausal for at least 12 consecutive months. Documentation of postmenopausal status must be provided. Female subjects of childbearing potential must not be lactating (Note: Breast milk cannot be stored for future use while the mother is being treated on study)
- Female subjects of childbearing potential must be willing to abstain from heterosexual activity or to use 2 forms of effective methods of contraception from the time of informed consent until 6 months after study treatment discontinuation. The two contraception methods can be comprised of two barrier methods, or a barrier method plus a hormonal method or an intrauterine device that meets < 1% failure rate for protection from pregnancy in the product label. Women of childbearing potential will also be instructed to tell their male partners to use a condom
- Subject is willing and able to comply with study procedures based on the judgement of the investigator or protocol designee
- Must not be using systemic corticosteroids at doses ≥ 10 mg prednisone daily or its equivalent; those receiving < 10 mg daily may be enrolled at discretion of investigator. Inhaled steroids are allowed
- Must not have an active infection with HIV or hepatitis C virus (HCV) (tests can be pending at the time of cell procurement; only those samples confirming lack of active infection will be used to generate transduced cells). Note: To meet eligibility subjects are required to be negative for HIV antibody and negative for HCV antibody or HCV viral load
- Must not be positive for hepatitis B surface antigen (can be pending at the time of cell procurement; only those samples confirming lack of active infection will be used to generate transduced cells). Subjects who are hepatitis B surface antigen negative but hepatitis B core antibody positive must have their hepatitis B viral load checked. Subjects are not eligible if their viral load is positive at baseline. Subjects who are core antibody positive and viral load negative at baseline will be considered eligible
- Subject has life expectancy ≥ 6 weeks
- Hemoglobin ≥ 8.0 g/dL (within 7 days of cell procurement) (transfusion prior to procurement are allowed)
- Total bilirubin ≤ 2 x upper limit of normal (ULN), unless attributed to Gilbert's syndrome (within 7 days of cell procurement)
- Aspartate aminotransferase (AST) ≤ 3 x ULN (within 7 days of cell procurement)
- Alanine aminotransferase ≤ 3 x ULN (within 7 days of cell procurement)
- Creatinine ≤ 2 x ULN (within 7 days of cell procurement)
- Pulse oximetry of > 90% on room air (within 7 days of cell procurement)
- Subjects must have active disease by imaging assessment within 90 days prior to procurement
Additional locations may be listed on ClinicalTrials.gov for NCT04083495.
Locations matching your search criteria
United States
North Carolina
Chapel Hill
PRIMARY OBJECTIVE:
I. To estimate the median progression free survival (PFS) after administration of the CD30 CAR-expressing autologous CD30CAR-CD28-CD3zeta-expressing T-lymphocytes (ATLCAR.CD30) in subjects with relapsed/refractory CD30+ peripheral T cell lymphoma.
SECONDARY OBJECTIVES:
I. To determine the best overall response rate (BOR) mediated by the ATLCAR.CD30 product administered in subjects with relapsed/refractory CD30+ peripheral T cell lymphoma.
II. To determine the objective response rate (ORR) mediated by the first infusion of the ATLCAR.CD30 product administered in patients with relapsed/refractory CD30+ peripheral T cell lymphoma.
III. To determine the percentage of responses improved by the second infusion of the ATLCAR.CD30 product administered in subjects with relapsed/refractory CD30+ peripheral T cell lymphoma with either partial response or stable disease following the first infusion of ATLCAR.CD30.
IV. To determine the safety and tolerability of administering two sequential infusions of the ATLCAR.CD30 product in subjects with relapsed/refractory CD30+ peripheral T cell lymphoma.
V. To estimate the median overall survival (OS) after administration of the ATLCAR.CD30 administered to subjects with relapsed/refractory CD30+ peripheral T cell lymphoma.
VI. To measure and compare the expansion and persistence of ATLCAR.CD30 in peripheral blood when infused after a single infusion of ATLCAR.CD30 cells and after two infusions with ATLCAR.CD30 cells.
EXPLORATORY OBJECTIVES:
I. To measure and compare homeostatic cytokines and immunophenotypes in the peripheral blood after infusion with ATLCAR.CD30 with either bendamustine and fludarabine or cyclophosphamide and fludarabine lymphodepletion.
II. To measure the tumor microenvironment before and after ATLCAR.CD30 infusion.
III. To determine potential correlation between chimeric antigen receptor T-cells (CAR T) cell behavior and the integration location of CAR.CD30.
IV. To measure patient-reported symptoms at baseline and over time in subjects with relapsed/refractory CD30+ peripheral T cell lymphoma receiving ATLCAR.CD30.
V. To describe the percent of subjects who progress after responding to the first infusion and went into remission after the second infusion.
OUTLINE:
Patients receive bendamustine intravenously (IV) over 1 hour daily and fludarabine over 30 minutes IV daily for 3 days, followed by ATLCAR.CD30 IV over 5-10 minutes 2-14 days later. After 8 weeks-6 months, patients then receive cyclophosphamide IV daily and fludarabine IV over 30 minutes daily for 3 days, followed by a second dose of ATLCAR.CD30 IV over 5-10 minutes 2-14 days later. Patients who have a partial response or complete response, but subsequent progressive disease before receiving the second infusion, may still receive the second infusion if the investigator believes there may be clinical benefit. Additionally, patients undergo buccal swab sample collection on study and blood sample collection, tumor biopsy, and positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), or nuclear imaging throughout the study.
After completion of study treatment, patients are followed up every 3 months for 1 year, every 6 months for 4 years, and then annually for up to 15 years.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationUNC Lineberger Comprehensive Cancer Center
Principal InvestigatorAnne Wood Beaven
- Primary IDLCCC1904-ATL
- Secondary IDsNCI-2019-06539
- ClinicalTrials.gov IDNCT04083495