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Activated T Cells Armed With GD2 Bispecific Antibody in Children and Young Adults With Neuroblastoma and Osteosarcoma

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ClinicalTrials.gov Identifier: NCT02173093
Recruitment Status : Recruiting
First Posted : June 24, 2014
Last Update Posted : December 4, 2017
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Maxim Yankelevich, Barbara Ann Karmanos Cancer Institute

Brief Summary:
The investigators have found in the previous research that the investigators can coat (arm) T cells with a special molecule called GD2 bispecific antibody that will help T cells recognize neuroblastoma and osteosarcoma cells and kill them. This bispecific antibody recognizes GD2, a protein found on almost all neuroblastoma and osteosarcoma cells. The investigators put the GD2 bispecific antibody on T cells and give large numbers of these T cells back to patients. The investigators think that these T cells may have a better chance of killing neuroblastoma tumor cells when they are armed with GD2 bispecific antibody. This trial studies the side effects and best dose of activated T cells armed with GD2 bispecific antibody and how well they work in treating patients with neuroblastoma, osteosarcoma, and other GD2-positive solid tumors.

Condition or disease Intervention/treatment Phase
Desmoplastic Small Round Cell Tumor Disseminated Neuroblastoma Metastatic Osteosarcoma Recurrent Neuroblastoma Recurrent Osteosarcoma Biological: IL-2 Biological: GD2Bi-aATC Biological: GM-CSF Other: laboratory evaluations of immune responses Phase 1 Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To perform a phase I dose-escalation study in patients with recurrent or refractory neuroblastoma (NB) and other GD2-positive tumors to evaluate the safety and tolerability and to determine the maximum tolerated dose (MTD) for anti-CD3 x hu3F8 bispecific antibody (GD2Bi)-armed activated T cells (aATC) infused twice a week for a total of eight infusions in combination with daily IL-2 (300,000 IU/m^2/day) and GM-CSF (250 ug/m^2 twice per week) in a standard 3 + 3 dose escalation schema with 40, 80, and 160 x 10^6 cells/kg/infusion dose levels.

II. To conduct a phase II clinical trial to explore efficacy and confirm the toxicity profile of GD2Bi-aATC combined with IL-2 and GM-CSF in a phase II expansion cohort of 22 patients with neuroblastoma (NB) using MTD determined in the phase I.

SECONDARY OBJECTIVES:

I. Evaluate immune responses in the phase I/II trial by sequential monitoring of anti-NB cytotoxicity of peripheral blood lymphocytes and IFN-gamma EliSpots directed at NB lines.

II. To evaluate persistence of aATC in the blood and tumor biopsies by staining for murine IgG2a to confirm trafficking of armed T cells to tumor.

III. To conduct exploratory study of (18F FDG) positron emission tomography (PET)/computed tomography (CT) after armed ATC infusions in selected patients with PET/CT measurable soft tissue and skeletal lesions.

OUTLINE: This is a phase I, dose-escalation study of OKT3/humanized 3F8 bispecific antibody-aATC followed by a phase II study.

Patients receive IL-2 subcutaneously (SC) daily on days -2 to 35, sargramostim SC twice weekly for 4 weeks, and OKT3/humanized 3F8 bispecific antibody-aATC intravenously (IV) over 30 minutes twice weekly for 4 weeks.

After completion of study treatment, patients are followed up at 1, 3, 6, and 12 months.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Treatment of Neuroblastoma and GD2-Positive Tumors With Activated T Cells Armed With OKT3 X Humanized 3F8 Bispecific Antibodies (GD2Bi): A Phase I/II Study
Study Start Date : November 2014
Estimated Primary Completion Date : May 2018
Estimated Study Completion Date : May 2018


Arm Intervention/treatment
Experimental: Treatment (IL-2, GM-CSF, GD2Bi-aATC)
Patients receive IL-2 SC daily on days -2 to 35, GM-CSF SC twice weekly x 5 weeks, and GD2Bi-aATC IV over 30 minutes twice weekly x 4 weeks for a total of 8 infusions. Laboratory evaluations of immune responses are obtained prior and after immunotherapy.
Biological: IL-2
Given SC
Other Names:
  • aldesleukin
  • Proleukin
  • recombinant human interleukin-2
  • recombinant interleukin-2

Biological: GD2Bi-aATC
Given IV
Other Name: GD2Bi-armed aATC

Biological: GM-CSF
Given SC
Other Names:
  • sargramostin
  • Leukine
  • Prokine

Other: laboratory evaluations of immune responses
Correlative studies
Other Name: laboratory biomarker analysis




Primary Outcome Measures :
  1. Maximum tolerated dose (MTD) of GD2Bi-aATC [ Time Frame: 35 days ]
    Safety of GD2Bi-aATC infusions is evaluated to determine MTD


Secondary Outcome Measures :
  1. Anti-tumor activity [ Time Frame: Up to 12 months ]
    Objective response rate to GD2Bi-aATC infusions

  2. Immune responses after GD2Bi-aATC infusions [ Time Frame: Up to 12 months ]
    In vitro anti-tumor activity of patients' lymphocytes; changes in cytokine profile; changes in lymphocyte phenotypes



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Ages Eligible for Study:   13 Months to 29 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The target tumor is limited to neuroblastoma, osteosarcoma, and GD2-positive solid tumors; patients must have histologic verification of neuroblastoma, osteosarcoma or other GD2-positive solid malignancy including desmoplastic small round cell tumor (DSRCT) at original diagnosis or time of recurrence
  • Tumor GD2 status does not need to be determined for eligibility of the patients with neuroblastoma, osteosarcoma or DSRCT;
  • Patients must have refractory or recurrent malignancy; patient's current disease state must be one for which no known curative therapy is available;
  • Patients should not receive any other experimental or phase 1 therapy within 3 weeks prior to study enrollment and monoclonal antibody therapy within 6 weeks
  • To be eligible for phase I study patients should have primary refractory or relapsed disease as evidenced by:

    • Local tumor recurrence measurable on CT or magnetic resonance imaging (MRI) scans with or without metastatic lesions
    • Refractory bone marrow involvement in patients with NB
    • NB with MIBG-positive skeletal lesions
    • lung lesions consistent with metastatic osteosarcoma (OST)
  • The presence of radiographically measurable disease immediately prior to start of Phase I immunotherapy is not an eligibility requirement in the following situations:

    • In patients with NB who have documented bone marrow (BM) involvement;
    • In patients with NB who have MIBG-positive bony lesion(s);
    • In patients with OST who had resection of the pulmonary lesion(s)
  • An additional eligibility requirement for phase II study includes the presence of radiographically measurable disease with the exception of MIBG-positive NB or NB with bone marrow involvement:
  • Patients must have a Lansky or Karnofsky performance status score of >= 70
  • Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy

    • Myelosuppressive chemotherapy: must not have received within 3 weeks of starting immunotherapy (IT)
    • Hematopoietic growth factors: at least 7 days since the last dose of growth factor therapy
    • Immunotherapy: at least 6 weeks must have elapsed since prior therapy that includes a monoclonal antibody
  • Normal organ function
  • All patients or their parents or legal guardians must sign a written informed consent; assent, when appropriate, will be obtained according to institutional guidelines
  • All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met

Exclusion Criteria:

  • Patients who are pregnant or breast-feeding are not eligible for this study; negative pregnancy tests must be obtained in girls who are postmenarchal; males or females of reproductive potential may not participate unless they have agreed to use an effective contraceptive method for the duration of study therapy and for 3 months after the last dose of GD2Bi-aATC; breastfeeding women should be excluded
  • Patients who have an uncontrolled infection are not eligible
  • Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study are not eligible

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02173093


Locations
United States, Michigan
Children's Hospital of Michigan Recruiting
Detroit, Michigan, United States, 48201
Contact: Maxim Y. Yankelevich, MD    313-745-5516    myankele@med.wayne.edu   
Contact: Kathy Miller, RN    313-745-8214      
Principal Investigator: Maxim Y. Yankelevich, MD         
United States, New York
Memorial Sloan-Kettering Cancer Center Recruiting
New York, New York, United States, 10065
Contact: Shakeel Modak, M.D.       modaks@mskcc.org   
Principal Investigator: Shakeel Modak, M.D.         
Sub-Investigator: Alexandar Chou, M.D.         
United States, Virginia
University of Virginia, Department of Pediatrics, Hematology/Oncology Recruiting
Charlottesville, Virginia, United States, 22908
Contact: Daniel (Trey) Lee, MD    434-297-4289    DWL4Q@Virginia.edu   
Principal Investigator: Daniel (Trey) Lee, MD         
Sponsors and Collaborators
Barbara Ann Karmanos Cancer Institute
National Cancer Institute (NCI)
Investigators
Principal Investigator: Maxim Yankelevich Barbara Ann Karmanos Cancer Institute

Responsible Party: Maxim Yankelevich, Principal Investigator, Barbara Ann Karmanos Cancer Institute
ClinicalTrials.gov Identifier: NCT02173093     History of Changes
Other Study ID Numbers: 2013-171
NCI-2014-01149 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
2013-171 ( Other Identifier: Barbara Ann Karmanos Cancer Institute )
P30CA022453 ( U.S. NIH Grant/Contract )
First Posted: June 24, 2014    Key Record Dates
Last Update Posted: December 4, 2017
Last Verified: November 2017

Keywords provided by Maxim Yankelevich, Barbara Ann Karmanos Cancer Institute:
Neuroblastoma
Osteosarcoma
Solid tumor
Immunotherapy targeting GD2
Bispecific antibodies
Activated T cells

Additional relevant MeSH terms:
Osteosarcoma
Neuroblastoma
Desmoplastic Small Round Cell Tumor
Neuroectodermal Tumors, Primitive, Peripheral
Neuroectodermal Tumors, Primitive
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Neoplasms, Bone Tissue
Neoplasms, Connective Tissue
Neoplasms, Connective and Soft Tissue
Sarcoma
Antibodies
Immunoglobulins
Antibodies, Bispecific
Aldesleukin
Interleukin-2
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Anti-HIV Agents
Anti-Retroviral Agents