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Pilot Study of Expanded , Activated Haploidentical Natural Killer Cell Infusions for Sarcomas (NKEXPSARC)

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ClinicalTrials.gov Identifier: NCT02409576
Recruitment Status : Unknown
Verified June 2016 by National University Hospital, Singapore.
Recruitment status was:  Recruiting
First Posted : April 7, 2015
Last Update Posted : November 6, 2017
Sponsor:
Collaborator:
KK Women's and Children's Hospital
Information provided by (Responsible Party):
National University Hospital, Singapore

Brief Summary:

Progress in the treatment of children with leukemia and lymphoma results in high cure rates but progress in the treatment of children and adolescents with solid tumors has been slow. Despite aggressive therapy with multimodality treatment involving surgery, radiation and chemotherapy, about two thirds of the patients with metastatic Ewing sarcoma (EWS), metastatic osteosarcoma (OS) and intermediate and high risk rhabdomyosarcoma (RMS) will relapse. The available second line therapies for relapse are limited and often not effective. There is a dire need to look for treatment options beyond conventional means for the treatment of these patients.

Infusions of allogeneic natural killer (NK) cells in leukemia patients have shown to be tolerated well without inducing graft versus host disease (GVHD). There is also mounting evidence that NK cells have activity against solid tumors.

In the lab the investigators tested NK cell activity against cell lines from different paediatric solid tumors. Among paediatric solid tumors, EWS and RMS are exquisitely sensitive to killing by expanded NK cells; NK cells also have activity against OS cells. Preliminary clinical data suggest that donor NK cells may exert antitumor activity in children with solid tumors undergoing allogeneic hematopoietic stem cell transplantation.

Taking into account the safety of adaptive NK cell infusion, and their efficacy against EWS, RMS and OS, NK cells could be a powerful new tool in the treatment of paediatric solid tumors.

The great anti-tumor activity of expanded and activated NK cells, together with the feasibility of infusing haploidentical NK cells in a non-transplant setting form a compelling rationale for the clinical testing of these NK cells in patients with sarcoma.


Condition or disease Intervention/treatment Phase
Ewing Sarcoma Osteosarcoma Rhabdomyosarcoma Biological: Expanded , Activated NK cells Phase 1 Phase 2

Detailed Description:

Adoptive transfer of allogeneic NK cells has been shown to be safe in patients with leukemia.

The patients enrolled on this will receive lymphodepleting chemotherapy with cyclophosphamide (1 day) followed by fludarabine (5 days) Each patient will receive IL-2 on alternate days starting 1 day before infusion of NK cells for a total of 6 doses.

Patient will undergo imaging MRI or PET or CT scan one month after the infusion to assess response to the NK cell infusion.

In our study we aim to determine the feasibility, safety and efficacy of expanded, activated NK cells in patients with EWS, RMS and OS.

We will also study the persistence and phenotype of expanded NK cells in research participants with EWS, RMS and OS.

The main hypothesis to be tested in this study is that infusion of expanded, activated haploidentical NK cells can produce measurable clinical responses in patients with EWS, RMS and OS.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Pilot Study of Expanded , Activated Haploidentical Natural Killer Cell Infusions for Sarcomas
Study Start Date : February 2015
Estimated Primary Completion Date : August 2018
Estimated Study Completion Date : September 2018


Arm Intervention/treatment
Experimental: Expanded, activated NK Cells(NKEXPSARC)
Intravenous infusion of expanded, activated NK Cells Donor cell will be expanded and activated in the cGMP compliant TECT lab for 10 to 12 days prior to infusion into the patient.
Biological: Expanded , Activated NK cells
  1. Chemotherapy - Each patient will receive immunosuppressive chemotherapy before infusion of NK cells.

    Day -7 Cyclophosphamide at 60mg/kg Day -6 Fludarabine at 25mg/m2 daily for 5 days

  2. Radiation - Each patient will receive radiation within 48 hr of NK cell infusion to make the tumor cells more sensitive to NK cell killing Radiation 2Gy
  3. Cytokine support - Each pateint will receive IL-2 to support NK cell activation and expansion in vivo Day -1 alternate day for a total of 6 doses
  4. NK cells - Expanded activated haploidentical NK cells will be infused on day 0.




Primary Outcome Measures :
  1. Disease response after expanded activated NK cell infusion [ Time Frame: 1 month post-NK cell infusion (and at regular intervals thereafter till a year post-NK cell infusion) ]
    Radiological response will be measured based on PET or MRI or CT scan whichever is appropriate imaging for the tumor type and location.


Secondary Outcome Measures :
  1. Persistence and phenotype of expanded NK cells in research participants with EWS, RMS and OS. [ Time Frame: 1 month ( 30 days) post- NK cell infusion ]
    NK cell persistence and phenotype will be monitored weekly upto 4 weeks post infusion from peripheral blood.

  2. Toxicity of NK cells infusion (NCI toxicity criteria CTC version 4.0) [ Time Frame: 1 month ( 30 days) post- NK cell infusion ]
    Patients will be monitored for toxicity based on NCI toxicity criteria CTC version 4.0

  3. Performance status will be assessed by age-dependent Performances Scores ( Lansky scale or Karnofsky performance scale) [ Time Frame: Initiation of conditioning till 30 days post-NK cell infusion ]
    Patients performance status will be monitored using Lansky scale for patients below 16 years of age and Karnofsky performance scale for patients more than 16 years of age.

  4. Acute and Chronic GVHD [ Time Frame: Initiation of conditioning until 1 month ( 30 days) post- last dose of IL-2 ]
    Patients will monitored for clinical evidence of GVHD



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Ages Eligible for Study:   up to 80 Years   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

A ) NK cell Recipient:

  1. Age 0 months to 80 years old.
  2. Patients with metastatic, progressive or relapsed EWS, RMS or OS after completing standard of care therapy who are at high risk of relapse even if they do not have any evidence of residual disease.
  3. Shortening fraction greater than or equal to 25%. Left ventricular ejection fraction (LVEF) greater than or equal to 40%
  4. Glomerular filtration rate greater than or equal to 60 ml/min/1.73 m2.
  5. Pulse oximetry greater than or equal to 92% on room air.
  6. Direct bilirubin less than or equal to 3.0 mg/dL (50 mmol/L).
  7. Alanine aminotransferase (ALT) is no more than 2 times the upper limit of normal.
  8. Aspartate transaminases (AST) is no more than 2 times the upper limit of normal.
  9. Karnofsky or Lansky performance score of greater than or equal to 50.
  10. Does not have a current pleural or pericardial effusion.
  11. Has a suitable adult family member donor available for NK cell donation.
  12. Has recovered from all acute NCI Common Terminology Criteria for Adverse Events (CTCAE) grade II-IV non-hematologic acute toxicities resulting from prior therapy per the judgment of the PI.
  13. At least two weeks since receipt of any biological therapy, systemic chemotherapy, and/or radiation therapy.
  14. Is not receiving more than the equivalent of prednisone 10 mg daily.
  15. Not pregnant (negative serum or urine pregnancy test to be conducted within 7 days prior to enrollment).
  16. Not lactating.

B) NK cell Donor:

  1. First and second degree relative acceptable.
  2. 18 years of age or above.
  3. Not lactating.
  4. Greater than or equal to 3 of 6 HLA match to recipient.
  5. Meets eligibility and suitability criteria for hematopoietic cells donation as per institutional guidelines.
  6. Not pregnant (negative serum or urine pregnancy test to be conducted within 7 days prior to enrollment).
  7. HIV negative. Negative results must be within 60 days prior to enrolment.

Exclusion Criteria:

Failure to meet any of the inclusion criteria.


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): NCT02409576


Contacts
Contact: Chetan Dhamne, MBBS (65)6772 3361 chetan_dhamne@nuhs.edu.sg

Locations
Singapore
National University Hospital Recruiting
Singapore, Singapore, 119228
Contact: Chetan Dhamne    (65) 6772 3361    chetan_dhamne@nuhs.edu.sg   
Contact: Clarice Chan    (65) 67726586    chan_zi_ying_clarice@nuhs.edu.sg   
Principal Investigator: Chetan Dhamne         
Sub-Investigator: Dario Campana         
KK Women's and Children's Hospital Not yet recruiting
Singapore, Singapore
Contact: Tan Ah Moy       tan.ah.moy@kkh.com.sg   
Contact: Jillian Teo    +65 6394-5025    Jillian.Teo.CL@kkh.com.sg   
Sponsors and Collaborators
National University Hospital, Singapore
KK Women's and Children's Hospital
Investigators
Principal Investigator: Chetan Dhamne Department of Paediatrics, National University Hospital
Principal Investigator: Dario Campana Department of Paediatrics, National University of Singapore

Publications:
Responsible Party: National University Hospital, Singapore
ClinicalTrials.gov Identifier: NCT02409576     History of Changes
Other Study ID Numbers: DSRB 2014/00452
CTC1400413 (NUH) ( Other Identifier: Health Sciences Authority; Singapore )
CTC1400412 (KKWCH) ( Other Identifier: Health Sciences Authority ; Singapore )
First Posted: April 7, 2015    Key Record Dates
Last Update Posted: November 6, 2017
Last Verified: June 2016

Keywords provided by National University Hospital, Singapore:
EWS
OS
RMS

Additional relevant MeSH terms:
Sarcoma
Osteosarcoma
Rhabdomyosarcoma
Sarcoma, Ewing
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Bone Tissue
Neoplasms, Connective Tissue
Myosarcoma
Neoplasms, Muscle Tissue