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Memory-enriched CAR-T Cells Immunotherapy for B Cell Lymphoma (MeCAR)

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ClinicalTrials.gov Identifier: NCT02652910
Recruitment Status : Recruiting
First Posted : January 12, 2016
Last Update Posted : February 27, 2019
Sponsor:
Collaborators:
Xuzhou Medical University
Hrain Biotechnology Co., Ltd.
Shanghai Changzheng Hospital
Information provided by (Responsible Party):
Qingzhu Jia, M.D., Xinqiao Hospital of Chongqing

Brief Summary:
The goal of this clinical trial is to study how approaches for manufacturing chimeric antigen receptor (CAR)-modified T (CAR-T) cells affect their in vivo persistence and therapeutic efficacy against B lymphoma. Recently, cancer immunotherapy, treatments aiming to arm patients with immunity specifically against cancer cells, has emerged as a promising therapeutic strategy. Among the many emerging immunotherapeutic approaches, clinical trials utilizing CARs against B cell malignancies have demonstrated remarkable potential. CARs combine the variable region of an antibody with T-cell signaling moieties to confer T-cell activation with the targeting specificity of an antibody. Thus, CARs are not MHC-restricted so they are not vulnerable to MHC down regulation by tumors. However, defined by the activation and contraction program of their mother cells, the persistency and function of CAR-T cells are also restricted by the protocol of manufacturing. Previous clinical studies largely utilized interleukin-2 (IL-2) for the ex vivo expansion of CAR-T cells, which preferentially generate CAR-T cells with characteristics of terminally differentiated effector cells. Our preliminary data indicated that two common gamma chain cytokines, IL-7 and IL-15, can help to selectively expand CAR-T cells with various memory phenotypes. CAR-T Cells prepared under this condition resulted in improved therapeutic efficacy in preclinical animal models. This clinical investigation is to test a hypothesis whether IL-7/IL-15-programmed anti-CD19 CAR-T cells persist longer in lymphoma patients after infusion and whether the persistency of CAR-T cells can lead to improved anti-lymphoma efficacy.

Condition or disease Intervention/treatment Phase
Recurrent Adult Diffuse Large Cell Lymphoma Recurrent Follicular Lymphoma Recurrent Mantle Cell Lymphoma Stage III Adult Diffuse Large Cell Lymphoma Stage III Follicular Lymphoma Stage III Mantle Cell Lymphoma Stage IV Adult Diffuse Large Cell Lymphoma Stage IV Follicular Lymphoma Stage IV Mantle Cell Lymphoma Drug: CD19.CAR-T cells Phase 1 Phase 2

Detailed Description:

Primary Objectives

  1. To determine the safety and feasibility of CD19.CAR-T cells manufactured through IL-7/IL-15-mediated expansion or IL-2-mediated expansion
  2. To determine in vivo dynamics and persistency of IL-7/IL-15 programmed CD19.CAR-T cells.
  3. To determine the efficacy of IL-7/IL-15 programmed CD19.CAR-T cells in treating patients with CD19-positive lymphoma

Secondary Objectives

  1. To determine whether the IL-7/IL-15 programmed CD19.CAR-T cells are superior to the IL-2 programmed cells as measured by their in vivo persistence post infusion
  2. To determine whether the IL-7/IL-15 programmed CD19.CAR-T cells are superior to the IL-2 programmed cells as measured by their efficacy in lymphoma therapy
  3. To assess the dynamics of intratumoral infiltration of CD19.CAR-T cells.
  4. To correlate the subsets and differentiation of CD19.CAR-T cells to observed anti-tumor efficacy

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 20 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Two-Arm, Single-Center, Open-Label Pilot Study of IL-2 Programmed or IL-7/IL-15 Programmed Anti-CD19:TCRz:CD28 T-cells in Patient With CD19-Positive Lymphoma That is Resistant or Refractory to Chemotherapy
Study Start Date : December 2015
Estimated Primary Completion Date : June 2019
Estimated Study Completion Date : December 2019


Arm Intervention/treatment
Experimental: IL-2 programmed CD19.CAR-T cells
Administrated with IL-2 programmed CD19.CAR-T cells on day 0,1,2 in the lympho-depleted patients
Drug: CD19.CAR-T cells
Retroviral vector-transduced autologous T cells to express CD19-specific CARs
Other Name: DSCAR01

Experimental: IL-7/IL-15 programmed CD19.CAR-T cells
Administrated with IL-7/IL-15 programmed CD19.CAR-T cells on day 0,1,2 in the lympho-depleted patients
Drug: CD19.CAR-T cells
Retroviral vector-transduced autologous T cells to express CD19-specific CARs
Other Name: DSCAR01




Primary Outcome Measures :
  1. Phase 1: Safety measured by occurrence of study related adverse effects defined by NCI CTCAE 4.0 [ Time Frame: 4 weeks ]
  2. Phase 2: Overall complete remission rate defined by the standard response criteria for malignant lymphoma for each arm [ Time Frame: 8 weeks ]
  3. Phase 2: Comparison of overall complete remission rate for the two arms [ Time Frame: One year ]

Secondary Outcome Measures :
  1. Duration of remission [ Time Frame: One year ]
  2. Minimum residual disease negative remission rate [ Time Frame: 8 weeks ]
  3. Duration of CAR-positive T cells in circulation [ Time Frame: 6 months ]
  4. Total number of CAR-positive T cells infiltrated into lymphoma tissue [ Time Frame: 6 months ]
  5. Overall survival [ Time Frame: One year ]


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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. 18 Years to 70 Years, Male and female;
  2. Expected survival > 12 weeks;
  3. Performance score 0-2;
  4. Histologically confirmed as CD19-positive lymphoma and who meet one of the following conditions;

    • Patient receive at least 2-4 prior combination chemotherapy regimens (not including single agent monoclonal antibody therapy) and fail to achieve CR; or have disease recurrence; or not eligible for allogeneic stem cell transplantation; or disease responding or stable after most recent therapy but refused further treatment;
    • Disease recurrence after stem cell transplantation;
    • Diagnosis as lymphoma, but refuse conventional treatment such as chemotherapy, radiation, stem cell transplantation and monoclonal antibody therapy
  5. Creatinine < 2.5 mg/dl;
  6. ALT/AST < 3x normal;
  7. Bilirubin < 2.0 mg/dl;
  8. Adequate venous access for apheresis, and no other contraindications for leukapheresis;
  9. Take contraceptive measures before recruit to this trial;
  10. Written voluntary informed consent is given.

Exclusion Criteria:

  1. Patients with symptoms of central nervous system
  2. Accompanied by other malignant tumor
  3. Active hepatitis B or C, HIV infection
  4. Any other diseases could affect the outcome of this trial
  5. Suffering severe cardiovascular or respiratory disease
  6. Poorly controlled hypertension
  7. A history of mental illness and poorly controlled
  8. Taking immunosuppressive agents within 1 week due to organ transplantation or other disease which need long-lasting administration
  9. Occurrence of unstable pulmonary embolism, deep vein thrombosis, or other major arterial/venous thromboembolic events 30 days prior to assignment
  10. Reaching a steady dose if receiving anticoagulant therapy before assignment
  11. Female study participants of reproductive potential must have a negative serum or urine pregnancy test performed within 48 hours before infusion
  12. Pregnant or lactating women
  13. Subject suffering disease affects the understanding of informed consent or comply with study protocol.

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): NCT02652910


Contacts
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Contact: Qingzhu Jia, M.D. +(86)-152-2333-4184 jiaqingzhu0801@outlook.com

Locations
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China, Chongqing
Department of Oncology Recruiting
ChongQing, Chongqing, China, 400000
Contact: Qingzhu Jia, MD    152-2333-4184 ext +86    jiaqinghzu0801@outlook.com   
Sponsors and Collaborators
Xinqiao Hospital of Chongqing
Xuzhou Medical University
Hrain Biotechnology Co., Ltd.
Shanghai Changzheng Hospital
Investigators
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Principal Investigator: Bo Zhu, M.D., Ph.D. Department of Cancer of Xinqiao Hospital

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Responsible Party: Qingzhu Jia, M.D., Director of Department of Cancer, Xinqiao Hospital of Chongqing
ClinicalTrials.gov Identifier: NCT02652910     History of Changes
Other Study ID Numbers: 20151117
First Posted: January 12, 2016    Key Record Dates
Last Update Posted: February 27, 2019
Last Verified: April 2016

Additional relevant MeSH terms:
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Lymphoma
Lymphoma, Follicular
Lymphoma, Non-Hodgkin
Lymphoma, Mantle-Cell
Lymphoma, Large B-Cell, Diffuse
Neoplasms by Histologic Type
Neoplasms
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Lymphoma, B-Cell