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Trial to Determine the Efficacy and Safety of JCAR017 in Adult Subjects With Aggressive B-Cell Non-Hodgkin Lymphoma (TRANSCENDWORLD)

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ClinicalTrials.gov Identifier: NCT03484702
Recruitment Status : Recruiting
First Posted : April 2, 2018
Last Update Posted : May 10, 2019
Sponsor:
Information provided by (Responsible Party):
Celgene

Brief Summary:
Phase 2 single-arm, multi-cohort study to determine the efficacy and safety of JCAR017 (autologous T cells expressing anti-CD19 chimeric antigen receptor) in adult subjects with aggressive B-NHL (diffuse large B-cell lymphoma (DLBCL) NOS [de novo or transformed follicular lymphoma (tFL)], double/triple-hit lymphoma [DHL/THL], follicular lymphoma Grade 3B [FL3B], primary central nervous system lymphoma [PCNSL] and Richter's transformation).

Condition or disease Intervention/treatment Phase
Lymphoma, Non-Hodgkin Drug: JCAR017 Phase 2

Detailed Description:

This is a single-arm, multi-cohort, multi-center, Phase 2 study to determine the efficacy and safety of JCAR017 in adult subjects with aggressive B-cell NHL. The study will enroll subjects in Europe and Japan with DLBCL NOS (de novo or tFL), high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (DHL/THL), FL3B, PCNSL and Richter's transformation. Subjects with secondary central nervous system (CNS) involvement are allowed.

Once enrolled subjects will undergo leukapheresis to enable JCAR017 cell product generation. Upon successful JCAR017 cell product generation, subjects will receive LD followed by infusion of JCAR017. JCAR017 will be administered at a dose of 1 x 10^8 JCAR017-positive transfected viable T cells by intravenous infusion.

Subjects will be followed for approximately 2 years after their JCAR017 infusion for safety, disease status, survival and health-related quality of life. Delayed adverse events following exposure to gene modified T cells will be assessed and long-term persistence of these modified T cells will continue to be monitored under a separate long-term follow-up protocol for up to 15 years after JCAR017 infusion as per competent authority guidelines.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 124 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2, Single-arm, Multi-center Trial to Determine the Efficacy and Safety of JCAR017 in Subjects With Relapsed or Refractory Diffuse Large B-Cell Lymphoma or With Other Aggressive B-Cell Malignancies
Actual Study Start Date : June 5, 2018
Estimated Primary Completion Date : August 2, 2022
Estimated Study Completion Date : August 2, 2022


Arm Intervention/treatment
Experimental: Administration of JCAR017
JCAR017 will be infused at a dose of 1 x 10^8 JCAR017-positive transfected viable T cells (5×10^7 CD8+ CAR+ T cells and 5×10^7 CD4+ CAR+ T cells), on Day 1 (2 to 7 days after completion of lymphodepleting chemotherapy [LD]).
Drug: JCAR017
JCAR017




Primary Outcome Measures :
  1. Overall Response Rate (ORR) of JCAR017 in subjects with Non-Hodgkin Lymphoma (NHL; including secondary central nervous system (CNS) involvement) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Proportion of subjects achieving a complete response (CR) or partial response (PR) based on the Lugano classification (Cheson, 2014)

  2. ORR of JCAR017 in subjects with relapsed/refractory (r/r) primary central nervous system lymphoma (PCNSL) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Proportion of subjects achieving a CR/complete response unconfirmed (CRu) or PR based on the International Workshop to Standardize Baseline Evaluation and Response Criteria in Primary CNS Lymphoma (Abrey, 2005)


Secondary Outcome Measures :
  1. Adverse Events (AEs) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Type, frequency, and severity of AEs, including serious adverse events (SAEs) and laboratory abnormalities

  2. Overall Response Rate (ORR)on the underlying chronic lymphocytic leukemia (CLL) in subjects with Richter´s transformation [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Proportion of subjects achieving a CR, CR with incomplete bone marrow recovery (CRi), nodular PR (nPR), PR or PR with lymphocytosis (PRL) based on International Workshop on Chronic Lymphocytic Leukemia (IWCLL) guidelines

  3. Complete response rate (CRR) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Proportion of subjects achieving a CR (or CR and CRu for subjects with PCNSL) following JCAR017 infusion

  4. Event-free survival (EFS) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Time from JCAR017 infusion to death from any cause, progressive disease (PD), or starting a new anticancer therapy, whichever occurs first

  5. Progression-free survival (PFS) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Time from JCAR017 infusion to the first documentation of PD, or death due to any cause, whichever occurs first

  6. Overall survival (OS) [ Time Frame: Up to 2 years after last patient's JCAR017 infusion ]
    Time from JCAR017 infusion to time of death due to any cause

  7. Duration of response (DOR) [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Time from first response to progressive disease or death from any cause, whichever occurs first

  8. Pharmacokinetics by quantitative polymerase chain reaction (qPCR) - Cmax [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Maximum concentration

  9. Pharmacokinetics by qPCR - Tmax [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Time to peak concentration

  10. Pharmacokinetics by qPCR - AUC [ Time Frame: Up to 2 years after JCAR017 infusion ]
    Area under the curve

  11. Patient-Reported Outcomes - EORTC QLQ-C30 [ Time Frame: Up to 2 years after JCAR017 infusion ]
    The European Organization for Research and Treatment of Cancer - Quality of Life C30 questionnaire will be used as a measure of health-related quality of life

  12. Patient-Reported Outcomes - EQ-5D-5L [ Time Frame: Up to 2 years after JCAR017 infusion ]
    European Quality of Life-5 Dimensions health state classifier to 5 Levels questionnaire: EQ-5D is a standardized measure of health status developed by the EuroQol Group to provide a simple, generic measure of health for clinical and economic appraisal.

  13. Patient-Reported Outcomes - FACT-Lym [ Time Frame: Up to 2 years after JCAR017 infusion ]

    Functional Assessment of Cancer Therapy-Lymphoma "Additional concerns" subscale:

    Only the LYM subscale will be administered in this study. This scale addresses symptoms and functional limitations (15 item) that are important to lymphoma patients.




Information from the National Library of Medicine

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

Inclusion Criteria:

Subjects must satisfy the following criteria to be enrolled in the study:

  1. Subject is ≥ 18 years of age at the time of signing the informed consent form (ICF).
  2. Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.
  3. Subject is willing and able to adhere to the study visit schedule and other protocol requirements.
  4. Investigator considers the subject is appropriate for adoptive T cell therapy.
  5. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1 (Cohort 1, 4, 5 or 6). Subjects not eligible for transplant (TNE) with ECOG performance status 0, 1 or 2 may be enrolled in cohort 2 or 3 only, if they meet all other inclusion/exclusion criteria.
  6. Subjects with one of the following:

    • Cohort 1: Subjects with DLBCL NOS (de novo or tFL), high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (DHL/THL) and FL3B per WHO 2016 classification, after ≥ 2 lines of therapy*, including an anthracycline and rituximab (or other CD20-targeted agent).
    • Cohort 2: Transplant not eligible subjects with DLBCL NOS (de novo or tFL), highgrade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (DHL/THL) and FL3B per WHO 2016 classification, who failed first line therapy including an anthracycline and rituximab (or other CD20-targeted agent).

      • Transplant not eligible subjects will include those who are deemed ineligible for high-dose chemotherapy and HSCT due to age, performance status or comorbidity. At the very least, subjects have to meet one of the following criteria: age ≥ 70 years, ECOG performance status ≥ 2, impaired pulmonary function (DLCO ≤ 60%), impaired cardiac function (LVEF < 50%), impaired renal function (CrCl < 60 mL/min) or impaired hepatic function (AST/ALT > 2x ULN, bilirubin > 2 mg/dL or cirrhosis Child-Pugh B or C).
      • Subjects must fulfil all other in- and exclusion criteria.
    • Cohort 3 (Japan only): Subjects meeting eligibility criteria for either Cohort 1 or 2.
    • Cohort 4: Subjects with high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements with DLBCL histology (DHL/THL) who failed first line therapy. Subjects may be screened at time of initial diagnosis and leukapheresis may be performed prior to initiation of first line therapy.
    • Cohort 5: Subjects with PCNSL after ≥ 1 line of therapy, including high-dose methotrexate.
    • Cohort 6: Subjects with Richter's transformation after ≥ 1 line of therapy for Richter's transformation.

      • For subjects with transformed disease, the subject should have had at least 2 lines of systemic therapy for his/her transformed disease (ie, the DLBCL) for Cohort 1 and 1 line for Cohort 2 to be eligible. Lines of therapy do not include those given for a previously indolent condition (eg, follicular lymphoma). Subjects do NOT have to have anthracycline for their DLBCL if received for indolent disease.

    Note: Subjects with secondary central nervous system (CNS) lymphoma involvement may enroll in Cohorts 1 to 4 and 6; subjects with PCNSL are eligible for Cohort 5. Subject selection must consider clinical risk factors for severe adverse events (AEs) and alternative treatment options. Subjects should only be enrolled if the Investigator considers the potential benefit outweighs the risk for the subject.

  7. Histological confirmation of diagnosis at last relapse. Enough tumor material must be available for central confirmation of diagnosis, otherwise a new tumor biopsy is mandated.

    NOTE: if the subject did not experience CR since last biopsy, the most recent biopsy will be considered adequate to participate. For subjects with PCNSL, at a minimum, corresponding pathology report is required if archival tumor material is not available and repeated biopsy not feasible.

  8. For subjects with NHL and Richter's transformed CLL: Subject must have positron emission tomography (PET)-positive disease as per Lugano Classification.
  9. For subjects with PCNSL: Subjects must have disease that is objectively measurable by International Workshop to Standardize Baseline Evaluation and Response Criteria in Primary Central Nervous System (CNS) Lymphoma, cerebrospinal fluid (CSF) cytology (in case of leptomeningeal only disease), or vitreal aspiration cytology and/or retinal photographs (in case of ocular lymphoma if clinically indicated).
  10. Adequate organ function, defined as:

    • Adequate bone marrow function to receive LD chemotherapy as assessed by the Investigator.
    • Serum creatinine < 1.5 upper limit of normal (ULN) or creatinine clearance > 30 mL/min (estimated glomerular filtration rate [eGFR] by Cockroft-Gault).
    • Alanine aminotransferase (ALT) ≤ 5 x ULN and total bilirubin < 2.0 mg/dL (or < 3.0 mg/dL for subjects with Gilbert's syndrome or lymphomatous infiltration of the liver).
    • Adequate pulmonary function, defined as ≤ Grade 1 dyspnea according to Common Toxicity Criteria for Adverse Events (CTCAE) and SaO2 ≥ 92% on room air.
    • Adequate cardiac function, defined as left ventricular ejection fraction (LVEF) ≥ 40% as assessed by echocardiogram or multigated acquisition (MUGA) scan performed within 4 weeks prior to leukapheresis.
  11. Adequate vascular access for leukapheresis procedure.
  12. Subjects must agree to not donate blood, organs, sperm or semen, and egg cells for usage in other individuals until at least 12 months after the JCAR017 infusion and until CAR T cells are no longer present by quantitative polymerase chain reaction (qPCR) on two consecutive tests, whichever occurs last.
  13. Female subjects of childbearing potential (FCBP) must:

    • Have two negative pregnancy tests as verified by the Investigator (one negative serum beta human chorionic gonadotropin [ß-hCG] pregnancy test result at screening and one negative serum pregnancy test within 48 hours prior to the first dose of LD chemotherapy). Subjects must agree to have another pregnancy test performed 90 days post JCAR017 infusion. This applies even if the subject practices true abstinence* from heterosexual contact.
    • Either commit to true abstinence* from heterosexual contact (which must be reviewed on a monthly basis and source documented) or agree to use, and be able to comply with, effective contraception without interruption. Contraception methods must include 1 highly effective and 1 additional effective (barrier) method of contraception from screening until at least 12 months following JCAR017 infusion and until CAR T cells are no longer present by qPCR on two consecutive tests, whichever occurs last.

Note: Highly effective methods are defined as those that result in a low failure rate (ie, less than 1% per year) when used consistently and correctly. The following are examples of contraception:

Highly effective methods:

  • Intrauterine device (IUD)
  • Hormonal (birth control pill, injections, implants)
  • Tubal ligation
  • Partner's vasectomy

Additional effective methods:

  • Male condom
  • Diaphragm
  • Cervical cap

    • Agree to abstain from breastfeeding during study participation and for at least 90 days after JCAR017 infusion and until CAR T cells are no longer present by qPCR on two consecutive tests, whichever occurs last.

      14. Male subjects must:

    • Practice true abstinence* (which must be reviewed on a monthly basis and source documented) or agree to use a condom during sexual contact with a pregnant female or a female of childbearing potential while participating in the study and until at least 12 months following JCAR017 infusion even if he has undergone a successful vasectomy and until CAR T cells are no longer present by qPCR on two consecutive tests, whichever occurs last.

      • True abstinence is acceptable when this is in line with the preferred and usual lifestyle of the subject. In contrast, periodic abstinence (eg, calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.

Exclusion Criteria:

The presence of any of the following will exclude a subject from enrollment:

  1. Subject has any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study.
  2. Subject has any condition including the presence of laboratory abnormalities, which would place the subject at unacceptable risk if participating in the study.
  3. Subject has any condition that confounds the ability to interpret data from the study.
  4. Subjects with T cell rich/histiocyte rich large B-cell lymphoma (THRBCL), primary cutaneous large B-cell lymphoma, primary mediastinal B-cell lymphoma (PMBCL), EBV positive DLBCL of the elderly and Burkitt lymphoma.
  5. Subjects with prior history of malignancies, other than aggressive R/R NHL, unless the subject has been in remission for ≥2 years with the exception of the following non-invasive malignancies:

    • Basal cell carcinoma of the skin
    • Squamous cell carcinoma of the skin
    • Carcinoma in situ of the cervix
    • Carcinoma in situ of the breast
    • Incidental histologic finding of prostate cancer (T1a or T1b using the TNM [tumor, notes, metastasis] clinical staging system) or prostate cancer that is curative
    • Other completely resected stage 1 solid tumor with low risk for recurrence
  6. Treatment with any prior gene therapy product.
  7. Subjects who have received previous CD19-targeted therapy.
  8. Previous history of or active hepatitis B, hepatitis C, or human immunodeficiency virus (HIV) infection.
  9. Subjects with uncontrolled systemic fungal, bacterial, viral or other infection (including tuberculosis) despite appropriate antibiotics or other treatment at the time of leukapheresis or JCAR017 infusion.
  10. Presence of acute or chronic graft-versus-host disease (GVHD).
  11. Active autoimmune disease requiring immunosuppressive therapy.
  12. History of any one of the following cardiovascular conditions within the past 6 months:

    • Heart failure class III or IV as defined by the New York Heart Association (NYHA)
    • Cardiac angioplasty or stenting
    • Myocardial infarction
    • Unstable angina
    • Other clinically significant cardiac disease
  13. History or presence of clinically relevant CNS pathology such as epilepsy, seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, or psychosis.
  14. Pregnant or nursing women
  15. Treatment with alemtuzumab within 6 months of leukapheresis, or treatment with fludarabine or cladribine within 3 months of leukapheresis
  16. Use of the following:

    • Therapeutic doses of corticosteroids (defined as > 20 mg/day prednisone or equivalent) within 7 days prior to leukapheresis or 72 hours prior to JCAR017 infusion. Physiologic replacement, topical, and inhaled steroids are permitted.
    • Low-dose chemotherapy (eg, vincristine, rituximab, cyclophosphamide ≤ 300 mg/m2) given after leukapheresis to maintain disease control must be stopped ≥ 7 days prior to LD chemotherapy.
    • Cytotoxic chemotherapeutic agents that are not considered lymphotoxic (see below) within 1 week prior to leukapheresis. Oral anticancer agents, including lenalidomide and ibrutinib, are allowed if at least 3 half-lives have elapsed prior to leukapheresis.
    • Lymphotoxic chemotherapeutic agents (eg, cyclophosphamide, ifosfamide, bendamustine) within 2 weeks prior to leukapheresis.
    • Experimental agents within 4 weeks prior to leukapheresis unless no response or progressive disease (PD) is documented on the experimental therapy and at least 3 half-lives have elapsed prior to leukapheresis.
    • Immunosuppressive therapies within 4 weeks prior to leukapheresis and JCAR017 infusion (eg, calcineurin inhibitors, methotrexate or other chemotherapeutics, mycophenolate, rapamycin, thalidomide, immunosuppressive antibodies such as antitumor necrosis factor [TNF], anti-IL-6, or anti-IL-6R).
    • Donor lymphocyte infusions (DLI) within 6 weeks prior to JCAR017 infusion.
    • Radiation within 6 weeks prior to leukapheresis. Subjects must have progressive disease in irradiated lesions or have additional non-irradiated, PET-positive lesions to be eligible. Radiation to a single lesion, if additional non-irradiated, measurable PET positive lesions are present, is allowed up to 2 weeks prior to leukapheresis.
    • Allogeneic HSCT within 90 days prior to leukapheresis.
    • Prior hematopoietic stem cell transplant (only applicable to Cohort 2).
  17. Tumor invasion of venous or arterial vessels
  18. Deep venous thrombosis (DVT)/pulmonary embolism (PE) within 3 months of ICF signature and/or DVT/PE that requires ongoing therapeutic levels of anti-coagulation.

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): NCT03484702


Contacts
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Contact: Associate Director Clinical Trial Disclosure 1-888-260-1599 clinicaltrialdisclosure@celgene.com

Locations
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Austria
Allgemeinen Krankenhaus (AKH) Wien - Medizinische Universitaet Wien Recruiting
Wien, Austria, 1090
Belgium
Universitair Ziekenhuis Gent Recruiting
Gent, Belgium, 9000
Finland
Helsinki University Recruiting
Helsinki, Finland, 00029
France
CHRU-Hopital Claude Huriez Recruiting
Lille, France, 59037
Centre Hospitalier Lyon Sud Recruiting
Pierre Benite cedex, France, 69495
Germany
Medizinische Kinik und Poliklinik I Not yet recruiting
Dresden, Germany, 01307
Universitat zu Koln Not yet recruiting
Köln, Germany, 50937
LMU Klinikum der Universität Not yet recruiting
München, Germany, 81377
Universitatsklinikum Ulm Not yet recruiting
Ulm, Germany, 89081
Italy
Fondazione IRCCS Istituto Nazionale dei Tumori Recruiting
Milan, Italy, 20133
Azienda Ospedaliera Citta della Salute e della Scienza di Torino Recruiting
Torino, Italy, 10126
Japan
National Cancer Center Hospital Recruiting
Chuo-ku, Japan, 104-0045
Toranomon Hospital Recruiting
Minato-ku, Japan, 105-8470
Netherlands
Erasmus Medisch Centrum Recruiting
Rotterdam, Netherlands, 3015 CE
Spain
Hospital Vall d'Hebron Recruiting
Barcelona, Spain, 08035
Switzerland
Universitatsspital Bern Recruiting
Bern, Switzerland, 3010
United Kingdom
UCL Cancer Institute Recruiting
London, United Kingdom, WC1E 6BT
The Christie NHS Foundation Trust Recruiting
Manchester, United Kingdom, M20 4BX
Sponsors and Collaborators
Celgene
Investigators
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Study Director: Claudia Schusterbauer, MD Celgene Corporation

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Responsible Party: Celgene
ClinicalTrials.gov Identifier: NCT03484702     History of Changes
Other Study ID Numbers: JCAR017-BCM-001
U1111-1209-4055 ( Other Grant/Funding Number: WHO )
2017-000106-38 ( EudraCT Number )
First Posted: April 2, 2018    Key Record Dates
Last Update Posted: May 10, 2019
Last Verified: May 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes

Keywords provided by Celgene:
JCAR017
Non-Hodgkin lymphoma
Aggressive B-cell non-Hodgkin lymphoma
Diffuse large B-cell lymphoma
Relapse / refractory lymphoma
Transplant not eligible
Double-hit lymphoma
Triple-hit lymphoma
Primary/secondary central nervous system lymphoma
Richter's transformation/syndrome
Transformed follicular lymphoma
Follicular lymphoma Grade 3B
CAR T cell therapy
CD19 targeted therapy.
Efficacy and safety
Europe / Japan
TPTD

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