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A Cancer Research UK Phase I Trial of Adoptive Transfer of Autologous Tumor Antigen-Specific T Cells With Preconditioning Chemotherapy and Intravenous IL2 in Patients With Advanced CEA Positive Tumors


Phase 1
18 Years
N/A
Not Enrolling
Both
Breast Cancer, Colorectal Cancer, Gastric Cancer, Lung Cancer, Ovarian Cancer, Pancreatic Cancer, Unspecified Adult Solid Tumor, Protocol Specific

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Trial Information

A Cancer Research UK Phase I Trial of Adoptive Transfer of Autologous Tumor Antigen-Specific T Cells With Preconditioning Chemotherapy and Intravenous IL2 in Patients With Advanced CEA Positive Tumors


OBJECTIVES:

Primary

- To evaluate the feasibility of MFE23 scFv-expressing autologous anti-CEA MFEz T
lymphocytes in combination with preconditioning chemotherapy comprising
cyclophosphamide and fludarabine phosphate plus aldesleukin in patients with
CEA-positive tumors.

- To assess the toxicity of this regimen in these patients.

- To determine the dose of MFE23 scFv-expressing autologous anti-CEA MFEz T lymphocytes
required to give optimal survival of these cells in the circulation (recommended phase
II dose).

Secondary

- To assess whether MFE23 scFv-expressing autologous anti-CEA MFEz T lymphocytes isolated
from the circulation are functional.

- To determine the preliminary tumor response to MFE23 scFv-expressing autologous
anti-CEA MFEz T lymphocytes.

- To evaluate the safety of MFE23 scFv-expressing autologous anti-CEA MFEz T lymphocytes.

OUTLINE: This is a phase I, dose-escalation study of MFE23 scFv-expressing autologous
anti-CEA MFEz T lymphocytes.

Patients undergo leukapheresis 7-14 days before study therapy begins. Cells are then
transduced with a retrovirus vector and expanded to produce MFE23 scFv-expressing autologous
anti-CEA MFEz T lymphocytes.

Patients receive preconditioning chemotherapy comprising fludarabine phosphate IV over 15
minutes on days -5 to -1 or cyclophosphamide IV over 1 hour on days -7 to -6 and fludarabine
phosphate IV over 15 minutes on days -5 to -1. They receive MFE23 scFv-expressing autologous
anti-CEA MFEz T lymphocytes IV over 30 minutes on day 0. Patients also receive high-dose
aldesleukin IV over 15 minutes every 8 hours for up to 12 doses beginning on day 0, in the
absence of disease progression or unacceptable toxicity. If there is evidence of MFE23
scFv-expressing autologous anti-CEA MFEz T lymphocytes survival, patients may receive
additional high-dose aldesleukin.

Patients undergo blood sample collection periodically for pharmacokinetic and
pharmacodynamic studies. Some patients may undergo a tumor biopsy.

After completion of study treatment, patients are followed up every 2 weeks for 6 weeks,
every 4 weeks for 6 months, every 3 months for 1 year, and then every 6 months thereafter.

Peer Reviewed and Funded or Endorsed by Cancer Research UK

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed malignancy

- Metastatic or unresectable disease

- Standard curative or palliative measures do not exist, are no longer effective,
have been completed, or have been refused

- CEA-positive tumor (either by immunohistochemistry or as demonstrated by elevated CEA
> 50 μg/L)

- No primary brain tumor or brain metastases

PATIENT CHARACTERISTICS:

- WHO performance status 0-1

- Life expectancy ≥ 3 months

- Hemoglobin ≥ 10 g/dL

- Platelet count ≥ 100 x 10^9/L

- Neutrophil count ≥ 2.0 x 10^9/L

- Lymphocyte count ≥ 1.0 x 10^9/L

- Serum bilirubin ≤ 1.5 times upper limit of normal (ULN)

- ALT/AST ≤ 5 times ULN

- Alkaline phosphatase ≤ 5 times ULN

- Calculated creatinine clearance OR isotope clearance measurement ≥ 50 mL/min

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception 4 weeks prior to, during, and for 6
months after completion of study therapy (male patients must use barrier-method
contraception)

- LVEF ≥ 50% on MUGA scan (for patients receiving cyclophosphamide)

- ECG and exercise ECG (or stress ECHO) normal (may be abnormal but not clinically
significant)

- Urine dipstick normal (may be abnormal but not clinically significant)

- No medical high risk due to nonmalignant systemic disease including active
uncontrolled infection

- No known serologically positive hepatitis B, hepatitis C, HIV, or HTLV

- No history of autoimmune disease

- No inflammatory bowel disease

- No concurrent congestive heart failure or prior history of NYHA class III-IV cardiac
disease

- No concurrent malignancies originating from other primary sites, except for
adequately treated cone-biopsied carcinoma in situ of the cervix uteri or basal cell
or squamous cell carcinoma of the skin

- No other condition that, in the investigator's opinion, would make the patient an
unsuitable candidate for the clinical trial

PRIOR CONCURRENT THERAPY:

- At least 30 days since prior and no concurrent participation in another clinical
trial

- At least 4 weeks since prior and no concurrent radiotherapy (except for palliative
reasons [i.e., control of bone pain])

- At least 4 weeks since prior and no concurrent endocrine therapy, immunotherapy, or
chemotherapy (6 weeks for nitrosoureas and mitomycin C)

- No toxic manifestations of previous treatment, except for alopecia or certain grade 1
toxicities that, in the opinion of the investigator and CRUK (Cancer Research UK),
would exclude the patient (e.g., grade 1 neuropathy or grade 1 fatigue)

- No prior major thoracic and/or abdominal surgery from which the patient has not yet
recovered

- No prior bone marrow transplant or extensive radiotherapy to > 25% of bone marrow

- No concurrent systemic steroids or other immunosuppressive therapy

- No other concurrent anticancer therapy or investigational drugs

Type of Study:

Interventional

Study Design:

Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Percentage of patients (goal is 50%) who are evaluable for MFE23 scFv-expressing autologous anti-CEA MFEz T lymphocytes survival

Safety Issue:

No

Principal Investigator

Robert E. Hawkins, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Christie Hospital NHS Foundation Trust

Authority:

United Kingdom: Medicines and Healthcare Products Regulatory Agency

Study ID:

CDR0000685060

NCT ID:

NCT01212887

Start Date:

August 2007

Completion Date:

April 2010

Related Keywords:

  • Breast Cancer
  • Colorectal Cancer
  • Gastric Cancer
  • Lung Cancer
  • Ovarian Cancer
  • Pancreatic Cancer
  • Unspecified Adult Solid Tumor, Protocol Specific
  • unspecified adult solid tumor, protocol specific
  • recurrent colon cancer
  • stage IIIA colon cancer
  • stage IIIB colon cancer
  • stage IIIC colon cancer
  • stage IV colon cancer
  • stage IVB colon cancer
  • recurrent rectal cancer
  • stage IIIA rectal cancer
  • stage IIIB rectal cancer
  • stage IIIC rectal cancer
  • stage IVA rectal cancer
  • stage IVB rectal cancer
  • recurrent gastric cancer
  • stage IV gastric cancer
  • recurrent pancreatic cancer
  • stage III pancreatic cancer
  • stage IV pancreatic cancer
  • recurrent breast cancer
  • stage IIIC breast cancer
  • stage IV breast cancer
  • extensive stage small cell lung cancer
  • recurrent non-small cell lung cancer
  • recurrent small cell lung cancer
  • stage IIIA non-small cell lung cancer
  • stage IIIB non-small cell lung cancer
  • stage IV non-small cell lung cancer
  • recurrent ovarian epithelial cancer
  • recurrent ovarian germ cell tumor
  • stage IIIA ovarian epithelial cancer
  • stage IIIA ovarian germ cell tumor
  • stage IIIB ovarian epithelial cancer
  • stage IIIB ovarian germ cell tumor
  • stage IIIC ovarian epithelial cancer
  • stage IIIC ovarian germ cell tumor
  • stage IV ovarian epithelial cancer
  • stage IV ovarian germ cell tumor
  • Breast Neoplasms
  • Colorectal Neoplasms
  • Lung Neoplasms
  • Stomach Neoplasms
  • Ovarian Neoplasms
  • Pancreatic Neoplasms

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