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Phase I/II Study of Metastatic Cancer Using Lymphodepleting Conditioning Followed by Infusion of Anti-mesothelin Gene Engineered Lymphocytes


Phase 1/Phase 2
18 Years
N/A
Open (Enrolling)
Both
Metastatic Cancer, Pancreatic Cancer, Mesothelioma

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Trial Information

Phase I/II Study of Metastatic Cancer Using Lymphodepleting Conditioning Followed by Infusion of Anti-mesothelin Gene Engineered Lymphocytes


Background:

- We have constructed a single retroviral vector that contains a chimeric T cell receptor
(CAR) that recognizes mesothelin, which can be used to mediate genetic transfer of this
CAR with high efficiency (> 50%) without the need to perform any selection.

- In co-cultures with mesothelin expressing cells, anti-mesothelin transduced T cells
secreted significant amounts of IFN-gamma with high specificity.

Objectives:

Primary Objectives:

- To evaluate the safety of the administration of anti-mesothelin CAR engineered
peripheral blood lymphocytes in patients receiving a non- myeloablative conditioning
regimen, and aldesleukin.

- Determine if the administration anti-mesothelin CAR engineered peripheral blood
lymphocytes and aldesleukin to patients following a nonmyeloablative but lymphoid
depleting preparative regimen will result in clinical tumor regression in patients with
metastatic cancer.

Secondary Objective:

-Determine the in vivo survival of CAR gene-engineered cells.

Eligibility:

Patients who are 18 years of age or older must have

- Metastatic or unresectable cancer that expresses mesothelin;

- Previously received and have been a non-responder to or recurred after standard care;

Patients may not have:

-Contraindications for low dose aldesleukin administration.

Design:

- PBMC obtained by leukapheresis will be cultured in order to stimulate T-cell growth.

- Transduction is initiated by exposure of approximately 108 to 5 X 108 cells to
retroviral vector supernatant containing the anti-mesothelin CAR.

- Patients will receive a nonmyeloablative but lymphocyte depleting preparative regimen
consisting of cyclophosphamide and fludarabine followed by intravenous infusion of ex
vivo CAR gene-transduced PBMC plus low dose IV aldesleukin

- Patients will undergo complete evaluation of tumor with physical examination, CT of the
chest, abdomen and pelvis and clinical laboratory evaluation four to six weeks after
treatment. If the patient has SD or tumor shrinkage, repeat complete evaluations will
be performed every 1-3 months. After the first year, patients continuing to respond
will continue to be followed with this evaluation every 3-4 months until off study
criteria are met.

- The study will be conducted using a Phase I/II optimal design. The protocol will
proceed in a phase 1 dose escalation design. Once the MTD has been determined, the
study then would proceed to the phase II portion. Patients will be entered into two
cohorts based on histology: cohort 1 will include patients with mesothelioma, and
cohort 2 will include patients with other types of cancer that express mesothelin.

- For each of the 2 strata evaluated, the study will be conducted using a phase II
optimal design where initially 21 evaluable patients will be enrolled. For each of
these two arms of the trial, if 0 or 1 of the 21 patients experiences a clinical
response, then no further patients will be enrolled but if 2 or more of the first 21
evaluable patients enrolled have a clinical response, then accrual will continue until
a total of 41 evaluable patients have been enrolled in that stratum.

Inclusion Criteria


- INCLUSION CRITERIA:

1. Metastatic or unresectable measurable cancers that express mesothelin.
Epithelial mesotheliomas and pancreatic cancers do not need to be assessed for
mesothelin expression since all of these tumors have been shown to express
mesothelin.

2. Patients must have previously received at least one systemic standard care (or
effective salvage chemotherapy regimens) for metastatic or unresectable disease,
if known to be effective for that disease, and have been either non-responders
(progressive disease) or have recurred.

3. Greater than or equal to 18 years of age.

4. Willing to sign a durable power of attorney

5. Able to understand and sign the Informed Consent Document

6. Clinical performance status of ECOG 0 or 1.

7. Life expectancy of greater than three months.

8. Patients of both genders must be willing to practice birth control from the time
of enrollment on this study and for up to four months after receiving the
preparative regimen.

9. Serology:

1. Seronegative for HIV antibody. (The experimental treatment being evaluated
in this protocol depends on an intact immune system. Patients who are HIV
seropositive can have decreased immunecompetence and thus be less
responsive to the experimental treatment and more susceptible to its
toxicities.)

2. Seronegative for hepatitis B antigen, and seronegative for hepatitis C
antibody. If hepatitis C antibody test is positive, then patient must be
tested for the presence of antigen by RT-PCR and be HCV RNA negative.

3. Women of child-bearing potential must have a negative pregnancy test
because of the potentially dangerous effects of the preparative
chemotherapy on the fetus.

10. Hematology:

1. Absolute neutrophil count greater than 1000/mm(3) without the support of
filgrastim.

2. WBC (> 3000/mm(3)).

3. Platelet count greater than 100,000/mm(3).

4. Hemoglobin greater than 8.0 g/dl.

11. Chemistry:

1. Serum ALT/AST less or equal to 2.5 times the upper limit of normal.

2. Serum creatinine less than or equal to 1.6 mg/dl.

3. Total bilirubin less than or equal to 1.5 mg/dl, except in patients with
Gilbert's Syndrome who must have a total bilirubin less than 3.0 mg/dl.

12. More than four weeks must have elapsed since any prior systemic therapy at the
time the patient receives the preparative regimen, and patients' toxicities must
have recovered to a grade 1 or less (except for toxicities such as alopecia or
vitiligo).

EXCLUSION CRITERIA:

1. Patients with sarcomatoid mesothelioma as mesothelin is not expressed in this type of
mesothelioma.

2. Women of child-bearing potential who are pregnant or breastfeeding because of the
potentially dangerous effects of the preparative chemotherapy on the fetus or infant.

3. Patients with known brain metastases.

4. Patients receiving full dose anticoagulative therapy.

5. Active systemic infections, coagulation disorders or other major medical illnesses of
the cardiovascular, respiratory or immune system, myocardial infarction, cardiac
arrhythmias, obstructive or restrictive pulmonary disease.

6. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency
Disease).

7. Concurrent opportunistic infections (The experimental treatment being evaluated in
this protocol depends on an intact immune system. Patients who have decreased immune
competence may be less responsive to the experimental treatment and more susceptible
to its toxicities).

8. Patients with diabetic retinopathy.

9. Concurrent Systemic steroid therapy.

10. History of severe immediate hypersensitivity reaction to any of the agents used in
this study.

11. History of coronary revascularization or ischemic symptoms.

12. Documented FEV1 less than or equal to 60% predicted tested in all patients.

13. In patients over 60 years of age, LVEF of less than 45%

Type of Study:

Interventional

Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Evaluate safety of anti-mesothelin CAR engineered PBL in patients receiving the protocol regimen.

Principal Investigator

Steven A Rosenberg, M.D.

Investigator Role:

Principal Investigator

Investigator Affiliation:

National Cancer Institute (NCI)

Authority:

United States: Federal Government

Study ID:

120111

NCT ID:

NCT01583686

Start Date:

March 2012

Completion Date:

April 2018

Related Keywords:

  • Metastatic Cancer
  • Pancreatic Cancer
  • Mesothelioma
  • Metastatic Cancer
  • Immunotherapy
  • Gene Therapy
  • Mesothelioma
  • Pancreatic Cancer
  • Mesothelioma
  • Neoplasm Metastasis
  • Neoplasms
  • Neoplasms, Second Primary
  • Pancreatic Neoplasms

Name

Location

National Institutes of Health Clinical Center, 9000 Rockville Pike Bethesda, Maryland  20892