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Unspecified Adult Solid Tumor, Protocol SpecificPhase 1NCT02070406

Gene-Modified T Cells, Vaccine Therapy, and Ipilimumab in Treating Patients With Locally Advanced or Metastatic Malignancies

A Phase 1 study testing cyclophosphamide, fludarabine phosphate and NY-ESO-1 reactive TCR retroviral vector transduced autologous PBL in people with Unspecified Adult Solid Tumor, Protocol Specific, run by Jonsson Comprehensive Cancer Center at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This pilot phase I trial studies the side effects of taking ipilimumab after gene-modified T cells and vaccine therapy when treating patients with advanced cancer that has spread to other areas of the body and has not responded to standard therapies. Read more about this study

Who is it for?
Ages 16 years and older
What is being tested?
cyclophosphamide, fludarabine phosphate and NY-ESO-1 reactive TCR retroviral vector transduced autologous PBL
Could I receive a placebo?
No, everyone receives an active treatment
How many people
4 participants
Where
1 siteUnited States
Study dates
17 Jul 2014to 18 Dec 2018
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Stage IV or locally advanced cancers for which no alternative therapies with proven survival advantage are available
  • At least 1 lesion amenable for outpatient biopsies; this should be a cutaneous or palpable metastatic site or a deeper site accessible by image-guided biopsy that is deemed safe to access by the treating physicians and interventional radiologists; patients without accessible lesions for biopsy but with prior tissue available from metastatic disease would be eligible at the investigator's discretion
  • NY-ESO-1 positive malignancy by immunohistochemistry (IHC) utilizing commonly available NY-ESO-1 antibodies
  • Human leukocyte antigen (HLA)-A*0201 (HLA-A2.1) positivity by molecular subtyping
  • Life expectancy greater than 3 months assessed by a study physician
  • A minimum of one measurable lesion defined as:
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  • Meeting the criteria for measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST)
  • Skin lesion(s) selected as non-completely biopsied target lesion(s) that can be accurately measured and recorded by color photography with a ruler to document the size of the target lesion(s)
  • No restriction based on prior treatments
  • Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
  • Absolute neutrophil count >= 1.5 x 10^9 cells/L
  • Platelets >= 100 x 10^9/L
  • Hemoglobin >= 10 g/dL
  • Aspartate and alanine aminotransferases (AST, ALT) =< 2.5 x upper limit of normal (ULN) (=< 5 x ULN, if documented liver metastases are present)
  • Total bilirubin =< 2 x ULN (except patients with documented Gilbert's syndrome)
  • Creatinine < 2 mg/dl (or a glomerular filtration rate > 60)
  • Must be willing and able to accept two leukapheresis procedures
  • Must be willing and able to provide written informed consent

Who cannot join

  • Previously known hypersensitivity to any of the agents used in this study
  • Received systemic treatment for cancer, including immunotherapy, within one month prior to initiation of dosing within this protocol
  • History of, or significant evidence of risk for, chronic inflammatory or autoimmune disease (eg, Addison's disease, multiple sclerosis, Graves' disease, Hashimoto's thyroiditis, inflammatory bowel disease, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, hypophysitis, pituitary disorders, etc.); patients will be eligible if prior autoimmune disease is not deemed to be active (e.x. fibrotic damage of the thyroid after thyroiditis or its treatment, with stable thyroid hormone replacement therapy); vitiligo will not be a basis for exclusion
  • History of inflammatory bowel disease, celiac disease, or other chronic gastrointestinal conditions associated with diarrhea or bleeding, or current acute colitis of any origin
  • Potential requirement for systemic corticosteroids or concurrent immunosuppressive drugs based on prior history or received systemic steroids within the last 4 weeks prior to enrollment (inhaled or topical steroids at standard doses are allowed)
  • Human immunodeficiency virus (HIV) seropositivity or other congenital or acquired immune deficiency state, which would increase the risk of opportunistic infections and other complications during chemotherapy-induced lymphodepletion; if there is a positive result in the infectious disease testing that was not previously known, the patient will be referred to their primary physician and/or infectious disease specialist
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  • Hepatitis B or C seropositivity with evidence of ongoing liver damage, which would increase the likelihood of hepatic toxicities from the chemotherapy conditioning regimen and supportive treatments; if there is a positive result in the infectious disease testing that was not previously known, the patient will be referred to their primary physician and/or infectious disease specialist
  • Dementia or significantly altered mental status that would prohibit the understanding or rendering of informed consent and compliance with the requirements of this protocol
  • Clinically active brain metastases; radiological documentation of absence of active brain metastases at screening is required for all patients; prior evidence of brain metastasis successfully treated with surgery or radiation therapy will not be exclusion for participation as long as they are deemed under control at the time of study enrollment
  • Pregnancy or breast-feeding; female patients must be surgically sterile or be postmenopausal for two years, or must agree to use effective contraception during the period of treatment and 6 months after; all female patients with reproductive potential must have a negative pregnancy test (serum/urine) within 14 days from starting the conditioning chemotherapy; the definition of effective contraception will be based on the judgment of the study investigators
  • Since IL-2 is administered following cell infusion:
  • Patients will be excluded if they have a history of clinically significant electrocardiogram (ECG) abnormalities, symptoms of cardiac ischemia or arrhythmias and have a left ventricular ejection fraction (LVEF) < 45% on a cardiac stress test (stress thallium, stress multi gated acquisition (MUGA) scan, dobutamine echocardiogram, or other stress test)
  • Similarly, patients who are 50 years old with a baseline LVEF < 45% will be excluded
  • Patients with ECG results of any conduction delays (PR interval > 200 ms, corrected QT interval [QTC] > 480 ms), sinus bradycardia (resting heart rate < 50 beats per minute), sinus tachycardia (heart rate > 120 beats per minute) will be evaluated by a cardiologist prior to starting the trial; patients with any arrhythmias, including atrial fibrillation/atrial flutter, excessive ectopy (defined as > 20 PVCs per minute), ventricular tachycardia, 3rd degree heart block will be excluded from the study unless cleared by a cardiologist
  • Patients with pulmonary function test abnormalities as evidenced by a forced expiratory volume of the lung in 1 second (FEV1)/forced vital capacity (FVC) < 70% of predicted for normality will be excluded
  • Evidence of diverticulitis at baseline, including evidence limited to computed tomography (CT) scan only

Trial locations and contacts

1 site in 1 country.

United States1 site

  • Jonsson Comprehensive Cancer Center

    Los Angeles, California, 90095

Other trials in United States

About this study

Official title: NY-ESO-1 TCR Engineered Adoptive Cell Transfer Therapy With CTLA4 Blockade

This pilot phase I trial studies the side effects of taking ipilimumab after gene-modified T cells and vaccine therapy when treating patients with advanced cancer that has spread to other areas of the body and has not responded to standard therapies. This trial also will determine the best dose of Ipilimumab to use in this combination treatment. T cells are a special type of white blood cell (immune cell) that have the ability to kill cancer cells. T cells are taken from the blood and modified in the laboratory to recognize a specific protein expressed on cancer cells, called NY-ESO-1. This may allow the T cells to target and kill cancer cells that express that protein. Dendritic cells are another type of blood cell that can teach other cells in the body to look for cancer cells and attack them. Giving a dendritic cell vaccine with the NY-ESO-1 protein may help dendritic cells teach the immune system to target cancer cells expressing that protein, and further help the T cells attack cancer. Ipilimumab is a monoclonal antibody, a type of drug manufactured in the laboratory that is similar to antibodies made in the human body that fight off infection. Ipilimumab blocks a protein that turns down the immune system, so blocking this protein may make the immune system more active. This may increase the ability of immune cells to kill cancer cells and improve the effectiveness of the T cell transplant. Giving gene-modified T-cells, a dendritic cell vaccine, and ipilimumab together may teach the immune system to recognize and kill cancer cells that have the NY-ESO-1 protein.

Read the detailed description

PRIMARY OBJECTIVES:

  1. The safety of NY-ESO-1 T-cell receptor (TCR) transgenic adoptive cell transfer (ACT) has been reported. The current protocol includes the addition of the cytotoxic T-lymphocyte-associated protein 4 (CTLA4) blocking monoclonal antibody ipilimumab to NY ESO TCR ACT in a dose escalation scheme in two study cohorts at 1 and 3 mg/kg of ipilimumab intravenous (i.v.) every three weeks with a maximum of 4 doses (q3wx4).

SECONDARY OBJECTIVES:

  1. To determine the feasibility of delivering the TCR transgenic cell dose and CTLA blockade to patients.

II. To determine the persistence of NY-ESO-1 TCR-engineered peripheral blood mononuclear cells (PBMC) in serial peripheral blood samples and in biopsies of accessible metastatic lesions.

III. To explore the use of positron emission tomography (PET)-based imaging using the PET tracer [18F] fluorodeoxy-glucose ([18F]FDG) with the goal of determining if the adoptively transferred NY-ESO-1 TCR-engineered PBMC when administered with ipilimumab home and expand in secondary lymphoid organs and tumor deposits.

IV. Clinical antitumor activity recording objective response rate will be an exploratory endpoint in this pilot clinical trial.

OUTLINE: This is a dose-escalation study of ipilimumab.

CONDITIONING CHEMOTHERAPY REGIMEN: Patients receive cyclophosphamide IV on days -5 and -4 and fludarabine phosphate IV over 30 minutes daily on days -4 to -1.

NY-ESO-1 TCR PBMC INFUSION: Patients receive NY-ESO-1 reactive TCR retroviral vector transduced autologous T cells IV on day 0.

IPILIMUMAB ADMINISTRATION: Patients receive ipilimumab IV over 90 minutes before the NY-ESO-1 TCR PBMC infusion on day 0 or after the infusion on day 1. Treatment repeats every 3 weeks for up to 4 doses in the absence of disease progression or unacceptable toxicity.

NY-ESO-1(157-165) PEPTIDE PULSED DENDRITIC CELL (DC) ADMINISTRATION: Patients receive NY-ESO-1(157-165) peptide pulsed DC vaccine intradermally (ID) on days 1, 14, and 30.

LOW DOSE INTERLEUKIN-2 (IL-2) ADMINISTRATION: Patients receive aldesleukin (IL-2) subcutaneously (SC) twice daily (BID) on days 1-14.

After completion of study treatment, patients are followed up periodically for 90 days, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

Being tested
cyclophosphamide, fludarabine phosphate, NY-ESO-1 reactive TCR retroviral vector transduced autologous PBL, dendritic cell vaccine therapy, aldesleukin

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • cyclophosphamideDrug

    Also called CPM, CTX, Cytoxan, Endoxan

    Given IV

  • fludarabine phosphateDrug

    Also called 2-F-ara-AMP, Beneflur, Fludara

    Given IV

  • NY-ESO-1 reactive TCR retroviral vector transduced autologous PBLBiological

    Also called anti-NY-ESO-1 TCR gene-engineered lymphocytes, anti-NY-ESO-1 TCR retroviral vector-transduced lymphocytes

    Given NY-ESO-1 reactive TCR retroviral vector transduced autologous T cells IV

  • dendritic cell vaccine therapyBiological

    NY-ESO-1157-165 peptide pulsed DC vaccine given ID

  • aldesleukinBiological

    Also called IL-2, Proleukin, recombinant human interleukin-2, recombinant interleukin-2

    Given SC

  • fludeoxyglucose F 18Radiation

    Also called 18FDG, FDG

    Correlative studies

  • positron emission tomographyProcedure or surgery

    Also called FDG-PET, PET, PET scan, tomography, emission computed

    Correlative studies

  • laboratory biomarker analysisOther

    Correlative studies

Study groups in NCT02070406
Study groupRoleWhat they receive
Treatment (gene-modified T-cells, vaccine therapy, ipilimumab)ExperimentalCONDITIONING CHEMOTHERAPY REGIMEN: Patients receive cyclophosphamide IV on days -5 and -4 and fludarabine phosphate IV over 30 minutes daily on days -4 to -1. NY-ESO-1 TCR PBMC INFUSION: Patients receive NY-ESO-1 reactive TCR retroviral vector transduced autologous T cells IV on day 0. IPILIMUMAB ADMINISTRATION: Patients receive ipilimumab IV over 90 minutes before the NY-ESO-1 TCR PBMC infusion on day 0 or after the infusion on day 1. Treatment repeats every 3 weeks for up to 4 doses in the absence of disease progression or unacceptable toxicity. NY-ESO-1(157-165) PEPTIDE PULSED DC ADMINISTRATION: Patients receive NY-ESO-1(157-165) peptide pulsed DC vaccine ID on days 1, 14, and 30. LOW DOSE IL-2 ADMINISTRATION: Patients receive aldesleukin (IL-2) SC BID on days 1-14.
Receives: Drug: cyclophosphamide; Drug: fludarabine phosphate; Biological: NY-ESO-1 reactive TCR retroviral vector transduced autologous PBL; Biological: dendritic cell vaccine therapy; Biological: aldesleukin; Radiation: fludeoxyglucose F 18; Procedure: positron emission tomography; Other: laboratory biomarker analysis

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of toxicity as defined using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0

    Simple descriptive statistics will be used to summarize toxicities observed after each TCR transgenic cell infusion in terms of type (organ affected or laboratory determination such as absolute neutrophil count), severity (by toxicity table) and nadir or maximum values for the laboratory measures, time of onset (i.e. course number), duration, and reversibility or outcome. Tables will be created to summarize these toxicities and side effects by dose and by course. Baseline information (e.g. the extent of prior therapy) and demographic information will be presented, as well.

    Measured: Up to 5 years

  2. Maximum tolerable dose (MTD) based on the number of subjects experiencing dose limiting toxicities (DLTs)

    Adverse events are defined following the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events version 3.0.

    Measured: 60 days

Secondary outcomes (4)

  1. Feasibility of NY-ESO-1 TCR cells, determined by incidence of preparation not meeting the lot release criteria

    Descriptive statistics including simple summary measures and plots appropriate for longitudinal data will be used. If appropriate, single group inferences of counts will be made with 2-sided confidence intervals.

    Measured: 1 month

  2. Transgenic cell persistence, analyzed using immune monitoring and molecular techniques

    Molecular analysis of the persistence of cells bearing the NY-ESO-1 TCR complementary deoxyribonucleic acid (cDNA) will be done by real time polymerase chain reaction (PCR) techniques using primers specific for the transgenes and retroviral vector sequences. Immunological monitoring will consist primarily of quantifying T cells bearing surface NY-ESO-1 TCR by NY-ESO-1 126-157/ major histocompatibility complex (MHC) tetramer or dextramer analysis. Descriptive statistics including simple summary measures and plots appropriate for longitudinal data will be used.

    Measured: Up to 5 years

  3. NY-ESO-1 TCR transgenic cell tumor trafficking (imaging), assessed using 18F-FDG PET

    Regional uptake of 18F-FDG within metastatic tumor sites and secondary lymphoid organs will be quantified by standard uptake value (SUV) normalized to the body weight of the patient. As an internal quality control, SUVs will also be determined for several normal organs, such as muscle, liver and lungs. Descriptive statistics including simple summary measures and plots appropriate for longitudinal data will be used. If appropriate, single group inferences of SUVs will be made with 2-sided confidence intervals.

    Measured: Up to 60 days after ACT

  4. Antitumor activity, assessed using RECIST

    Descriptive statistics including simple summary measures and plots appropriate for longitudinal data will be used.

    Measured: Up to day 90

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Feb 2014 (estimated)
  2. Study start17 Jul 2014
  3. Primary completion18 Dec 2018
  4. Study completion18 Dec 2018

Why it stopped: low accrual

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
4 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02070406
Sponsor's protocol ID
13-001624
Other IDs
NCI-2014-00221, 13-001624, P30CA016042
Status last verified
Feb 2019
First submitted
21 Feb 2014
Last updated
28 Feb 2019
Results posted
No
Data monitoring committee
Yes

Publications

  • Nowicki TS, Berent-Maoz B, Cheung-Lau G, Huang RR, Wang X, Tsoi J, Kaplan-Lefko P, Cabrera P, Tran J, Pang J, Macabali M, Garcilazo IP, Carretero IB, Kalbasi A, Cochran AJ, Grasso CS, Hu-Lieskovan S, Chmielowski B, Comin-Anduix B, Singh A, Ribas A. A Pilot Trial of the Combination of Transgenic NY-ESO-1-reactive Adoptive Cellular Therapy with Dendritic Cell Vaccination with or without Ipilimumab. Clin Cancer Res. 2019 Apr 1;25(7):2096-2108. doi: 10.1158/1078-0432.CCR-18-3496. Epub 2018 Dec 20.

    PubMed 30573690

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing cyclophosphamide, fludarabine phosphate and NY-ESO-1 reactive TCR retroviral vector transduced autologous PBL in people with Unspecified Adult Solid Tumor, Protocol Specific, run by Jonsson Comprehensive Cancer Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 18 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 28 Feb 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was stopped early (reason given: low accrual). Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of toxicity as defined using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (time frame: Up to 5 years). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02070406, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Feb 2019.

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