CTLA-4 and PD-1 Antibodies Expressing EGFR-CAR-T Cells for EGFR Positive Advanced Solid Tumor

A Clinical Study of CTLA-4 and PD-1 Antibodies Expressing EGFR-CAR-T Cells for Patients With EGFR Positive Advanced Solid Tumors

This is a single-arm, open-label, one center clinical study, to determine the safety and efficacy of infusion of autologous T cells engineered to express immune checkpoint antibodies (CTLA-4 and PD-1) and chimeric antigen receptor targeting epidermal growth factor receptor (EGFR-CAR) in adult patients with EGFR positive, advanced recurrent or refractory malignant solid tumors.

Study Overview

• Status: Unknown
• Conditions: Advanced Solid Tumor
• Intervention / Treatment: Biological: anti-CTLA-4/PD-1 expressing EGFR-CAR-T

Detailed Description

This study will be conducted using a phase I/II trial design to assess the efficacy and safety of the CTLA-4 and PD-1 antibodies expressing EGFR-CAR-T for patients with EGFR positive advanced recurrent or refractory malignant solid tumors. EGFR-CAR-T can specificly and effectively kill the EGFR positive cancer cells, CTLA-4 and PD-1 antibodies are secreted from the CAR-T cells could improve immunosuppression microenvironment, new CAR-T cells contain the advantages of CAR-T and immune checkpoint inhibitor, which is a promising therapeutic method for advanced solid tumors.

The new CAR-T therapy is applied to clinical practice as bellow. T cells are prepared from peripheral blood mononuclear cells (PBMC) by leukapheresis, then activated and engineered to express CTLA-4 and PD-1 antibodies and chimeric antigen receptor targeting EGFR. Cells are proliferated in culture and returned to the patients by venous transfusion therapy. A total of 40 patients may be enrolled in the study. The total duration of the study is expected to be approximately 24 months.

• Study Type: Interventional
• Enrollment (Anticipated): 40
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Zhiwei Zhang, Ph.D; Phone Number: 0086-021-39595338; Email: zhangzw@shcell.com

Study Locations

• China
  • Zhejiang
    • Ningbo, Zhejiang, China, 315201
      • Recruiting
      • Ningbo No.5 Hospital (Ningbo Cancer Hospital)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Patients with relapsed or refractory advanced solid malignancies (diagnosed by histology or cytology detection).
2. Progressive disease and no response after at least second-line therapy.
3. Gender unlimited, age from 18 years to 80 years.
4. Life expectancy ≥3 months.
5. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2.
6. Adequate venous access for peripheral blood mononuclear cell (PBMC) apheresis, and no other contraindications.
7. Immunohistochemistry (IHC) score of EGFR on tumor tissue ≥1+.
8. Adequate hepatic function, renal function and bone marrow function (withhin 7 days before enrollment): white blood cell (WBC) ≥3.0×10^9/L; platelet ≥100×10^9/L; hemoglobin ≥90 g/L; lymphocyte ≥0.7×10^9/L; total bilirubin ≤2 times the upper limit of the normal value; alanine aminotransferase and aspartate transaminase(ALT and AST) ≤2.5 times the upper limit of the normal value; serum creatinine ≤1.5 times the upper limit of the normal value.
9. There is no other treatments (chemotherapy, radiotherapy, etc.) within four weeks before enrollment.
10. There is at least one measurable tumor lesion.
11. Patients have adequate ability to understand, sign informed consents and take part in the clinical research voluntarily.
12. Female patients in child bearing period must have evidence of negative pregnancy test, and agree to take effective contraceptive measures until 4 months after cells infusion.

Exclusion Criteria:

1. Patients with two or more kinds of tumors.
2. Patients with active viral or bacterial infection, and have failed to be controlled by anti-infective treatment.
3. Patients with seropositive reponse of Human immunodeficiency virus (HIV) and syphilis, or fail to control the hepatitis B virus or hepatitis C virus infection.
4. Patients with active rheumatic diseases, organ transplantation and other diseases affecting the immune system seriously.
5. Patients with severe heart and lung dysfunction.
6. Patients with severe chronic diseases of kidney, liver and other important organs.
7. Patients with any other serious illnesse that the investigators consider it will may affect the patient's treatments, follow-up or assessment, including any uncontrolled clinically significant neurological or psychiatric disorders, immunoregulatory diseases, metabolic diseases, infectious diseases and so on.
8. Patients who take part in clinical trials of other drugs or biological therapy at present or within 30 days before enrollment.
9. Patients who need long-term use of immunosuppressive drugs or patients who are undergoing treatment of autoimmune diseases.
10. Patients who need long-term use of glucocorticoid.
11. Women patients in gestation period or suckling period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: anti-CTLA-4/PD-1 expressing EGFR-CAR-T; This study have only one arm that is anti-CTLA-4/PD-1 expressing EGFR-CAR-T group. All patients with advanced solid tumor will take part in the screening, who matching all the conditions will be chosen for the treatment using CTLA-4 and PD-1 antibodies expressing EGFR-targeted CAR-T cells. New CAR-T cells are cultured from PBMC and returned to the patients by venous transfusion.

Biological: anti-CTLA-4/PD-1 expressing EGFR-CAR-T; Every cycle, peripheral blood mononuclear cells (PBMC) are collected on day 0, CAR-T cells are cultured in a GMP standard workshop. Patients are given a three-day regimen of chemotherapy consisting of cyclophosphamide aimed to deplete the lymphocytes before cells infusion. Then the patients will receive an i.v.gtt infusion of CTLA-4 and PD-1 antibodies expressing EGFR-CAR-T cells at (2-5) ×10^7 cells/kg from day 18 to day 19 (±2 days). 2 cycles are regarded as a treatment period.; Other Names: CTLA-4 and PD-1 antibodies expressing EGFR-CAR-T cells

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of treatment-related adverse events as assessed by CTCAE v4.0	Determine treatment-related adverse events of the immunotherapy with common toxicity criteria for adverse effects (CTCAE) version 4.0.	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The response evaluation of of the treatment for advanced solid tumors	The efficacy of the treatment is assessed according to the response evaluation criteria in solid tumor version 1.1 (RECIST1.1), which is defined as complete remission (CR), partial remission (PR), stable disease (SD), or progressive disease (PD).	2 years
Progression free survival	Progression free survival is defined as the time from the day in which the patient is enrolled to the date on which tumor progresses or the date on which the patient dies for any cause.	2 years
Overall survival	Overall survival is defined as the time from the day in which the patient is enrolled to the date on which the patient dies for any cause.	2 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
The quality of life as assessed by EORTC QLQ-30	The quality of life is assessed before and after the treatment by EORTC QLQ-30.	2 years
Proliferation and persistence of EGFR-CAR-T cells in peripheral blood	CAR-T proportion in peripheral blood of the patients is detected by flow cytometry assay to study the proliferation and persistence of EGFR specific CAR-T cells.	6 months
CTLA-4 and PD-1 antibodies level in peripheral blood	CTLA-4 and PD-1 antibodies level are detected by ELISA assay to asess the expressing level of CTLA4 and PD-1 antibodies from CAR-T cells.	6 months

Collaborators and Investigators

• Sponsor: Shanghai Cell Therapy Research Institute

Publications and helpful links

General Publications

• Zhang Y, Zhang Z, Ding Y, Fang Y, Wang P, Chu W, Jin Z, Yang X, Wang J, Lou J, Qian Q. Phase I clinical trial of EGFR-specific CAR-T cells generated by the piggyBac transposon system in advanced relapsed/refractory non-small cell lung cancer patients. J Cancer Res Clin Oncol. 2021 Dec;147(12):3725-3734. doi: 10.1007/s00432-021-03613-7. Epub 2021 May 25.

Study record dates

Study Major Dates

• Study Start (ANTICIPATED): June 7, 2017
• Primary Completion (ANTICIPATED): January 20, 2019
• Study Completion (ANTICIPATED): April 20, 2019

Study Registration Dates

• First Submitted: June 5, 2017
• First Submitted That Met QC Criteria: June 7, 2017
• First Posted (ACTUAL): June 9, 2017

Study Record Updates

• Last Update Posted (ACTUAL): June 9, 2017
• Last Update Submitted That Met QC Criteria: June 7, 2017
• Last Verified: June 1, 2017

More Information

Terms related to this study

• Keywords: PD-1; solid tumor; CTLA-4; chimeric antigen receptor T cells; epidermal growth factor receptor
• Additional Relevant MeSH Terms: Neoplasms
• Other Study ID Numbers: H2017-03-P01

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No