TCR Modified T Cells MDG1011 in High Risk Myeloid and Lymphoid Neoplasms

February 13, 2023 updated by: Medigene AG

A Phase I/II, Open-Label, Non-Randomized, Multicentre, Dose-Escalation Clinical Trial With Control Group to Evaluate the Safety, Feasibility and Preliminary Efficacy of PRAME TCR Modified T Cells, MDG1011, in Subjects With High Risk Myeloid and Lymphoid Neoplasms

This is a multicentre, non-randomized, open-label, Phase I/II clinical trial of MDG1011, an investigational medicinal product (IMP), consisting of patient-derived autologous T cells, persistently transduced with a Preferentially Expressed Antigen in Melanoma (PRAME)-specific human leukocyte antigen (HLA)-A*02:01-restricted T cell receptor (TCR).

Study Overview

Detailed Description

Phase I:

The Phase I dose escalation part will establish the MTD/RP2D in subjects with high risk myeloid and lymphoid neoplasms, a total of 3 disease entities.

Phase I subjects will be enrolled into the following cohorts and treated with a single intravenous (i.v.) infusion of IMP:

  • Cohort 1: target dose of 1 x 105 T cells/kg ± 20%
  • Cohort 2: target dose of 1 x 106 T cells/kg ± 20%
  • Cohort 3: target dose of 5 x 106 T cells/kg ± 20%
  • Optional cohort 4: up to 1 x 107 T cells/kg + 20%

Phase II:

The Phase II part consists of two arms, each representing one disease entity. Within each arm, representing a disease entity, subjects will be enrolled in 2 different treatment groups to receive either:

  1. IMP in the treatment group (up to 20 subjects who are positive for human leukocyte antigen (HLA)-A*02:01); Or
  2. therapy as per Investigator's discretion in the concurrent control (up to 20 subjects who are negative for HLA-A*02:01).

Study Type

Interventional

Enrollment (Actual)

9

Phase

  • Phase 2
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

      • Dresden, Germany
        • University Hospital Dresden
      • Erlangen, Germany
        • University Hospital Erlangen
      • Frankfurt, Germany
        • University Hospital Frankfurt
      • Freiburg, Germany
        • University Hospital Freiburg
      • Heidelberg, Germany
        • University Hospital Heidelberg
      • Leipzig, Germany
        • University Hospital Leipzig
      • Mainz, Germany
        • University Hospital Mainz
      • Regensburg, Germany
        • University Hospital Regensburg
      • Wuerzburg, Germany
        • University Hospital Wuerzburg

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

INCLUSION CRITERIA:

  1. Signed written informed consent prior to any clinical trial-related activities
  2. Documented diagnosis with the last disease staging within the last 4 weeks prior to screening
  3. Human leukocyte antigen (HLA):

    1. Phase I and Phase II (treatment group): Subjects positive for HLA-A*02:01 according to genotyping results
    2. Phase II (concurrent control group): Subjects negative for HLA-A*02:01 according to genotyping results
  4. Age ≥ 18 years
  5. Life expectancy of at least 4 months.
  6. Eastern Cooperative Oncology Group (ECOG) performance status 0-2
  7. Subjects not planned for allogeneic HSCT (e.g. based on disease characteristics or subject characteristics). Bridging to an allogeneic HSCT will be allowed.
  8. Females of childbearing potential must have a negative serum beta human chorionic gonadotropin (β-hCG) pregnancy test result before leukapheresis and before administration of lymphodepleting chemotherapy. Females of non-childbearing potential are those who are postmenopausal greater than 2 years or who have had a bilateral tubal ligation or hysterectomy.
  9. Females of childbearing potential and males who have partners of childbearing potential must agree to use an effective contraception method during the clinical trial and for 6 months following the last dose of IMP.

Effective birth control includes:

  1. intrauterine device plus 1 barrier method; or (b) 2 barrier methods. Effective barrier methods are male or female condoms, diaphragms, and spermicides (creams or gels that contain a chemical to kill sperm).

    AML-SPECIFIC INCLUSION CRITERIA:

    1. No Complete remission/response (CR) or Complete remission with incomplete hematologic recovery (CRi) after completion of at least 2 cycles of intensive induction chemotherapy or 1 cycle of intensive induction and consolidation (intermediate or high dose cytarabine) chemotherapy each and/or
    2. No CR or no CRi after completion of at least 1 cycle of intensive induction chemotherapy including at least 5 days of cytarabine 100-200 mg/m^2 continuously or an equivalent regimen with cytarabine with total dose not less than 500 mg/m^2 per cycle and at least 2 days of an anthracycline (e.g. daunorubicine, idarubicin), unable to undergo allogeneic HSCT and/or
    3. Refractory disease (including stable disease [SD], progressive disease [PD]) or relapsed disease after hypomethylating agent therapy (e.g. azacitidine, decitabine) and/or
    4. Any SD, partial response (PR), CRi, CR obtained after re-induction or salvage-therapy and/or
    5. Relapsed AML patients unable to undergo allogeneic HSCT and/or
    6. Relapsed AML after allogeneic HSCT

      1. at least 100 days after transplant
      2. no evidence of active acute or chronic GvHD at enrolment
      3. in case of history of acute (> overall grade 1) or chronic GvHD (moderate/severe) requiring immunosuppression treatment, no immunosuppression within the last 3 months
      4. no immunosuppression (with the exception of low dose steroids <= 10 mg prednisone or equivalent) 4 weeks before enrolment and ongoing and
    7. Myeloid blasts must positively express PRAME

    MDS-SPECIFIC INCLUSION CRITERIA:

    1. IPSS INT-2 or High Grade MDS Excess Blasts-2 (EB-2) not responding to at least 6 courses of azacitidine or 4 courses of decitabine and/or
    2. IPSS INT-1, INT-2 or High Grade MDS with recurrence after initial response and
    3. Blasts must positively express PRAME

    MM-SPECIFIC INCLUSION CRITERIA:

    1. Relapsed and refractory multiple myeloma:

      • Progressive MM, also defined as relapsed disease, defined as:

      1. A 25% increase from baseline in the serum M-protein (absolute increase

        • 0.5 g/dL), urine M-protein (absolute increase > 200 mg/day), and/or the difference between involved and uninvolved free light chain levels (absolute increase ≥ 10 mg/dL).
      2. The presence of definite new bone lesions and/or soft tissue plasmacytomas with a clear increase in the size of existing plasmacytomas, or hypercalcemia, that cannot be attributed to another cause. • Relapsed and refractory MM is defined as disease progression within 60 days of a patient's last treatment where at least a minimal response was achieved. • Primary refractory MM is defined as disease that fails to achieve at least a minimal response with any therapy. and
    2. At least 3 previous therapy lines with at least one proteasome inhibitor and one immunomodulatory derivate (IMiDs). Induction with or without hematopoietic stem cell transplant and with or without maintenance therapy is considered a single regimen. and
    3. Myeloma cells must positively express PRAME

      CRITERIA FOR PRE-EMPTIVE LEUKAPHERESIS PROCEDURE

      • subject is positive for HLA-A*02:01 and their blasts/myeloma cells express PRAME

      • subject fulfills at least some inclusion criteria and, based on the judgement of the investigator, have a likelihood of being eligible for IMP administration in the further course of the subjects disease

      • subject does not fulfill any exclusion criterion that would be considered permanent (i.e.

      irreversible organ function impairment) and therefore would certainly preclude the subject from receiving the IMP in the future

      EXCLUSION CRITERIA:

    1. Subjects with acute promyelocytic leukemia exhibiting t(15;17)(q22;q12); PML-RARA, or with variant translocations
    2. Pregnant or lactating women
    3. Known positive for HIV, active hepatitis B virus (HBV) or hepatitis C virus (HCV) infection
    4. Any clinically significant, advanced or unstable disease or inadequate main organ function that may put the subject at special risk, such as: a. creatinine > 2.0 times the upper normal serum level b. total bilirubin, ALT, AST >3 times the upper normal serum level c. cardiac left ventricular ejection fraction < 40% at rest d. severe restrictive or obstructive lung disease
    5. History of haploidentical allogeneic stem cell transplantation
    6. Subjects both with urinary outflow obstructions and on dialysis or subjects for whom cyclophosphamide is contraindicated for other reasons
    7. Clinical significant and ongoing immune suppression including, but not limited to: immunosuppressive agents such as cyclosporine or corticosteroids (at an equivalent dose of >= 10 mg prednisone per day). Inhaled steroid and physiological replacement for adrenal insufficiency is allowed.
    8. Subjects with currently active autoimmune disease.
    9. Subjects with a history of primary immunodeficiency.
    10. Subjects with a currently active second malignancy other than non- melanoma skin cancers or subjects with history of prior malignancy and previously treated with a curative intent therapy less than 1 year ago
    11. Known or suspected hypersensitivity or intolerance to IMP, cyclophosphamide, fludarabine and/or tocilizumab or to any of the excipients
    12. Participation in any clinical trial < 60 days prior to first IMP administration in case of antibodies and < 14 days for all other IMPs
    13. Vulnerable subjects and/or subjects unwilling or unable to comply with procedures required in this clinical trial protocol

    MM-SPECIFIC EXCLUSION CRITERIA FOR PHASE I AND PHASE II (TREATMENT GROUP):

    1. Prior therapy with IMiDs within 14 days prior to leukapheresis and/or infusion of IMP
    2. Prior therapy with corticosteroids within 7 days prior to leukapheresis or 7 days prior to infusion of IMP

    EXCLUSION CRITERIA FOR TREATMENT WITH IMP IN PHASE I AND PHASE II (TREATMENT GROUP):

    1. Uncontrolled central nervous system (CNS) disease
    2. Uncontrolled infections or uncontrolled disseminated intravascular coagulation; however, if these problems resolve, the start of treatment can be initiated on a delayed schedule
    3. Ongoing 3 grade cardiac, renal, pulmonary, gastrointestinal or hepatic toxicities according to CTCAE v4.03; however, if these problems resolve, the start of treatment can be initiated on a delayed schedule
    4. Evidence of acute or chronic GvHD

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Phase I - 3 disease entities
MDG1011 administration of escalating doses
PRAME-T-Cell Receptor Gene Modified Autologous T Cells
Experimental: Phase II - HLA*02:01 - disease entity 1
MDG1011 administration of Phase II recommended dose
PRAME-T-Cell Receptor Gene Modified Autologous T Cells
Active Comparator: Phase II - HLA*other - disease entity 1
Investigator Choice therapy
Any intervention/therapy chosen by the investigator
Experimental: Phase II - HLA*02:01 - disease entity 2
MDG1011 administration of Phase II recommended dose
PRAME-T-Cell Receptor Gene Modified Autologous T Cells
Active Comparator: Phase II - HLA*other - disease entity 2
Investigator Choice therapy
Any intervention/therapy chosen by the investigator

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Phase I: Adverse Events and Dose Limiting Toxicities (Safety and Tolerability)
Time Frame: 3 months
Incidence and severity of adverse events according to the NCI CTCAE, v4.03; MTD and/or RP2D of IMP measured by dose-limiting toxicities (DLTs) up to 28 days post infusion
3 months
Phase I: maximum tolerated dose (MTD) and/or recommended Phase II dose (RP2D) of MDG101
Time Frame: 28 days
28 days
Phase I: For feasibility: percent of all subjects who receive the planned target dose of MDG1011
Time Frame: 3 months
3 months
Phase II: Adverse Events (Safety)
Time Frame: 3 months
Incidence and severity of adverse events according to NCI CTCAE, v4.03
3 months
Phase II: overall response rate (ORR)
Time Frame: 3 months
3 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Phase I: overall response rate (ORR)
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase I: time to event and duration of response (DoR) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase I: time to event and time to progression (TTP) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase I: time to event and progression-free survival (PFS) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase I: time to event and overall survival (OS) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase I: Change in quality of life (QoL)
Time Frame: baseline, 3, 6 and 12 months
EQ-5D-5L questionaire
baseline, 3, 6 and 12 months
Phase I: Change in quality of life (QoL)
Time Frame: baseline, 3, 6 and 12 months
EORTC-QLQ-C30 [AML/MDS] questionaire
baseline, 3, 6 and 12 months
Phase I: Change in quality of life (QoL)
Time Frame: baseline, 3, 6 and 12 months
EORTC-MY20 [MM] questionaire
baseline, 3, 6 and 12 months
Phase I: Correlation of PRAME expression with the antitumor response
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase II: time to event and duration of response (DoR) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase II: time to event and time to progression (TTP) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase II: time to event and progression-free survival (PFS) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase II: time to event and overall survival (OS) rate
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase II: changes in quality of life (QoL)
Time Frame: baseline, 3, 6 and 12 months
EQ-5D-5L questionaire
baseline, 3, 6 and 12 months
Phase II: changes in quality of life (QoL)
Time Frame: baseline, 3, 6 and 12 months
EORTC-QLQ-C30 [AML/MDS] questionaire
baseline, 3, 6 and 12 months
Phase II: changes in quality of life (QoL)
Time Frame: baseline, 3, 6 and 12 months
EORTC-MY20 [MM] questionaire
baseline, 3, 6 and 12 months
Phase II: For feasibility, the percent of all subjects who receive the RP2D of MDG1011
Time Frame: 3 months
3 months
Phase II: correlation of PRAME expression with the antitumor response
Time Frame: 3, 6 and 12 months
3, 6 and 12 months
Phase I: Adverse Events (safety)
Time Frame: 6 and 12 months
Incidence and severity of adverse events according to NCI CTCAE, v4.03
6 and 12 months
Phase II: Adverse Events (safety)
Time Frame: 6 and 12 months
Incidence and severity of adverse events according to NCI CTCAE, v4.03
6 and 12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

March 27, 2018

Primary Completion (Actual)

June 28, 2022

Study Completion (Actual)

July 15, 2022

Study Registration Dates

First Submitted

March 21, 2018

First Submitted That Met QC Criteria

April 11, 2018

First Posted (Actual)

April 20, 2018

Study Record Updates

Last Update Posted (Actual)

February 15, 2023

Last Update Submitted That Met QC Criteria

February 13, 2023

Last Verified

February 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CD-TCR-001

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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