- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05582590
Autologous T Cells Targeting HPV16 HPV18 & Survivin in Patients With R/R HPV-related Oropharyngeal Cancers
A Phase 1 Open-Label Dose-Escalation Study of the Safety of Adoptively Transferred Autologous CD8+ T Lymphocytes Targeting HPV-16 E6/E7, HPV-18 E6/E7 and Survivin in Patients With Relapsed or Refractory HPV-related Oropharyngeal Cancers
Study Overview
Status
Conditions
- Head and Neck Cancer
- Head and Neck Squamous Cell Carcinoma
- Oropharyngeal Squamous Cell Carcinoma
- Oropharyngeal Cancer
- Human Papilloma Virus
- Head and Neck Cancer Metastatic
- HPV-Related Squamous Cell Carcinoma
- Oropharyngeal Cancer, Metastatic
- HPV-Related Mucosal Head and Neck Squamous Cell Carcinoma
- Relapsed Oropharyngeal SCC
- Refractory Oropharyngeal Squamous Cell Carcinoma
Intervention / Treatment
Detailed Description
The primary objective is to assess the safety of NEXI-003 in patients with relapsed or refractory HPV-related oropharyngeal cancers. The study will consist of two stages: a Dose-Escalation (Stage 1) and a Dose Expansion (Stage 2).
The first stage of the trial is the Dose-Escalation (Stage 1). A standard dose-escalation 3+3 design will be utilized to identify a safe maximum tolerated dose (MTD) of NEXI-003 in patients with relapsed or refractory HPV-related oropharyngeal cancers. The MTD of NEXI-003 T cells will be identified during the first 28-day cycle (Cycle 1) of the Dose-Escalation Stage, which is defined as the DLT period. A total of 4 dosing cohorts are planned in the Dose Escalation Stage.
Initially 3 patients are enrolled into a dosing cohort. After all 3 patients in a cohort have been followed for 28 days of Cycle 1 (the DLT Period), the safety information will be assessed by the Data Review Committee (DRC). If no DLT is reported in the first 3 patients enrolled during the 28-day initial cycle of treatment (the DLT Period), enrollment into the next higher dose cohort may begin, after safety information is assessed by the DRC. If 1 of the first 3 patients has a DLT, then 3 more patients will be enrolled into that cohort. If a DLT occurs in ≥ 2 patients, then the MTD will be judged to have been exceeded and the next lower cohort dose will be considered the MTD. If a DLT occurs in ≤ 1 of 6 patients, then patients may be enrolled in the next highest dose level. The DRC will review eligibility criteria, doses of all study treatments and safety data and make recommendations as to the further conduct of the study. If ≥ 2 patients in Cohort 1 experience a DLT, then Cohort -1 (1 x 10^8 NEXI-003 T cells on Day 1 of Cycle 1; stepdown dose, if needed) will be evaluated using the 3+3 design.
After identification of the MTD, or the finding that the last dosing cohort is tolerated well (i.e., the maximum practical dose [MPD]), 12 patients will be enrolled to receive NEXI-003 treatment at the MTD/MPD level in the Dose Expansion Stage to gain additional safety, clinical activity, and pharmacokinetic data (i.e., persistence and expansion) of the NEXI-003 antigen specific CD8+ T cell product. Safety, clinical activity, and pharmacokinetic data from the Dose Escalation and Dose Expansion stages will be assessed to determine the recommended Phase 2 dose (RP2D).
Patients in both the Dose Escalation and Dose Expansion Stages may receive additional cycles of NEXI-003 per investigator discretion and if protocol-specified criteria are met.
Each of the two stages of the study will consist of the following three consecutive study periods for each patient: Pretreatment Period (consisting of Screening, Leukapheresis/Manufacturing, and Baseline Re-evaluation), Treatment Period (consisting of lymphodepletion [LD] chemotherapy and NEXI-003 treatment), and Post-Treatment Period (consisting of Post-treatment Follow-up and Survival Follow-up). The Pretreatment Period will be approximately 4 to 6 weeks. The Treatment Period will consist of at least 28-day cycle (i.e., 4 weeks), and per investigator discretion if the patient meets protocol-specified criteria, the patient may receive additional 4-week cycles. The Post-Treatment Follow-up Period will consist of up to 9 months of post-treatment assessments, and up to 9 months of survival follow-up.
Study Type
Enrollment (Estimated)
Phase
- Phase 1
Contacts and Locations
Study Contact
- Name: Kristi Jones
- Phone Number: 650-743-4135
- Email: kjones@neximmune.com
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- The patient will be typed for HLA-A*0201 expression as determined by high resolution sequence-based typing method. If documented HLA results are available from a previous test, the patient can be enrolled using these results after review and approval by the sponsor.
- Patients with cytologically or histologically confirmed locally advanced or metastatic HPV related oropharyngeal cancers with confirmed detection of HPV-16 and/or HPV-18.
Patients with HPV-related oropharyngeal cancers who have received at least 1 prior line of standard-of-care (SOC) treatment (for example, per the current NCCN Guidelines for Patients with Oropharyngeal Cancer) consisting of systemic immunotherapy and/or chemotherapeutic treatment.
- The last dose of cytotoxic chemotherapy and/or steroids must be administered at least 28 days prior to the leukapheresis procedure.
- Any adverse event(s) that the patient may have experienced from prior therapy must have resolved to ≤ Grade 1 according to NCI CTCAE version 5.0.
- Measurable disease per RECIST v1.1 criteria (at least 1 lesion that can be measured accurately in at least 1 dimension with the longest diameter ≥ 10 mm [MRI or CT scan sliced thickness ≤ 5 mm]).
- Pulse oximetry ≥ 92% on room air.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
- Life expectancy of at least 3 months.
- Be willing to comply with the study schedule and all other protocol requirements.
- Women of childbearing potential (WOCBP), defined as a sexually mature woman who has not undergone a hysterectomy or tubal ligation or who has not been naturally postmenopausal for at least 24 consecutive months, must have 2 negative pregnancy tests prior to treatment. All sexually active WOCBP and all sexually active male patients must agree to use highly effective methods of birth control throughout the study.
- Ability of the patient to understand and willingness to sign a written informed consent form.
Exclusion Criteria:
- A diagnosis of other malignancies if the malignancy has required therapy within the last 3 years or is not in complete remission. Exceptions are non-metastatic basal cell or squamous cell carcinomas of the skin or prostate cancer that does not require treatment. Patients taking adjuvant hormonal therapy for definitively treated cancers (e.g., breast cancer, prostate cancer) are eligible.
- Major surgery within 28 days prior to the first study drug administration (minimally invasive procedures, such as diagnostic biopsies, are permitted).
- Known central nervous system involvement.
- Treatment with an allogeneic hematopoietic stem cell transplantation.
- Treatment with any investigational agent(s) at the time of informed consent.
- Left ventricular ejection fraction (LVEF) < 45%, congestive heart failure (as defined by New York Heart Association Functional Classification III or IV), unstable angina, serious uncontrolled cardiac arrhythmia, a myocardial infarction within 6 months prior to study entry or a history of myocarditis.
The following hematological laboratory results at Screening (these results must be independent of blood product or hematopoietic growth factor support):
- Hemoglobin < 9.0 g/dL.
- Platelet count < 100,000/μL.
- Absolute neutrophil count (ANC) < 1000/ μL.
The following chemistry laboratory results at Screening:
- Serum creatinine ≥ 1.5 mg/dL or estimated glomerular filtration rate (eGFR) ≤ 50 mL/min/1.73 m^2.
- Serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 3x the upper limit of normal (ULN) or serum total bilirubin > 2 mg/dL (except for patients in whom hyperbilirubinemia is attributed to Gilbert's Syndrome).
- International normalized ratio (INR) or activated partial thromboplastin time (aPTT) > 1.5x ULN within 1 week prior to the start of lymphodepletion chemotherapy, unless on a stable dose of an anticoagulant.
- Are pregnant or breastfeeding.
Vaccination with any live virus vaccine is not permitted prior to the initiation of study treatment.
- Inactivated annual influenza vaccination is allowed.
- Vaccines such as COVID-19 vaccine, e.g., SARS-CoV-2 vaccine > 7 days before administration is acceptable. For vaccines requiring more than 1 dose, the full regimen should be completed prior to Cycle 1 Day 1.
- Active bacterial, viral, or fungal infection within 72 hours of the start of lymphodepletion chemotherapy; patients with ongoing use of prophylactic antibiotics, antifungal agents, or antiviral agents remain eligible as long as there is no evidence of active infection.
- Have human immunodeficiency virus (HIV) active infection as indicated by positive HIV polymerase chain reaction (PCR) test, human T-cell leukemia virus type 1 infection, or hepatitis B virus (HBV) or hepatitis C virus (HCV) viremia or are at risk for HBV reactivation (at risk for HBV reactivation is defined as being hepatitis B surface antigen [HbsAg] positive, or anti-HBe-antibody positive), or are positive for HBV DNA. HCV ribonucleic acid (RNA) must be undetectable by laboratory test.
- Any condition including the presence of laboratory abnormalities, that places the patient at an unacceptable risk if the patient was to participate in the study.
Have an active autoimmune disease that has required systemic treatment in past 2 years (i.e., with use of disease modifying agents, corticosteroids, or immunosuppressive drugs).
Note: Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is permitted.
Patients who experienced the following immune checkpoint inhibitor-related AEs even if the AE resolved to ≤ Grade 1 or baseline:
- ≥ Grade 3 ocular AE
- Changes in liver function tests that met the criteria for Hy's Law (> 3× ULN of either ALT/AST with concurrent > 2× ULN of total bilirubin (total and direct) and without alternate etiology)
- ≥ Grade 3 neurologic toxicity
- ≥ Grade 3 colitis
- ≥ Grade 3 renal toxicity
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Cohort 1
2 x 10^8 NEXI-003 T cells (derived from peripheral blood mononuclear cells [PBMCs] of the patient) administered by intravenous infusion on Day 1 of each cycle
|
Lymphodepletion Chemotherapy on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Lymphodepletion Chemotherapy administered on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Adoptive Cell Therapy specified dose on specified day(s)
|
Experimental: Cohort 2
2 x 10^8 NEXI-003 T cells (derived from peripheral blood mononuclear cells [PBMCs] of the patient) administered by intravenous infusion on Days 1 and 8 of each cycle
|
Lymphodepletion Chemotherapy on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Lymphodepletion Chemotherapy administered on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Adoptive Cell Therapy specified dose on specified day(s)
|
Experimental: Cohort 3
2 x 10^8 NEXI-003 T cells (derived from peripheral blood mononuclear cells [PBMCs] of the patient) administered by intravenous infusion on Days 1, 8, and 15 of each cycle
|
Lymphodepletion Chemotherapy on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Lymphodepletion Chemotherapy administered on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Adoptive Cell Therapy specified dose on specified day(s)
|
Experimental: Cohort 4
4 x 10^8 NEXI-003 T cells (derived from peripheral blood mononuclear cells [PBMCs] of the patient) administered by intravenous infusion on Day 1, and 2 x 10^8 NEXI-003 T cells administered by intravenous infusion on Days 8 and 15 of each cycle
|
Lymphodepletion Chemotherapy on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Lymphodepletion Chemotherapy administered on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Adoptive Cell Therapy specified dose on specified day(s)
|
Experimental: Dose Expansion Stage
Dose Expansion Stage to further define the safety and clinical activity, and to confirm the recommended Phase 2 dose of the NEXI- 003 T cell product at the dose established from the Dose Escalation Stage.
|
Lymphodepletion Chemotherapy on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Lymphodepletion Chemotherapy administered on Days -5, -4, and -3 before Cycle 1 ONLY
Other Names:
Adoptive Cell Therapy specified dose on specified day(s)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adverse Events (AEs)
Time Frame: 12 months
|
Frequencies of patients with treatment-emergent AEs (TEAEs)
|
12 months
|
Dose-Limiting Toxicities (DLTs)
Time Frame: 28 days
|
DLTs in Cycle 1
|
28 days
|
Severities of AEs
Time Frame: 12 months
|
Frequencies of patients with treatment-emergent AEs (TEAEs) by severity
|
12 months
|
Relationship of AEs
Time Frame: 12 months
|
Frequencies of patients with treatment-emergent AEs (TEAEs) by relationship to NEXI-003 T cells
|
12 months
|
Serious Adverse Events (SAEs)
Time Frame: 12 months
|
Frequencies of patients with treatment-emergent SAEs
|
12 months
|
Adverse Events of Special Interest (AESIs) - Cytokine Release Syndrome (CRS)
Time Frame: 12 months
|
Frequencies of patients with treatment-emergent CRS
|
12 months
|
Adverse Events of Special Interest (AESIs) - Immune Effector cell-associated neurotoxicity syndrome (ICANS)
Time Frame: 12 months
|
Frequencies of patients with treatment-emergent ICANS
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall response rate (ORR)
Time Frame: 12 months
|
ORR as measured by Response Evaluation Criteria in Solid Tumors (RECIST) v 1.1
|
12 months
|
Duration of response (DoR)
Time Frame: 12 months
|
Response as measured by RECIST v1.1 over time
|
12 months
|
Determine the persistence of NEXI-003 T cells in peripheral blood
Time Frame: 12 months
|
Determine NEXI-003 at pre-dose and different times post-dose by multimer-based staining of antigen-specific NEXI-003 T cells.
|
12 months
|
Determine manufacturing feasibility by assessing the manufactured product for Cell Viability
Time Frame: 1 month
|
Percent NEXI-003 T cell viability in each manufactured product
|
1 month
|
Determine manufacturing feasibility by assessing the manufactured product for Cell Yield
Time Frame: 1 month
|
Total cell count for each manufactured product
|
1 month
|
Determine manufacturing feasibility by assessing the manufactured product for Percent CD3+/CD4- T cells
Time Frame: 1 month
|
Percent of CD3+/CD4- T cells in each NEXI-003 T cell product
|
1 month
|
Determine manufacturing feasibility by assessing the manufactured product for Percent CD3+/CD8+ T cells
Time Frame: 1 month
|
Percent of CD3+/CD8+ T cells in each NEXI-003 T cell product
|
1 month
|
Determine manufacturing feasibility by assessing the memory immunophenotypes in the manufactured product
Time Frame: 1 month
|
Percent of antigen-specific-NEXI-003 T cell memory immunophenotypes in the investigational product
|
1 month
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms by Site
- Neoplasms, Glandular and Epithelial
- Pharyngeal Neoplasms
- Otorhinolaryngologic Neoplasms
- Pharyngeal Diseases
- Stomatognathic Diseases
- Otorhinolaryngologic Diseases
- Neoplasms, Squamous Cell
- Head and Neck Neoplasms
- Carcinoma
- Carcinoma, Squamous Cell
- Squamous Cell Carcinoma of Head and Neck
- Oropharyngeal Neoplasms
- Papilloma
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antirheumatic Agents
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Myeloablative Agonists
- Cyclophosphamide
- Fludarabine
Other Study ID Numbers
- NEXI-003-HPV-101
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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