Mitoxantrone Hydrochloride Liposome Injection-containing Bridging Regimen and CD19-targeting CAR-T Therapies

Study on the Safety and Efficacy of Mitoxantrone Hydrochloride Liposome Injection-containing Bridging Regimen in CD19-targeting CAR-T Therapies

The goal of this open, single-arm practical, phase II, clinical study is to evaluate the efficacy and safety of the mitoxantrone hydrochloride liposome injection-containing regimens in bridging therapies of CD19 CAR-T cells. The main question it aims to answer is:

• the efficacy of the mitoxantrone hydrochloride liposome injection-containing combination regimens in bridging therapies of CD19 CAR-T cells.

Participants will receive combination bridging regimens including mitoxantrone hydrochloride liposomal injection and CAR-T cell therapy to see if the combination regimens have a positive effect on the efficacy of bridging therapies.

Study Overview

• Status: Recruiting
• Conditions: B-cell Acute Lymphoblastic Leukemia; B-cell Lymphoma Refractory
• Intervention / Treatment: Drug: Mitoxantrone hydrochloride liposome Injection-based bridging therapy+ Fludarabine-based chemotherapy +CD19 CAR-T Cells

Detailed Description

Chimeric antigen receptor T-cell (CAR-T) therapy has been approved for a variety of relapsed/refractory hematologic malignancies and has significantly improved patient outcomes. The preparation of CAR-T cells, including a variety of relevant individual factors, usually takes at least 3-4 weeks, or more, so patients may require bridging therapy (BT) to control disease progression and prevent the rapid exacerbation of systemic cancer. Clinical trial data have shown that about 7% of patients do not survive while waiting for CAR-T cell preparation to be completed, so individual bridging therapy can be given after apheresis and 4-6 weeks before CAR-T infusion to achieve effective CAR-T cell therapy.

Mitoxantrone, a traditional anthracycline quinone, is an antibiotic antineoplastic drug. It exerts antitumor effects by interfering with DNA, RNA, and inhibition of topoisomerase II, and is a cell cycle non-specific drug[]. Liposomes are excellent carriers of anti-tumor drugs, which can reduce the distribution of drugs in normal tissues and increase the accumulation of drugs in tumor tissues, thereby reducing toxicity and improving treatment efficacy. To reduce the toxicity of mitoxantrone and improve its efficacy, CSPC Pharmaceutical Group has developed the liposomal formulation of mitoxantrone, which is based on liposomal R&D technology. A new technical upgrade has been carried out on the mitoxantrone liposome, making it the only liposome with a higher dosage than the ordinary preparation, and it is a new anthracycline liposome that has been comprehensively upgraded. In the pivotal phase II study of liposomal mitoxantrone, monotherapy with PTCL was associated with an ORR of 41.7%, a CR rate of 23.1%, a median PFS of 8.5 months, a median OS not reached, and a high incidence of adverse events such as neutropenia and pigmentation, with a good cardiac safety profile and no progression of cardiotoxicity. Single-agent 16mg/m2 and 20mg/m2 doses were also explored in DLBCL, and 35 patients with relapsed and refractory DLBCL were enrolled, with an overall objective response rate of 38.5% in the 26 full analysis sets, which had certain activity in DLBCL.

• Study Type: Interventional
• Enrollment (Estimated): 28
• Phase: Phase 2

Contacts and Locations

Study Locations

• China
  • Hubei
    • Wuhan, Hubei, China, 430022
      • Recruiting
      • Union Hospital, Huazhong University of Science and Technology
      • Principal Investigator: Heng Mei, M.D., Ph.D
      • Contact: Heng Mei, M.D., Ph.D; Phone Number: 027-8572600; Email: hmei@hust.edu.cn
      • Contact: Yun Kang; Phone Number: 17362995329; Email: cloudykang@hust.edu.cn
      • Sub-Investigator: Danying Liao, M.D., Ph.D

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Aged ≥ 18 years and <75 years.
2. Eastern Cooperative Oncology Group score≤ 2.
3. Clinically diagnosed refractory or relapsed B-cell malignancies. Relapse refers to "relapse after a complete response (CR) from initial chemotherapy"; refractory refers to "diagnosis can be made if any of the following are met:(1) tumor shrinkage of <50% or disease progression (PD) after standard chemotherapy; (2) CR is achieved by standard chemotherapy but relapses within six months, (3) 2 or more recurrences after CR, (4) recurrence after hematopoietic stem cell transplantation"; B-cell malignancies include the following 3 categories: (1) B-cell acute lymphoblastic leukemia (B-ALL); (2) indolent B-cell lymphoma (CLL, FL, MZL); (3) aggressive B-cell lymphoma (DLBCL, BL, MCL).
4. Flow cytometry (FCM) or immunohistochemistry showed positive CD19 expression in tumor cells;
5. Organ function needs to meet the following conditions:

1) EF >50%, and there is no obvious abnormality on ECG; 2) SpO2≥90%； 3) Cr≤2.5 ULN; 4) ALT and AST≤5 ULN, TBil≤3 ULN; 6. Negativity of blood pregnancy test for women, and participants use effective methods of contraception until the last follow-up. 7. The patient or his or her legal guardian voluntarily participates in and signs an informed consent form.

Exclusion Criteria:

1. Prior treatment with doxorubicin or other anthracyclines with a total cumulative dose of doxorubicin >360 mg/m2 (other anthracyclines convert 1 mg of doxorubicin to 2 mg epirubicin).
2. Hypersensitivity to any of the study drugs or their components.
3. Concomitant other diseases that are not effectively controlled, including but not limited to persistent or poorly controlled infections, symptomatic congestive heart failure, unstable angina, cardiac arrhythmias, poorly controlled pulmonary diseases, or psychiatric disorders.
4. Investigators judge patients with central nervous system involvement who may be at high risk of receiving bridging therapy and CD19 CAR-T cell treatment.
5. Participants with other active malignancies within five years.
6. Patients with relapse after allogeneic hematopoietic stem cell transplantation who have had grade 3~4 acute graft-versus-host response (GVHD).
7. Patients who are pregnant or breast-feeding.
8. Active autoimmune disease requiring systemic immunosuppressive therapy.
9. Other conditions considered to increase the risk to the subject or interfere with the results of the trial by the researcher.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Effective of MHL injection-containing bridging regimens with CD19 CAR-T; After enrollment, all subjects will receive a combination regimen of mitoxantrone hydrochloride liposomal injection within 28 days to 7 days before CAR-T infusions will be included, including but not limited to the R-MINE regimen (mitoxantrone hydrochloride liposomal injection combined with rituximab, mesna, ifosfamide and etoposide), G-MINE regimen (mitoxantrone hydrochloride liposomal injection combined with obinutuzumab, mesna, ifosfamide and etoposide), MAE scheme (mitoxantrone hydrochloride liposomal injection combined with cytarabine, etoposide), etc.

Drug: Mitoxantrone hydrochloride liposome Injection-based bridging therapy+ Fludarabine-based chemotherapy +CD19 CAR-T Cells; Bridging therapies from enrollment before CD19 CAR-T infusion. A treatment regimen containing mitoxantrone hydrochloride liposome injection, including but not limited to the following recommended regimens: R-MINE regimen (rituximab + ifosfamide + mitoxantrone hydrochloride liposome + etoposide) G-MINE regimen (obinutuzumab + ifosfamide + mitoxantrone hydrochloride liposome + etoposide) MAE regimen (mitoxantrone liposome hydrochloride + cytarabine + etoposide) . The recommended dose of mitoxantrone liposome hydrochloride is not limited. For patients who achieve SD or better after one cycle of bridging treatment, it is up to the investigator to decide whether to receive CAR-T therapy. Fludarabine-based lymphodepletion chemotherapy was followed by CD19 CAR-T cells (relma-cel, axi-cel or humanized CAR19). Relma-cel and axi-cel will be infused according to the instructions. CART19 infusion is conducted at a dose of 1x10^6/kg on day 0 and day 1 respectively.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The overall response rate (ORR) of patients after bridging therapy	The overall response rate (ORR) was based on the Lugano 2014 Lymphoma Efficacy Evaluation Criteria (Cheson 2014) and the 2021 version of the ALL Efficacy Evaluation Index	After bridging therapy and before CD19 CAR-T infusion

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Complete response rate (CR) of patients after bridging therapy and CD19 CAR-T infusion	CR will be assessed from CAR-T cell infusion to death or last follow-up (censored)	within 2 years after infusion
In vivo expansion and survival of CD19 CAR-T cells	The quantity of CD19 CAR copies in bone marrow, peripheral blood and cerebrospinal fluid will be determined by using a quantitative polymerase chain reaction.	within 2 years after infusion
Incidence of Treatment-related Adverse Events	Therapy-related adverse events (AE), including severe adverse events (SAE) and laboratory outliers with clinical significance, will be recorded and assessed according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE, Version 5.0).	before bridging therapy and within 2 years after infusion

Collaborators and Investigators

• Sponsor: Wuhan Union Hospital, China
• Collaborators: CSPC Pharmaceutical Group Limited

Publications and helpful links

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2024
• Primary Completion (Estimated): August 1, 2024
• Study Completion (Estimated): December 30, 2025

Study Registration Dates

• First Submitted: January 11, 2024
• First Submitted That Met QC Criteria: January 11, 2024
• First Posted (Estimated): January 23, 2024

Study Record Updates

• Last Update Posted (Estimated): January 23, 2024
• Last Update Submitted That Met QC Criteria: January 11, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Immune System Diseases; Neoplasms by Histologic Type; Neoplasms; Lymphoproliferative Disorders; Lymphatic Diseases; Immunoproliferative Disorders; Leukemia, Lymphoid; Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Peripheral Nervous System Agents; Enzyme Inhibitors; Analgesics; Sensory System Agents; Antineoplastic Agents; Topoisomerase II Inhibitors; Topoisomerase Inhibitors; Fludarabine; Mitoxantrone
• Other Study ID Numbers: bridging regimen of CD19CAR-T

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