Intraperitoneal Cytokine-Induced Memory Like (CIML) Natural Killer (NK) Cells in Recurrent Ovarian Cancer

A Phase 1b Study of Cytokine-Induced Memory Like (CIML) Natural Killer (NK) Cell Therapy in Recurrent Ovarian Cancer

The goal of this research study is to evaluate the safety and effectiveness of the use of cytokine-induced memory-like (CIML) natural killer (NK) cell therapy in recurrent, high grade ovarian cancer (HGOC).

Names of the study therapies involved in this study are:

CIML NK (cellular therapy) Interleukin-2 (IL-2)

Study Overview

• Status: Recruiting
• Conditions: Ovarian Cancer; Platinum-resistant Ovarian Cancer; Ovarian Carcinoma; Recurrent Ovary Cancer; Ovarian Carcinoma, Recurrent; Endometroid Ovarian Carcinoma; Clear Cell Ovarian Carcinoma
• Intervention / Treatment: Biological: Cytokine-Induced Memory-like Natural Killer Cells; Drug: Interleukin 2

Detailed Description

This is an open-label, single site, phase 1b study to evaluate the safety and effectiveness of the use of cytokine-induced memory-like (CIML) natural killer (NK) cell therapy in recurrent, high grade ovarian cancer.

Participants will be enrolled to test the safety of intraperitoneal CIML NK cell therapy

The U.S. Food and Drug Administration (FDA) has not approved CIML NK cell therapy as a treatment for recurrent, high grade ovarian cancer.

The research study procedures include screening for eligibility, collection of natural killer (NK) cells in a process called leukapheresis, lymphodepleting chemotherapy, infusion of CIML NK cell therapy into the abdominal cavity (intraperitoneal), administration of low-dose IL-2, Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI), or Positron Emission Tomography (PET) scans, blood tests, urine tests, electrocardiograms (ECGs), and echocardiograms.

Participants in this research study will be followed for up to for 5 years after start of study treatment.

It is expected that about 12-18 people will take part in this research study.

The PHASE ONE Foundation Community Research Grant is providing funding for this research study.

• Study Type: Interventional
• Enrollment (Estimated): 18
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Rebecca Porter, MD, PhD; Phone Number: (617) 632-5269; Email: rebecca_porter@dfci.harvard.edu
• Study Contact Backup: Name: DFCI Clinical Trials Hotline DFCI Clinical Trials Hotline; Phone Number: 877-DF-TRIAL; Email: rebecca_porter@dfci.harvard.edu

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Recruiting
      • Dana-Farber Cancer Institute
      • Contact: Rebecca Porter, MD, PhD; Phone Number: 617-632-2334; Email: Rebecca_Porter@dfci.harvard.edu
      • Principal Investigator: Rebecca Porter, MD, PhD
    • Boston, Massachusetts, United States, 02215
      • Not yet recruiting
      • Brigham and Women's Hospital
      • Principal Investigator: Rebecca Porter, MD, PhD
      • Contact: Rebecca Porter, MD, PhD; Phone Number: (617) 632-2334; Email: rebecca_porter@dfci.harvard.edu

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Participants must have histologically or cytologically confirmed recurrent epithelial ovarian cancer. Eligible histologies include high grade serous, high grade endometrioid and clear cell ovarian carcinoma.
• Participants must have measurable cancer defined by RECIST 1.1 criteria. See Section 12 (Measurement of Effect) for the evaluation of measurable disease.
• Patients must have received at least 1 lines of prior systemic therapy and be deemed platinum resistant/intolerant by their treating oncologist. Patients with germline or somatic BRCA1 or BRCA2 mutations must have received prior PARP inhibitor therapy as maintenance or treatment. Prior receipt of immune checkpoint blockade is allowed if grade 3 or higher toxicities were not experienced.
• Age ≥18 years and <85 years old. Because no dosing or adverse event data are currently available on the use of CIML NK cells in combination with N-803 in participants <18 years of age, children are excluded from this study.
• ECOG performance status of 0 or 1 (see Appendix A).

• Participants must meet the following organ and marrow function as defined below:

  • Absolute neutrophil count ≥1,000/mcL
  • Platelets ≥75,000/mcL
  • AST(SGOT)/ALT(SGPT) ≤3 x institutional ULN
  • Total bilirubin ≤1.5 x institutional upper limit of normal (ULN) (except Gilbert's or disease-related hemolysis, then < 3 x ULN)
  • Serum creatinine ≤ 2.0 mg/dL OR glomerular filtration rate (GFR) ≥40 mL/min/1.73 m2
  • Oxygen saturation: ≥ 90% on room air
  • Left ventricular ejection fraction (cardiac function) ≥ 40%
  • No laboratory evidence of ongoing hemolysis in opinion of investigator
• Participants with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.
• Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, participants should be class 2B or better.
• Physician assessment indicating the patient would be able to tolerate undergoing a brief procedure for placement of an intraperitoneal port for NK cell infusion.
• Ability to understand and the willingness to sign a written informed consent document. (Providing consents in as many languages as possible is encouraged)
• The effects of CIML NK cells and N-803 on the developing human fetus are unknown. For this reason and because CIML NK cells and N-803 are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.

Exclusion Criteria:

• Participants who have had anti-tumor chemotherapy or other investigational agents within two weeks prior to NK cell infusion (6 weeks for nitrosoureas or mitomycin C), or immunotherapy within 6 weeks prior, or those who have not recovered from adverse events due to agents administered more than two weeks prior. The intent of the language is to ensure that anti-tumor chemotherapy or other investigational agents are not administered to subjects within the specified window since the can potentially affect NK cell activity. Therefore, the washout period is defined by time from NK cell infusion and not patient enrollment. During eligibility confirmation from the study team is requested to confirm that according to the planned NK cell dosing schedule, the washout period should be completed, based on each drug class.
• Participants with a bowel obstruction within the last 3 months or high risk for bowel obstruction (in the opinion of the investigator) or current need for parenteral nutrition or dependence on intravenous fluids.
• Participants who are receiving any other investigational agents.
• Solid organ transplant (allograft) recipients.
• Participants with known additional malignancy that is progressing or requires active treatment, or history of other malignancy within 2 years of the first dose of study treatment with the exception of cured basal cell or squamous cell carcinoma of the skin, superficial bladder cancer, prostate intraepithelial neoplasm, carcinoma in situ of the cervix, or other non-invasive or indolent malignancy, or cancers from which the patient has been disease-free for > 1 year after treatment with curative intent.
• History of severe or anaphylactic allergic reactions attributed to compounds of similar chemical or biologic composition to N-803 or any of the other agents used in study.
• For patients with prior exposure to check point inhibitor therapy, those with a prior history of immune-related toxicity during immune therapy that resulted in permanent discontinuation of therapy (as recommended per product label or consensus guidelines) OR any immune-related toxicity requiring intensive or prolonged immunosuppression to manage (with the exception of endocrinopathy that is well-controlled on replacement hormones) are excluded.
• Autoimmune disease: patients with a history of inflammatory bowel disease, including ulcerative colitis and Crohn's disease, are excluded from this study, as are patients with a history of symptomatic disease (e.g., rheumatoid arthritis, systemic progressive sclerosis [scleroderma], systemic lupus erythematosus, autoimmune vasculitis [Wegener's granulomatosis]) and motor neuropathy considered of autoimmune origin (e.g., GuillainBarre syndrome and myasthenia gravis). Patients with Hashimoto thyroiditis are eligible.
• Systemic corticosteroid therapy (> 10 mg of prednisone or equivalent dose of systemic steroids for at least 4 weeks prior to NK cell infusion). The intent of this language is to ensure that systemic steroids are not administered to subjects within the specified window since this can potentially affect NK cell activity. Therefore, the washout period is defined by time from NK cell infusion and not patient enrollment. During eligibility confirmation the study team is requested to confirm that according to the planned NK cell dosing schedule, the washout period should be completed.
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Pregnant women are excluded from this study because of the unknown teratogenic risk of CIML NK cells and NIZ985 and with the potential for teratogenic or abortifacient effects by fludarabine/cyclophosphamide chemotherapy regimen. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with CIML NK cells and NIZ985, breastfeeding should be discontinued if the mother is treated on this study.
• HIV-positive participants are ineligible because of the potential for pharmacokinetic interactions with anti-retroviral agents used in this study. In addition, these participants are at increased risk of lethal infections when treated with marrow-suppressive therapy.
• Individuals with active uncontrolled hepatitis B or C are ineligible as they are at high-risk of lethal treatment-related hepatotoxicity in the setting of marrow suppression. Known non-infectious pneumonitis or any history of interstitial lung disease.
• Receipt of a live vaccine within 30 days of start of study treatment. During eligibility confirmation the study team is requested to confirm that according to the planned NK cell dosing schedule, the washout period should be completed.
• Anaphylactic reactions to murine-based antibody therapy or iron dextran as the CIML NK cell product contains similar reagents at end of manufacturing/infusion.
• Prior history of Grade 2 or higher hemolytic anemia (>/= 2g decrease in hemoglobin plus laboratory evidence of hemolysis) from any cause.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dose Level 0; Participants will be enrolled in a staggered fashion into a 3+3 dose de-escalation per protocol to establish a maximum tolerated dose (MTD). Dosage will start at dose level 0.; Baseline visit.; MRIs, PET scans, and/or CT scans every 8 weeks.; Cycle 0:Day -7 of 8 day cycle: Apheresis for autologous NK cell collection.Days -6 through -2 of 8 day cycle: Predetermined dose of lymphodepleting chemotherapy per protocol.Days -5 through -4 of 8 day cycle:Predetermined dose of lymphodepleting chemotherapy per protocol.Predetermined dose of premedication per institutional standards.Day 0 of 8 day cycle:Predetermined dose of CIML NK cells onceSubcutaneous low-dose IL-2 once; Cycle 1:- Days 2-8: Subcutaneous low-dose IL-2 every other day for 4 additional doses; Off-Treatment:Long-term follow up for 5 years after last CIML NK cell infusion.	Biological: Cytokine-Induced Memory-like Natural Killer Cells; Cytokine Induced Memory-like Natural Killer (CIML NK) Cells Autologous, cytokine induced memory-like natural killer cells, via intraperitoneal (IP) infusion per protocol.; Other Names: CIML NK Cells; Drug: Interleukin 2; Low dose subcutaneous IL-2 will be administered every other day for 5 doses after CIML NK cell infusion
Experimental: Dose Level -1; 3+3 de-escalation to dose level -1 per protocol if DLTs occur in Cohort 1 dose Level 0.; Baseline visit.; MRIs, PET scans, and/or CT scans every 8 weeks.; Cycle 0:Day -7 of 8 day cycle: Apheresis for autologous NK cell collection.Days -6 through -2 of 8 day cycle: Predetermined dose of lymphodepleting chemotherapy per protocol.Days -5 through -4 of 8 day cycle:Predetermined dose of lymphodepleting chemotherapy per protocol.Predetermined dose of premedication per institutional standards.Day 0 of 8 day cycle:Predetermined dose of CIML NK cells onceSubcutaneous low-dose IL-2 once; Cycle 1:- Days 2-8: Subcutaneous low-dose IL-2 every other day for 4 additional doses; Off-Treatment:Long-term follow up for 5 years after last CIML NK cell infusion.	Biological: Cytokine-Induced Memory-like Natural Killer Cells; Cytokine Induced Memory-like Natural Killer (CIML NK) Cells Autologous, cytokine induced memory-like natural killer cells, via intraperitoneal (IP) infusion per protocol.; Other Names: CIML NK Cells; Drug: Interleukin 2; Low dose subcutaneous IL-2 will be administered every other day for 5 doses after CIML NK cell infusion

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum Tolerated Dose (MTD) (Cohort 1)	The MTD of the use of cytokine induced memory-like natural killer (CIML NK) cell therapy is determined by the number of participants who experience a dose limiting toxicity (DLT). See subsequent primary outcome measure for DLT definition.	60 days
Dose Limiting Toxicity (DLT) (Cohort 1)	A DLT is defined as an adverse event that is related to CIML NK cell therapy with an attribution of possible, probable, or definite, and meets the criteria defined in protocol section 5.4.	60 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Response Rate (ORR)	ORR is defined as the proportion of participants who achieved partial response or complete response during study treatment based on RECIST 1.1 and immune-related RECIST criteria.	Up to 5 years
Median Progression Free Survival (PFS)	PFS is defined as the time from registration to the earlier of progression (PD) or death due to any cause based on Kaplan-Meier methodology. Participants alive without disease progression are censored at date of last disease evaluation.	Up to 5 years
Clinical Benefit Rate (CBR)	CBR is defined as the proportion of participants who achieved a complete response, partial response, or had stable disease for 6 months or more based on RECIST 1.1 and immune-related RECIST criteria.	Up to 5 years
Duration of Response (DOR)	DOR is measured from the time measurement criteria are met for complete response or partial response (whichever is first recorded) until the first data that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started, or death due to any cause. Participants without events reported are censored at the last disease evaluation.	Up to 5 years
6 months Progression Free Survival (PFS6)	PFS6 is the percent probability estimate at 6 months based on the Kaplan-Meier method. PFS is defined as the time from registration to the earlier of progression (PD) or death due to any cause. Participants alive without disease progression are censored at date of last disease evaluation.	6 months

Collaborators and Investigators

• Sponsor: Dana-Farber Cancer Institute
• Collaborators: ImmunityBio, Inc.
• Investigators: Principal Investigator: Rebecca Porter, MD, PhD, Dana-Farber Cancer Institute

Study record dates

Study Major Dates

• Study Start (Actual): October 9, 2024
• Primary Completion (Estimated): November 30, 2026
• Study Completion (Estimated): October 31, 2031

Study Registration Dates

• First Submitted: October 30, 2023
• First Submitted That Met QC Criteria: March 13, 2024
• First Posted (Actual): March 20, 2024

Study Record Updates

• Last Update Posted (Actual): March 4, 2026
• Last Update Submitted That Met QC Criteria: March 2, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Ovarian Cancer; Ovarian Carcinoma; Platinum-Resistant Ovarian Cancer; Recurrent Ovary Cancer; Ovarian Carcinoma, Recurrent; Endometroid Ovarian Carcinoma; Clear Cell Ovarian Carcinoma
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Endocrine System Diseases; Pathologic Processes; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Disease Attributes; Genital Diseases, Female; Endocrine Gland Neoplasms; Ovarian Diseases; Adnexal Diseases; Genital Neoplasms, Female; Gonadal Disorders; Pathological Conditions, Signs and Symptoms; Recurrence; Ovarian Neoplasms; Peptides; Amino Acids, Peptides, and Proteins; Proteins; Biological Factors; Intercellular Signaling Peptides and Proteins; Cytokines; Interleukins; Lymphokines; Interleukin-2
• Other Study ID Numbers: 23-493

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
• IPD Sharing Time Frame: Data can be shared no earlier than 1 year following the date of publication
• IPD Sharing Access Criteria: Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No