CMV-specific Cytotoxic T Lymphocytes Expressing CAR Targeting HER2 in Patients With GBM

Overview

This study is for patients that have a type of brain cancer called glioblastoma multiforme (GBM). The body has different ways of fighting infection and disease. No single way seems perfect for fighting cancers. This research study combines two different ways of fighting cancer: antibodies and T cells. Antibodies are types of proteins that protect the body from infectious diseases and possibly cancer. T cells, also called T lymphocytes, are special infection-fighting blood cells that can kill other cells, including cells infected with viruses and tumor cells. Both antibodies and T cells have been used to treat patients with cancers. They have shown promise, but have not been strong enough to cure most patients. The antibody used in this study is called anti-HER2 (Human Epidermal Growth Factor Receptor 2). This antibody sticks to GBM cells because of a substance on the outside of these cells called HER2. Up to 80% of GBMs are positive for HER2. HER2 antibodies have been used to treat people with HER2-positive cancers. For this study, the HER2 antibody has been changed so that instead of floating free in the blood it is now attached to T cells. When an antibody is joined to a T cell in this way it is called a chimeric receptor. These chimeric receptor-T cells seem to be able to kill tumors like GBM, but they don't last very long and so their chances of fighting the cancer are limited. Therefore, developing ways to prolong the life of these T cells should help them fight cancer. We found that T cells work better if we also attach a protein called CD28 to the HER2 chimeric receptor (HER2-CAR). In this study we placed this HER2-CAR into T cells that were pre-selected for their ability to recognize Cytomegalovirus (CMV). This virus exists in most people. These CMV-specific cytotoxic T cells (CMV-T cells) will be more active since they will react to the virus as well as to tumor cells. These HER2-CD28 CMV-T cells are an investigational product not approved by the Food and Drug Administration. The purpose of this study is to find the largest safe dose of HER2-CD28 CMV-T cells, to learn what the side effects are, and to see whether this therapy might help patients with GBM.

When the patient enrolls on this study, they will be assigned to a dose of HER2-CAR CMV-T cells. The patient will be given a single injection of cells into the vein through an IV line at the assigned dose. The injection will take between 1 and 10 minutes. The patient will be followed in the clinic after the injection for 1 to 4 hours. If later the subject seems to be experiencing a benefit (confirmed by radiological studies, physical exam and/or symptoms), s/he may be able to receive up to six additional doses of the T cells if they wish. These additional infusions would be at least 6 to 12 weeks apart and at the same dose level received the first time. Medical tests before treatment-- Before being treated, the patient will receive a series of standard medical tests as follows: Physical exam, Blood tests to measure blood cells, kidney and liver function, Routine heart function tests (Echocardiogram),Measurements of the tumor by routine imaging studies Medical tests during and after treatment-- The patient will receive standard medical tests when getting the infusions and after:Physical exams, Blood tests to measure blood cells, kidney and liver function, Routine heart function tests (Echocardiogram) at 6 weeks after the infusion, Measurements of the tumor by routine imaging studies 6 weeks after the infusion To learn more about the way the HER2-CAR CMV-T cells are working and how long they last in the body, blood will be taken on the day of the T-cell infusion, before, 1 hour and 4 hours after the T-cell infusion, 1, 2, 4 and 6 weeks after the T-cell infusion and every 3 months for 1 year, every 6 months for 4 years, then yearly for a total of 15 years.