This phase I trial studies the side effects and best dose of genetically modified stem cells when given together with irinotecan hydrochloride in treating patients with recurrent high-grade gliomas. Irinotecan hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Placing a gene that has been created in the laboratory into neural stem cells and injecting it into the brain may help irinotecan hydrochloride kill more tumor cells once it reaches the brain.
PRIMARY OBJECTIVES: I. To define the recommend phase II doses of intracranially administered active modified human form of carboxylesterase (hCE1m6)- neuronal stem cells (NSCs) (carboxylesterase-expressing allogeneic neural stem cells) in combination with intravenous irinotecan (irinotecan hydrochloride). II. To determine the biologic activity of the hCE1m6-NSCs by comparing SN-38 concentrations in the brain after treatment with hCE1m6-NSCs and irinotecan compared to irinotecan alone. SECONDARY OBJECTIVES: I. To investigate the relationship between hCE1m6-NSC dose and SN-38 concentrations in brain interstitium. II. To characterize the relationship between intracerebral and systemic concentrations of irinotecan and SN-38. III. To assess for possible development of NSC immunogenicity after first exposure and with repeat doses of NSCs. IV. To evaluate the intracerebral distribution of NSCs by using iron-labeling as a cellular tracker. V. To describe the clinical benefit (defined as stable disease, partial response, or complete response) in patients who receive treatment with repeat cycles of NSCs and irinotecan. VI. To determine, at time of autopsy, the fate of the NSCs. OUTLINE: This is a dose-escalation study of carboxylesterase-expressing allogeneic neural stem cells. Patients receive carboxylesterase-expressing allogeneic neural stem cells via intracerebral catheter on day 1 of week 1; weeks 1 and 3, weeks 1, 2, and 3; or weeks 1, 2, 3, and 4. Patients also receive irinotecan hydrochloride intravenously (IV) over 90 minutes on day 3 of week 1; weeks 1 and 3, weeks 1, 2, and 3; or weeks 1, 2, 3, and 4. Courses repeat every 6 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for at least 15 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Given via intracerebral catheter
Given IV
Correlative studies
City of Hope Medical Center
Duarte, California, United States
Incidence of dose-limiting toxicity (DLT), graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Tables will be created to summarize all toxicities and side effects by dose, course, organ severity (by NCI CTCAE version 4.0), and attribution. Rates and associated 95% Clopper Pearson confidence limits will be estimated for the DLT and clinical benefit at the MTD for cohort 1 and cohort 2 and in combination if the results are similar.
Time frame: 6 weeks
Incidence of all attributable toxicities, graded according to NCI CTCAE version 4.0
Tables will be created to summarize all toxicities and side effects by dose, course, organ severity (by NCI CTCAE version 4.0), and attribution.
Time frame: Up to 15 years
Biologic activity of the hCE1m6-NSCs through Cmax and AUC of irinotecan and SN-38 in dialysate and plasma
Data from patients who undergo intracerebral microdialysis will be summarized using descriptive statistics and graphical methods.
Time frame: Prior to the start of the irinotecan infusion and at 90 minutes (just prior to the end of the infusion), and then at 30 minutes, 1, 2, 4, 8, 24, and 48 hours after the end of the infusion on day 3 of week 1
Incidence of immunogenicity measured by the development of T cell responses and antibodies against the NSCs using TcR Vβ spectratyping, CD 107 degranulation assays, and flow cytometry
Results will be summarized in an exploratory fashion using descriptive statistics and graphical methods.
Time frame: Up to 15 years
NSC biodistribution in the brain via Feraheme-labeling of NSCs and MR imaging
Results will be summarized in an exploratory fashion using descriptive statistics and graphical methods.
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Time frame: Up to 15 years
Clinical benefit measured by tumor response
Time frame: Up to 15 years
NSC persistence at autopsy
Results will be summarized in an exploratory fashion using descriptive statistics and graphical methods.
Time frame: Up to 15 years