The purpose of this first in human study is to determine the safety and feasibility of 1RG-CART therapy in patients with relapsed or refractory neuroblastoma. 1RG-CART therapy is a novel immunotherapy under investigation in which patients have their T-cells (a type of white blood cell) collected and modified in the laboratory, before they are given back to the patient. The T-cells are modified to express a chimeric antigen receptor (CAR) which targets disialoganglioside (GD2), a marker expressed on the surface of neuroblastoma cells.
The purpose of this trial is to explore the safety and feasibility of deploying autologous anti-GD2 CAR T-cells for the immunotherapy of neuroblastoma. The CAR T-cell trials employing second generation receptors and lymphodepleting conditioning regimes have produced objective clinical responses in patients with relapsed leukaemias. The trial aims to evaluate similar CAR T-cells but directed against the antigen GD2. Neuroblastoma is well suited to this form of targeted therapy because of the homogeneous and almost universal expression of GD2 on the surface of neuroblastoma cells, and because of the poor prognosis of eligible patients. 1RG-CART will be administered intravenously. As the CAR T-cells are designed to survive and proliferate on encountering antigen, no direct relationship is anticipated between cell dose and either efficacy or toxicity. Rather, clinical benefit is more likely to be observed in those patients in whom in vivo expansion successfully occurs. A possible key determinant of expansion will be prior lymphodepletion of the patients. For this reason this trial is designed to evaluate a phased introduction of lymphodepletion in successive patient cohorts, rather than T-cell dose escalation. Only if there is insufficient expansion of T-cells following full lymphodepletion will the T-cell dose be escalated. Rituximab (MabThera®) will be used as a rescue medication only when necessary, and will be considered a non-investigational medicinal product (NIMP) in this trial.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
17
University College London Institute of Child Health & Great Ormond Street Hospital
London, United Kingdom
To Evaluate the Feasibility of 1RG-CART Therapy in Patients With Relapsed or Refractory Neuroblastoma
Feasibility of 1RG-CART therapy assessed as the number of patients who commence T-cell processing and are subsequently evaluable for 1RG-CART engraftment at Day 14.
Time frame: Day 14
Safety and Tolerability of 1RG-CART Therapy
Number of serious adverse events, non-serious adverse events and adverse events that are related to fludarabine, cyclophosphamide or 1RG-CART.
Time frame: From the time of informed consent to leukapheresis until withdrawal from the trial or start of other anti-cancer therapy (a median time period of 132 days [range 68 to 301 days])
To Determine Recommended Phase II Regimen by Assessing the Number of DLTs at Each Dose Level
Number of dose limiting toxicities (DLTs) at each dose level.
Time frame: From the time of informed consent to leukapheresis until withdrawal from the trial or start of other anti-cancer therapy (a median time period of 132 days [range 68 to 301 days])
1RG-CART Counts in the Peripheral Blood
Number of patients with 1RG-CART levels in peripheral blood above the limit of quantification for the assay (10 cells/µL) by flow cytometry.
Time frame: From Day 0 until end of trial (median 38.5 days, range 20 to 233 days)
Assessment of Tumour Response From Baseline (RECIST)
Assessment of best tumour response from baseline according to Response Evaluation Criteria in Solid Tumours (RECIST) v1.1.
Time frame: Day 28, 2 months and 4 months
Assessment of Tumour Response From Baseline (irRC)
Assessment of best tumour response from baseline according to Immune Related Response Criteria (irRC).
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Time frame: Day 28, 2 months and 4 months
Assessment of Tumour Response From Baseline (INRC)
Assessment of best tumour response from baseline according to International Neuroblastoma Response Criteria (INRC).
Time frame: Day 28, 2 months and 4 months
To Evaluate Anti-tumour Activity (Progression Free Survival)
Progression free survival (progression by RECIST criteria).
Time frame: Up to 2 years
To Evaluate Anti-tumour Activity (Overall Survival)
Overall survival.
Time frame: Up to 2 years