Adoptive T-cell therapy is a therapeutic approach that aims to generate an anti-tumor T-cell immune response by infusing a cancer subjects own T-cells obtained by leukapheresis, engineered and expanded in-vitro to express a tumor specific T-cell receptor. NY-ESO-1 and LAGE-1a antigens are tumor-associated proteins that have been found in several tumor types, including synovial sarcoma. This is an open-label study to evaluate the safety and efficacy of GSK3377794 (genetically engineered NY-ESO-1 Specific \[c259\] T Cells), in combination with anticancer agents including pembrolizumab in subjects with NY-ESO-1 and/or LAGE-1a positive relapsed and refractory synovial sarcoma. The study will consist of a target expression screening to determine if subjects are human leukocyte antigen (HLA)-A\*02:01, HLA-A\*02:05 and/or HLA-A\*02:06 positive and if their tumors express NY-ESO-1 and/or LAGE-1a, followed by a leukapheresis screening phase of up to 42 days prior to leukapheresis. Eligible subjects will enter a leukapheresis phase followed by lymphodepletion phase with cyclophosphamide and fludarabine. During the treatment phase, subjects will be administered GSK3377794 on Day 1 followed by pembrolizumab infusion once every 3 weeks from Day 22 (or Week 7) for up to 2 years. There will be a long-term follow-up phase from the end of treatment phase and for up to 15 years from the date of GSK3377794 administration.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
GSK3377794 is genetically engineered NY-ESO-1 Specific (c259) T cells.
Pembrolizumab will be administered at a dose of 200 mg once every 3 weeks for adults and 2 mg/kg (up to 200 mg) once every 3 weeks for children.
Fludarabine will be used as a lymphodepleting chemotherapy.
Cyclophosphamide will be used as a lymphodepleting chemotherapy.
Number of subjects with treatment limiting toxicities (TLT)
The following toxicities will be considered as TLTs: Any \>=Grade 4 adverse event (AE) except for Grade 4 fever and chills and Grade 4 hypoalbuminemia or abnormal electrolytes that are responding to supplementation/correction; Grade 3 non-infectious pneumonitis; Any other Grade 3 AE (excluding pneumonitis), that does not improve to Grade 2 within 7 days after onset despite medical management and supportive care; Any AE that permanently prevents subject from dosing with pembrolizumab in this trial.
Time frame: Up to 2 years
Number of subjects with AEs
An AE is any untoward medical occurrence in a clinical study subject, temporally associated with the use of a study intervention, whether or not considered related to the study intervention.
Time frame: Up to 2 years
Severity of AEs
The severity of AEs will be graded according to National Cancer Institute-Common terminology criteria for adverse events (NCI-CTCAE) version 4.03.
Time frame: Up to 2 years
Number of subjects with serious adverse events (SAEs)
An SAE is defined as any untoward medical occurrence that, at any dose: results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent disability/incapacity; is a congenital anomaly/birth defect; and other important medical events that may jeopardize the subject or may require medical or surgical intervention to prevent one of the other outcomes listed before.
Time frame: Up to 2 years
Number of subjects with AE /SAEs leading to pembrolizumab administration delay, interruptions, and withdrawals
Number of subjects with AE /SAEs leading to pembrolizumab administration delay, interruptions, and withdrawals will be summarized.
Time frame: Up to 2 years
Number of subjects with abnormal hematology parameters
Blood samples will be collected for the assessment of the following hematology parameters: platelet count, red blood cell (RBC) count, hemoglobin, hematocrit, mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), reticulocytes, neutrophils, lymphocytes, monocytes, eosinophils and basophils.
Time frame: Up to 2 years
Number of subjects with abnormal clinical chemistry parameters
Blood samples will be collected for the assessment of the following clinical chemistry parameters: blood urea nitrogen (BUN), creatinine, glucose, albumin, potassium, sodium, calcium, phosphorus, magnesium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, lactate dehydrogenase (LDH), bicarbonate, total and direct bilirubin, total protein, chloride and urea.
Time frame: Up to 2 years
Number of subjects with abnormal urine parameters
Urine samples will be collected for the analysis of the following urine parameters: specific gravity, potential of hydrogen (pH), glucose, protein, blood, ketones, bilirubin, urobilinogen, nitrite and leukocyte esterase by dipstick.
Time frame: Up to 2 years
Number of subjects with abnormal vital signs
Vital signs will be measured in a semi-supine position after 5 minutes of rest and will include temperature, systolic and diastolic blood pressure, and pulse rate.
Time frame: Up to 2 years
Eastern Cooperative Oncology Group (ECOG) performance scores
For subjects \>10 years of age, the performance status will be assessed using ECOG.
Time frame: Up to 2 years
Lansky performance scores
For subjects \<=10 years of age, the performance status will be assessed using Lansky scale.
Time frame: Up to 2 years
Number of subjects with abnormal electrocardiogram (ECG) parameters
12-lead ECG will be obtained in triplicate using an automated ECG machine.
Time frame: Up to 2 years
Overall Response Rate
Overall response rate is defined as the percentage of subjects with a confirmed complete response (CR) or a partial response (PR) at any time as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1.
Time frame: Up to 2 years
Progression free survival
Progression-free survival is defined as the time from the date of T-cell infusion until the earliest date of disease progression (PD) as assessed by the investigator per RECIST version 1.1, or death due to any cause.
Time frame: Up to 2 years
Disease Control Rate
Disease Control Rate is defined as the percentage of subjects with a confirmed CR, PR, or stable disease (SD) for at least 6 months as per RECIST version 1.1.
Time frame: Up to 2 years
Duration of Response
Duration of response is defined as the time from first documented evidence of CR or PR until the first documented sign of disease progression or death, in the subset of subjects who show a confirmed CR or PR.
Time frame: Up to 2 years
Time to Response
Time to response is defined as the time from the first dose to the first documented evidence of CR or PR for subjects with a confirmed CR or PR.
Time frame: Up to 2 years
Maximum transgene persistence (Cmax)
Peripheral blood samples will be collected at indicated time points for measurement of GSK3377794 transduced cell quantities. GSK3377794 T-cell persistence in the peripheral blood will be measured to establish the relationship between persistence and response to GSK3377794.
Time frame: Day -14 to Day -9, Days 1, 2, 4, 8, 15, 22, Weeks 5, 7 and once every 3 weeks from Week 10 to 106
Time to Cmax (Tmax)
Peripheral blood samples will be collected at indicated time points for measurement of GSK3377794 transduced cell quantities. GSK3377794 T-cell persistence in the peripheral blood will be measured to establish the relationship between persistence and response to GSK3377794.
Time frame: Day -14 to Day -9, Days 1, 2, 4, 8, 15, 22, Weeks 5, 7 and once every 3 weeks from Week 10 to 106
Area under the time curve from zero to time t (AUC[0-t])
Peripheral blood samples will be collected at indicated time points for measurement of GSK3377794 transduced cell quantities. GSK3377794 T-cell persistence in the peripheral blood will be measured to establish the relationship between persistence and response to GSK3377794.
Time frame: Day -14 to Day -9, Days 1, 2, 4, 8, 15, 22, Weeks 5, 7 and once every 3 weeks from Week 10 to 106
Number of subjects with NY-ESO-1/LAGE-1a expression in tumor tissues
Biopsy of tumor tissue will be obtained to assess the tissue expression of the target antigen NY-ESO-1 and/or LAGE-1a.
Time frame: Up to 2 years
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