The primary objectives of this study are: Phase 1: To evaluate the safety of axicabtagene ciloleucel in combination with utomilumab and to identify the most appropriate dose and timing of utomilumab to carry forward into Phase 2 Phase 2: To evaluate the efficacy of axicabtagene ciloleucel and utomilumab as measured by complete response rate in participants with refractory large B-cell lymphoma
This study was intended to be a Phase 1/2. Enrollment was stopped prior to completion of Phase 1 portion of the study based on the sponsor's decision to end the program. No participants were enrolled in Phase 1 Cohort 5 and Phase 2. After the study ends, participants who received an infusion of axicabtagene ciloleucel and utomilumab will complete the remainder of the 15-year follow-up assessments in a separate Long-term Follow-up study, KT-US-982-5968 (NCT05041309).
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Administered according to package insert
Administered according to package insert
A single infusion of chimeric antigen receptor (CAR)-transduced autologous T cells administered intravenously
Stanford Cancer Institute
Palo Alto, California, United States
UCLA Hematology/ Oncology
Santa Monica, California, United States
Moffitt Cancer Center
Tampa, Florida, United States
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Phase 1: Percentage of Participants Experiencing Adverse Events Defined as Dose Limiting Toxicities (DLTs)
DLTs are study drug-related events with onset within first 28 days following infusion of axicabtagene ciloleucel or utomilumab: * Grade (GR) 4 hematologic toxicity lasting more than 30 days (except lymphopenia or B-cell aplasia) * All study drug-related GR 3 lasting for \> 7 days or 4 non-hematologic toxicities regardless of duration (except: aphasia/dysphasia or confusion/cognitive disturbance which resolves to at least GR 1 within 2 weeks or baseline within 4 weeks, fever of any grade, immediate study drug-related hypersensitivity reactions within 2 hours of drug infusion that are reversible to grade 2 or less within 24 hours, renal toxicity which requires dialysis for ≤ 7 days, intubation for airway protection if ≤ 7 days, tumor lysis syndrome, grade 3 liver function test elevation, provided there is resolution to ≤ GR 2 within 14 days, grade 4 transient serum hepatic enzyme abnormalities provided there is resolution to ≤ GR 3 within \< 72 hours, grade 3 nausea and/or anorexia).
Time frame: Up to 28 days
Phase 2: Complete Response (CR) Rate
CR Rate: Percentage of participants with CR \[complete metabolic response (CMR); complete radiological response (CRR)\]. CMR: positron emission tomography (PET) 5-point scale (5-PS) scores of 1 (no uptake above background), 2 (uptake ≤ mediastinum), 3 (uptake \> mediastinum but ≤ liver) with/without a residual mass); no new lesions; and no evidence of fluorodeoxyglucose (FDG)-avid disease in bone marrow (BM). CRR: target nodes/nodal masses regressed to ≤ 1.5 cm in longest transverse diameter of lesion (LDi); no extralymphatic sites of disease; absent non-measured lesion (NMLs); organ enlargement regress to normal; no new sites; and bone marrow normal by morphology.
Time frame: Up to 1 year
Phase 1 and Phase 2: Objective Response Rate (ORR)
ORR: Percentage of participants with CR \[CMR;CRR\] or PR \[partial metabolic response (PMR); partial radiologic response (PRR)\].CMR: PET 5PS scores of 1 (no uptake above background, 2 (uptake ≤ mediastinum), 3 (uptake\>mediastinum but ≤ liver) with/without a residual mass; no new lesions; no evidence of FDG-avid disease in BM. CRR: target nodes/nodal masses regressed to ≤1.5 cm in LDi; no extralymphatic sites of disease; absent NMLs;organ enlargement regress to normal; no new sites; bone marrow morphology normal. PMR: scores 4 (uptake moderately \> liver),5 (uptake markedly \> liver, new lesions) with reduced uptake compared with baseline and residual mass; no new lesions; responding disease at interim/residual disease at end of treatment (EOT).PRR: ≥ 50% decrease in sum of the product of perpendicular diameters (SPD) of up to 6 target measurable nodes and extra-nodal sites;absent/normal, regressed, but no increase of NMLs; spleen regressed by \> 50% in length beyond normal; no new sites.
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Administered as an IV infusion
Columbia University Medical Center
New York, New York, United States
Time frame: From first infusion date of axicabtagene ciloleucel until first occurrence of CR or PR (maximum duration: 42.6 months)
Phase 1 and Phase 2: Duration of Response (DOR)
DOR is time from first objective response (OR) to disease progression (PD)/death from any cause/up to last date known alive in the study. PD:score 4(uptake moderately\>liver)/5(uptake markedly\>liver and/or new lesions) with increase in intensity of uptake from baseline; new fluorodeoxyglucose (FDG)-avid foci consistent with lymphoma at interim/EOT assessment; new FDG-avid foci consistent with lymphoma rather than another etiology; new/recurrent FDG-avid foci in bone marrow; an individual node/lesion must be abnormal with: LDi \>1.5 cm, increase by ≥50% from cross-product of LDi and perpendicular diameter (PPD) nadir, increase in LDi/shortest axis perpendicular to LDi from nadir, splenic length must increase by \>50% of extent of its prior increase beyond baseline. If no prior splenomegaly, increase must be ≥2 cm from baseline; new/recurrent splenomegaly; new or clear progression of pre-existing NMLs; new lesion; new/recurrent bone marrow involvement. OR is defined in outcome measure 3.
Time frame: From first documentation of CR or PR until first occurrence of PD or death from any cause or up to last date known alive in the study (maximum duration: 42.6 months)
Phase 1 and Phase 2: Progression Free Survival (PFS)
PFS is defined as the time from the axicabtagene ciloleucel infusion date to the date of PD per Lugano classification or death from any cause or up to last date known alive in the study. PD is defined in outcome measure 4.
Time frame: From first infusion date of axicabtagene ciloleucel to the date of PD or death from any cause or up to last date known alive in the study (maximum duration: 43.5 months)
Phase 1 and Phase 2: Overall Survival (OS)
OS was defined as the time from axicabtagene ciloleucel infusion to the date of death from any cause or up to last date known alive in the study.
Time frame: From first infusion date of axicabtagene ciloleucel to date of death from any cause or up to last date known alive in the study (maximum duration: 43.5 months)
Phase 1 and Phase 2: Percentage of Participants Experiencing Treatment-Emergent Adverse Events (TEAEs)
An AE was any untoward medical occurrence in a participant in a clinical trial participant, which did not necessarily have a causal relationship with the treatment. TEAEs were defined as any worsening of a pre-existing medical condition that occurred on or after axicabtagene ciloleucel infusion or any AE with onset on or after axicabtagene ciloleucel infusion.
Time frame: From first dose up to 30 days post last dose (maximum duration: 23.0 months)
Phase 1 and Phase 2: Percentage of Participants Experiencing Laboratory Toxicity Grade Shifts to Grade 3 or Higher Resulting From Increased Parameter Value
Grading categories were determined by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Grade 1: mild, Grade 2: moderate, Grade 3: severe or medically significant, Grade 4: life-threatening.
Time frame: From first dose up to 30 days post last dose (maximum duration: 23.0 months)
Phase 1 and Phase 2: Percentage of Participants Experiencing Laboratory Toxicity Grade Shifts to Grade 3 or Higher Resulting From Decreased Parameter Value
Grading categories were determined by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Grade 1: mild, Grade 2: moderate, Grade 3: severe or medically significant, Grade 4: life-threatening.
Time frame: From first dose up to 30 days post last dose (maximum duration: 23.0 months)
Phase 1 and Phase 2: Pharmacokinetics: Peak Levels of Axicabtagene Ciloleucel in Blood
Peak was defined as the maximum number of CAR T cells in blood measured after infusion.
Time frame: Day 1 (Pre-utomilumab (UTO) Dose 1), Day 3 (Post-UTO Dose 1), Day 7, Day 10, Week 2, Week 3, Week 4 (Pre and Post-UTO Dose 2), Week 8 (Pre and Post-UTO Dose 3), Week 12 (Pre-UTO Dose 4), Week 16 (Pre-UTO Dose 5), Week 20 (Pre-UTO Dose 6), Week 24
Phase 1 and Phase 2: Pharmacodynamics: Peak Levels of Cytokines in Serum
Peak is defined as the maximum post-baseline level of cytokine in the blood.
Time frame: Baseline, Day 0, Day 7, Week 2, Week 4 (Pre and Post-UTO Dose 2)