This early phase I trial investigates how well duvelisib exposure before CAR-T cell manufacturing works to enhance immune profiles of T cells in patients with diffuse large B-cell lymphoma that has come back (recurrent) or does not respond to treatment (refractory). Duvelisib, an oral phosphoinositide 3-kinase (PI3K) inhibitor, may favorably change a patient's T cells to make them more efficient and have a longer duration for manufacturing of CAR-T cells.
PRIMARY OBJECTIVE: I. To assess the increase in CD27+/CD28+ T cells, after 8 to 15 day exposure duvelisib prior to collection of mononuclear cells for chimeric antigen receptor T-cell (CART cell) manufacturing. SECONDARY OBJECTIVES: I. To evaluate patient compliance with duvelisib. II. To evaluate the time required for manufacturing CAR-T using mononuclear cells from duvelisib-treated patients. III. To describe the frequencies of CD27/28 double positive T cells and CD4/8 double negative T cells. IV. To evaluate expansion and persistence of CAR-T cells V. To evaluate overall response rates following CAR-T cell therapy VI.To evaluate survival rates following CAR-T cell therapy VII. To describe the frequency of CRS and neurotoxicity requiring ICU transfer (for CRS or neurotoxicity) and/or treatment VIII. Describe the safety and tolerability profile of duvelisib OUTLINE: Patients receive duvelisib orally (PO) twice daily (BID) for 2 weeks prior to collection of CAR-T cells in the absence of disease progression or unacceptable toxicity. Patients then receive tisagenlecleucel via infusion. Patients are followed up 100 days after CAR-T infusion.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
4
Given PO
Given via infusion
Emory University Hospital/Winship Cancer Institute
Atlanta, Georgia, United States
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, United States
Fold-change increase in CD27/CD28 double positive T cells
Will estimate fold-change increase in CD27/CD28 double positive T cells following in vivo exposure to duvelisib using multiparametric flow cytometry.
Time frame: From Baseline up to day 15
Proportion of patients that completed at least 75% of duvelisib doses
Descriptive statistics will be used to calculate the proportion of patients that completed at least 75% of duvelisib doses as documented by the patient pill diaries. The proportion along with an exact 95% confidence interval will be reported.
Time frame: Up to day 15
Manufacturing time of CAR-T 19 cells
Descriptive statistics will be used to calculate the median manufacturing time from the 10 patients that completed at least 75% of duvelisib doses. The median will be reported along with the minimum and maximum manufacturing times.
Time frame: Up to day 15
Change in proportion of CD27/28 double positive T cells and CD4/8 double negative T cells
A Wilcoxon signed-rank test will evaluate the change in proportion of CD27+/CD28+ and CD4-/CD8- T cells using multiparametric flow cytometry.
Time frame: At baseline and at day 15
Overall response rate (ORR)
The ORR (complete response or partial response) will be summarized along with an exact 95% confidence interval. Disease response will be based on the Response Evaluation Criteria in Solid Tumors criteria (version 1.1).
Time frame: At 3 months following CAR-T cell infusion
Frequency of intensive care unit (ICU) transfers due to cytokine release syndrome (CRS) and/or neurotoxicity
Descriptive statistics will be used to calculate the frequency of ICU transfers due to CRS and/or neurotoxicity. Descriptive statistics will also be used to calculate the frequency of administration of tocilizumab and/or corticosteroids use for CRS and/or neurotoxicity.
Time frame: Up to day 90 post CAR-T cell infusion
Incidence of grade III-IV adverse events
Grade III-IV toxicities (as defined by Common Terminology Criteria for Adverse Events version 5.0) during duvelisib administration or for two weeks after the last dose of duvelisib.
Time frame: Up to 2 weeks after last dose of duvelisib
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.