This phase I trial investigates the efficacy and safety of brain-targeting epidermal growth factor receptor chimeric antigen receptor immune cells (EGFRvIII-CAR T cells) in treating patients with leptomeningeal disease from glioblastoma. T cells are part of the immune system and help the body fight malignant tumours. Immune cells can be genetically modified to destroy brain tumor cells in the laboratory. EGFRvIII -CAR T cells are brain tumor specific and can enter and express its genes in immune cells. Administering patients EGFRvIII -CAR T cells may help to recognize and destroy brain tumor cells in patients with leptomeningeal disease from glioblastoma.
PRIMARY OBJECTIVES: 1. Examine and describe the safety and feasibility of EGFRvIII-specific hinge-optimized CD3 ζ-stimulatory/41BB-co-stimulatory Chimeric Antigen Receptor autologous T-lymphocytes (EGFRvIII -CAR T cells) through intracerebroventricular (ICV) delivery as adjuvant therapy in participants with EGFRvIII+ leptomeningeal disease from glioblastoma. 2. Determine the activity of EGFRvIII -CAR T cells based on survival rate at 12 months for both arms. SECONDARY OBJECTIVES: 1. Describe persistence, expansion and phenotype of endogenous and EGFRvIII -CAR T cells in peripheral blood (PB), tumor cyst fluid (TCF) and cerebral spinal fluid (CSF) at applicable time points 2. Describe cytokine levels in PB, TCF, and CSF at applicable time points 3. Estimate the rate of disease response by Response Assessment in Neuro-Oncology Leptomeningeal Metastases (RANO LM) criteria 4. Estimate rate of progression free survival at 6 months. Estimate rate of overall survival (OS) at 12 months by study arm. 5. Estimate time to next treatment 6. Evaluate EGFRvIII -CAR T cell persistence in the tumor tissue and the location of the EGFRvIII -CAR T cells with respect to the infusion site. 7. Evaluate biomarkers and cytokine levels OUTLINE: Patients receive EGFRvIII -CAR T cells intracerebroventricular over 15 minutes on day 1. Patients may receive additional cycles based on the persistence of the cells. The patients are followed extensively according to the clinical pharmacology sampling plan; on days 1-30, months 2-12, and three times per year up to 10 years based on response
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Jyväskylä Central Hospital
Jyväskylä, Finland
University Of Oulu
Oulu, Finland
Apollo Hospital
New Delhi, India
Incidence of adverse events
Common Terminology Criteria for Adverse Events (CTCAE) version 5.0
Time frame: Up to 10 years
Overall survival
Time frame: 12 months
CAR (chimeric antigen receptor) T cell levels detected in tumor cyst fluid (TCF), peripheral blood (PB), and cerebrospinal fluid (CSF)
Measured by absolute number per ul by flow
Time frame: Up to 6 cycles (3 months), at the end of each cycle 1 (each cycle is 14 days)
Endogenous T cell levels detected in tumor cyst fluid (TCF), peripheral blood (PB), and cerebrospinal fluid (CSF)
Measured by absolute number per ul by flow
Time frame: Up to 6 cycles (3 months), at the end of each cycle 1 (each cycle is 14 days)
Cell phenotype detected in tumor cyst fluid (TCF), peripheral blood (PB), and cerebrospinal fluid (CSF)
Measured by absolute number per ul by flow
Time frame: Up to 6 cycles (3 months), at the end of each cycle 1 (each cycle is 14 days)
Cytokine levels (Procartaplex panel) in PB, TCF and CSF
Time frame: Up to 6 cycles (3 months), at the end of each cycle 1 (each cycle is 14 days)
Disease response
Measured by Response Assessment in Neuro-Oncology Criteria (RANO LM).
Time frame: Up to 10 years
Time to progression
Progression defined by RANO LM criteria
Time frame: Up to 10 years
Overall survival
Time frame: Up to 10 years
CAR T and endogenous cells detected in tumor tissue
Detected in tumor tissue by immunohistochemistry (IHC)
Time frame: Baseline and additional time points according to response (through study completion, up to 10 years by as needed basis)
EGFRvII (epidermal growth factor receptor) antigen expression levels in tumor tissue.
Descriptive statistics will be provided
Time frame: Baseline and additional time points according to response (through study completion, up to 10 years by as needed basis)
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