This study is an open-label, multiple-dose escalation, Investigator-Initiated Trial (IIT) clinical trial designed to evaluate the safety and tolerability of CC312 in adult patients with relapsed and refractory autoimmune diseases. The trial also assesses pharmacokinetics (PK) and preliminary efficacy. CC312 is a trispecific T cell engager (TriTE) that targets the B cell surface antigen CD19, the T cell antigen CD3, and the T cell co-stimulatory molecule CD28. Given its mechanism of action, which is similar to the "biopharmaceutical version" of CAR-T, there is a higher risk of cytokine release syndrome (CRS) at the onset of infusion administration. Therefore, a lower priming dose will be administered before the therapeutic dosing phase to mitigate this risk and ensure safety, followed by a therapeutic dose to achieve and maintain efficacy. The study is divided into three dose groups, with 3-6 subjects enrolled in each group, resulting in a total of 9-18 subjects in the study. A "3+3" dose escalation design is employed to systematically evaluate the safety and determine the optimal dose of CC312.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
After a 28-day screening period, subjects who meet the inclusion and exclusion criteria will be enrolled for baseline assessments and biological sample collection prior to the guided administration period. The guided dose of CC312 will be administered via IV infusion on Day -3, followed by safety and tolerability assessments on the third day after the initial administration (i.e., Day -1). The therapeutic dose of CC312 will be administered via IV infusion on Day 1, with subsequent infusions scheduled on Day 4, Day 8, Day 11, Day 15, Day 18, Day 22, and Day 25. Comprehensive safety and tolerability assessments will be conducted at each of these time points.
Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences
Tianjin, China, China
RECRUITINGDose-limiting toxicity (DLT)
Hematological DLT is defined as a Grade 4 toxic reaction (excluding lymphopenia) that is not attributable to the underlying disease and persists for more than 29 days. Non-hematological DLT refers to any Grade ≥4 toxicities that may be associated with CC312 treatment, or Grade 3 toxicities that may be associated with CC312 treatment and persist for ≥7 days during the DLT observation period following CC312 infusion.
Time frame: 2 years
Adverse events (AE)/serious adverse events (SAE)
All adverse events will be evaluated and graded according to the severity criteria of CTCAE (Common Terminology Criteria for Adverse Events) version 5.0, with the exception of Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), which will be assessed using the ASTCT (American Society for Transplantation and Cellular Therapy) standard.
Time frame: 2 years
Maximum Serum Concentration (Cmax) of CC312
Blood samples will be collected for serum concentration analysis at the following time points: within 1 hour before (0 hour) and 1 hour after the infusion of the initial dose; within 1 hour before (0 hour) and 1 hour after the infusion of the first and second doses in the first and third weeks of the therapeutic dose; within 1 hour before (0 hour) and 1 hour after the infusion of the first dose in the second and fourth weeks of the therapeutic dose; and at the time of early withdrawal/end of study (EOS).
Time frame: 2 years
Area Under the Concentration-time Curve (AUC) of CC312
The area under the concentration-time curve (AUC) over the dosing interval of 72 hours was calculated using the linear trapezoidal rule.
Time frame: 2 years
Minimum Concentration (Cmin) of CC312
The timing of blood sample collection is consistent with the sampling time for Cmax determination.
Time frame: 2 years
Counts of peripheral B cells
Blood samples will be collected for CD19+ and CD20+ B cell subsets analysis: For the priming dose: within 1 hour before (0 hour) and at 1 hour and 24 hours after infusion. For the therapeutic dose in the first week: within 1 hour before (0 hour) and at 1 hour and 24 hours after the first and second doses. At early withdrawal/End of Study (EOS).
Time frame: 2 years
Cytokine Indicators
Including but not limited to IL-2, IL-6, IL-10, IFN-γ, TNF-α, etc.
Time frame: 2 years
Anti-drug Antibodies
Collect blood samples at specific time points for the analysis of anti-drug antibody (ADA) levels and neutralizing antibody (NAb) levels.
Time frame: 2 years
Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2000) score
SLEDAI-2000 score is used to evaluate the clinical symptoms and disease activity of SLE. The score ranges from 0 to 15, with higher scores indicating more severe disease activity.
Time frame: 2 years
Total Improvement Score (TIS)
The Total Improvement Score (TIS) for idiopathic inflammatory myopathies (IIM) is a validated composite endpoint (typically ranging from 0 to 100) that quantifies the magnitude of overall clinical improvement, with higher scores denoting greater response and lower baseline scores often reflecting more severe disease activity.
Time frame: 2 years
ACR 20/50 score
ACR20/50 scores are standardized measures of treatment response in rheumatoid arthritis (RA) that directly correlate with reductions in disease activity. ACR20 represents the minimum clinically meaningful response in RA, while ACR50 indicates a robust response that is strongly associated with significant reduction in disease activity and improved long-term outcomes.
Time frame: 2 years
Overall Response Rate (ORR) for primary immune thrombocytopenia (ITP)
Overall Response Rate (ORR): proportion of ITP subjects whose efficacy is assessed as Complete Response (CR) or Response (R) at 4/8/12 weeks after the first infusion (treatment dose).
Time frame: 2 years
Overall Response Rate (ORR) for Autoimmune Haemolytic Anaemia (AIHA)
Overall Response Rate (ORR): proportion of subjects whose efficacy is assessed as CR or R at 4/8/12 weeks after the first infusion (treatment dose).
Time frame: 2 years
Peripheral blood mononuclear cell (PBMC) transcriptome analysis
Collect peripheral blood at baseline and specific post-treatment time points, isolate peripheral blood mononuclear cells (PBMCs), and decode the global gene expression profiles of immune cells.
Time frame: 2 years
Single-cell RNA sequencing (scRNA-seq) of peripheral blood mononuclear cells (PBMCs)
Peripheral blood is collected at baseline and specific post-treatment time points, followed by PBMC isolation and single-cell sequencing to resolve immune cell heterogeneity, uncover dynamic changes in cell states, and decipher cell-cell communication mechanisms.
Time frame: 2 years
Bone Marrow Lymphocyte Subtype Analysis
Collect bone marrow samples at baseline and specific post-treatment time points to analyze the proportion and counts of each immune cell subsets.
Time frame: 2 years
B-cell depletion analysis in lymph nodes
To evaluate the drug-induced deep depletion of B cells, lymph node samples are collected at baseline and specific post-dose time points to quantify the percentage and count of B cells within the tissue.
Time frame: 2 years
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