The purpose of this research study is to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. This cell therapy is called B7- H3.CD28Z.CART, referred to as B7-H3 CAR T cells. B7-H3 is a protein that is over-expressed on many tumor cells, making it a good target for cancer cell therapy. The names of the study investigational therapies involved in this study are: * Fludarabine (a type of chemotherapy) * Cyclophosphamide (a type of chemotherapy) * B7-H3 CAR T cells (a type of cellular therapy)
This is a single-institution, Phase 1/1b, open-label study to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. This cell therapy is called B7- H3.CD28Z.CART, referred to as B7-H3 CAR T cells. B7-H3 is a protein that is over-expressed on many tumor cells, making it a good target for cancer cell therapy. The U.S. Food and Drug Administration (FDA) has not approved B7-H3 CAR T cells as a treatment for any disease. Fludarabine and cyclophosphamide are standard lymphodepleting chemotherapy medications that are being used in this study to prepare the body for cell therapy. They are approved by the U.S. Food \& Drug Administration (FDA) for this purpose and are not intended to be treatment for recurrent or progressive brain tumors. The structure of the study will be by dose-escalation using a modified 3+3 design in two risk strata (standard risk, high risk), followed by a two-stage Phase 1b expansion at the recommended Phase 2 dose. Participation in this study is expected to last up to 15 years. It is expected that about 70 people will participate in this study.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
70
Autologous CAR T cells targeting B7-H3 (CD276), administered intravenously (into the vein) per protocol.
Lymphodepleting chemotherapy administered intravenously per institutional standards.
Lymphodepleting chemotherapy administered intravenously per institutional standards.
Boston Children's Hospital
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
Boston, Massachusetts, United States
Manufacturing Success Rate of Autologous B7-H3.CD28Z CAR T Cells
Each participant's product will be tested for the following criteria: cell viability ≥ 70%; cell number within ± 20% of the planned dose; CD3+ T cells ≥ 80% of leukocytes; CAR-positive cells ≥ 10% of CD3+ T cells; endotoxin ≤ 5 EU/kg; mycoplasma not detected; vector copy number (VCN) per transduced cell ≤ 10; replication-competent retrovirus (RCR) not detected; and sterility confirmed as "No Growth to Date" (NGTD) after a minimum of 5 days in culture. A participant will be classified as a manufacturing success if the final product satisfies all release criteria. If any criterion is not met, the participant will be classified as a manufacturing failure. The manufacturing success rate is defined as the proportion of participants classified as a success.
Time frame: Participants will receive the CART cell infusion on Day 0.
Maximum Tolerated Dose (MTD) of B7-H3.CD28Z.CART Cells
The MTD is defined as the highest dose level of B7-H3.CD28Z.CART cells at which the rate of dose-limiting toxicity (DLT) is considered acceptable according to the modified 3+3 rules. Additional details are provided in Protocol Section 13.1. Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Time frame: 28 days
Recommended Phase 2 Dose (RP2D) of B7-H3.CD28Z.CART Cells
The recommended phase 2 dose (RP2D) is the dose of B7-H3.CD28Z.CAR T cells selected for Phase 2 based on Phase 1 results, considering safety, tolerability, manufacturing feasibility, and observed clinical activity, and may be at or below the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD).
Time frame: 28 days
Number of Participants Experience Dose-Limiting Toxicity (DLT) during Dose Escalation
Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Time frame: 28 years
Number of Participants Experience Dose-Limiting Toxicity (DLT) at Maximum Tolerated Dose (MTD) / Recommend Phase 2 Dose (RP2D)
Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Time frame: 28 days
Number of Participants with Two Additional ICV B7-H3.CD28Z.CAR T Infusions
The number of participants in the High-Risk Stratum who receive two additional intracerebroventricular (ICV) infusions of B7-H3.CD28Z.CAR T cells following the initial intravenous(IV) infusion.
Time frame: From Day 0 (initial IV infusion) through Day 56 (third ICV infusion)
Adverse Events of Special Interest (AESIs) Rate
AESIs rate is defined as the proportion of participants who experience AESIs during treatment period. AESIs is defined in protocol section 7.3. Adverse events will be summarized and graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 6.0.
Time frame: From Day 0 (initial IV infusion) through Day 56 (third ICV infusion) plus a 28-day follow-up period, for a total of 74 days.
Complete Response Rate (CRR) at Day 28
CRR is defined as the proportion of participants who achieve complete response (CR) assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Time frame: Day 28
Partial Response Rate (PRR) at Day 28
PRR is defined as the proportion of participants who achieve partial response (PR) assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Time frame: Day 28
Stable Disease Rate (SDR) at Day 28
SDR is defined as the proportion of participants who achieve stable disease (SD) assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Time frame: Day 28
3 Month Complete Response Rate (CRR3)
CRR3 is defined as the proportion of participants who achieve complete response (CR) at 3 months, which assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Time frame: 3 months
3 Month Partial Response Rate (PRR3)
PRR3 is defined as the proportion of participants who achieve partial response (PR) at 3 months, which assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Time frame: 3 months
3 Month Stable Disease Rate (SDR3)
SDR3 is defined as the proportion of participants who achieve stable disease (SD) at 3 months, which assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Time frame: 3 months
Best Overall Response Rate (BORR)
BORR is defined as the proportion of participants who achieve a best overall response of complete response (CR), partial response (PR), or stable disease (SD) from the start of treatment until progressive disease (PD) or recurrence, taking as reference for progression the smallest measurements recorded since treatment initiation. Per Pediatric Neuro-Oncology (RAPNO) response guidelines, PD is defined as meeting any of the following criteria: a ≥25% increase in the sum of perpendicular diameters of measurable lesions or clear progression of non-measurable disease on MRI (brain/spine), appearance of any new lesion (biopsy confirmation if feasible), conversion of CSF cytology from negative to positive, clinical deterioration not attributable to other causes, or new extra-CNS disease.
Time frame: Treatment duration may be up to 224 days, and disease evaluations will be performed at Day 28 (±4 days), at Months 2 and 3 (±1 week), and every 3 months thereafter through Month 24 (±4 weeks) after the end of treatment.
Median Duration of Response (DOR)
DOR, estimated using the Kaplan-Meier method, is measured from the time when the criteria for complete response (CR) or partial response (PR) are first met until the first documented date of recurrent or progressive disease (PD) or death from any cause, using as reference for progression the smallest measurements recorded since treatment initiation. Participants without events are censored at the date of their last disease evaluation. Per Pediatric Neuro-Oncology (RAPNO) response guidelines, PD is defined as meeting any of the following criteria: a ≥25% increase in the sum of perpendicular diameters of measurable lesions or clear progression of non-measurable disease on MRI (brain/spine), appearance of any new lesion (biopsy confirmation if feasible), conversion of CSF cytology from negative to positive, clinical deterioration not attributable to other causes, or new extra-CNS disease.
Time frame: Treatment duration may be up to 224 days, and disease evaluations will be performed at Day 28 (±4 days), at Months 2 and 3 (±1 week), and every 3 months thereafter through Month 24 (±4 weeks) after the end of treatment.
2 Year Progression-Free Survival (PFS2)
PFS2 is the percent probability estimate at 2 years based on the Kaplan-Meier method. PFS is defined as the time from infusion of B7-H3.CD28Z.CART to the first occurrence of an event (progression, relapse, or death due to any cause). Participants alive without an event are censored at date of last disease evaluation. Per Pediatric Neuro-Oncology (RAPNO) response guidelines, PD is defined as meeting any of the following criteria: a ≥25% increase in the sum of perpendicular diameters of measurable lesions or clear progression of non-measurable disease on MRI (brain/spine), appearance of any new lesion (biopsy confirmation if feasible), conversion of CSF cytology from negative to positive, clinical deterioration not attributable to other causes, or new extra-CNS disease.
Time frame: 2 years
Median Overall Survival (OS)
OS based on Kaplan-Meier method is defined as the time from infusion of B7-H3.CD28Z.CART to death due to any cause, or censored at date last known alive.
Time frame: 15 years
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