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CAR T Cell Receptor Immunotherapy Targeting EGFRvIII for Patients With Malignant Gliomas Expressing EGFRvIII

Information source: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Malignant Glioma; Glioblastoma; Brain Cancer

Intervention: Anti-EGFRvIII CAR transduced PBL (Biological); Aldesleukin (Drug); Fludarabine (Drug); Cyclophosphamide (Drug)

Phase: Phase 1/Phase 2

Status: Recruiting

Sponsored by: National Cancer Institute (NCI)

Official(s) and/or principal investigator(s):
Steven A Rosenberg, M.D., Principal Investigator, Affiliation: National Cancer Institute (NCI)

Overall contact:
Jessica G Yingling, R.N., Phone: (866) 820-4505, Email: ncisbirc@mail.nih.gov

Summary

Background: The NCI Surgery Branch has developed an experimental therapy for treating patients with gliomas that involves taking white blood cells from the patient, growing them in the laboratory in large numbers, genetically modifying these specific cells with a type of virus (retrovirus) to attack only the tumor cells, and then giving the cells back to the patient. This type of therapy is called gene transfer. In this protocol, we are modifying the patient s white blood cells with a retrovirus that has the gene for anti-EGFRvIII incorporated in the retrovirus. Objective: The purpose of this study is to determine a safe number of these cells to infuse and to see if these particular tumor-fighting cells (anti-EGFRvIII cells) are a safe and effective treatment for advanced gliomas. Eligibility:

- Adults age 18-70 with malignant glioma expressing the EGFRvIII molecule.

Design: Work up stage: Patients will be seen as an outpatient at the NIH clinical Center and undergo a history and physical examination, scans, x-rays, lab tests, and other tests as needed Leukapheresis: If the patients meet all of the requirements for the study they will undergo leukapheresis to obtain white blood cells to make the anti-EGFRvIII cells. {Leukapheresis is a common procedure, which removes only the white blood cells from the patient.} Treatment: Once their cells have grown, the patients will be admitted to the hospital for the conditioning chemotherapy, the anti-EGFRvIII cells, and aldesleukin. They will stay in the hospital for about 4 weeks for the treatment. Follow up: Patients will return to the clinic for a physical exam, review of side effects, lab tests, and scans every month for the first year, and then every 1-2 months as long as their tumors are shrinking. Follow up visits will take up to 2 days.

Clinical Details

Official title: A Phase I/II Study of the Safety and Feasibility of Administering T Cells Expressing Anti-EGFRvIII Chimeric Antigen Receptor to Patients With Malignant Gliomas Expressing EGFRvIII

Study design: Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: To evaluate the safety of the administration of anti- EGFRvIII CAR engineered peripheral blood lymphocytes in patients receiving the non-myeloablative conditioning regimen, and aldesleukin and todetermine the six month progression free surviv...

Detailed description: BACKGROUND:

- Patients with recurrent gliomas have very limited treatment options. EGFR variant III

(EGFRvIII) is the most common mutant variant of EGFR and is present in 24-67% of patients with glioblastoma.

- EGFRvIII expression promotes oncogenesis and is associated with poor prognosis.

- EGFRvIII is not expressed in normal tissue and is an attractive target for

immunotherapy.

- We have constructed a retroviral vector that contains a chimeric antigen receptor (CAR)

that recognizes the EGFRvIII tumor antigen, which can be used to mediate genetic transfer of this CAR with high efficiency without the need to perform any selection. OBJECTIVES: Primary Objectives

- To evaluate the safety of the administration of anti-EGFRvIII CAR engineered peripheral

blood lymphocytes in patients receiving the non-myeloablative conditioning regimen, and aldesleukin

- Determine the six month progression free survival of patients receiving anti-EGFRvIII

CAR-engineered peripheral blood lymphocytes and aldesleukin following a nonmyeloablative but lymphoid depleting preparative regimen. Secondary objectives

- Determine the in vivo survival of CAR gene-engineered cells.

- Evaluate radiographic changes after treatment

ELIGIBILITY:

- Histologically proven glioblastoma or gliosarcoma expressing EGFRvIII as determined by

IHC or RT-PCR

- Failed prior standard treatment with radiotherapy with or without chemotherapy

- Karnofsky score greater than or equal to 60%

- Cardiac, pulmonary and laboratory parameters within acceptable limits

DESIGN:

- The study will be conducted using a Phase I/II design.

- Patients will receive a non-myeloablative but lymphocyte depleting preparative regimen

consisting of cyclophosphamide and fludarabine followed by intravenous infusion of ex vivo tumor reactive, CAR gene-transduced PBMC, plus IV aldesleukin.

- Once the MTD has been determined, the study will proceed to the phase II portion.

- In the phase 2 portion of the trial, patients will be accrued to two groups:

- Patients with recurrent malignant glioma requiring steroid use at the start of

treatment

- Patients with recurrent malignant glioma not requiring steroids at the start of

treatment

- A total of 107 patients may be enrolled over a period of 7 years.

Eligibility

Minimum age: 18 Years. Maximum age: 70 Years. Gender(s): Both.

Criteria:

- INCLUSION CRITERIA:

1. Patients with histologically proven glioblastomas or gliosarcomas that express EGFRvIII as assessed by IHC or PCR. 2. Patients must have progression of disease after radiotherapy (including patients that undergo surgery for recurrent disease and are rendered NED). This includes recurrent GBM after receiving all standard first-line treatment, including surgery (if feasible due to neurosurgical and neuro-anatomical considerations) and adjuvant radiotherapy +/- chemotherapy. 3. Patients must either not be receiving steroids, or be on a stable dose of steroids for at least five days prior to registration. 4. Patients must be > 18 years old and less than or equal to age 70, and must have a life expectancy > 8 weeks 5. Patients must be able to understand and sign the Informed Consent Document 6. Must be willing to sign a durable power of attorney. 7. Patients must have a Karnofsky performance status of greater than or equal to 60 8. Patients of both genders must be willing to practice birth control for four months following treatment. 9. Women of child bearing potential must have a negative pregnancy test because of the potentially dangerous effects of the treatment on the fetus. 10. Serology:

- Seronegative for HIV antibody. (The experimental treatment being evaluated in

this protocol depends on an intact immune system. Patients who are HIV seropositive can have decreased immune-competence and thus be less responsive to the experimental treatment and more susceptible to its toxicities.)

- Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody

unless antigen negative. If hepatitis C antibody test is positive, then patients must be tested for the presence of antigen by RT-PCR and be HCV RNA negative. 11. Hematology

- WBC greater than or equal to 3000/mm(3)

- ANC greater than or equal to 1000/mm(3) without the support of filgrastim

- Platelet count greater than or equal to 100,000/mm(3)

- Hemoglobin greater than or equal to 8. 0 g/dl (eligibility level for hemoglobin

may be reached by transfusion) 12. Chemistry:

- ALT/AST less than or equal to to 2. 5 times the upper limit of normal

- Creatinine less than or equal to to 1. 6 mg/dl

- Total bilirubin less than or equal to to 1. 5 mg/dl, except in patients with

Gilbert s Syndrome who must have a total bilirubin less than 3. 0 mg/dl. 13. Patients must be at least 4 weeks from radiation therapy. Additionally, patients must be at least 6 weeks from nitrosoureas, 4 weeks from temozolomide, 3 weeks from procarbazine, 2 weeks from vincristine and 4 weeks from last bevacizumab administration. Patients must be at least 4 weeks from other cytotoxic therapies not listed above and 2 weeks for non-cytotoxic agents (e. g., interferon, tamoxifen) including investigative agents. All toxicities from prior therapies should be resolved to CTCAE less than or equal to grade 1 (except for toxicities such as alopecia, or vitiligo). EXCLUSION CRITERIA: 1. A prior history of gliadel implantation in the past six months.. 2. Women who are currently pregnant or breast feeding because of the potentially dangerous effects of the treatment on the fetus or infant. 3. Active systemic infections, coagulation disorders or other major medical illnesses including those of the cardiovascular, respiratory or immune system, myocardial infarction, cardiac arrhythmias, obstructive/restrictive pulmonary disease. 4. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease). 5. Concurrent opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have decreased immune competence may be less responsive to the experimental treatment and more susceptible to its toxicities). 6. History of severe immediate hypersensitivity to any of the agents including cyclophosphamide, fludarabine, or aldesleukin. 7. History of coronary revascularization or ischemic symptoms. 8. Clinically significant hemorrhagic or ischemic stroke, including transient ischemic attacks and other central nervous system bleeding in the preceding 6 months that were not related to glioma surgery. History of prior intratumoral bleeding is not an exclusion criteria; patients who with history of prior intratumoral bleeding, however, need to undergo a non-contrast head CT to exclude acute bleeding. 9. Other concomitant anti-cancer therapy except corticosteroids. 10. Any patient known to have an LVEF less than or equal to 45%.

Locations and Contacts

Jessica G Yingling, R.N., Phone: (866) 820-4505, Email: ncisbirc@mail.nih.gov

National Institutes of Health Clinical Center, 9000 Rockville Pike, Bethesda, Maryland 20892, United States; Recruiting
For more information at the NIH Clinical Center contact NCI/Surgery Branch Recruitment Center, Phone: 866-820-4505, Email: ncisbirc@mail.nih.gov
Additional Information

NIH Clinical Center Detailed Web Page

Related publications:

FRANKEL SA, GERMAN WJ. Glioblastoma multiforme; review of 219 cases with regard to natural history, pathology, diagnostic methods, and treatment. J Neurosurg. 1958 Sep;15(5):489-503.

Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005 Mar 10;352(10):987-96.

Bloom HJ. Combined modality therapy for intracranial tumors. Cancer. 1975 Jan;35(1):111-20. Review.

Starting date: September 2011
Last updated: July 29, 2015

Page last updated: August 23, 2015

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