A Phase I/II Study Administering Peripheral Blood Lymphocytes Transduced With a Murine T-Cell Receptor Recognizing the G12V Variant of Mutated RAS in HLA-A*11:01 Patients

  • STATUS
    Recruiting
  • End date
    Jun 29, 2028
  • participants needed
    110
  • sponsor
    National Cancer Institute (NCI)
Updated on 20 October 2022
platelet count
antibiotics
cancer
fludarabine
cyclophosphamide
filgrastim
absolute neutrophil count
systemic therapy
lung cancer
KRAS
NRAS
metastasis
oxaliplatin
gemcitabine
EGFR
leucovorin
irinotecan
metastatic colorectal cancer
bevacizumab
cancer treatment
antibiotic
amino acids
cancer chemotherapy
hepatitis b antigen
immunoglobulin
5-fluorouracil
pancreatic cancers

Summary

Background

A new cancer therapy involves taking white blood cells from a person, growing them in the lab, genetically modifying them, then giving them back to the person. This therapy is called gene transfer using anti-KRAS G12V mTCR cells.

Objective

To see if anti-KRAS G12 V mTCR cells are safe and can shrink tumors.

Eligibility

Adults at least 18 years old with cancer that has the KRAS G12V molecule on the surface of tumors.

Design

In another protocol, participants will:

Be screened

Have cells harvested and grown

Have leukapheresis

In this protocol, participants will have the procedures below.

Participants will be admitted to the hospital.

Over 5 days, participants will get 2 chemotherapy medicines as an infusion via catheter in the upper chest.

A few days later, participants will get the anti-KRAS G12V mTCR cells via catheter.

For up to 3 days, participants will get a drug to make the cells active.

A day after getting the cells, participants will get a drug to increase their white blood cell count. This will be a shot or injection under the skin.

Participants will recover in the hospital for 1-2 weeks. They will have lab and blood tests.

Participants will take an antibiotic for at least 6 months.

Participants will have visits every few months for 2 years, and then as determined by their doctor.

Visits will be 1-2 days. They will include lab tests, imaging studies, and physical exam. Some visits may include leukapheresis or blood drawn.

Participants will have blood collected over several years.

Description

Background
  • We generated an HLA-A*11:01-restricted murine T-cell receptor (mTCR) that specifically recognizes the G12V-mutated variant of KRAS (and other RAS family genes), expressed by many human cancers and constructed a single retroviral vector that contains its alpha and beta chains that confers recognition of this antigen when transduced into PBL.
  • In co-cultures with HLA-A*11:01+ target cells expressing this mutated oncogene, mTCR transduced T cells lyse target cells and secrete IFN-gamma with high specificity.
    Objectives

Primary objectives:

  • Phase I: determine the safety of administering PBL transduced with anti-KRAS G12V mTCR in concert with preparative lymphodepletion and high dose interleukin-2 (IL-2; aldesleukin).
  • Phase II:To determine if anti-KRAS G12V mTCR-transduced PBL can mediate the regression of tumors harboring the RAS G12V mutation.
    Eligibility

Patients must be/have:

  • Age greater than or equal to 18 years and less than or equal to 70 years
  • HLA-A*11:01 positive
  • Metastatic or unresectable RAS G12V-expressing cancer which has progressed after standard therapy (if available).

Patients may not have:

-Allergies or hypersensitivities to high-dose aldesleukin, cyclophosphamide or fludarabine.

Design
  • This is a Phase I/II, single center study of PBL transduced with anti-KRAS G12V mTCR in HLA-A*11:01 positive patients with advanced solid tumors expressing G12V mutated RAS.
  • PBMC obtained by leukapheresis will be cultured in the presence of anti-CD3 (OKT3) and aldesleukin in order to stimulate T-cell growth.
  • Transduction is initiated by exposure of these cells to retroviral vector supernatant containing replication-incompetent virus encoding the anti-KRAS G12V mTCR.
  • All patients will receive a non-myeloablative, lympho-depleting preparative regimen of cyclophosphamide and fludarabine.
  • On day 0 patients will receive their PBL transduced with the anti-KRAS G12V mTCR and will then begin high-dose aldesleukin.
  • A complete evaluation of lesions will be conducted approximately 6 weeks (+/- 2 weeks) after treatment.
  • The study will be conducted using a phase I/II Simon minimax design, with two separate

cohorts for the Phase II component: Cohort 2a, patients with RAS G12V pancreatic

cancer, and Cohort 2b, patients with RAS G12V non-pancreatic cancer.

-A total of 110 patients may be required; approximately 24 patients in the phase I portion of the study and 86 (41, plus an allowance of up to 2 non-evaluable per phase II cohort) patients in the phase II portion of the study.

Details
Condition Pancreatic Cancer, Gastric Cancer, Gastrointestinal Cancer, Colon Cancer, Rectal Cancer
Treatment aldesleukin, cyclophosphamide, Fludarabine, anti-KRAS G12V mTCR, Anti-KRAS G12V mTCR PBL, High-dose Aldesleukin
Clinical Study IdentifierNCT03190941
SponsorNational Cancer Institute (NCI)
Last Modified on20 October 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Measurable metatstatic unresectable malignancy expressing G12V mutated KRAS as assessed by one of the following methods: RT-PCR on tumor tissue, tumor DNA sequencing or any other CLIA certified laboratory test on resected tissue. Patients shown to have tumors expressing G12V mutated NRAS and HRAS will also be eligible as these oncogenes share complete amino acid homology with G12V mutated KRAS for their first 80 N-terminal amino acids, completely encompassing the target epitope
Patients must be HLA-A11:01 positive as confirmed by the NIH Department of Transfusion Medicine
Confirmation of the diagnosis of cancer by the Laboratory of Pathology of the NCI
Patients must
have previously received standard systemic therapy for their advanced cancer and have been either non-responders or have recurred. Specifically
For patients with metastatic colorectal cancer, they must have had at least two systemic chemotherapy regimens that include 5FU, leucovorin, bevacizumab, oxaliplatin and irinotecan (or similar agents) or have contraindications to receiving those medications
Patients with pancreatic cancer must have received gemcitabine, 5FU, and oxaliplatin (or similar agents), or have contraindications to receiving those medications
Patients with non-small cell lung cancer (NSCLC) must have had appropriate targeted therapy as indicated by abnormalities in ALK, EGFR or expression of PDL-
Other patients must have had platinum-based chemotherapy
Patients with ovarian cancer or prostate cancer must have had approved first line
OR
chemotherapy
have declined standard treatment
Patients with 3 or fewer brain metastases that are less than 1 cm in diameter and asymptomatic are eligible. Lesions that have been treated with stereotactic radiosurgery must be clinically stable for 1 month after treatment for the patient to be eligible. Patients
with surgically resected brain metastases are eligible
Age greater than or equal to 18 years and less than or equal to 70 years
Clinical performance status of ECOG 0 or 1
Patients of both genders must be willing to practice birth control from the time of enrollment on this study and for up to four months after treatment
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 may be less responsive to the experimental treatment and more susceptible to its toxicities.)
Women of child-bearing potential must be willing to undergo a pregnancy test prior to the start of treatment because of the potentially dangerous effects of the treatment on the fetus
Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then patient must be tested for the presence of antigen by RT-PCR and be HCV RNA negative
Hematology
ANC greater than or equal to 1000/mm^3 without the support of filgrastim
Hemoglobin > 8.0 g/dL
WBC greater than or equal to 2500/mm^3
Chemistry
Platelet count greater than or equal to 80,000/mm^3
Serum ALT/AST less than or equal to 5.0 times ULN
Total bilirubin less tha or equal to 2.0 mg/dL, except in patients with Gilbert s Syndrome who must have a total bilirubin less than or equal to 3.0 mg/dL
Patients must have either an eGFR > 60 mL/m (based on serum creatinine and lab
nomogram) or a formal 6-24h CrCl > 60 mL/m
Patients must have completed any prior systemic therapy and enrollment
Note: Patients may have undergone minor surgical procedures or limited field radiotherapy
within the four weeks before enrollment, as long as related major organ toxicities have
Willing to sign a durable power of attorney
recovered to less than or equal to grade 1
Ability of subject to understand and the willingness to sign a written informed
consent document
Subjects must be co-enrolled on NCI-SB cell harvest protocol 03-C-0277 (Cell Harvest
and Preparation for Surgery Branch Adoptive Cell Therapy Protocols)

Exclusion Criteria

Concurrent systemic steroid therapy
Large volume pulmonary irradiation
History of coronary revascularization or ischemic symptoms
Women of child-bearing potential who are pregnant or breastfeeding because of the
potentially dangerous effects of the treatment on the fetus or infant
Active systemic infections requiring anti-infective treatment, coagulation disorders
or any other active or uncompensated major medical illnesses
Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency
Disease)
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)
History of severe immediate hypersensitivity reaction to cyclophosphamide
aldesleukin, or fludarabine
For select patients with a clinical history prompting cardiac evaluation: last known
LVEF less than or equal to 45%
For select patients with a clinical history prompting pulmonary evaluation: known FEV1
less than or equal to 50% or DLCO less than 60%
j) Patients who are receiving any other investigational agents
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