GD2 Specific CAR and Interleukin-15 Expressing Autologous NKT Cells to Treat Children With Neuroblastoma (GINAKIT2)

  • STATUS
    Recruiting
  • End date
    Aug 10, 2034
  • participants needed
    36
  • sponsor
    Baylor College of Medicine
Updated on 4 October 2022
platelet count
cancer
interleukin
fludarabine
cyclophosphamide
tumor cells
14g2a

Summary

This research study combines two different ways of fighting cancer: antibodies and Natural Killer T cells (NKT). Antibodies are types of proteins that protect the body from infectious diseases and possibly cancer. T cells, also called T lymphocytes, are special white blood cells that can kill other cells, including cells infected with viruses and tumor cells. Both antibodies and T cells have been used to treat patients with cancers. Investigators have found from previous research that they can put a new gene into T cells that will make them recognize cancer cells and kill them. In a previous clinical trial, investigators made artificial genes called a chimeric antigen receptors (CAR), from an antibody called 14g2a that recognizes GD2, a molecule found on almost all neuroblastoma cells (GD2-CAR). Investigators put these genes into the patients' own T cells and gave them back to patients that had neuroblastoma.

NKT cells are another special subgroup of white blood cells that can specifically go into tumor tissue of neuroblastoma. Inside the tumor, there are other white blood cells called macrophages which help the cancer cells to grow and recover from injury. NKT cells can specifically kill these macrophages and slow the tumor growth.

We will expand NKT cells and add GD2-specific chimeric antigen receptors to the cells. We think these cells might be better able to attack NB since they also work by destroying the macrophages that allows the tumor to grow. The chimeric antigen receptor will also contain a gene segment to make the NKT cells last longer. This gene segment is called CD28. In addition, to further improve the antitumor activity of the GINAKIT cells we added another gene expressing a molecule called Interleukin -15 (IL-15). The combination of these 3 components showed the most antitumor activity by CAR expressing NKT cells and improved these cells' survival in animal models.

GD2-CAR expressing NKTs have not been tested in patients so far. The purpose of this study is to find the largest effective and safe dose of GD2-CAR NKT cells (GINAKIT cells), to evaluate their effect on the tumor and how long they can be detected in the patient's blood and what affect they have on the patient's neuroblastoma.

Description

In this study the first step is to collect blood from the patient to make the GINAKIT cells. Once the GINAKIT cells are made they will be administered to the patient.

This is a dose escalation study. This means that at the beginning, patients will be started on the lowest dose (1 of 6 different levels) of GINAKIT cells. Once that dose schedule proves safe, the next group of patients will be started at a higher dose. This process will continue until all 6 dose levels are studied. If the side effects are too severe, the dose will be lowered or the infusions will be stopped.

Before getting the GINAKIT cells, the patient will receive cyclophosphamide and fludarabine intravenously (through a needle inserted into a vein or the patient's port-a-cath) for 2 days and then fludarabine alone for one more day. The patient will then have one day of rest with no chemotherapy before receiving the GINAKIT cells.

The patient will be given an injection of GINAKIT cells into the vein through an IV line at the assigned dose. Before the patient receives the injection, they may be given a dose of Benadryl (diphenhydramine) and Tylenol (acetaminophen). The injection will take up to 10 minutes. The patient will be monitored in the clinic after the injection for about 4 hours. The treatment will be given by the Center for Cell and Gene Therapy at Texas Children's Hospital.

The patient will need to stay in Houston for 4 weeks after the infusion so investigators can monitor the patient for side effects. The patient will have follow-up visits (at weeks 1, 2, 3, 4 and 8; months 3, 6, 9, and 12; twice a year for 4 years and then once a year for the next 10 years - for a total of 15 years) and scheduled disease evaluations after the GINAKIT cell infusion (at week 6 and then as clinically needed).

Before being treated, the patient will receive a series of standard medical tests as follows:

  • Physical exam
  • Blood tests to measure blood cells, kidney and liver function
  • Measurements of your tumor by routine imaging studies and bone marrow evaluation within 4 weeks (preferably 2 weeks) before treatment study entry (no other cancer treatment should be given after these studies and the GINAKIT cell infusion). Imaging studies that have been used in the past to best assess your tumor will be used (Computer Tomogram (CT) or Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET/CT), and/or MIBG scan). A PET scan is an imaging test that uses radioactive material to look for disease in the body. A MIBG scan is an imaging test that uses radioactive material and a special scanner to find or confirm the presence of neuroblastoma.

The patient will receive standard medical tests when they are getting the infusions and afterwards as follows:

  • Physical exams
  • Blood tests to measure blood cells counts, kidney and liver function.
  • Measurements of the patient's tumor by routine imaging studies 4-6 weeks after the infusion.
  • Tumor biopsy at 2 weeks and between 4-6 weeks after the infusion and as clinically indicated thereafter. The evaluation at week 2 after the infusion is for research only and is done to see whether or not there are GINAKIT cells in the tumor. For all clinically indicated tumor biopsies a portion of the sample for research will be requested.
  • If a tumor was in the bone marrow at the time of treatment, the procedure will be repeated at 2 weeks and between 4-6 weeks after the infusion and as clinically indicated thereafter. The evaluation at week 2 after the infusion is for research only and is done to see whether or not there are GINAKIT cells in the bone marrow. For all clinically indicated bone marrow collections a portion of the sample for research will be requested.

To learn more about the way the GINAKIT cells are working and how long they last in the body, an extra amount of blood will be obtained before the chemotherapy, on the day of the GINAKIT cell infusion (before and at the end of the infusion), 1, 2, 3, 4 and 8 weeks after the GINAKIT cell infusion, every 3 months for the 1st year, every 6 months for the next 4 years and then once a year for the next 10 years (for a total of 15 years). The amount of blood taken will be based on the patient's weight with up to a maximum of 60 ml (12 teaspoons) of blood to be obtained at any one time. For children, the total amount of blood drawn will not be more than 3 ml (less than 1 teaspoon) per 1 kg of body weight on any given day. This volume is considered safe, but may be decreased if the patient is anemic (have a low red blood cell count).

During the time points listed above, if the GINAKIT cells are found in the patient's blood at a certain amount, an extra 5ml of blood may need to be collected for additional testing.

If the patient has a procedure where tumor samples are obtained, investigators will request a sample to be used for research purposes.

If the patient develops a second abnormal growth, significant blood or nervous system disorder during the trial, a biopsy sample of the tissue will be tested (if a sample can be obtained).

The patient will receive supportive care for any acute or chronic toxicities, including blood components or antibiotics, and other intervention as appropriate.

Because the patient will receive cells with a new gene in them they will be followed for a total of 15 years to see if there are any long term side effects of gene transfer.

Details
Condition Neuroblastoma
Treatment cyclophosphamide, Fludarabine, GINAKIT Cells
Clinical Study IdentifierNCT03294954
SponsorBaylor College of Medicine
Last Modified on4 October 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Relapsed or refractory high risk neuroblastoma
Life expectancy of at least 12 weeks
Age greater than 1 year and less than 21 years old
Karnofsky/Lansky score of 60% or greater
Patients must have an ANC greater than or equal to 500/µl #, platelet count greater
than or equal to 20,000/µl. Patients may be transfused to obtain a platelet count
Pulse Ox greater than or equal to 90% on room air
Serum AST less than 3 times the upper limit of normal
greater than or equal to 20,000/µl
Total Bilirubin less than 1.5 times the upper limit of normal
Creatinine < 1.5 times the upper limit of normal
Recovered from the acute toxic effects of all prior chemotherapy based on the
enrolling physician's assessment (if some effects of chemotherapy are expected to last
Informed consent and assent (as applicable) obtained from parent/guardian and child
long term, patient is eligible if meeting other eligibility criteria and expected to
Weight greater than 12kg
tolerate lymphodepletion)
Absence of human anti-mouse antibodies (HAMA) prior to enrollment for patients who
have received prior therapy with murine antibodies
Patients must have autologous transduced NKTs with greater than or equal to 20%
expression of GD2-specific CAR

Exclusion Criteria

Rapidly progressive disease
Currently receiving any investigational drugs
History or hypersensitivity to murine protein-containing products
Tumor potentially causing airway obstruction
Pregnancy or lactation or not willing to use birth control
HIV infection
Cardiomegaly or bilateral pulmonary infiltrates on chest radiograph or CT. However
patients with cardiomegaly on imaging may be enrolled if they have an assessment of
cardiac function (i.e., ECHO or MUGA) within 3 weeks of starting protocol therapy that
is within normal limits. Additionally, patients with bilateral pulmonary infiltrates
on imaging may be enrolled if the lesions are not consistent with active neuroblastoma
(i.e., negative on functional imaging with PET or MIBG, or by pathologic assessment)
Currently receiving immunosuppressive drugs such as corticosteroids$, tacrolimus or
cyclosporine
Severe previous toxicity form cyclophosphamide or fludarabine based on the enrolling
physician's assessment
All labs must be collected within 10 days prior to initiation of study related
treatment (except for verification of GD2 transduction) #: ANC ≥ 500/µl without
the use G-CSF or GM-CSF for at least 48hrs. $: Patients may receive treatment if
treated with corticosteroids with dose of less than 0.5mg/kg/day of prednisone
equivalent
Clear my responses

How to participate?

Step 1 Connect with a study center
What happens next?
  • You can expect the study team to contact you via email or phone in the next few days.
  • Sign up as volunteer  to help accelerate the development of new treatments and to get notified about similar trials.

You are contacting

Investigator Avatar

Primary Contact

site

Additional screening procedures may be conducted by the study team before you can be confirmed eligible to participate.

Learn more

If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

Learn more

Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

Learn more

Similar trials to consider

Loading...

Browse trials for

Not finding what you're looking for?

Every year hundreds of thousands of volunteers step forward to participate in research. Sign up as a volunteer and receive email notifications when clinical trials are posted in the medical category of interest to you.

Sign up as volunteer

user name

Added by • 

 • 

Private

Reply by • Private
Loading...

Lorem ipsum dolor sit amet consectetur, adipisicing elit. Ipsa vel nobis alias. Quae eveniet velit voluptate quo doloribus maxime et dicta in sequi, corporis quod. Ea, dolor eius? Dolore, vel!

  The passcode will expire in None.
Loading...

No annotations made yet

Add a private note
  • abc Select a piece of text from the left.
  • Add notes visible only to you.
  • Send it to people through a passcode protected link.
Add a private note