The study team will collect up to 180 mL (approximately 12 tablespoons) of participants
blood. This will be used to grow T cells. The study team grows the T cells and uses a
retrovirus (a special virus that can insert the GPC3 CAR and IL15 genes into the T cells)
to genetically engineer them. After the CAR and IL15 genes were put into the T cells, the
study team ensures that they could kill GPC3 positive solid tumor cells in the
laboratory.
WHAT THE TREATMENT WILL BE LIKE:
After making these cells, they were frozen. If the participant agrees to participate in
this study, at the time they are scheduled to be treated, the cells will then be thawed
and administered in the participants tumor area, called an intracavitary administration,
during the participants already scheduled surgical resection. The participant will only
get one dose of GO-CART T cells. The participant may be pretreated with Tylenol
(acetaminophen) and Benadryl (diphenhydramine). Tylenol and Benadryl are given to prevent
a possible allergic reaction to the T cell administration.
In addition to the GO-CART T cell treatment, during surgery the surgeon will place a
small device called an Ommaya reservoir. This device consists of a small tube
approximately 3 millimeters in diameter whose tip will sit in the normal fluid filled
spaces in the participants brain (called the ventricles). The other end of the tube will
be attached to a small reservoir that will sit underneath the participants scalp. Ommaya
reservoirs are commonly placed in cancer participants to treat participants with cancer
cells in the cerebrospinal fluid and pose a low risk of complications. The purpose of
this reservoir is to help reduce the pressure in the participants brain should they
experience this from the treatment which is an unlikely but reported side effect . The
reservoir will also be used to monitor the participants response to the study treatment
rather than to administer treatment.
This is a dose escalation study, which means that the study team does not know the
highest dose of GO-CART T cells that is safe. To find out, the cells will be given to at
least 3 participants at a lower dose. If that is safe, the study team will raise the dose
level that is given to the next group of participants. The dose a participant received
will get will depend on how many participants get the agent before the participant and
how they react. The investigator will tell the participant this information. Since the
treatment is experimental, what is likely to happen at any dose is not known.
All the treatments will be given by the Center for Cell and Gene Therapy at Baylor St.
Luke's Medical Center.
Medical tests before treatment:
Before being treated, the participant will receive a series of standard medical tests:
Physical exam and history
Blood tests to measure blood cells, kidney and liver function.
Pregnancy test (if the participant is a female who can get pregnant)
If the participant is infected with the hepatitis B virus (HBV) the study team will
do a test to measure the levels of the virus
Measurements of the participants tumor by scans (either CT or MRI). Side effects are
rare and include risk of developing an unrelated cancer due to radiation exposure
from the machine, but this is unlikely.
Medical tests during and after treatment:
The participant will receive standard medical tests when they are getting the infusions
and after:
Physical exams and History
Blood tests to measure blood cells, kidney and liver function.
If the participant is infected with the hepatitis B virus (HBV) the study team will
repeat the test and monitor the levels of the virus
Cerebral spinal fluid collections to monitor for any side effects during the course
of the treatment
Measurements of the participants tumor by scans (1 week, and 4 - 6 weeks after the
treatment)
FOLLOW-UP STUDIES:
The study team will follow the participant during and after the injections. To learn more
about the way the T cells are working in the participants body, up to 60 mL (up to 12
teaspoons, no more than 3mL/kg/day) of blood will be taken before the chemotherapy,
before the T-cell infusion, 1 to 4 hours after the infusion, 3 to 4 days after the
infusion (this time point is optional) at 1 week, 2 weeks, 3 weeks, 4 weeks and 8 weeks
after the injection, every 3 months for 1 year, every 6 months for 4 years and then every
year for the next 10 years. Total participation time for this study will be 15 years.
During the time points listed above, if the T cells are found in the participants blood
at a certain amount an extra 5mL of blood may need to be collected for additional
testing.
The study team will use this blood to look for the frequency and activity of the cells
that have been given ; that is, to learn more about the way the T cells are working and
how long they last in the body. The study team will also use this blood to see if there
are any long-term side effects of putting the new gene (chimeric antigen receptor, CAR)
into the cells. In addition to the blood draws, because the participant has received
cells that have had a new gene put in them, they will need to have long term follow up
for 15 years to see if there are any long-term side effects of the gene transfer.
Once a year, the participant will be asked to have their blood drawn and answer questions
about their general health and medical condition. The study team may ask the participant
to report any recent hospitalizations, new medications, or the development of conditions
or illness that were not present during enrollment in the study and may request that
physical exams and/or laboratory tests be performed if necessary.
If the participants tumor requires further surgery after the study treatment, for
clinical reasons the study team will request permission to obtain excess sample to learn
more about the effects of the treatment on the participants disease.
In the event of death, the study team will request permission to perform an autopsy to
learn more about the effects of the treatment on the participants disease and if there
were any side effects from the cells with the new gene.
In addition, the study team will ask for the participants permission to use tumor biopsy
for research purposes only. Associated risk with the biopsy will be discussed with the
participant in detail in a procedure specific consent form. The study team will test the
sample to see if the GO-CART T cells can be found in the tumor and what effect they had
on the tumor cells.
If the participant develops a second abnormal cancer growth, significant blood or nervous
system disorder during the trial, the study team will request that a biopsy sample of the
tissue will be tested.
The remaining blood and/or tissue samples that are not needed directly for the
participant could be used to help researchers learn about this disease and/or immune
therapy. These specimens and information about the participants circumstances may be
shared with other cancer researchers. Although there will be a record identifying under
what circumstances these specimens were obtained, under all circumstances the
participants identity will be kept confidential. There is a small risk for the loss of
confidentiality. However, study personnel will make every effort to minimize this risk.
Samples will be kept at Baylor College of Medicine until they are exhausted.