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Clinical Trial 21113

Cancer Type: Gynecological Tumor
Study Type: Treatment
NCT#: NCT05316129

Phase: Phase I
Principal Investigator: Wenham, Robert

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Overview

Study Title

A Phase I Clinical Trial of an Infusion of Autologous T Cells Genetically Engineered with a Chimeric Receptor to Target the Follicle-Stimulating Hormone Receptor in Patients with Recurrent Ovarian Cancer

Summary

The purpose of this first in human study is to evaluate the safety of treatment with autologous T cells genetically modified to express a CER (chimeric endocrine receptor) targeting the FSHR (follicle-stimulating hormone receptor) (FSHCER T cells), with or without conditioning chemotherapy, in participants with recurrent or persistent ovarian, fallopian tube, or primary peritoneal cancer.

Objective

Primary: To assess the safety of the IP and IV infusions of autologous anti-FSHR T cells with or without prior high-dose cyclophosphamide plus fludarabine. Secondary: -To assess the antitumor efficacy of adoptively transferred anti-FSHR CER T cells -To assess the in vivo persistence of adoptively transferred FSHR T cells Tertiary/Exploratory -To assess whether the infusion of anti-FSHR T cells enhances the expansion of endogenous tumor-targeted T cells -To compare IP and IV routes of administration for tolerability, toxicity, and efficacy -To compare formalin-fixed western blot and FFPE immunohistochemistry (IHC) for FSHR expression

Treatments

Therapies

Chemotherapy (NOS); Immunotherapy

Medications

FSHR T-Cells (); cyclophosphamide (); cytoxan (cyclophosphamide); fludarabine (Fludarabine phosphate)

Inclusion Criteria

Inclusion Criteria:

  • Pathologically confirmed diagnosis of high-grade (grade 2-3) epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube carcinoma (EOC), which are serous, endometrioid, clear cell, mucinous, mixed epithelial, or undifferentiated.
  • Measurable disease or detectable (non-measurable) disease as defined in protocol.
  • Patient's carcinoma should express the FSHR antigen, detectable by PCR analysis of archival tumor sample.
  • Patients must have had 1 prior platinum-based chemotherapeutic regimen for the management of ovarian, primary peritoneal, or fallopian tube carcinoma and at least 2 prior chemotherapy regimens.
  • Patients should be considered platinum- refractory (progression while on a prior platinum chemotherapy) or resistant (persistence or recurrence within 6 months after a prior platinum chemotherapy) and be deemed unlikely to have significant benefit from any standard therapies by the treating investigator.
  • Any available alternative standard options (such as targeted therapies like poly [ADP-ribose] polymerase [PARP] inhibitors) should be considered and discussed with eligible patients.
  • Patients with a known germline or somatic BRCA pathogenic mutation should have a prior PARP inhibitor and subsequent progression, unless they have a documented history of intolerance or inability to swallow oral medications
  • Patients are allowed to receive, but are not required to receive, up to 6 additional prior chemotherapy treatment regimens (including platinum-based chemotherapy). Prior maintenance therapy with an agent when there has not been progression will not be a separate treatment regimen. Prior hormonal therapy is allowed, and when used alone, even as a therapeutic agent, it does not count toward this prior regimen requirement. Hormonal therapy must be discontinued at least 1 week before T-cell infusion. Continuation of hormone replacement therapy is permitted
  • Patients are allowed to receive, but are not required to receive, biologic/targeted therapy alone or as part of their treatment regimens. When used as treatment after progression, these treatments will count as a separate therapy.
  • ECOG status of 2 or better (or Karnofsky Performance Status score of ≥60%)
  • Life expectancy of at least 3 months.
  • Adequate bone marrow, renal, and hepatic function.
  • No anticancer therapy (chemotherapy, biologic therapy, or immunotherapy) in the 3 weeks before the T-cell infusion (and all hematologic effects have resolved). No prior immunotherapy with checkpoint blockade (e.g., PD1 inhibitor, PDL1 inhibitor, or CTL4- antagonist or similar agent) in the 6 months before the T-cell infusion (and all clinically significant related side effects must be resolved).
  • Patient agrees to undergo placement of either interventional radiologically placed or surgically placed peritoneal port (may be temporary or subcutaneous).
  • Although it is anticipated that patients who are eligible for this study will not have childbearing potential, any patient the treating doctor or investigator deems to have childbearing potential must agree to an acceptable means of contraception from the time of screening to at least 6 months after T-cell infusion.

  • Exclusion Criteria

    Exclusion Criteria:

  • Known active hepatitis B infection, known history of hepatitis C or HIV infection.
  • Clinical or radiographic evidence of bowel obstruction or need for parenteral hydration and/or nutrition.
  • Known or suspected extensive abdominal adhesions that would preclude port placement or infusion.
  • Any of the following cardiac conditions: Clinically significant heart disease (New York Heart Association class 3 or 4) or symptomatic congestive heart failure. Myocardial infarction > Active autoimmune disease (excluding autoimmune thyroid disease on a stable thyroid regimen). Such conditions include but are not limited to systemic lupus erythematous, rheumatoid arthritis, ulcerative colitis, Crohn's disease, and temporal arteritis.
  • Known or suspected leptomeningeal disease and patients with metastases to the brain stem, midbrain, pons, or medulla.
  • Known or suspected untreated brain metastases. Patients with radiographically stable, asymptomatic previously irradiated lesions are eligible provided patient is >4 weeks beyond completion of cranial irradiation and >3 weeks off of corticosteroid therapy at the time of study intervention.
  • Prior history of clinically significant seizure disorder (e.g., not including childhood febrile seizures).
  • Any concurrent active malignancies, defined as malignancies requiring any therapy other than expectant observation, because adverse events (AEs) resulting from these malignancies or their treatment may confound our assessment of the safety of adoptive T-cell therapy for ovarian cancer.
  • Prior radiotherapy to any portion of the abdominal cavity or pelvis.
  • Current lactation or pregnancy
  • Any of the following within 28 days of first date of study treatment: Serious uncontrolled medical illness or disorder that in the opinion of the treating physician would make the patient ineligible for the study. Active uncontrolled infection (with the exception of uncomplicated urinary tract infection). Abdominal fistula, gastrointestinal perforation, or intraabdominal abscess. Abdominal surgery (for reasons other than IP port placement).
  • Any other issue which, in the opinion of the treating physician or principal investigator, would make the patient ineligible for the study.

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