A first-in-human clinical trial in adult patients with advanced non-small cell lung cancer of a personalised therapy targeting specific mutations that occur in all cancer cells within a single patient

Phase 1

Recruiting

• Conditions: MedDRA version: 20.0Level: LLTClassification code: 10025055Term: Lung cancer non-small cell stage IV Class: 10029104; on-small cell lung cancer; MedDRA version: 21.1Level: PTClassification code: 10059515Term: Non-small cell lung cancer metastatic Class: 100000004864; MedDRA version: 20.0Level: LLTClassification code: 10025053Term: Lung cancer non-small cell stage IIIA Class: 10029104; MedDRA version: 21.1Level: PTClassification code: 10029522Term: Non-small cell lung cancer stage IV Class: 100000004864; MedDRA version: 20.0Level: LLTClassification code: 10025044Term: Lung cancer Class: 10029104; MedDRA version: 21.1Level: PTClassification code: 10023780Term: Large cell lung cancer stage IV Class: 100000004864; MedDRA version: 21.1Level: PTClassification code: 10001254Term: Adenosquamous cell lung cancer stage IV Class: 100000004864; MedDRA version: 21.1Level: PTClassification code: 10029521Term: Non-small cell lung cancer stage IIIB Class: 100000004864; MedDRA version: 21.1Level: PTClassification code: 10023775Term: Large cell lung cancer recurrent Class: 100000004864

• Registration Number: CTIS2024-513060-26-00
• Lead Sponsor: Achilles Therapeutics UK Limited

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2024-04-26
• Last Update Posted: 22 July 2024

Recruitment & Eligibility

• Status: Recruiting
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

Patient must be between 18 and 75 years old at the screening visit, Anticipated life expectancy = 6 months at the time of tissue procurement, Patients must have locally advanced unresectable or metastatic NSCLC and: a. Whose disease has progressed or recurred following standard of care. This includes patients who have received a component of standard of care therapy as part of a previous clinical trial in first line treatment; or b. Who are ineligible for, or who cannot tolerate, standard of care therapies. Patients who stop treatment due to immunotherapy toxicities do not need to progress in order to receive treatment with ATL001, Patients must have measurable disease according to RECIST v1.1 criteria prior to lymphodepletion, Patient is considered, in the opinion of the Investigator, well enough (i.e. ECOG Performance Status 0-1) to receive ATL001 treatment (This will be checked prior to lymphodepletion and again prior to receiving ATL001), Prior to treatment with ATL001, the treatment regimen must have included a PD-1/PD-L1 inhibitor and patients should have experienced: a. Radiological disease progression; or b. Stable disease following at least 4 doses of a PD-1/PD-L1 inhibitor, In addition to the need for highly effective contraception as outlined in Inclusion Criterion 8 above, female patients in Cohort B of childbearing potential must agree to use effective contraception during treatment with pembrolizumab and for at least 4 months after the last dose of pembrolizumab. Patients must also agree to provide a serum or urine pregnancy test before each pembrolizumab administration during the treatment period in Cohort B, Patient must have given written informed consent to participate in the study, Patients must have histologically confirmed diagnosis of non-small cell lung cancer that is considered to be smoking-related, Patient is considered medically fit enough to undergo all study procedures and interventions: procedures to procure blood and tumour tissue, including a general anaesthetic if required, and to receive fludarabine, cyclophosphamide and IL-2 at protocol doses and schedules, Patient is considered, in the opinion of the Investigator, capable of adhering to the protocol, Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1, Adequate organ function indicated by the following laboratory parameters: a. Haemoglobin = 10.0 g/dL. b. White Blood Cell Count (WBC) = 3.0 x10?/L. c. Absolute Neutrophil Count (ANC) = 1.5 x10?/L (without support of filgrastim (G-CSF)). d. Platelets = 100 x10?/L. e. INR/PT and APTR/APTT < 1.5x ULN, unless receiving therapeutic anticoagulation. Investigator discretion is required to ensure surgery is safe or that anticoagulants can be safely stopped. f. AST or ALT = 2.5x ULN. g. Bilirubin < 1.5x ULN (< 3x ULN in Gilbert’s Syndrome). h. Creatinine clearance/estimated glomerular filtration rate (GFR) = 50 mL/min, Female patients who are of childbearing potential must agree to use a highly effective method of contraception during the study and for at least 12 months after the ATL001 infusion. Non-sterilised male participants who intend to be sexually active with a female partner of childbearing potential must use an acceptable method of contraception from the time of screening, throughout the duration of the study and for at least 6 months after the ATL001 infusion, To be eligible to enter this study for procurement, the patient must fall into one of the following groups: a. Patients with advan

Exclusion Criteria

Patients with known central nervous system (CNS) metastases that are untreated or symptomatic or progressing. Lesions should be clinically and radiologically stable for 2 months after treatment, as determined by MRI or CT evaluation, in line with accepted standard of care procedures, and should not require steroids, Patients with a history of = Grade 2 diarrhoea/colitis caused by previous immunotherapy within 6 months of screening. Patients that have been asymptomatic for at least 6 months or have had a normal colonoscopy post-immunotherapy (with uninflamed mucosa by visual assessment following discontinuation of immune suppression other than permitted modified release steroids) are not excluded, Patients who are pregnant or breastfeeding, Patients who have undergone major surgery in the previous 3 weeks, Patients with an active concurrent cancer or a history of cancer within the past 3 years (except for in situ carcinomas, early prostate cancer with normal Prostate-Specific Antigen (PSA) or non-melanomatous skin cancers), Patients with a history of organ transplantation, Patients who have previously received any investigational cell or gene therapies, Patients with contraindications for cyclophosphamide, fludarabine and IL-2 at per protocol doses, Patients who have received any cytotoxic chemotherapy or anti-angiogenesis agent within the 3 weeks prior to tissue and blood procurement, Patients with evidence of disease progression at the first scan after commencing standard first line therapy (i.e. primary refractory disease), unless responsive to subsequent lines of therapy. Patients who are refractory to pembrolizumab monotherapy are not excluded, Patients with a confirmed history of allergic reactions to amphotericin b, penicillin and/or streptomycin, Patients with hepatitis B or C, human immunodeficiency virus infection (HIV1/2), syphilis or HTLVI/II infection, Patients with any contraindications for pembrolizumab, Patients who have received a live vaccination within the 28 days prior to lymphodepletion, Patients with an active infection requiring antibiotics, Patients who have received any cytotoxic chemotherapy within the 3 weeks prior to lymphodepletion, Patients who have never smoked (defined as having smoked < 100 cigarettes in their lifetime, per WHO criteria), Patients for whom there is documented evidence of an actionable tumour driver oncogene mutation (EGFR, ALK or ROS-1) at the time of initial screening. Patients who have progressed on standard targeted therapies, or for whom no approved targeted treatments are available, are not excluded, Patients with active, known, or suspected autoimmune disease requiring immunosuppressive treatments, Patients requiring regular treatment with steroids at a dose higher than prednisolone 10 mg/day (or equivalent), Patients with superior vena cava syndrome, Patients with a current or recent history, as determined by the Investigator, of clinically significant, progressive, and/or uncontrolled renal, hepatic, haematological, endocrine, pulmonary, cardiac, gastroenterological or neurological disease. Additionally, the following criteria apply: a. Patients with a Left Ventricular Ejection Fraction (LVEF) < 45%. b. Patients with a history of coronary revascularization. c. Patients with clinically significant atrial and/or ventricular arrhythmias including but not limited to: atrial fibrillation, ventricular tachycardia, 2° or 3° heart block. d. Patients with a forced expiratory volume in one

Study & Design

• Study Type: Interventional clinical trial of medicinal product
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
Main Objective: To assess the safety and tolerability of ATL001 as a monotherapy and in combination with pembrolizumab;Secondary Objective: To evaluate the clinical efficacy of ATL001 treatment as a monotherapy and in combination with pembrolizumab;Primary end point(s): Frequency and severity of adverse events (AEs) and serious adverse events (SAEs) following tissue procurement and administration of lymphodepletion agents, ATL001 (monotherapy or in combination with pembrolizumab) and IL-2.

Secondary Outcome Measures

Name	Time	Method
Secondary end point(s):Percentage change from baseline in tumour size at 6 weeks, 12 weeks and best change from baseline;Secondary end point(s):Overall Response Rate (ORR) (based on RECIST v1.1 and imRECIST);Secondary end point(s):Time to response (based on RECIST v1.1 and imRECIST);Secondary end point(s):Duration of response (based on RECIST v1.1 and imRECIST);Secondary end point(s):Disease Control Rate (CR + PR + durable SD) (based on RECIST v1.1);Secondary end point(s):Progression free survival (PFS) (based on RECIST v1.1 and imRECIST);Secondary end point(s):Overall survival (OS)