CAR-T Hepatic Artery Infusions or Pancreatic Venous Infusions for CEA-Expressing Liver Metastases or Pancreas Cancer
- Conditions
- Liver Metastases
- Interventions
- Biological: anti-CEA CAR-T cells
- Registration Number
- NCT02850536
- Lead Sponsor
- Roger Williams Medical Center
- Brief Summary
This is an open label, fixed dose, phase Ib trial of anti-CEA CAR-T cell infusions delivered via the hepatic artery or splenic vein using the Surefire Infusion System (SIS) for patients with CEA-expressing liver metastases or pancreas cancer.
- Detailed Description
Patients undergo leukapheresis from which peripheral blood mononuclear cells are purified. T cells are activated and then re-engineered to express chimeric antigen receptors (CARs) specific for CEA. Cells are expanded in culture and returned to the patient by percutaneous hepatic artery infusion at specific cell doses. Prior to the first dose, each patient will undergo diagnostic angiography to verify suitable arterial anatomy. Three anti-CEA CAR-T doses per patient are planned at 1-week intervals. Low dose interleukin-2 will be given via an ambulatory infusion pump for 4 weeks. Normal liver and tumor biopsies will be obtained at the time of the initial diagnostic angiogram and during the final session following the 3rd CAR-T infusion.
Patients with CEA+ liver metastases who exhibit in-liver control following CAR-T therapy who also have CEA+ primary pancreatic tumors may be eligible to receive direct intrapancreatic CAR-T retrograde venous infusions. A maximum of 2 infusions will be delivered. No additional IL-2 will be given and there will be no additional biopsies.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 5
- Patient with histologically confirmed diagnosis of CEA+ adenocarcinoma and liver metastases. Patient must have either histologic confirmation of the liver metastases or histologic documentation of the primary tumor and definitive radiologic evidence of liver involvement. Measurable disease is required with lesions of > 1.0 cm by CT. Soluble CEA is not acceptable as the sole measure of disease. Limited extrahepatic disease is acceptable if confined to the lungs or peritoneal cavity.
- Tumor must be CEA-expressing as demonstrated by elevated serum CEA levels (≥10ng/ml) or immunohistochemistry on a biopsy specimen. Archived tissue is acceptable for determination of CEA expression.
- Patient must be at least 18 years of age.
- Patient able to understand and sign informed consent.
- Patient with a life expectancy of greater than four months.
- Patient failed at least one line of standard systemic chemotherapy and has unresectable disease.
- Patient with performance status of 0 to 1 (ECOG).
- Patient with adequate organ function as defined in protocol.
- Acceptable hepatic vascular anatomy as determined by CT, MR, or conventional angiography. A nuclear medicine study will be performed to document the absence of a significant hepatic-pulmonary shunt (<20%).
- Female patients of childbearing age will be tested for pregnancy. Pregnant patients will be excluded from the study. Males who are actively seeking to have children will be made aware of the unknown risks of this study protocol on human sperm and the need to practice birth control.
- Patients with serious or unstable renal, hepatic, pulmonary, cardiovascular, endocrine, rheumatologic, or allergic disease based on history, physical exam and laboratory tests will be excluded, as outlined in section 5.2.8.
- Patients with active clinical disease caused by CMV, hepatitis B or C, HIV or tuberculosis will be excluded from the study.
- Patients who have had cytotoxic and/or radiation therapy within 4 weeks prior to entry into the trial or 4 weeks prior to infusion will be excluded. Patients with other concurrent malignancies will be excluded.
- Patients requiring systemic steroids will be excluded.
- Patients with unsuitable hepatic vascular anatomy will be excluded from the study.
- Patients with extrahepatic metastatic disease beyond the lungs or abdominal/ retroperitoneal lymph nodes.
- Patients with >50% liver replacement at time of treatment will be excluded.
- Previous external beam radiotherapy to the liver.
- Portal vein thrombosis.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description anti-CEA CAR-T cells anti-CEA CAR-T cells Three infusions of gene-modified anti-CEA T cells over the course of 3 weeks into the hepatic artery via a percutaneous approach along with low dose IL-2.
- Primary Outcome Measures
Name Time Method Safety of CAR-T cell hepatic artery infusions delivered using the Surefire Infusion System (SIS) as Measured by Number of Participants with Adverse Events 10 weeks To determine the safety and regimen limiting toxicity (RLT) of anti-CEA CAR-T hepatic artery infusions (HAI) via the Surefire Infusion System (SIS) for CEA-expressing liver metastases
- Secondary Outcome Measures
Name Time Method Tumor biopsy 10 weeks Assessment of tumor necrosis and fibrosis
CAR-T detection in normal liver tissue 10 weeks Quantification of CAR-T cells in normal liver core biopsies
Radiographic treatment response by PET 10 weeks Changes in tumor metabolic activity
Radiographic treatment response by MRI 10 weeks Changes in tumor size
CAR-T detection in liver tumors 10 weeks Quantification of CAR-T cells in liver tumor core biopsies
CAR-T detection in extrahepatic sites 10 weeks Quantification of CAR-T in blood samples
Serum Cytokine Levels 10 weeks Measurement of cytokines as indicators of immune response
CEA level 10 weeks Measurement of serum tumor marker (ng/ml)
Safety of Direct Intrapancreatic CAR-T Retrograde Venous Infusions (RVI) Delivered Using the Surefire Infusion System (SIS) 10 weeks RVI via the Surefire Infusion System (SIS) for CEA+ Primary Pancreatic Tumors Following In-liver Disease Control
Trial Locations
- Locations (2)
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Roger Williams Medical Center
🇺🇸Providence, Rhode Island, United States