A Phase I Trial of Intratumoral Administration of CCL21-Gene Modified Dendritic Cell (Ad-CCL21-DC) Combined With Intravenous Pembrolizumab for Advanced NSCLC
试验速览
- 阶段
- 1 期
- 状态
- 进行中（未招募）
- 入组人数
- 24
- 试验地点
- 1
- 主要终点
- Maximum tolerated dose (MTD)/maximum administered dose (MAD) (dose escalation)
研究概览
简要总结
This phase I trial studies the side effects and best dose of autologous dendritic cell-adenovirus CCL21 vaccine (CCL21-gene modified dendritic cell vaccine) combined with intravenous pembrolizumab, and to see how well they work in treating patients with stage IV non-small cell lung cancer. Vaccines made from a gene-modified virus may help the body build an effective immune response to kill tumor cells. Monoclonal antibodies, such as pembrolizumab, may interfere with the ability of tumor cells to grow and spread. Giving CCL21-gene modified dendritic cell vaccine with pembrolizumab may work better in treating patients with stage IV non-small cell lung cancer.
详细描述
PRIMARY OBJECTIVES:
I. Dose escalation: To determine the safety and maximum tolerated dose (MTD) of intratumoral injection of autologous dendritic cell-adenovirus CCL21 vaccine (CCL21 gene-modified DC [Ad-CCL21-DC]) when combined with intravenous pembrolizumab in 1) patients with advanced non-small cell lung cancer (NSCLC) without a sensitizing epidermal growth factor receptor (EGFR) mutation and/or anaplastic lymphoma kinase (ALK) gene rearrangement who have received prior systemic anti-cancer therapy for advanced disease that includes a PD -1 and/or PD-L1 inhibitor or 2) patients who have sensitizing EGFR mutations and/or ALK gene rearrangements and have received prior tyrosine kinase inhibitor therapy.
II. Dose expansion: To evaluate the objective response rate (ORR) in subjects treated with the dose established during dose escalation (ExD) of intratumoral injection of Ad-CCL21-DC when administered with intravenous pembrolizumab in 1) patients with advanced non-small cell lung cancer (NSCLC) without a sensitizing epidermal growth factor receptor (EGFR) mutation and/or anaplastic lymphoma kinase (ALK) gene rearrangement who have received prior systemic anti-cancer therapy for advanced disease that includes a PD -1 and/or PD-L1 inhibitor or 2) patients who have sensitizing EGFR mutations and/or ALK gene rearrangements and have received prior tyrosine kinase inhibitor therapy.
SECONDARY OBJECTIVES:
I. To define the adverse event (AE) profile of intratumoral injection of Ad-CCL21-DC (determined during dose escalation) when administered with intravenous pembrolizumab in 1) patients with advanced non-small cell lung cancer (NSCLC) without a sensitizing epidermal growth factor receptor (EGFR) mutation and/or anaplastic lymphoma kinase (ALK) gene rearrangement who have received prior systemic anti-cancer therapy for advanced disease that includes a PD -1 and/or PD-L1 inhibitor or 2) patients who have sensitizing EGFR mutations and/or ALK gene rearrangements and have received prior tyrosine kinase inhibitor therapy.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Sequential
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Participants with histologically confirmed diagnosis of NSCLC will be enrolled in this study.
- •Stage IV pathologically proven NSCLC.
- •The participant (or legally acceptable representative if applicable) provides written informed consent for the trial.
- •Must have received prior systemic anti-cancer therapy for advanced disease that includes either:
- •A PD-1 and/or PD-L1 inhibitor in patients without a sensitizing EGFR mutation and/or ALK gene rearrangement or.
- •Have received prior tyrosine kinase inhibitor therapy in patients with a sensitizing EGFR mutation and/or ALK gene rearrangement. For patients with sensitizing EGFR mutations, prior therapy must include osimertinib if a T790M mutation in the EGFR gene has been documented, and for patients with ALK gene rearrangements, prior therapy must include a second generation ALK inhibitor (e.g. alectinib, brigatinib, ceritinib). Note: For this group, prior cytotoxic chemotherapy is permitted, but prior therapy with a PD-1 or PD-L1 inhibitor is not permitted.
- •Measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.
- •Eastern Cooperative Oncology Group (ECOG) performance status of 0,
- •Absolute neutrophil count (ANC) >= 1500/uL.
- •Platelets >= 100,000/uL.
- •Hemoglobin >= 9.0 g/dL or >= 5.6 mmol/L.
- •Criteria must be met without erythropoietin dependency and without packed red blood cell (pRBC) transfusion within last 2 weeks.
- •Creatinine =< 1.5 x upper limit of normal (ULN) OR measured or calculated creatinine clearance (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance [CrCl]) >= 30mL/min for participant with creatinine levels >1.5 x institutional ULN.
- •Creatinine clearance (CrCl) should be calculated per institutional standard.
- •Total bilirubin =< 1.5 x ULN OR direct bilirubin =< ULN for participants with total bilirubin levels > 1.5 x ULN.
- •Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN (=< 5 x ULN for participants with liver metastases).
- •International normalized ratio (INR) OR prothrombin time (PT) =< 1.5 x ULN unless participant is receiving anticoagulant therapy as long as PT or activated partial prothrombin time (aPTT) is within therapeutic range of intended use of anticoagulants.
- •Activated partial thromboplastin time (aPTT) =< 1.5 x ULN unless participant is receiving anticoagulant therapy as long as PT or aPTT is within therapeutic range of intended use of anticoagulants.
- •A lesion that either:
- •Is intended to be accessed bronchoscopically OR.
- •Is intended to be accessed with computed tomography (CT) guided transthoracic injection and in the estimation of the radiologist performing the procedure will not require transversing a bullae that significantly increases the risk of pneumothorax.
- •Male participants:
- •A male participant must agree to use a contraception of this protocol during the treatment period and for at least 4 months after the last dose of study treatment and refrain from donating sperm during this period.
- •Female participants:
- •A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least one of the following conditions applies:
- •Not a woman of childbearing potential (WOCBP). OR
- •A WOCBP who agrees to follow the contraceptive guidance during the treatment period and for at least 4 months after the last dose of study treatment.
排除标准
- •Comorbid disease or a medical or psychiatric condition that would impair the ability of the patient to receive or comply with the study protocol.
- •Any use of systemic corticosteroids within 10 days of treatment initiation.
- •Respiratory failure (defined as oxygen saturation [SaO2] < 90% on room air; partial pressure of carbon dioxide [PCO2] > 45 mmHg; or forced expiratory volume in one second [FEV1] <1.0 liter).
- •Acute viral, bacterial, or fungal infection, which requires specific therapy. Acute therapy must have been completed at least 7 days prior to study treatment.
- •Human immunodeficiency virus (HIV) infected patients (defined as HIV-1/HIV-2 antibody positive).
- •Patients with active hepatitis B or C. Active hepatitis B is defined as a known positive hepatitis B virus surface antigen (HBsAg) result. Active hepatitis C is defined by a known positive hepatitis (hep) C antibody (Ab) result and known quantitative hepatitis C virus (HCV) ribonucleic acid (RNA) results greater than the lower limits of detection of the assay.
- •Hypersensitivity to any reagents used in the study.
- •Pregnancy or inadequate contraception.
- •Lactating females.
- •Clinically active brain metastases, defined as untreated and symptomatic, or requiring therapy with steroids or anticonvulsants to control associated symptoms. In patients with brain metastases that have been treated with radiation therapy, treatment must end at least 14 days prior to starting study treatment. History of leptomeningeal disease is exclusionary regardless of prior therapy.
- •Subjects with organ allografts.
- •Previous or concurrent evidence of autoimmune disease requiring systemic steroids or immunosuppressive agents. Subjects with vitiligo or resolved childhood asthma/atopy would be an exception to this rule. Subjects that require inhaled steroid or local steroid injections will not be excluded from the study. Subjects with hypothyroidism who are managed by hormone replacement will not be excluded from the study.
- •Patients with a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
研究组 & 干预措施
Treatment (Ad-CCL21-DC vaccine, pembrolizumab)
Patients receive pembrolizumab IV over 30 minutes followed by autologous dendritic cell-adenovirus CCL21 vaccine by CT-guided or bronchoscopic IT injection on days 0, 21, and 42. Patients then receive pembrolizumab every 3 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
干预措施: Autologous Dendritic Cell-Adenovirus CCL21 Vaccine (Biological)
Treatment (Ad-CCL21-DC vaccine, pembrolizumab)
Patients receive pembrolizumab IV over 30 minutes followed by autologous dendritic cell-adenovirus CCL21 vaccine by CT-guided or bronchoscopic IT injection on days 0, 21, and 42. Patients then receive pembrolizumab every 3 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.
干预措施: Pembrolizumab (Biological)
结局指标
主要结局
Maximum tolerated dose (MTD)/maximum administered dose (MAD) (dose escalation)
时间窗: At 28 days
Overall response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) version (v) 1.1 (dose expansion)
时间窗: Up to 1 year
Demographic characteristics of patients including age, gender ethnicity, performance status, prior therapies and other baseline characteristics as collected on the case report form will be summarized by Ad-CCL21-DC dose cohort using descriptive statistics. For continuous variables, descriptive statistics (n, mean, standard deviation, standard error, median, minimum, and maximum) will be provided. For categorical variables, patient counts and percentages will be provided. Categories for missing data will be presented if necessary. The ORR will be summarized using descriptive statistics by dose level. The ORR will be analyzed using one-sample exact Binomial test for the patients treated at MTD or MAD in both the dose escalation phase and dose expansion phase. The 95% exact confidence interval (CI) will be provided.
次要结局
- Incidence of adverse events per Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0(Up to 1 year)
- Biomarker assessment(Up to 1 year)