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A clinical trial to assess the safety and efficacy of genetically-engineered Tumor Infiltrating Lymphocytes (TIL) in which the intracellular immune checkpoint CISH has been inhibited using CRISPR gene editing for the treatment of Metastatic Non-small Cell Lung Cancer (NSCLC).
Full description
Tumor Infiltrating Lymphocytes (TIL) have shown efficacy in certain cancers, principally in melanoma, but also in non-small cell lung cancer (NSCLC). Combination cell surface checkpoint inhibitor therapy has also been employed in an attempt to enhance the efficacy of these cell therapies. Genetic engineering of T cells to further increase anti-tumor activity is now possible.
CISH (Cytokine-induced SH2 protein) is a novel intra-cellular immune checkpoint and an important negative regulator of T-cell signaling and function. The inhibition of CISH in mouse anti-tumor lymphocytes results in a marked increase in the ability of these lymphocytes to mediate tumor regression following administration to tumor bearing mice.
Additionally, data in genetically-engineered, neoantigen-specific human T cells in which CISH was inhibited, showed enhanced TCR functional avidity and increased ability of these T cells to detect cancer specific mutations and mount robust polyfunctional cytokine immune responses against their cognate cancer antigens. Thus, these T cells appear to have a significant advantage in inducing anti-tumor responses compared to wild-type anti-tumor lymphocytes.
The researchers have developed and optimized a CRISPR/Cas9 based strategy for precise and efficient genetic engineering in primary human T-cells without sacrificing cell viability or function, allowing for inhibition of a heretofore undruggable intracellular checkpoint.
Thus, in this protocol, the researchers propose to inhibit the gene encoding the intracellular checkpoint target CISH in TIL from patients with metastatic NSCLC whose tumors are PD-L1 negative or positive in order to evaluate the safety and efficacy of genetically engineered T cell therapy in the setting of novel checkpoint inhibition .
Enrollment
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Volunteers
Inclusion and exclusion criteria
Inclusion Criteria (1st Screening prior to Tumor Resection - See below for evaluation of continuing eligibility prior to start of investigational treatment):
Confirmed histologic diagnosis of either PD-L1 negative or positive metastatic non-small cell lung cancer (NSCLC)
Candidate to receive 1st line treatment with anti-PD-1/anti-PD-L1 immunotherapy in combination with chemotherapy or be within 6 months (Phase 1) or 3 months (Phase 2) of initiation of this type of systemic treatment (regardless of where such treatment was started) when the tumor resection is performed. Patients who have received adjuvant or neoadjuvant anti-PD-1/anti-PD-L1 immunotherapy and/or chemotherapy can be screened for the trial if they experienced a relapse more than 6 months from the end of their last systemic treatment. The tumor resection for investigational product manufacturing should be undertaken before the initiation of this 1st line therapy; however, patients who have already started their 1st line treatment should have these procedures performed and completed as soon as deemed clinically appropriate, but no later than 6 months (Phase 1) or 3 months (Phase 2) from the start of 1st line treatment. After documented radiographic disease progression on or following this 1st line of treatment, patients will receive investigational product as 2nd line therapy.
Measurable disease per RECIST v1.1 with at least one lesion identified as resectable for cell therapy manufacturing (minimum volume of tumor tissue required is 1 cm^2 as single mass or fragments) and at least one other lesion meeting the RECIST criteria for measurable disease to serve as an indicator of disease response. The location of the tumor resection and method used to obtain tumor (i.e., laparoscopy, endoscopic ultrasound, etc.) will be determined based on an individual patient's disease. Note: previously irradiated lesions with radiographic progression are not eligible for tumor resection.
Patients who have asymptomatic and or treated brain metastases are eligible, but must be discussed with and approved by the Coordinating Investigator. Lesions that have been treated with stereotactic radiosurgery must be clinically stable for 1 month after treatment for the patient to be eligible. Patients with surgically resected brain metastases are eligible. Patients with brain metastases must not be receiving systemic steroids (oral progestin/estrogen combinations used for contraception are an exception). Brain metastases are assessed using the RANO-BM criteria.
Clinical performance status of Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 and an estimated life expectancy of ≥ 6 months.
Age ≥ 18 years and ≤ 70 years.
Hematology within 14 days of study enrollment:
Adequate organ function within 14 days of study enrollment defined as:
Serology testing within 3 months of study enrollment (tumor resection):
Sexually active females of childbearing potential and males with female partners of childbearing potential must agree to use effective contraception for the duration of study treatment starting with Screening and for 12 months (females) and 4 months (males) after the last dose of cyclophosphamide; if receiving pembrolizumab, for 4 months (females and males) after the last dose of pembrolizumab. Examples of effective contraception include oral progestin/estrogen combinations (an exception to the strict prohibition of systemic steroid use), an IUD or implant plus a condom. Women of non-childbearing potential are defined as those who have no uterus, ligation of the fallopian tubes, or permanent cessation of ovarian function due to ovarian failure or surgical removal of the ovaries. A woman also is presumed to be infertile due to natural causes if she has been amenorrheic for > 12 months and/or has a follicle-stimulating hormone (FSH) > 40 IU/L.
Agrees to remain near the treatment site (within approximately a 1-hour drive) after the investigational product infusion through the Day 28/Week 4 follow-up visit.
Voluntary written consent prior to the performance of any research-related procedures.
Exclusion Criteria (1st Screening prior to Tumor Resection - See below for evaluation of continuing eligibility prior to start of investigational treatment):
Criteria for Confirmation of Continuing Eligibility (2nd Screening Prior to Hospital Admission for Investigational Treatment Start)
Measurable disease per RECIST v1.1 within 4 weeks of starting lymphodepleting chemotherapy.
Clinical performance status of ECOG 0 or 1.
Adequate hematologic, liver, and renal laboratory parameters within 7 days of starting lymphodepleting chemotherapy:
Seronegative for HIV antibody, HbsAg, anti-HBc, and hepatitis C antibody as tested within 3 months of beginning lymphodepleting chemotherapy. If anti-HBc is positive, patient must have negative HBV DNA to be eligible. Seronegative for anti-HCV. If anti-HCV test is positive, then patient must be tested for HCV by RT-PCR and be HCV RNA negative.
Negative SARS-CoV-2 by RT-PCR or antigen test within 7 days of starting lymphodepleting chemotherapy.
More than 4 weeks must have elapsed since the last dose of prior systemic therapy and the start of the lymphodepleting chemotherapy, and acute toxicities must have recovered to Grade 1 or less (except for toxicities such as alopecia or vitiligo). Minor surgical procedures within the 3 weeks prior to of the start of lymphodepleting chemotherapy is permitted as long as all toxicities have recovered to Grade 1 or less.
Continues to agree to use of contraception for sexually active females of childbearing potential and males with female partners of childbearing potential.
Negative pregnancy test within 7 days of starting lymphodepleting chemotherapy in women of childbearing potential.
No concurrent opportunistic infection.
No receipt of a live or attenuated vaccination within 28 days prior to the start of lymphodepleting chemotherapy.
No active systemic infections requiring anti-infective treatment, coagulation disorders, or any other active major medical illnesses.
No requirement for or use of systemic steroids (0 mg) within 21 days prior to investigational product infusion or anticipated any time after that infusion (oral progestin/estrogen combinations used for contraception are an exception).
If ≥ 12 weeks has passed since initial screening test or if clinically indicated, confirm LVEF is not ≤ 45%.
No history of Grade ≥ 2 pneumonitis or active interstitial lung disease/pneumonitis requiring treatment with systemic steroids.
If ≥ 12 weeks has passed since initial screening test or if clinically indicated, confirm FEV1 is not ≤ 50% or FEV1/FVC is not ≤ 0.7 (6 minute walk test if unable to perform or unreliable spirometry).
No change in medical status or social situation that would make study participation not in the best interest of the patient in the opinion of the enrolling investigator.
Continues to agree to remain near the site (within approximately a 1-hour drive) after the investigational product infusion through the Day 28 /Week 4 follow-up visit.
Agrees to and signs the consent form for the LTFU study (2022LC LTFUP 001).
Voluntarily signed the study treatment consent form within 28 days prior to the start of the lymphodepleting chemotherapy.
Primary purpose
Allocation
Interventional model
Masking
70 participants in 4 patient groups
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Data sourced from clinicaltrials.gov
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