Gene Modified Immune Cells (IL13Ralpha2 CAR T Cells) After Conditioning Regimen for the Treatment of Stage IIIC or IV Melanoma or Metastatic Solid Tumors
This phase I trial studies the side effects and best dose of modified immune cells (IL13Ralpha2 CAR T cells) after a chemotherapy conditioning regimen for the treatment of patients with stage IIIC or IV melanoma or solid tumors that have spread to other places in the body (metastatic). The study agent is called IL13Ralpha2 CAR T cells. T cells are a special type of white blood cell (immune cells) that have the ability to kill tumor cells. The T cells are obtained from the patient's own blood, grown in a laboratory, and modified by adding the IL13Ralpha2 CAR gene. The IL13Ralpha2 CAR gene is inserted into T cells with a virus called a lentivirus. The lentivirus allows cells to make the IL13Ralpha2 CAR protein. This CAR has been designed to bind to a protein on the surface of tumor cells called IL13Ralpha2. This study is being done to determine the dose at which the gene-modified immune cells are safe, how long the cells stay in the body, and if the cells are able to attack the cancer.
Stanford is currently accepting patients for this trial.
Stanford Investigator(s):
Intervention(s):
- drug: Cyclophosphamide
- drug: Fludarabine Phosphate
- biological: IL13Ralpha2-specific Hinge-optimized 4-1BB-co-stimulatory CAR/Truncated CD19-expressing Autologous TN/MEM Cells
- procedure: Biopsy
- procedure: Biospecimen Collection
- procedure: Computed Tomography
- other: Fludeoxyglucose F-18
- procedure: Magnetic Resonance Imaging
- procedure: Positron Emission Tomography
Eligibility
Inclusion Criteria:
- Histologically confirmed malignancy that is considered surgically incurable with
either:
- Stage IIIC melanoma including locally relapsed, satellite, in-transit lesions or
bulky draining node metastasis
- Stage IV melanoma including patients with known brain metastases
- Other metastatic, non-central nervous system (CNS) solid tumor relapsed or
refractory after all standard-of-care systemic therapies for which the patient is
eligible
- Confirmed IL13Ralpha2 tumor expression by immunohistochemistry (immunohistochemical
assay [IHA] H-Score >= 50 in at least 10% of the total tumor specimen and in at least
two high-power fields)
- Age greater than or equal to 18 years old and less than 70 years old
- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
- A minimum of one measurable lesion defined as:
- Meeting the criteria for measurable disease according to Response Evaluation
Criteria in Solid Tumors (RECIST), OR
- Skin lesion(s) selected as non-completely biopsied target lesion(s) that can be
accurately measured and recorded by color photography with a ruler to document
the size of the target lesion(s)
- Absolute neutrophil count (ANC) >= 1 x 10^9 cells/L (determined within 30-60 days
prior to enrollment; re-evaluated within 14 days of beginning conditioning
chemotherapy)
- Platelets >= 75 x 10^9/L (determined within 30-60 days prior to enrollment;
re-evaluated within 14 days of beginning conditioning chemotherapy)
- Hemoglobin >= 9.5 g/dL (determined within 30-60 days prior to enrollment; re-evaluated
within 14 days of beginning conditioning chemotherapy)
- Aspartate and alanine aminotransferases (AST, ALT) =< 2.5 x upper limit of normal
(ULN) (determined within 30-60 days prior to enrollment; re-evaluated within 14 days
of beginning conditioning chemotherapy)
- Total bilirubin =< 2 x ULN (except patients with documented Gilbert's syndrome)
(determined within 30-60 days prior to enrollment; re-evaluated within 14 days of
beginning conditioning chemotherapy)
- Creatinine < 2 mg/dL (or a glomerular filtration rate > 45) (determined within 30-60
days prior to enrollment; re-evaluated within 14 days of beginning conditioning
chemotherapy)
- Patients with melanoma must have progressed following >= 1 line of systemic therapy,
including immune checkpoint inhibitor and a BRAF inhibitor in combination with MEK
inhibitor for patients with BRAF V600-activating mutation and is not considered to
have an alternate treatment option with curative intent
- Must be willing and able to accept at least one leukapheresis procedure (This does not
apply for patients receiving a second infusion of IL13R a2 CAR T cells as they will
not undergo leukapheresis)
- Must be willing and able to provide written informed consent
Exclusion Criteria:
- Inability to purify >= 1 x 10^7 T cells from leukapheresis product (this does not
apply to patients receiving a second infusion of IL13Ra2 CAR T cells as they will not
undergo leukapheresis)
- Previously known hypersensitivity to any of the agents used in this study; known
sensitivity to cyclophosphamide or fludarabine
- Received systemic treatment for cancer, including immunotherapy, within 14 days prior
to initiation of conditioning chemotherapy administration within this protocol
- Clinically active brain metastases. Radiological documentation of absence of active
brain metastases at screening is required for all patients. Prior evidence of brain
metastasis successfully treated with surgery or radiation therapy will not be
exclusion for participation as long as they are deemed under control at the time of
study enrollment
- Potential requirement for systemic corticosteroids or concurrent immunosuppressive
drugs based on prior history or received systemic steroids within the last 2 weeks
prior to enrollment; not including patients with primary or secondary adrenal
insufficiency who require physiologic replacement with steroids, or patients on
inhaled or topical steroids at standard doses
- Human immunodeficiency virus (HIV) seropositivity or other congenital or acquired
immune deficiency state, which would increase the risk of opportunistic infections and
other complications during chemotherapy-induced lymphodepletion. If there is a
positive result in the infectious disease testing that was not previously known, the
patient will be referred to their primary physician and/or infectious disease
specialist
- Hepatitis B or C seropositivity with evidence of ongoing liver damage, which would
increase the likelihood of hepatic toxicities from the chemotherapy conditioning
regimen and supportive treatments. If there is a positive result in the infectious
disease testing that was not previously known, the patient will be referred to their
primary physician and/or infectious disease specialist
- Dementia or significantly altered mental status that would prohibit the understanding
or rendering of informed consent and compliance with the requirements of this protocol
- A Tiffeneau-Pinelli index < 70% of the predicted value. Subjects will be excluded if
pulmonary function tests indicate they have insufficient pulmonary capability
- Patients will be excluded if they have a history of clinically significant
electrocardiography (ECG) abnormalities, symptoms of cardiac ischemia or arrhythmias
and have a left ventricular ejection fraction (LVEF) < 45% on a cardiac stress test
(stress thallium, stress multigated acquisition scan (MUGA), dobutamine
echocardiogram, or other stress test)
- Patients with ECG results of any conduction delays (PR interval > 200 ms, corrected QT
(QTC) > 480 ms), sinus bradycardia (resting heart rate < 50 beats per minute), sinus
tachycardia (HR > 120 beats per minute) will be evaluated by a cardiologist prior to
starting the trial. Patients with any arrhythmias, including atrial
fibrillation/atrial flutter, excessive ectopy (defined as > 20 ventricular premature
complex [PVC]s per minute), ventricular tachycardia, 3rd degree heart block will be
excluded from the study unless cleared by a cardiologist
- Pregnancy or breast-feeding. Female patients must be surgically sterile or be
postmenopausal for two years, or must agree to use effective contraception during the
period of treatment and for 6 months afterwards. All female patients with reproductive
potential must have a negative pregnancy test (serum/urine) at screening and again
within 14 days from starting the conditioning chemotherapy. The definition of
effective contraception will be based on the judgment of the study investigators.
Patients who are breastfeeding are not allowed on this study
- A concomitant active malignancy that would be considered to interfere with the
assessment of the primary or secondary endpoints of the study
Ages Eligible for Study
18 Years - 70 Years
Genders Eligible for Study
All
Now accepting new patients
Contact Information
Stanford University
School of Medicine
300 Pasteur Drive
Stanford,
CA
94305
Recruiting
Our research team includes physicians, residents, medical students, research assistants, and volunteers. Our research topics include medical imaging, device validation, mobile application development, and pharmaceutical trials.
Some of the Neuro-Opthalmic concerns we investigate include Multiple Sclerosis, Optic Neuritis, IIH, and ICP.