RECRUITING

HER2 Chimeric Antigen Receptor (CAR) T Cells in Combination With Checkpoint Blockade in Patients With Advanced Sarcoma

Study Overview

This clinical trial focuses on testing the efficacy of different digital interventions to promote re-engagement in cancer-related long-term follow-up care for adolescent and young adult (AYA) survivors of childhood cancer.

Description

The purpose of this study is to learn whether it is safe to give HER2-CAR T cells in combination with an immune checkpoint inhibitor drug (pembrolizumab or nivolumab), to learn what the side effects are, and to see whether this therapy might help patients with sarcoma. Another goal of this study is to study the bacteria found in the stool of patients with sarcoma who are being treated with HER2 CAR T cells and immune checkpoint inhibitor drugs to see if the types of bacteria influence how well the treatment works. The investigators have found from previous research that they can put a new gene into T cells that will make them recognize cancer cells and kill them. They now want to see if they can put a new gene in these cells that will let the T cells recognize and kill sarcoma cells. The new gene that the investigators will put in makes an antibody specific for HER2 (Human Epidermal Growth Factor Receptor 2) that binds to sarcoma cells. In addition, it contains CD28, which stimulated T cells and make them last longer. After this new gene is put into the T cell, the T cell becomes known as a chimeric antigen receptor T cell or CAR T cell. In another clinical study using these CAR T cells targeting HER2 as well as other studies using CAR T cells, investigators found that giving chemotherapy before the T cell infusion can improve the effect the T cells can have. Giving chemotherapy before a T cell infusion is called lymphodepletion since the chemotherapy is specifically chosen to decrease the number of lymphocytes in the body. Decreasing the number of the patient's lymphocytes first should allow the infused T cells to expand in the body, and potentially kill cancer cells more effectively. The chemotherapy used for lymphodepletion is a combination of cyclophosphamide and fludarabine. After the patient receives the lymphodepletion chemotherapy and CAR T cells during treatment on the study, they will receive an antibody drug called an immune checkpoint inhibitor, pembrolizumab or nivolumab. Immune checkpoint inhibitors are drugs that remove the brakes on the immune system to allow it to act against cancer.

Official Title

Phase I Study of HER2 Chimeric Antigen Receptor (CAR) T Cells in Combination With Checkpoint Blockade in Patients With Advanced Sarcoma (HEROS 3.0)

Quick Facts

Study Start:2021-12-07
Study Completion:2040-12-31
Study Type:Not specified
Phase:Not Applicable
Enrollment:Not specified
Status:RECRUITING

Study ID

NCT04995003

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Ages Eligible for Study:1 Year to 25 Years
Sexes Eligible for Study:ALL
Accepts Healthy Volunteers:No
Standard Ages:CHILD, ADULT
Inclusion CriteriaExclusion Criteria
  1. * Diagnosis of a HER2-positive sarcoma. Immunohistochemistry (IHC) will be used to determine HER2 expression.45,138 Standard HER2 positive breast cancer density gradient tissue microarrays will be used as positive controls. HER2 expression will be graded for percent positive tumor cells (Grade 0: no staining; Grade 1: 1-25%; Grade 2: 26-50% and Grade 3: 51-100%) and intensity of staining (Negative; 1+; 2+; and 3+). For the patient to meet eligibility, tumors are required to have at least ≥ grade 1 and ≥ 1+ intensity score for HER2 staining.
  2. * Age between 1 to 25 years
  3. * Karnofsky or Lansky performance score of ≥ 60
  4. * Informed consent explained to, understood by, and signed by patient/guardian. Patient or guardian given copy of informed consent.
  1. * Known HIV positivity
  2. * Severe previous toxicity from cyclophosphamide including, but not limited to, decreased heart function, abnormal heart rhythms, severe allergic reaction, or grade 4 hemorrhagic cystitis
  3. * Severe previous toxicity from fludarabine including, but not limited to, neurotoxicity, coma, renal injury requiring dialysis, development of hemolytic anemia, or development of a secondary malignancy
  4. * Severe hypersensitivity (≥Grade 3) to pembrolizumab or nivolumab or any of their excipients
  5. * History of allergic reactions attributed to murine protein containing products, DMSO or dextran 40
  6. * Cardiac disorder defined as left ventricular ejection fraction below the institution normal as determined by echocardiogram or New York Heart Association (NYHA) functional class III or IV or clinically significant cardiac arrhythmia
  7. * Active autoimmune disease that has required systemic treatment in the past 2 years (i.e. with use of disease-modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g. thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
  8. * History of non-infectious pneumonitis that required steroids or current pneumonitis
  9. * Known history of active tuberculosis
  10. * Has undergone solid organ transplantation at any time
  11. * Has a diagnosis of immunodeficiency or is receiving any other form of immunosuppressive therapy aside from cytotoxic chemotherapy
  12. * Presence of bulky tumor at the primary or metastatic site
  13. * Has a history or current evidence of any condition, therapy, or laboratory or radiologic abnormality that is not in the best interest of the subject to participate, as determined by the treating investigator

Contacts and Locations

Study Contact

Meenakshi Hegde, MD
CONTACT
832-824-4840
mghegde@bcm.edu
Brandon Garner
CONTACT
832-824-4594
bjgarner@texaschildrens.org

Principal Investigator

Meenakshi Hegde, MD
PRINCIPAL_INVESTIGATOR
Baylor College of Medicine
Shoba Navai, MD
PRINCIPAL_INVESTIGATOR
Baylor College of Medicine
Nabil Ahmed, MD
PRINCIPAL_INVESTIGATOR
Baylor College of Medicine

Study Locations (Sites)

Texas Children's Hospital
Houston, Texas, 77030
United States

Collaborators and Investigators

Sponsor: Baylor College of Medicine

  • Meenakshi Hegde, MD, PRINCIPAL_INVESTIGATOR, Baylor College of Medicine
  • Shoba Navai, MD, PRINCIPAL_INVESTIGATOR, Baylor College of Medicine
  • Nabil Ahmed, MD, PRINCIPAL_INVESTIGATOR, Baylor College of Medicine

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates

Study Start Date2021-12-07
Study Completion Date2040-12-31

Study Record Updates

Study Start Date2021-12-07
Study Completion Date2040-12-31

Terms related to this study

Keywords Provided by Researchers

  • Sarcoma
  • Her-2 Positive Sarcoma
  • autologous T cells
  • HER2 positive recurrent or progressive sarcoma
  • HER2 CAR T cells
  • Osteosarcoma
  • Rhabdomyosarcoma
  • Ewing sarcoma
  • Synovial sarcoma
  • Soft tissue sarcoma
  • Undifferentiated sarcoma

Additional Relevant MeSH Terms

  • Sarcoma
  • HER-2 Protein Overexpression
  • Osteosarcoma
  • Rhabdomyosarcoma
  • Ewing Sarcoma
  • Synovial Sarcoma
  • Soft Tissue Sarcoma
  • Undifferentiated Sarcoma