A Study of Experimental Immunotherapy With Autologous (your own) T-cells for Non-Small Cell Lung Cancer
Adoptive T-cell therapy (ACT) is a therapeutic approach that uses T lymphocytes of subjects with cancer, obtained by leukapheresis with the aim of generating an anti-tumor T-cell immune response. NY-ESO-1 and LAGE-1a antigens are tumor-associated proteins that have been found in several tumor types. Clinical trials using ACT with T-cells directed against NY-ESO-1/LAGE-1a have shown objective responses in subjects with cancer. Pembrolizumab is a monoclonal antibody that acts specifically on tumor targeting T-cells and increases T-cell anti-tumor function. Pembrolizumab will be used in combination with NY-ESO-1/LAGE-1a TCR engineered subject T-cells (GSK3377794) to potentially further improve therapy for subjects. The primary objective of the study is to evaluate the safety and tolerability of autologous genetically modified T-cells (GSK3377794) in human leukocyte antigen (HLA) positive plus NY-ES0-1/ LAGE-1 positive subjects alone or in combination with pembrolizumab. This study consists of screening phase, Leukapheresis/ GSK3377794 manufacture, lymphodepletion/treatment phase and follow-up. Subjects will receive GSK3377794 as monotherapy (Arm A) or as a combination therapy with pembrolizumab (Arm B), subjects in Arm C will receive the same treatment as subjects in the Arm B. Approximately 45 subjects will be enrolled into the study.
A Phase 1b/2a Pilot Randomized Study to Evaluate the Safety and Tolerability of Autologous T-Cells Expressing Enhanced TCRs (T Cell Receptors) Specific for NY-ESO-1/LAGE-1a (GSK3377794) Alone, or in Combination With Pembrolizumab in HLA-A2+ Participants With NY-ESO-1- or LAGE-1a-Positive Advanced or Recurrent Non-Small Cell Lung Cancer
Neoplasms GSK3377794 Pembrolizumab T Cell Receptors Adoptive T-cell therapy Non-Small Cell Lung Cancer Lung Neoplasms Carcinoma, Non-Small-Cell Lung
You can join if…
Open to people ages 18 years and up
Screening (Part 1):
- The subject (or legally acceptable representative if applicable) provides written informed consent for the trial.
- Age >=18 years on the day of signing informed consent for the screening process.
- Pending approval of Medical Monitor (or designee), subjects can be enrolled in other experimental interventional clinical studies during the screening and leukapheresis stages of this study (GSK208471).
- Histologically or cytologically diagnosed unresectable Stage IIIb or Stage IV NSCLC with measurable disease per RECIST version1.1 as assessed by local site investigator/radiology.
- ECOG Performance Status of 0 or 1.
- Predicted life expectancy that is >=3 months.
- Subject has left ventricular ejection fraction >=50% or as per institution's guidelines.
- Adequate venous access for leukapheresis.
- In the Investigator's opinion, the subject is fit for lymphodepleting chemotherapy and infusion of GSK3377794.
- An archived biopsy of the tumor tissue obtained at any time from the initial diagnosis of NSCLC to time of study entry is mandatory for expression of NY-ESO-1 and, when available, LAGE-1a.
Leukapheresis (Part 2):
In the Investigator's opinion, the subject is suitable for leukapheresis including the following laboratory parameters being above the thresholds: Absolute neutrophil count (ANC) >=1.5 x 109 cells/Liter (L), cluster of differentiation 3 (CD3) count >=200/microliter (μL) and Lymphocyte count >=0.5 x 109 cells/L.
- Leukapheresis can be collected as follows: Between the lines of therapies; after the first 3 cycles of current systemic chemotherapy; During programmed death receptor-1 (PD-1)/PD-1 ligand (PD-L1) regimen (alone or in combination with chemotherapy) or after the first 3 cycles of checkpoint blockade therapy. Wash-out for anti-PD-1/ PD-L1 monotherapy is not required; after 9 weeks of current tyrosine kinase inhibitor (TKI) therapy; after radiotherapy; pending approval of Medical Monitor (or designee), if standard of care (SoC) therapy is refused by the subject.
- An intermediate SoC line of therapy between leukapheresis (Part2)and treatment (Part3) at the time of disease progression is allowed.
Lymphodepletion/Treatment (Part 3):
- Prior to lymphodepleting chemotherapy, subjects must meet all the criteria for screening and Leukapheresis.This must be confirmed within 2 weeks before lymphodepletion.
- All subjects with NSCLC with wildtype epidermal growth factor receptor (WT EGFR) and WT ALK/ c-ros oncogene 1(ROS1) (Arms A and B) should have received and failed at least one line of PD-1/PD L-1 checkpoint blockade therapy (alone or in combination with systemic chemotherapy).
- All subjects with NSCLC with EGFR mutations or ALK/ROS1 aberration (Arm C only) should have received and failed appropriate targeted therapy following NCCN guidelines. These subjects could have received and failed PD 1/PD L1 checkpoint blockade therapy.
- Experimental systemic regimens are allowed.
- Must have received or are receiving at least 1 line of prior systemic therapy: Subjects who received or are receiving a PD-1/PD-L1 checkpoint blocker alone or in combination with other therapies; pending approval of Medical Monitor (or designee), prior SoC therapy is refused by the subject, subjects not eligible for radical chemo-radiotherapy, or have terminated prior treatment due to intolerable side effects. Subjects "intolerant" to a chemo-radiotherapy are those who are either ineligible to receive chemotherapy due to poor functional status OR have developed Grade ≥3 toxicity necessitating discontinuation of chemotherapy, or dose modification, and/or Grade ≥3 unplanned hospitalization to alleviate effects of toxicity.
- Following treatment with therapies other than PD-1/PD-L1 checkpoint blockade, progression is defined by RECIST v1.1. Alternatively, lymphodepleting regimen may start after clinical AND/OR radiographic disease progression without second confirmatory imaging, based upon benefit-risk evaluation in agreement with the Medical Monitor (or designee); following treatment with a PD-1/PD-L1 checkpoint blockade therapy administered either as monotherapy or in combination with other checkpoint inhibitors or other therapies, progression is defined by meeting all of the following criteria; has received at least 2 doses of an approved PD-1/PD-L1 checkpoint blockade therapy; progression has been documented within 12 weeks from the last dose of PD-1/PD-L1 checkpoint blockade therapy, has demonstrated progression after PD-1/PD-L1 therapy as defined by RECIST v1.1. The initial evidence of disease progression is to be confirmed by a second assessment no less than 4 weeks and no more than 8 weeks after the date of the first documented progression, in the absence of rapid clinical progression. Confirmatory imaging may not be required based upon a benefit-risk evaluation in agreement with the Medical Monitor (or designee)
- Have at least 2 tumor lesions,1 measurable as a target lesion and the other one required for biopsy.
- Prior radiotherapy is allowed if prior palliative or stereotactic radiosurgery to solitary lesions outside of the chest (no wash-out required).
- Central nervous system (CNS) metastases with low CNS disease burden are allowed on a case by case basis after benefit-risk evaluation in consultation with the Sponsor Medical Monitor (or designee)
- Lymphodepleting regimen initiation is allowed if: There is clinical and/or radiographic evidence of disease progression; the wash-out period for supportive therapy (chemotherapy or radiotherapy) has been fulfilled.
- Supportive radiotherapy has not affected >25% of bone marrow.
- An intermediate SoC line of therapy between leukapheresis (Part 2) and treatment (Part 3) at the time of disease progression is allowed based on the Investigator's evaluation of benefits and risks.
- A biopsy of tumor tissue obtained following cessation of the last line of treatment for NSCLC but within 2 weeks prior to initiating lymphodepleting chemotherapy is required unless clinically unsafe to do so.
- Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
- Male subjects are eligible to participate if they agree to the following: during the intervention period starting at the first dose of chemotherapy (lymphodepletion regimen) for at least 12 months after receiving the T-cell (GSK3377794) infusion, or 4 months after there is no evidence of persistence/ gene modified cells in the subjects's blood, whichever is longer, if receiving pembrolizumab, must use effective contraception for at least 4 months after the last dose of pembrolizumab if this time frame is longer than the duration of contraception required in the context of chemotherapy (lymphodepletion regimen) and gene modified cells; refrain from donating sperm plus either be abstinent from heterosexual or homosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent or must agree to use contraception/barrier), agree to use a male condom and should also be advised of the benefit for a female partner to use a highly effective method of contraception as a condom may break or leak when having sexual intercourse with a woman of childbearing potential who is not currently pregnant.
- A female subject is eligible to participate if they are not pregnant or breastfeeding and if she is not of childbearing potential.
Adequate Organ Function is defined as following >=1.5x109 cells/L for absolute neutrophil count, >=200microliter for CD3 count, >=0.5 x109 per liter for lymphocyte count,>=9 g/L or >=5.6 millimoles (mmol)/L for Hemoglobin, >=75x109/L for Platelets, >=2.5 grams/deciliter (g/dL) for albumin, <=1.5x upper limit of normal (ULN) (isolated bilirubin >=1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin <35%) for total bilirubin, <=2.5xULN (or <=5 x ULN if documented history of liver metastases for ALT, >=50 milliliters/minute/1.73 square meters for calculated creatinine clearance (CrCl) and <=1.5×ULN unless subject is receiving anticoagulant therapy as long as International normalized ratio (INR)/ prothrombin time (PT) or activated partial thromboplastin time (aPTT) is within therapeutic range.
Pembrolizumab therapy following disease progression after GSK3377794(Arm A only, Part 4):
- Subjects who have received GSK3377794 in Arm A are eligible for anti-PD-1 rescue therapy with pembrolizumab 200 milligrams flat dose once every 3 weeks (Q3W) if they fulfil all the following criteria:
- Radiographically confirmed progressive disease following treatment with GSK3377794 at or before the scheduled Week 25 scan.
- Any toxicity must be <= Grade 1 Common Terminology Criteria for Adverse Events (CTCAE) v4.03 at the time of first/dose (except for non-clinically significant toxicities e.g., alopecia, vitiligo). Subjects with Grade 2 toxicities that are deemed stable or irreversible (e.g., non-demyelinating peripheral neuropathy) can be enrolled on a case-by-case basis with prior consultation and agreement with the Sponsor's Medical Monitor.
- Treatment with anti-PD-1 rescue therapy with pembrolizumab is deemed appropriate by the Investigator and in agreement with the Sponsor Medical Monitor (or designee).
You CAN'T join if...
For screening (Part 1):
- NSCLC with BRAF, HER2, and/or any other actionable genetic aberration that can be treated with targeted standard of care (NCCN recommended) therapy.
- Prior therapies: Arm A and B: Has received and failed ≥3 lines of systemic therapy. Subjects who are receiving a second line of systemic therapy during the study screening period can be eligible if they have an expected time to progression of at least four months per investigator assessment, a positive benefit-risk evaluation is provided by the investigator, and there is agreement with the Sponsor Medical Monitor or designee (all parameters are necessary), Arm C: Has received ≥4 lines of systemic therapy, Arm C: Subjects with NSCLC with EGFR or ALK/ROS1 aberration who are receiving a fourth line of systemic therapy during the study screening period can be eligible if all the following parameters apply: Have an expected time to progression of at least four months per investigator assessment, a positive benefit-risk evaluation is provided by the investigator, In agreement with the Sponsor Medical Monitor (or designee).
- Any prior treatment with oncology cell therapy TCR-T-cell therapy or chimeric antigen receptor (CAR)-T therapy; Prior gene therapy using an integrating vector.
- Docetaxel therapy after having failed either doublet platinum-based chemotherapy or
PD-1/PD-L1 checkpoint blockade therapy treatment: Any prior treatment with oncology cell therapy TCR-T-cell therapy or chimeric antigen receptor (CAR)-T therapy; prior gene therapy using an integrating vector.
- Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression.
- Prior malignancy other than NSCLC, with exceptions agreed upon consultation between the Investigator and Sponsor Medical Monitor (or designee).
- Subject has a history of allergic reactions attributed to compounds of similar chemical or biologic composition to agents used in the study.
- Subject has severe hypersensitivity (>= Grade 3) to pembrolizumab and/or any of its excipients.
- Subject has an active autoimmune disease that has required systemic treatment in past 2 years.
- Subject has a history of chronic or recurrent (within the last year prior to enrollment) severe autoimmune or active immune-mediated disease requiring steroids or other immunosuppressive treatments.
- Prior allogeneic/autologous bone marrow or solid organ transplantation with some exceptions if occurred more than 5 years ago.
- Uncontrolled intercurrent illness including, but not limited to: Ongoing or active infection; Clinically significant cardiac disease defined by congestive heart failure New York Heart Association (NYHA) Class >; Uncontrolled clinically significant arrhythmia in last 6 months; acute coronary syndrome (angina or myocardial infarction) in last 6 months; Severe aortic stenosis, symptomatic mitral stenosis; Inadequate pulmonary function with mechanical parameters <40% predicted (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], total lung capacity [TLC], Pulmonary diffusing capacity for carbon monoxide [DLCO]); Interstitial lung disease (subjects with existing pneumonitis as a result of radiation are not excluded; however,subjects cannot be oxygen dependent).
- Current unstable liver or biliary disease per Investigator assessment .
- Subject has positive viral serology as defined in protocol.
- Subject is pregnant or breastfeeding.
- Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study in the opinion of the Investigator and Sponsor's Medical Monitor (or designee).
- Has known psychiatric or substance abuse disorders.
- Corrected QT interval (QTc)>480 milliseconds (msec).
Leukapheresis (Part 2):
- Toxicity from previous anti-cancer therapy that has not recovered to CTCAE v4.03 Grade ≤1 prior to enrollment (except for non-clinically significant toxicities, e.g.,alopecia, vitiligo). Subjects with existing pneumonitis because of radiation are not excluded; however, subjects cannot be oxygen-dependent. Subjects with Grade 2 toxicities that are deemed stable or irreversible (e.g., peripheral neuropathy) can be enrolled on a case-by-case basis with prior consultation and agreement with the Sponsor Medical Monitor (or designee).
- Investigational treatment within 30 days or 5 half-lives (whichever is shorter) prior to leukapheresis. Exceptions to this rule must be evaluated by the Investigator in agreement with the Sponsor's Medical Monitor (or designee).
- Radiotherapy that involves the lung (V20 exceeding 30% lung volume), or >25% bone marrow exposure, or mean heart dose >20Gy within 3 months.
Lymphodepletion/ Treatment (Part 3):
- Has been more than 3 years following randomization.
- Has received a live vaccine within 30 days prior to the first dose of study drug.Examples of live vaccines include,measles,mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, BacillusCalmette-Guérin (BCG), typhoid vaccine.
There are further inclusion /exclusion criteria within the protocol that need to be adhered to prior leukapharesis and lymphodepletion.
Major surgery >28 days before first dose of study treatment
For Anti-PD1 Rescue with Pembrolizumab (Arm A only):
- Persistence of toxicities such as Cytokine Release Syndrome (CRS) =>Grade 2 that preclude treatment with pembrolizumab.
- GSK Investigational Site
accepting new patients
Sacramento California 95817 United States
- GSK Investigational Site
accepting new patients
Duarte California 91010 United States
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