Glypican 3-specific Chimeric Antigen Receptor Expressing T Cells for Hepatocellular Carcinoma (GLYCAR)
| Status: | Recruiting |
|---|---|
| Conditions: | Liver Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/3/2019 |
| Start Date: | March 28, 2019 |
| End Date: | October 2036 |
| Contact: | Andras A Heczey, M.D. |
| Email: | axheczey@txch.org |
| Phone: | 832-824-4233 |
Glypican 3-specific Chimeric Antigen Receptor Expressing T Cells as Immunotherapy for Patients With Hepatocellular Carcinoma
This study enrolls patients who have a type of cancer that arises from the liver called
hepatocellular carcinoma. The cancer has come back, has not gone away after standard
treatment, has spread outside of the liver or the patient cannot receive standard treatment.
This research study uses special immune system cells called GLYCAR T cells, a new
experimental treatment.
The body has different ways of fighting infection and disease. No single way seems perfect
for fighting cancers. This research study combines two different ways of fighting cancer:
antibodies and T cells. Antibodies are types of proteins that protect the body from
infectious diseases and possibly cancer. T cells, also called T lymphocytes, are special
infection-fighting blood cells that can kill other cells, including cells infected with
viruses and tumor cells. Both antibodies and T cells have been used to treat patients with
cancers. They have shown promise, but have not been strong enough to cure most patients.
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. In preclinical studies, the
investigators made several genes called a chimeric antigen receptor (CAR), from an antibody
called GC33 that recognizes glypican-3, a protein found on almost all hepatocellular
carcinoma cells (GPC3-CAR). This study will test T cells genetically engineered with a
GPC3-CAR (GLYCAR T cells) in patients with hepatocellular carcinoma.
The GLYCAR T cells are an investigational product not approved by the Food and Drug
Administration.
The purpose of this study is to find the biggest dose of GLYCAR T cells that is safe, to see
how long they last in the body, to learn what the side effects are and to see if the GLYCAR T
cells will help people with GPC3-positive hepatocellular carcinoma.
hepatocellular carcinoma. The cancer has come back, has not gone away after standard
treatment, has spread outside of the liver or the patient cannot receive standard treatment.
This research study uses special immune system cells called GLYCAR T cells, a new
experimental treatment.
The body has different ways of fighting infection and disease. No single way seems perfect
for fighting cancers. This research study combines two different ways of fighting cancer:
antibodies and T cells. Antibodies are types of proteins that protect the body from
infectious diseases and possibly cancer. T cells, also called T lymphocytes, are special
infection-fighting blood cells that can kill other cells, including cells infected with
viruses and tumor cells. Both antibodies and T cells have been used to treat patients with
cancers. They have shown promise, but have not been strong enough to cure most patients.
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. In preclinical studies, the
investigators made several genes called a chimeric antigen receptor (CAR), from an antibody
called GC33 that recognizes glypican-3, a protein found on almost all hepatocellular
carcinoma cells (GPC3-CAR). This study will test T cells genetically engineered with a
GPC3-CAR (GLYCAR T cells) in patients with hepatocellular carcinoma.
The GLYCAR T cells are an investigational product not approved by the Food and Drug
Administration.
The purpose of this study is to find the biggest dose of GLYCAR T cells that is safe, to see
how long they last in the body, to learn what the side effects are and to see if the GLYCAR T
cells will help people with GPC3-positive hepatocellular carcinoma.
A maximum of 30 subjects will participate in the treatment part of this study.
Up to 180ml of blood is collected from patients to grow the T cells. The T cells are grown
and a retrovirus (a special virus that can carry the GPC3 CAR gene into the T cells) is used
to genetically engineer them. After the CAR gene is put into the T cells, the investigators
make sure that they are able to kill hepatocellular carcinoma cells in the laboratory.
LYMPHODEPLETION CHEMOTHERAPY:
Several studies suggest that the infused T cells need room to be able to proliferate and
accomplish their functions and that this may not happen if there are too many other T cells
in circulation. Because of that, participants will receive treatment with cyclophosphamide
(Cytoxan) and fludarabine for 3 days before receiving the T-cell infusion. These drugs will
decrease the numbers of the participants' own T cells before the investigators infuse the
GLYCAR T CELLS.
WHAT THE INFUSION WILL BE LIKE:
After making these cells, they will be frozen. If the patient agrees to participate in this
study, at the time the patient is scheduled to be treated, the cells will then be thawed and
injected into the patient over 5 to 10 minutes. The participant will receive the GLYCAR T
CELLS 48-72 hours after completing the chemotherapy. The participant may be pretreated with
Tylenol (acetaminophen) and Benadryl (diphenhydramine). Tylenol and Benadryl are given to
prevent a possible allergic reaction to the T cell administration.
This is a dose escalation study, which means that the investigators do not know the highest
dose of GLYCAR T cells that is safe. To find out, the investigators will give the cells to at
least 3 participants at one dose level. If that is safe, they will raise the dose given to
the next group of participants. The dose each patient gets will depend on how many
participants get the agent before that patient and how they react. The investigator will tell
each patient this information. This will help the patient think about possible harms and
benefits. Since the treatment is experimental, what is likely to happen at any dose is not
known.
All of the Treatments will be given by the Center for Cell and Gene Therapy at Houston
Methodist Hospital.
Medical tests before treatment:
- Physical exam and History
- EKG (electrocardiogram) to assess your heart function
- Blood tests to measure blood cells, kidney and liver function and blood clotting (INR).
- If the patient is infected with the hepatitis B virus (HBV) we will do a test to measure
the levels of the virus
- Pregnancy test (if the patient is a female who can get pregnant)
- Measurements of the patient's tumor by scans (within 4 weeks before chemotherapy) and
the tumor marker alfa-fetoprotein (AFP), if the patient's tumor produces this protein.
- Tumor biopsy
Medical tests during and after treatment:
- Physical exams and History
- Blood tests to measure blood cells, kidney and liver function and blood clotting (INR)
- If the patient is infected with the hepatitis B virus (HBV) we will do a test to measure
the levels of the virus
- Measurements of the tumor maker alfa-fetoprotein (AFP), if the patient's tumor produces
this protein
- Measurements of the patient's tumor by scans (4 - 8 weeks after the infusion +/- 1 week)
- Tumor biopsy (optional)
FOLLOW-UP STUDIES
The investigators will follow the participant during and after the injections. To learn more
about the way the T cells are working in the participant's body, up to 60 mL (12 teaspoons)
of blood will be taken from the participant before the chemotherapy, before the T-cell
infusion, 3 to 4 hours after the infusion, 3 to 4 days after the infusion (this time point is
optional ) at 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks after the injection, every 3
months for 1 year, every 6 months for 4 years and then every year for the next 10 years.
Total time participation for this study will be 15 years.
During the time points listed above, if the T cells are found in the participant's blood at a
certain amount an extra 5mL of blood may need to be collected for additional testing.
The investigators will use this blood to look for the frequency and activity of the cells
that they have given; that is, to learn more about the way the T cells are working and how
long they last in the body. They will also use this blood to see if there are any long-term
side effects of putting the new gene (chimeric antigen receptor, CAR) into the cells. In
addition to the blood draws, because the participants have received cells that have had a new
gene put in them, they will need to have long term follow up for 15 years so the
investigators can see if there are any long term side effects of the gene transfer.
Once a year, participants will be asked to have their blood drawn and answer questions about
their general health and medical condition. The investigators may ask participants to report
any recent hospitalizations, new medications, or the development of conditions or illness
that were not present when they enrolled in the study and may request that physical exams
and/or laboratory tests be performed if necessary.
Prior to procurement we confirmed GPC3-expression in your tumor by obtaining part of a biopsy
sample that was done for clinical purposes. We will obtain an additional tumor biopsy at 4
weeks after treatment for research purposes. These samples will be used to look for GPC3-CAR
T cells in the tumor and to learn more about the effects of the treatment on your disease.
In the event that a tumor biopsy is performed for clinical reasons the investigators will
request permission to obtain excess sample to learn more about the effects of the treatment
on the participant's disease. In the event of death, the investigators will request
permission to perform an autopsy to learn more about the effects of the treatment on the
participant's disease and if there were any side effects from the cells with the new gene.
If participants develop a second abnormal cancer growth, significant blood or nervous system
disorder during the trial, a biopsy sample of the tissue will be tested (if a sample can be
obtained).
Up to 180ml of blood is collected from patients to grow the T cells. The T cells are grown
and a retrovirus (a special virus that can carry the GPC3 CAR gene into the T cells) is used
to genetically engineer them. After the CAR gene is put into the T cells, the investigators
make sure that they are able to kill hepatocellular carcinoma cells in the laboratory.
LYMPHODEPLETION CHEMOTHERAPY:
Several studies suggest that the infused T cells need room to be able to proliferate and
accomplish their functions and that this may not happen if there are too many other T cells
in circulation. Because of that, participants will receive treatment with cyclophosphamide
(Cytoxan) and fludarabine for 3 days before receiving the T-cell infusion. These drugs will
decrease the numbers of the participants' own T cells before the investigators infuse the
GLYCAR T CELLS.
WHAT THE INFUSION WILL BE LIKE:
After making these cells, they will be frozen. If the patient agrees to participate in this
study, at the time the patient is scheduled to be treated, the cells will then be thawed and
injected into the patient over 5 to 10 minutes. The participant will receive the GLYCAR T
CELLS 48-72 hours after completing the chemotherapy. The participant may be pretreated with
Tylenol (acetaminophen) and Benadryl (diphenhydramine). Tylenol and Benadryl are given to
prevent a possible allergic reaction to the T cell administration.
This is a dose escalation study, which means that the investigators do not know the highest
dose of GLYCAR T cells that is safe. To find out, the investigators will give the cells to at
least 3 participants at one dose level. If that is safe, they will raise the dose given to
the next group of participants. The dose each patient gets will depend on how many
participants get the agent before that patient and how they react. The investigator will tell
each patient this information. This will help the patient think about possible harms and
benefits. Since the treatment is experimental, what is likely to happen at any dose is not
known.
All of the Treatments will be given by the Center for Cell and Gene Therapy at Houston
Methodist Hospital.
Medical tests before treatment:
- Physical exam and History
- EKG (electrocardiogram) to assess your heart function
- Blood tests to measure blood cells, kidney and liver function and blood clotting (INR).
- If the patient is infected with the hepatitis B virus (HBV) we will do a test to measure
the levels of the virus
- Pregnancy test (if the patient is a female who can get pregnant)
- Measurements of the patient's tumor by scans (within 4 weeks before chemotherapy) and
the tumor marker alfa-fetoprotein (AFP), if the patient's tumor produces this protein.
- Tumor biopsy
Medical tests during and after treatment:
- Physical exams and History
- Blood tests to measure blood cells, kidney and liver function and blood clotting (INR)
- If the patient is infected with the hepatitis B virus (HBV) we will do a test to measure
the levels of the virus
- Measurements of the tumor maker alfa-fetoprotein (AFP), if the patient's tumor produces
this protein
- Measurements of the patient's tumor by scans (4 - 8 weeks after the infusion +/- 1 week)
- Tumor biopsy (optional)
FOLLOW-UP STUDIES
The investigators will follow the participant during and after the injections. To learn more
about the way the T cells are working in the participant's body, up to 60 mL (12 teaspoons)
of blood will be taken from the participant before the chemotherapy, before the T-cell
infusion, 3 to 4 hours after the infusion, 3 to 4 days after the infusion (this time point is
optional ) at 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks after the injection, every 3
months for 1 year, every 6 months for 4 years and then every year for the next 10 years.
Total time participation for this study will be 15 years.
During the time points listed above, if the T cells are found in the participant's blood at a
certain amount an extra 5mL of blood may need to be collected for additional testing.
The investigators will use this blood to look for the frequency and activity of the cells
that they have given; that is, to learn more about the way the T cells are working and how
long they last in the body. They will also use this blood to see if there are any long-term
side effects of putting the new gene (chimeric antigen receptor, CAR) into the cells. In
addition to the blood draws, because the participants have received cells that have had a new
gene put in them, they will need to have long term follow up for 15 years so the
investigators can see if there are any long term side effects of the gene transfer.
Once a year, participants will be asked to have their blood drawn and answer questions about
their general health and medical condition. The investigators may ask participants to report
any recent hospitalizations, new medications, or the development of conditions or illness
that were not present when they enrolled in the study and may request that physical exams
and/or laboratory tests be performed if necessary.
Prior to procurement we confirmed GPC3-expression in your tumor by obtaining part of a biopsy
sample that was done for clinical purposes. We will obtain an additional tumor biopsy at 4
weeks after treatment for research purposes. These samples will be used to look for GPC3-CAR
T cells in the tumor and to learn more about the effects of the treatment on your disease.
In the event that a tumor biopsy is performed for clinical reasons the investigators will
request permission to obtain excess sample to learn more about the effects of the treatment
on the participant's disease. In the event of death, the investigators will request
permission to perform an autopsy to learn more about the effects of the treatment on the
participant's disease and if there were any side effects from the cells with the new gene.
If participants develop a second abnormal cancer growth, significant blood or nervous system
disorder during the trial, a biopsy sample of the tissue will be tested (if a sample can be
obtained).
Procurement Eligibility
Inclusion Criteria:
- Histology-proven hepatocellular carcinoma (HCC) which is unresectable, recurrent
and/or metastatic
- Barcelona Clinic Liver Cancer Stage A, B or C
- GPC3-positive HCC
- Age >18 years
- Karnofsky score >60% (See appendix I)
- Life expectancy >12 weeks
- Child-Pugh-Turcotte score <7
- Informed consent explained to, understood by and signed by patient/guardian.
Patient/guardian given copy of informed consent
Exclusion Criteria
- History of hypersensitivity reactions to murine protein-containing products OR
presence of human anti-mouse antibody (HAMA) prior to enrollment (only patients who
have received prior therapy with murine antibodies).
- History of liver transplantation
- Known HIV positivity
- Active bacterial, fungal or viral infection (except Hepatitis B or Hepatitis C virus
infections)
- Severe previous toxicity from cyclophosphamide or fludarabine
Treatment Eligibility
Inclusion Criteria:
- Histology-proven hepatocellular carcinoma (HCC) which is unresectable, recurrent
and/or metastatic
- Barcelona Clinic Liver Cancer Stage A, B or C
- GPC3-positive HCC
- Age ≥ 18 years
- Life expectancy of ≥ 12 weeks
- Karnofsky score ≥ 60%
- Child-Pugh-Turcotte score < 8
- Adequate organ function:
- creatinine clearance (as estimated by Cockcroft Gault) ≥ 60 ml/min
- serum AST< 5 times ULN
- total bilirubin < 3 times ULN for age
- INR ≤1.7
- absolute neutrophil count > 500/microliter
- platelet count > 20,000/microliter (can be transfused)
- Hgb ≥7.0 g/dl (can be transfused)
- Pulse oximetry >90% on room air
- Recovered from acute toxic effects of all prior antineoplastic drugs before entering
this study (including investigational drugs) based on the enrolling physician's
assessment (if some effects of chemotherapy are expected to last long term, patient is
eligible if meeting other eligibility criteria).
- Sexually active patients must be willing to utilize one of the more effective birth
control methods for 3 months after the T-cell infusion.
- Available autologous transduced T cell product
- Informed consent explained to, understood by and signed by patient/guardian.
Patient/guardian given copy of informed consent
Exclusion Criteria:
- Eligible for complete tumor resection or liver transplantation.
- Pregnancy or lactation (for women at child-bearing age, birth control is required)
- Hepatic encephalopathy
- Uncontrolled infection
- Systemic steroid treatment (greater than or equal to 0.5 mg prednisone
equivalent/kg/day)
- Known HIV positivity
- Active bacterial, fungal or viral infection (except Hepatitis B or Hepatitis C virus
infections)
- History of liver transplantation
- Heart failure of Class III-IV and / or C-D per NYHA Criteria
- History of hypersensitivity reactions to murine protein-containing products OR
presence of human anti-mouse antibody (HAMA) prior to enrollment (only patients who
have received prior therapy with murine antibodies)
- Severe previous toxicity from cyclophosphamide or fludarabine
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