A Study to Evaluate Tabelecleucel in Participants With Epstein-barr Virus-associated Diseases

Launched by ATARA BIOTHERAPEUTICS · Sep 14, 2020

Keywords

ClinConnect Summary

This clinical trial is studying a new treatment called tabelecleucel for people with diseases linked to the Epstein-Barr virus (EBV). EBV can cause a range of health issues, including certain types of cancer and complications after organ transplants. The goal of the study is to see how well tabelecleucel works and how safe it is for patients diagnosed with various EBV-related conditions. The trial is currently recruiting participants of all ages, including children, who have been diagnosed with specific EBV-associated disorders and for whom standard treatments are not suitable.

To be eligible for the study, participants must have a confirmed diagnosis of an EBV-related illness and meet certain health criteria, such as having stable organ function. Participants can expect to receive the investigational treatment and will be monitored closely by healthcare professionals throughout the study. It's important to know that individuals with certain other serious health conditions or recent treatments may not be able to participate. Overall, this trial aims to explore new treatment options for patients struggling with the effects of EBV.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Diagnosis of EBV+ disorder
• • Eastern Cooperative Oncology Group performance status \<= 3 for participants aged \>= 16 years; Lansky score \>= 20 for participants from \>=1 year to \< 16 years
• • Adequate organ function test results, unless organ dysfunction is considered to be due to the underlying EBV-associated disease by the investigator
• Cohort-specific Inclusion Criteria:
• * For participants with PID LPD:
• • R/R or newly diagnosed PID LPD for whom the standard first-line therapy is inappropriate, as determined by investigator. The LPD is confirmed by at least biopsy-proven EBV+ LPD or positive cerebrospinal fluid (CSF) cytology with or without radiographically measurable intracranial disease with EBV detected in CSF.
• • Participants with R/R disease must have had at least one prior line of systemic therapy and one of the following: radiographic disease progression per Lugano Classification (Cheson BD, et al. J Clin Oncol. 2014;27:3059) during or after treatment or failure to achieve a CR or partial response (PR) (defined by Lugano radiographic criteria) after standard first-line therapy
• • Participant may have systemic disease only, systemic and CNS disease, or CNS disease only
• * For participants with AID LPD:
• • R/R or newly diagnosed AID LPD for whom the standard first line therapy is inappropriate, as determined by the investigator. The LPD is confirmed by at least biopsy-proven EBV+ LPD or positive CSF cytology, with or without radiographically measurable intracranial disease, with EBV detected in CSF.
• • Participants with R/R disease must have had at least one prior line of systemic therapy and one of the following: radiographic disease progression per Lugano Classification during or after treatment or failure to achieve a CR or PR (defined by Lugano radiographic criteria) after standard first-line therapy
• • Participant may have systemic disease only, systemic and CNS disease, or CNS disease only
• • For participants with AID etiology or AID attributable to immunosenescence, objective laboratory evidence of immunodeficiency
• * For participants with CNS PTLD:
• • R/R or newly diagnosed EBV+ CNS PTLD for whom the standard first-line therapy is inappropriate, as determined by the investigator. The CNS PTLD is histologically confirmed by at least biopsy-proven EBV+ CNS PTLD or positive CSF cytology with or without radiographically measurable intracranial disease with EBV detected in CSF.
• • Participants with R/R disease must have had at least one prior line of systemic therapy and one of the following: radiographic disease progression per Lugano Classification during or after treatment or failure to achieve a CR or PR (defined by Lugano radiographic criteria) after standard first-line therapy
• • Participant may have systemic and CNS disease or CNS disease only
• * For participants with EBV+ PTLD, including CD20-negative disease:
• • Biopsy-proven EBV+ PTLD for whom standard first-line therapy (rituximab and/or chemotherapy) is inappropriate, as determined by the investigator
• • Participants must have systemic disease measurable per Lugano Classification criteria, except when contraindicated or mandated by local practice, then MRI may be used
• * For participants with sarcoma, including LMS, or smooth muscle tumors:
• • EBV+ sarcoma or smooth muscle tumor with rapidly progressive disease defined as progressive disease per RECIST 1.1 criteria as documented radiographically within a 6-month interval prior to enrollment
• • Participants with newly diagnosed EBV+ sarcoma for whom the standard first-line therapy is inappropriate, as determined by the investigator
• • Biopsy-proven EBV+ sarcoma meeting one of the criteria's of pathologically confirmed EBV+ Leiomyosarcoma or EBV+ sarcoma or smooth muscle tumor
• • Measurable disease using diagnostic CT and/or MRI following RECIST 1.1 criteria (Eisenhauer et al. 2009. Eur J Cancer 45\[2\]:228-247)
• Exclusion Criteria:
• • Currently active Burkitt, T-cell, natural killer/T-cell lymphoma/LPD, Hodgkin, plasmablastic, transformed lymphoma, active hemophagocytic lymphohistiocytosis, or other malignancies requiring systemic therapy
• • Serious known active infections, defined as ongoing uncontrolled adenovirus infection or infections requiring systemic therapy at the time of enrollment, or known history of human immunodeficiency virus (HIV) infection
• • Suspected or confirmed Grade \>= 2 acute graft-versus-host disease (GvHD) per the Center for International Blood and Marrow Transplant Research (CIBMTR) consensus grading system or extensive chronic GvHD per National Institutes of Health (NIH) consensus criteria at the time of the enrollment
• • Need for vasopressor or ventilatory support at the time of enrollment
• * Prior therapy (in order of increasing washout period) prior to enrollment as follows:
• • Within 4 weeks or 5 half-lives (whichever is shorter) for any investigational product and/ or any chemotherapy (systemic or intrathecal), targeted small molecule therapy, or antibody/biologic therapy. Note: prior anti-CD20 antibody use is permitted within the washout period if a subsequent disease response assessment indicates disease progression
• • Within 8 weeks: prior tabelecleucel (\>8 weeks prior to enrollment) is permitted if response was obtained or if usual protocol-directed therapeutic options were not exhausted, for cellular therapies (chimeric antigen receptor therapies directed at T-cells or T-cell subsets, donor lymphocyte infusion, other CTLs or virus-specific T-cells); and/or therapies which could impact tabelecleucel function (anti-thymocyte globulin, alemtuzumab)
• • Any prior treatment with EBV-CTLs with the exception of tabelecleucel as above
• • Women who are breastfeeding or pregnant
• • Unwilling to comply with protocol specified contraceptive/reproductive restrictions from enrollment through 90 days after the last treatment
• • Ongoing need for daily steroids of \> 0.5 mg/kg prednisone or glucocorticoid equivalent, ongoing methotrexate, or extracorporeal photopheresis (for participants with CNS disease, protocol-specified dexamethasone is permitted and concludes by the time of enrollment)
• • Any conditions that may put the study outcomes at undue risk (life expectancy \< 60 days or any life-threatening illness, medical condition, or organ system dysfunction)
• • For participants with PID LPD or AID LPD: history of prior allogeneic HCT or solid organ transplant
• • For participants with EBV+ PTLD: prior systemic therapy for PTLD