Study of B7-H3, EGFR806, HER2, And IL13-Zetakine (Quad) CAR T Cell Locoregional Immunotherapy For Pediatric Diffuse Intrinsic Pontine Glioma, Diffuse Midline Glioma, And Recurrent Or Refractory Central Nervous System Tumors

Launched by SEATTLE CHILDREN'S HOSPITAL · Mar 3, 2023

Keywords

ClinConnect Summary

This clinical trial is studying a new treatment for certain types of brain tumors in children and young adults, specifically diffuse intrinsic pontine glioma (DIPG), diffuse midline glioma (DMG), and recurrent or hard-to-treat central nervous system tumors. The treatment involves using modified immune cells, called CAR T cells, which are taken from the patient’s own blood, changed in the lab to better attack tumor cells, and then delivered directly into the brain through a special catheter. This trial is in its early phase, meaning researchers are primarily looking at the safety and effectiveness of this approach.

To participate in the trial, patients must be between 1 and 26 years old and have a specific brain tumor that hasn't responded to standard treatments. Key requirements include having a catheter already placed in the brain to allow the treatment to be administered and being well enough to tolerate the procedure. If eligible, participants can expect to undergo a process of collecting their immune cells, which will be modified and then infused back to help fight their cancer. This trial is actively recruiting participants, and it’s essential for families to discuss the potential benefits and risks with their healthcare team before deciding to join.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Subjects must be age ≥ 1 and ≤ 26 years (except for the first 3 subjects, who must be age ≥ 12 and ≤ 26 years).
• 2. Subject disease classified as one of the following:
• • 1. DIPG at any timepoint following completion of standard radiotherapy
• • 2. DMG at any timepoint following completion of standard radiotherapy
• 3. Evidence of refractory or recurrent CNS disease for which there is no routine therapy, defined by either of the following:
• • i. New site or sites of measurable or evaluable disease by radiographic imaging or histologic confirmation following completion of routine care first-line therapy for which curative salvage therapy is not available or amenable, OR ii. Measurable or evaluable disease that persists following completion of routine care first-line therapy for which curative salvage therapy is not available or amenable
• • 3. Able to tolerate apheresis or already has an apheresis product available for use in manufacturing
• • 4. CNS reservoir catheter, such as an Ommaya or Rickham catheter, present in the proper location for CNS-directed therapy delivered as specified for BrainChild-04
• • 5. Life expectancy ≥ 8 weeks
• • 6. Lansky or Karnofsky score ≥ 60.
• 7. If patient does not have previously obtained apheresis product, patient must have discontinued, and recovered from acute toxic effects of, all prior chemotherapy, immunotherapy, and radiotherapy and discontinue the following prior to enrollment:
• • ≥ 7 days post last chemotherapy/biologic therapy administration
• • 3 half lives or 30 days, whichever is shorter post last dose of anti-tumor antibody therapy
• • Must be at least 30 days from most recent cellular infusion
• • All systemically administered corticosteroid treatment therapy must be stable or decreasing within 1 week prior to enrollment with maximum dexamethasone dose of 2.5 mg/m2/day. Corticosteroid physiologic replacement therapy is allowed.
• • 8. Adequate organ function
• • 9. Adequate laboratory values
• • 10. Subjects of childbearing/fathering potential must agree to use highly effective contraception from the time of enrollment through 12 months following the last T cell infusion
• Exclusion Criteria:
• • 1. Presence of ≥ Grade 3 cardiac dysfunction or symptomatic arrhythmia requiring intervention
• • 2. Presence of primary immunodeficiency/bone marrow failure syndrome
• • 3. Presence of clinical and/or radiographic evidence of impending herniation in the CNS
• • 4. For Arm A subjects only: Presence of \> Grade 3 dysphagia
• • 5. Presence of active malignancy other than the CNS tumor under study
• 6. Presence of active severe infection, defined as either of the following:
• • 1. Positive blood culture within 48 hours of enrollment, OR
• • 2. Fever \> 38.2ºC AND clinical signs of infection within 48 hours of enrollment
• • 7. Pregnant or breastfeeding
• • 8. Subject and/or authorized legal representative unwilling to provide consent/assent for study participation, including participation in the 15-year follow-up period, which is required if CAR T cell therapy is administered
• • 9. Presence of any condition that, in the opinion of the investigator, would prohibit the subject from undergoing treatment under this protocol