tcr-t cell therapy on advanced pancreatic cancer

Conditions: Pancreatic Cancer

Summary: the primary aim of this study is to evaluate the efficacy of kras mutant antigen specific tcr-t cells in the treatment of patients with advanced pancreatic cancer. the secondary aim is to evaluate the pharmacokinetic/pharmacodynamic characteristics of tcr-t cell therapy in patients with advanced pancreatic cancer and the survival of tcr-t cells. the investigators will evaluate the changes of tumor microenvironment after treatment of advanced pancreatic cancer with kras mutant antigen specific tcr-t cells; evaluating the correlation between cytokines and the occurrence of crs and neurotoxicity

1.this study is a prospective and single arm clinical study. in this trial, 18 patients with advanced pancreatic cancer with kras g12v or g12d mutations and matching hla-a\*11:01 subtypes are recruited for autologous tumor-t cell receptor (tcr) -mediated t cells therapy(tcr-t) therapy.within 3 - 5 days after pretreatment, subjects will receive a single tcr-t infusion with an infusion dose of about 1 × 10⁹～1 × 10¹⁰.once every 12 hours within 24 hours after tcr-t cell infusion, recombinant human interleukin-2 will be injected intravenously for 14 days . after 3 months of treatment, the patient's condition was evaluated. if the subject did not occur tumor progression and did not occur adverse events (aes) of level 3 or higher, a second tcr-t cell reinfusion can be performed (informed consent form needs to be signed again). the study will evaluate the safety of tcr-t treatment by observing adverse events after cell therapy; evaluate the effectiveness of tcr-t compared to the results or historical data of the subject's own previous standard treatment regimen;and collect blood before and after cell infusion, measure the number and activity of tcr-t cells, and evaluate the pharmacokinetic (pk) characteristics of tcr-t.

Eligibility criteria:
inclusion criteria： 1. age greater than 18 years old； 2. pathological diagnosis of recurrent/metastatic pancreatic cancer (except intracranial metastasis). patients who have had prior therapy with at least one standard treatment regimen remain in stable or progressive disease states and refuse subsequent chemotherapy; 3. mutations in kras g12v or g12d and expression of matched hla -a\*11:01 subtypes are confirmed in previous tumor or biopsy tissues； 4. expected survival duration of more than 3 months； 5. eastern cooperative oncology group( ecog )score ≤2； 6. all participants voluntarily participate in this study and sign an informed consent. and the subjects have good compliance and can cooperate with investigators follow-up study. 7. patients at least have had at least one measurable lesion as defined by recist v1.1 criteria； 8. female participants can not be pregnant or lactating and their serum or urine human chorionic gonadotropin tests must be negative within 72 hours prior to study enrollment；all subjects must be using a medically accepted means of contraception ( (e.g., oral contraceptives, intrauterine device) during the course of this study and for at least 3 months after completion of study therapy. 9. organ function and bone marrow reserve are in good condition, and the following requirements must be met: 1)absolute neutrophil count≥1.5×10⁹/l；2)platelet count≥50×10⁹/l；3)hemoglobin≥90g/l；4)bilirubin \< 1.5 times upper limit of normal（bile duct obstruction due to tumor compression were excluded)；5)serum creatinine ≤ 1.5 times the upper limit of normal range or creatinine clearance ≥ 60 ml/min.6)serum alanine aminotransferase or aspartate aminotransferase is \< 2.5 times the upper limit of the normal value (uln) (if patients with liver metastasis, ≤5 times the uln).7)coagulation function normalised：inr≤1.5，ptt\<1.2 times the upper limit of normal（tumor - related anticoagulant therapy was excluded). exclusion criteria: 1. intracranial metastasis or patients with moderate or severe hydrothorax need drain placement to relieve symptoms. 2. active pulmonary tuberculosis 3. human immunodeficiency virus (hiv) positive； 4. active hepatitis b or hepatitis c infection； 5. pregnant women and lactating females； 6. previous or concurrent history of other malignant tumors. exceptions include curatively treated basal cell carcinoma of the skin, squamous cell carcinoma of the skin, or in situ cervical cancer that has undergone potentially curative therapy; 7. patients with central nervous metastases； 8. serious, uncontrolled comorbidities that may affect protocol compliance or interfere with interpretation of results，or any serious medical condition that may affect the safety of the subjects ; 9. history of clinically significant respiratory diseases or other respiratory diseases that seriously affect pulmonary function; 10. any active autoimmune disease,any condition requiring steroid hormones or immunosuppressive therapy( including but not limited to systemic lupus erythematosus, sjogren's syndrome, rheumatoid arthritis, psoriasis, multiple sclerosis, inflammatory bowel disease, etc., require \> 10 mg/d of prednisone or equivalent hormone） 11. a history of organ transplantation； 12. a history of myocardial infarction and severe arrhythmia within six months；ineligible also includes uncontrolled hypertension, coronary heart disease, stroke, liver cirrhosis, nephritis and other serious complications; 13. those who have a history of psychotropic drug abuse and cannot quit or have a history of psychiatric impairment； 14. participants with an allergic constitution, known sensitivity to human serum albumin, cyclophosphamide, fludarabine and interleukin 2; 15. those with bleeding or thromboembolic tendency：bleeding symptoms of clinical significance or a clear tendency to bleeding within 2 weeks prior to entering the study. and those with hereditary or acquired bleeding and thrombotic tendencies； serious arterial/venous thromboembolic events occurred in the previous 6 months; 16. other severe, acute or chronic medical or mental illnesses that in the investigator's judgement will might be increase the risk associated with the patient's participation in the study or interfere with interpretation of research results.

Keywords: pancreatic cancer pk/pd tcr-t safety efficacy