Safety and Efficacy Evaluation of 4th Generation Safety-engineered CAR T Cells Targeting Sarcomas

Study Overview
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Brief Summary
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The aim of this clinical trial is to assess the feasibility, safety and efficacy of CAR T cells immunotherapy in patients who have sarcoma that is relapsed or late staged. Another goal of the study is to assess the safety and efficacy of the therapy that combines CAR T cells and IgT cells to treat sarcoma.

Detailed Description
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Patients with late staged and/or recurrent sarcoma have poor prognosis despite complex multimodal therapy. Therefore, novel curative approaches are needed.This study will combine two different ways to fight sarcoma: antibodies and CAR-T cells. Several immune checkpoint antibodies have been examined on various tumors with good outcomes. Sarcoma is known to express increased levels of surface antigens that can be targeted by CAR-T cells. Thus, in this study, the 4SCAR-IgT cells targeting sarcoma surface antigens will be infused in dose escalation cohorts.This study will assess the feasibility, safety, efficacy and side effects of CAR T cells immunotherapy in patients who have sarcoma that is relapsed or late staged.

Official Title
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Safety and Efficacy Evaluation of 4th Generation Safety-engineered CAR T Cells Targeting Sarcomas

Conditions
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Sarcoma, Osteoid Sarcoma, Ewing Sarcoma

Intervention / Treatment
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* Biological: Sarcoma-specific CAR-T cells


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stage Ⅲ，Ⅳ sarcoma patients or recurrent sarcoma patients; Age: ≥ 18 and ≤65 years of age at the time of enrollment; At least 4 weeks since any chemotherapy or radiotherapy and at least 1 week since immunosuppressive therapy such as using steroid hormone before enrollment; Side effects of chemotherapy have been well managed; Malignant cells are target antigen positive(higher than ++) confirmed by IHC, quantitative PCR or sequencing; Karnofsky /jansky score of 50% or greater; Expected survival > 6 weeks; ANC≥ 1×10^6/L，PLT ≥ 1×10^8/L; Pulse oximetry of≥90% on room air； Adequate hepatic function,defined as aspartate aminotransferase(AST)< 5 times upper limit of normal(ULN),serum bilirubin < 3 times ULN; Adequate renal function,defined as serum creatinine less than 2 times ULN,if serum creatinine more than 1.5 times ULN,creatinine clearance rate test is needed; Patients must have autologous transduced T cells at levels greater than 15%; Sign an informed consent and assent. Exclusion Criteria: The disease is progresseing rapidly; The patient is receiving therapy of other new drugs; Evidence of tumor potentially causing airway obstruction; Epilepsy history or other CNS diseases; Patients who need immunosuppressive drugs because of GVAD; History of long QT syndrome or severe heart diseases; Uncontrolled active infection; Active hepatitis B virus,hepatitis C virus and HIV infection; Receiving systemic corticosteroid 2 weeks before enrollment except for inhaled steroids; Previous treatment with any gene therapy; Creatinine>2.5mg/dl or ALT/AST>3 times normal or bilirubin>2.0 mg/dl; Patients who have other uncontrolled diseases would preclude participation as outlined; Pregnant or lactating women; Patients previously experienced toxicity from cyclophosphamide; Patients who have CNS sarcoma; In condition that may bring risks to subjects or interference to clinical trials.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sarcoma-specific CAR-T cells<br>Peripheral blood mononuclear cells (PBMCs) of patients who have CD133, GD2, Muc1, CD117 or other marker positive sarcoma will be obtained through apheresis, and T cells will be activated and modified to sarcoma-specific CAR-T cells. | Biological: Sarcoma-specific CAR-T cells<br>* 1 infusion, for 1x10^6 1x10^7 cells/kg via IV<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety of CART cells in patients using CTCAE version 4.0 standard to evaluate the level of adverse events | Physiological parameter (measuring cytokine response) | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Persistence and proliferation of CART cells in patients | The expansion and functional persistence of CART cells in the peripheral blood of patients will be measured by qPCR on Day 7, 14, 21, 28, 60 and 90 after infusion. | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CART, PD-1, PDL-1, CTLA-4, sarcoma, solid tumor