Clinical trial NCT05218408: CYNK-001 IV and IC in Combination With IL2 in Surgical Eligible Recurrent GBM With IDH-1 Wild Type
Official title: A Phase I/IIa Open Label Multicenter, Non-Randomized, Trial to Assess the Safety and Efficacy of CYNK-001in Combination With Recombinant Human Interleukin-2 in Adults With Recurrent Resection Eligible IDH1 Wild-type Glioblastoma
Study type: INTERVENTIONAL
Overall status: WITHDRAWN
Phase: PHASE1
PHASE2
Conditions: Astrocytoma, Grade IV
Glioblastoma
Giant Cell Glioblastoma
Glioblastoma Multiforme
Keywords: Interleukin-1
Cyclophosphamide
Fludarabine
immunosuppressive agents
immunological factor
IDH wild type
Surgical GBM
Natural Killer
Cellular Therapy
Allogeneic
Allogeneic stem cell
Ommaya catheter
Lead sponsor: Celularity Incorporated
Sponsor class: INDUSTRY
First posted: 2022-02-01
Enrollment: 0
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Intervention model description: The study will contain two phases for the following objectives •The Phase 1 Dose Escalation will utilize a 3+3 dose escalation design and will evaluate safety, feasibility, and preliminary efficacy of four cohort dose levels of CYNK-001 administered after a 6M IU subcutaneous dose of rhIL-2 for both IV and IC cycles. Up to 21 patients will be enrolled over 4 dosing cohorts in Phase1 and 45 patients enrolled for phase IIa. Cohort 4 will be the safety run for Phase IIa. Cohort 4 in its entirety will be reviewed by the DMC prior to starting Phase 2a portion of this study. Phase 2a will continue to explore efficacy and safety of CYNK-001 in combination with rhIL2 in patients with recurrent resection eligible IDH1 wild-type glioblastoma.
Primary purpose: TREATMENT

Brief summary: A Phase 1/2a Open Label Multicenter, Non-Randomized, Trial to Assess the Safety and Efficacy of CYNK-001 in Combination with Recombinant Human Interleukin-2 in Adults with Recurrent Resection Eligible IDH1 wild-type Glioblastoma. For phase I portion, the study objectives to assess the safety and feasibility CYNK-001 in combination with rhIL2 of Intravenous (IV) infusion and Intracavitary (IC) administrations following tumor resection and to establish a maximum tolerated dose (MTD) and a Recommended Phase 2a Dose (RP2D) for IV and IC CYNK-001 administration. For Phase IIa, to evaluate efficacy and safety of CYNK-001 administrations in recurrent GBM as measured by Progression Free Survival at 6 months (PFS6M)


Eligibility criteria: Inclusion Criteria:

1. Be 18 years or older of age on the day of signing informed consent.
2. Have had historical or current histologically confirmed isocitrate dehydrogenase 1(IDH1) wild-type glioblastoma and variants as defined by the World Health Organization
3. Patient must have a T1 weighted 3D MRI with Gadolinium enhancement within 14 days prior to lymphodepletion at Day -5
4. Patient must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted.
5. Radiologically confirmed recurrent glioblastoma at first or second recurrence have contrast enhancing measurable disease with a bidimensional diameter greater than or equal to 10 mm x 10 mm according to RANO and be eligible to undergo tumor resection.
6. Patients must be a candidate to undergo non-emergent surgical resection of the primary target lesion.
7. Multifocal GBM is permissible in the study if there is contiguous T2FLAIR hyperintensity between enhancing lesions on T1 post gadolinium sequences and if in the opinion of the PI surgical resection of the multifocal disease is achievable.

   • NOTE: Multicentric disease with no demonstrated ventricle communication at the time of screening is excluded.
8. The patient must either be on no steroids or on a stable dose of dexamethasone or equivalent no greater than \> 2 mg a day for at least 5 days prior to lymphodepletion.
9. Karnofsky performance status (KPS) ≥ 60
10. Have washout periods for prior therapies defined as at five half-lives or (4 weeks) prior to the administration of lymphodepletion whichever is shorter
11. Demonstrate at screening adequate organ function by laboratory values as follows:

    * Absolute neutrophil count (ANC) ≥ 1.5 x 10\^9/L
    * Platelet count ≥ 100 x 10\^9/L (patient needs to have a minimum of 70 x10\^9/L to undergo resection)
    * Hemoglobin ≥ 9 g/dL or ≥ 5.6 mmol/L
    * Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) \<2 .5 the upper limit of normal (ULN)
    * Calculated creatinine clearance ≥ 45.0 mL/minute as estimated by Cockcroft-Gault formula
    * Total bilirubin ≤ 1.5 x ULN, unless due to Gilbert's syndrome
    * Total albumin ≥ 3.0 g/dL (30 g/L)
    * Prothrombin Time (PT) ≤1.5 x ULN unless patient is receiving anticoagulant therapy if PT or PTT is within therapeutic range of intended use of anticoagulants
    * activated Partial Thromboplastin Time (aPTT) ≤ 1.5 x ULN unless patient is receiving anticoagulant therapy if PT or PTT is within therapeutic range of intended use of anticoagulants.
    * Adequate coagulation function defined as INR ≤ 1.5 x ULN, unless the patient is receiving anticoagulant therapy with PT or a PTT/PTT is within therapeutic range.
12. Patients must agree to use a highly effective method of contraception if procreative potential exists from the start of the study until one year after the completion of lymphodepletion for females and 4 months after completion of lymphodepletion for males.

    * A Female of Childbearing Potential (FCBP) is defined as: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (ie, has had menses at any time in the preceding 24 consecutive months).

Exclusion Criteria:

Exclusion Criteria:

1. Midline shift greater than 0.5 cm or pending herniation.
2. Patients who were previously treated with Bevacizumab. The use of Bevacizumab for edema or radiation necrosis treatments may be allowed with prior approval from the medical monitor
3. Anticipated Extent of Resection by volumetric analysis is less than 70%
4. Patients with greater than two recurrences of GBM are excluded
5. Patients with any contraindications to MRIs
6. Treatment with other investigational agents, check point inhibitors and prior immunotherapy such as Vaccine therapy, dendritic cells vaccine within 4 weeks prior to lymphodepletion.
7. Prior radiation therapy within 12 weeks of screening MRI unless there is unequivocal histological confirmation of tumor progression.
8. Patients with known disease in the posterior fossa, gliomatous meningitis, extracranial disease or multicentric enhancing disease. Multicentric disease is defined as discrete sites of contrast enhancing disease without contiguous T2/FLAIR abnormality.

   • NOTE: Satellite lesions that are associated with a contiguous area of T2/FLAIR abnormality as the main lesion(s) may be included.
9. Patients with concurrent use of tumor treating fields (TTF) or laser interstitial thermal therapy (LITT) is excluded. Prior use of TTF or LITT is allowed prior to signing the ICF
10. Patients with current Carmustine wafers. (Patients that agree to remove the Carmustine wafers at the time of tumor resection during the study are allowed in the study)
11. Patents who are receiving systemic steroid therapy \> 2 mg of dexamethasone or equivalent total dose per day or any other form of immunosuppressive therapy within 5 days of lymphodepletion.

    • Patients that require intermittent use of bronchodilators or local steroid injections would not be excluded from the study. Patients requiring physiological doses of steroids (i.e., adrenal insufficiency or hypopituitarism) not to exceed equivalent of dexamethasone 2 mg will not be excluded from the study.
12. Patients with history of anaphylaxis, angioedema, interstitial pneumonitis, or acute respiratory distress syndrome
13. Active autoimmune disease other than controlled connective tissue disorder or those who are not on active therapy.
14. Any other organ dysfunction (CTCAE Version 5.0 Grade 3 or greater) that will interfere with the administration of the lymphodepletion regimen, rhIL-2, CYNK-001 or the surgical resection as outlined.
15. Known hypersensitivity to cyclophosphamide, fludarabine, Mesna or rhIL-2.
16. Have active or clinically significant cardiac disease including:

    * History or presence of serious uncontrolled cardiac arrhythmias.
    * Clinically significant resting bradycardia.
    * Left ventricular ejection fraction (LVEF) by echocardiogram (ECHO) \<50% or multiple gated acquisition scan (MUGA) \<45%.
    * Any of the following within 6 months prior to the start of the study treatments: myocardial infarction (MI), severe/unstable angina, congestive heart failure (CHF), transient ischemic attack (TIA).
17. Patients with an SaO2 ≤ 92% on room air.

    • Pulmonary Function Tests may be performed during screening for patients with SaO2 ≤ 92% on room air and based on the clinical judgment of the treating physician, patients with an FEV1 ≥ 50% of predicted and DLCO (corrected) of ≥ 40% of predicted may be enrolled.
18. Has any form of primary immunodeficiency, such as severe combined immunodeficiency disease or acquired immune deficiency syndrome (AIDS).

    • Patients with history of human immunodeficiency virus (HIV) infection must have undetectable HIV ribonucleic acid (RNA).
19. Known active infection with hepatitis B, hepatitis C or other viral infections requiring systemic therapy.
20. Has a QTc prolongation to \> 450 millisecond (ms) in males and \> 470 ms in females.
21. Is Pregnant or breastfeeding.
22. Received a live vaccine within 30 days prior to lymphodepletion (Day -5).
23. Any other clinically significant medical disease or condition that, in the Principal Investigator's opinion, may interfere with protocol adherence or the patient's ability to provide informed consent.

Primary outcomes:
measure: Phase I-Number of patients experience Dose limiting toxicity (DLT)
timeFrame: 42 days
measure: To establish maximum tolerated dose (MTD) and a Recommended Phase 2a Dose (RP2D)
timeFrame: 42 days
measure: Phase IIa CYNK-001 efficacy
timeFrame: 6 Months
Secondary outcomes:
measure: Phase 1-Progression free survival at 6 Months
timeFrame: 6 Months
measure: Overall survival phase I and IIa
timeFrame: 6,9 and 12 months
Other outcomes:
measure: Progression Free survival Phase I and IIa
timeFrame: 9 and 12 months
measure: Median Progression Free Survival (mPFS) post tumor resection
timeFrame: 6, 9,12 , 18 and 24 months
measure: Median Overall Survival (mOS) post tumor resection
timeFrame: 12 and 24 months
measure: Time to Progression (TTP) as measured by RANO
timeFrame: 12 and 24 months
measure: Overall Response Rate (ORR) pre and post tumor resection as measured by RANO
timeFrame: 12 and 24 months
measure: Health Quality of Life assessment using European Organization for Research and Treatment of Cancer-30 with Brain20 module scores
timeFrame: 22, 43, 64,92,120 days
measure: Evaluation of Neurological Assessment of the Neuro Oncology Scale in Glioblastoma (NANO
timeFrame: 22, 43, 64,92,120 days
measure: Incidence of Treatment Emergent adverse events (TEAE)
timeFrame: 26 months
measure: Incidence and Severity of adverse events (AEs) and clinically significant changes in laboratory values
timeFrame: 26 months
Locations:
Study officials:
affiliation: Celularity inc
name: Adrian Kilcoyne, MD
role: STUDY_DIRECTOR
References: