Clinical trial NCT05826535: Study of LYL314 in Aggressive Large B-Cell Lymphoma
Official title: A Phase 1/2 Multi-Center Study Evaluating the Safety and Efficacy of LYL314, a CD19/CD20 Dual-Targeting Chimeric Antigen Receptor T-Cell Therapy in Participants With Aggressive B-Cell Non-Hodgkin Lymphoma
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: PHASE1
PHASE2
Conditions: Relapsed Non-Hodgkin Lymphoma
Refractory Non-Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Large B-cell Lymphoma
Keywords: CAR T-cell
Non-Hodgkin Lymphoma
CD19/20
CD19
CD20
NHL
Diffuse Large B-cell lymphoma
DLBCL
Transformed follicular lymphoma
TFL
Primary mediastinal B-cell lymphoma
PMBCL
High-grade B-cell lymphoma
HGBL
follicular lymphoma Grade 3B
large cell follicular lymphoma
Aggressive B-cell NHL
Refractory Aggressive B-Cell Lymphoma
Refractory B-Cell Non-Hodgkin Lymphoma
Lymphoma, Non-Hodgkin
Lymphoma
Lymphoma, Large B-Cell, Diffuse
Cyclophosphamide
Fludarabine
Lymphoma, Follicular
Lymphoma, B-cell
Immunosuppressive Agents
Immunologic Factors
Disease Attributes
Immune System Diseases
Recurrence
PiNACLE
Lead sponsor: Lyell Immunopharma, Inc.
Sponsor class: INDUSTRY
First posted: 2023-04-24
Enrollment: 270
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: TREATMENT

Brief summary: This is a Phase 1/2, multi-center, open-label study evaluating the safety and efficacy of LYL314, a dual-targeting chimeric antigen receptor (CAR) targeting cluster of differentiation (CD)19 and CD20 in participants with aggressive large B-cell lymphoma.

Detailed description: This is a Phase 1/2, multi-center, open-label study evaluating the safety and efficacy of LYL314, a dual-targeting chimeric antigen receptor (CAR) targeting cluster of differentiation (CD)19 and CD20 in participants with aggressive large B-cell lymphoma.

Five cohorts of participants will be enrolled:

Cohort 1: Participants who have not received a prior CAR T-cell product (CAR T naïve) and have received at least two or more prior lines of treatment (third-line or later).

Cohort 2: Participants who have received a prior CAR T-cell product (CAR T experienced) and have received at least two or more prior lines of treatment including one CAR T-cell therapy.

Cohort 3: Participants with refractory disease or relapse within one year of first-line therapy (second-line).

Cohort 4: Participants who have received prior T-cell engager (TCE) therapy and have received at least two or more prior lines of treatment including one TCE therapy.

Cohort 5: Participants receiving first-line treatment for high-risk large B-cell lymphoma who remain with disease on positron emission tomography scanning (PET-positive) after 2 to 3 cycles of standard-of-care chemoimmunotherapy (high-risk first-line).

Up to approximately 150 participants (across all cohorts) will be enrolled in the dose finding Phase 1 part of the study.

The Phase 2 pivotal study (PiNACLE) will expand enrollment of Cohort 1 to approximately 120 participants to further evaluate the safety and efficacy of LYL314.

LYL314 treatment consists of a single administration of CAR transduced autologous T-cells administered intravenously after a conditioning chemotherapy regimen consisting of fludarabine and cyclophosphamide, administered over 3 days.

Individual participants will remain in the active post-treatment follow-up (PTFU) period for approximately 2 years. Participants will continue in long-term follow-up (LTFU) for 15 years from LYL314 treatment.

Eligibility criteria: Inclusion Criteria:

1. Age 18 years or older at time of informed consent
2. Willing and able to provide written informed consent
3. Histologically confirmed aggressive NHL, including the following types defined by the World Health Organization (WHO 2017):

   * DLBCL
   * DLBCL arising from follicular lymphoma (transformed FL, tFL)
   * Primary mediastinal (thymic) large B-cell lymphoma (PMBCL)
   * High-grade large B-cell lymphoma with or without MYC and BCL2 and/or BCL6 rearrangement (HGBL)
   * Grade 3B follicular lymphoma/Large cell follicular lymphoma (FL3B)
4. Received at least two prior lines of therapy for Cohorts 1, 2, and 4 and one prior line of therapy for Cohort 3. Prior therapy must have included:

   * Anti-CD20 monoclonal antibody, and
   * An anthracycline containing chemotherapy regimen
   * Participants with tFL must have received at least one of their prior lines of therapy after transformation to DLBCL

     4b. Cohort 5 (High-risk first-line) participants must have high-risk large B-cell lymphoma
5. Relapsed or refractory disease, defined by the following:

   * Disease progression after last regimen (including salvage therapy after autologous stem cell transplantation \[ASCT\]). In participants who have only received front-line therapy, progression should be ≤ 12 months of first-line therapy (applicable for Cohort 3)
   * In patients who received one line of therapy, refractory disease is defined as failure to achieve at least a PR after at least 4 cycles of therapy (applicable for Cohort 3)
   * In patients who received two or more lines of therapy (Cohorts 1, 2, and 4), refractory disease is defined as failure to achieve a CR to last line of therapy (including CAR T and/or salvage therapy).
6. At least 1 measurable lesion (per Lugano classification). Lesions that have been previously irradiated will be considered measurable only if progression has been documented following completion of radiation therapy
7. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 or ECOG 0 to 2 (Cohort 5)
8. Absolute neutrophil count (ANC) ≥ 1000/uL
9. Platelet count ≥ 50,000/uL
10. Absolute lymphocyte count (ALC) ≥ 200/uL

Other protocol-defined criteria apply.

Exclusion Criteria:

1. History of malignancy other than non-melanoma skin cancer or carcinoma in situ (e.g., cervix, bladder, breast) unless disease-free for at least 3 years. Participants who have received therapy for a prior malignancy within the prior 3 years, e.g., in the adjuvant setting, are not excluded
2. Active central nervous system (CNS) involvement by malignancy on magnetic resonance imaging (MRI) or by lumbar puncture. Participants with prior evidence of brain metastasis treated at least 8 weeks prior to enrollment will not be excluded for participation if CNS disease is deemed stable at the time of study enrollment
3. History of cardiac lymphoma involvement or Epstein-Barr virus (EBV)+ lymphoma
4. Ongoing or impending oncologic emergency (e.g., tumor mass effect, tumor lysis syndrome, known vascular invasion)
5. Received the following therapies in the specified time frame prior to enrollment/leukapheresis

   1. Any systemic therapy within 2 weeks
   2. Any systemic inhibitory/stimulatory immune checkpoint molecule therapy within 3 half-lives prior to enrollment (e.g., ipilimumab, nivolumab, pembrolizumab, atezolizumab, OX40 agonists, 4-1BB agonists)
   3. Fludarabine within 12 weeks
   4. Alemtuzumab, bendamustine or antithymocyte globuline (ATG) within 6 months
   5. Any T cell engager/bispecific antibody therapy such as CD20/CD3 or CD19/CD3 bispecific antibodies within 4 weeks
   6. Any experimental therapy within 4 weeks or 5 half-lives (whichever is shorter)
6. Received radiation therapy within 3 weeks prior to enrollment/leukapheresis
7. Experiencing non-hematologic toxicities due to prior therapy. Exceptions include: stable and recovered to grade ≤ 1 or non-clinically significant toxicities such as (1) alopecia, (2) toxicities where Grade 2 is solely defined by participant receiving hormone replacement therapy for endocrinopathies resulting from previous checkpoint inhibitor therapy, (3) Grade 2 lymphopenia, and (4) hearing loss or Grade 2 neuropathy associated with prior treatment with taxanes or platinating agents
8. History of allogeneic stem cell or solid organ transplantation
9. Receipt of autologous stem cell transplantation within 6 weeks prior to enrollment/leukapheresis
10. History of prior genetically modified cell therapy other than a product targeting CD19 with an FMC63-based CAR (e.g., axicabtagene ciloleucel (axi-cel), tisagenlecleucel (tisa-cel), or lisocabtagene maraleucel (liso-cel). For all other CAR T cell therapy treatments, discussion with the Sponsor's Medical Monitor is required
11. Primary immunodeficiency
12. History of autoimmune disease (e.g., Crohn's disease, rheumatoid arthritis, systemic lupus) resulting in end organ injury or requiring systemic immunosuppression/systemic disease modifying agents within the last 2 years. Participants who have other autoimmune condition(s) considered to be associated with underlying malignancy may be enrolled in the study after discussion with and approval of the Medical Monitor.

Other protocol-defined criteria apply.

Primary outcomes:
measure: Phase 1: Evaluate the safety and tolerability of a single dose of LYL314 administered as a single agent
timeFrame: Baseline to Month 24
measure: Phase 2: Estimate the efficacy of LYL314, as measured by ORR
timeFrame: Baseline to Month 24
Secondary outcomes:
measure: Phase 1: Evaluate the efficacy of LYL314
timeFrame: Baseline to Month 24
measure: Phase 1: Evaluate the feasibility of treatment with LYL314
timeFrame: Baseline to Month 24
measure: Phase 1: Evaluate the pharmacokinetics of LYL314 when administered as a single agent
timeFrame: Baseline to Month 24
measure: Phase 2: Estimate the efficacy of LYL314
timeFrame: Baseline to Month 24
measure: Phase 2: Estimate the efficacy of LYL314
timeFrame: Baseline to Month 24
measure: Phase 2: Estimate the efficacy of LYL314
timeFrame: Baseline to Month 24
measure: Phase 2: Estimate the efficacy of LYL314
timeFrame: Baseline to Month 24
measure: Phase 2: Estimate the efficacy of LYL314
timeFrame: Baseline to Month 24
measure: Phase 2: Evaluate the safety and tolerability of a single dose of LYL314 administered as a single agent
timeFrame: Baseline to Month 24
measure: Phase 2: Evaluate the pharmacokinetics of LYL314 when administered as a single agent
timeFrame: Baseline to Month 24
Other outcomes:
Locations:
city: Irvine
country: United States
facility: University of California-Irvine Medical Center
state: California
city: Los Angeles
country: United States
facility: Cedars-Sinai Medical Center
state: California
city: Los Angeles
country: United States
facility: University of California, Los Angeles (UCLA) Medical Center
state: California
city: San Diego
country: United States
facility: Scripps Clinic
state: California
city: Augusta
country: United States
facility: Augusta University Medical Center
state: Georgia
city: Indianapolis
country: United States
facility: Indiana Blood and Marrow Transplantation
state: Indiana
city: Iowa City
country: United States
facility: University of Iowa
state: Iowa
city: Louisville
country: United States
facility: University of Louisville Brown Cancer Center
state: Kentucky
city: Grand Rapids
country: United States
facility: Corewell Health
state: Michigan
city: Albuquerque
country: United States
facility: University of New Mexico Comprehensive Cancer Center
state: New Mexico
city: Bronx
country: United States
facility: Montefiore Medical Center
state: New York
city: Cincinnati
country: United States
facility: University of Cincinnati (UC) Physicians Company, LLC
state: Ohio
city: Dallas
country: United States
facility: Baylor University Medical Center
state: Texas
city: Salt Lake City
country: United States
facility: Huntsman Cancer Institute
state: Utah
city: Salt Lake City
country: United States
facility: Intermountain Healthcare
state: Utah
city: Richmond
country: United States
facility: Virginia Commonwealth University-Massey Cancer Center
state: Virginia
city: Milwaukee
country: United States
facility: Medical College of Wisconsin
state: Wisconsin
Study officials:
References: