Loc3CAR: Locoregional Delivery of B7-H3-specific Chimeric Antigen Receptor Autologous T Cells for Pediatric Patients With Primary CNS Tumors
Loc3CAR is a Phase I clinical trial evaluating the use of autologous B7-H3-CAR T cells for participants ≤ 21 years old with primary CNS neoplasms. B7-H3-CAR T cells will be locoregionally administered via a CNS reservoir catheter. Study participants will be divided into two cohorts: cohort A with B7-H3-positive relapsed/refractory non-brainstem primary CNS tumors, and cohort B with diffuse midline gliomas (DMG). Participants will receive four (4) B7-H3-CAR T cell infusions over a 4 week period. The purpose of this study is to find the maximum (highest) dose of B7-H3-CAR T cells that are safe to give patients with primary brain tumors. Primary objectives * To determine the safety, maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) for the locoregional delivery of autologous B7-H3-CAR T cells in patients ≤ 21 years of age with recurrent/refractory B7-H3+ primary CNS tumors (Cohort A) or DMG (Cohort B). Secondary objectives * To assess the efficacy, defined as sustained objective response, a partial response (PR) or complete response (CR) observed anytime on active treatment with B7-H3-CAR T cells in patients with relapsed/refractory B7-H3+ primary CNS tumors (Cohort A) or DMG (Cohort B). * To characterize and monitor neurologic toxicities in patients while on study (Cohort A and B).
⁃ Age ≤ 21 years of age
⁃ Primary CNS tumor
⁃ For Cohort A, must have evidence of relapsed or refractory non-brainstem CNS tumor
⁃ For Cohort B, must meet one of the following criteria:
∙ Adequate tumor tissue from primary tumor resection or biopsy for central pathology review (i.e., B7-H3 expression evaluation by immunohistochemistry \[IHC\] or H3K27M mutation if pontine lesion)
‣ Has a diagnosis of diffuse midline glioma that harbors a mutation associated with this entity (e.g. H3K27M)
‣ Has presumptive/suspected brainstem high-grade neoplasm with available imaging for central imaging review
⁃ Life expectancy of \> 12 weeks
⁃ Adult patient, parent or legal guardian can understand and is willing to sign a written informed consent document according to institutional guidelines
⁃ Age ≤ 21 years of age
⁃ Primary CNS tumor with measurable or evaluable disease and meets criteria for either Cohort A or B:
∙ Cohort A: relapsed/refractory non-brainstem CNS primary tumor AND tumor is B7-H3 positive
‣ Cohort B: Diffuse midline glioma AND tumor is:
⁃ B7-H3 positive if non-pontine
• OR H3K27-altered diffuse midline pontine glioma
• OR radiographically-confirmed classic/typical DIPG
⁃ Estimated life expectancy of \>12 weeks
⁃ Karnofsky or Lansky performance score ≥50
⁃ Participant of childbearing/child-fathering potential agrees to use contraception
⁃ For females of childbearing age:
∙ Not pregnant with negative serum pregnancy test
‣ Not lactating with intent to breastfeed
⁃ Chemotherapy/biologic therapy must be discontinued ≥ 7 days prior to enrollment
⁃ The last dose of antibody therapy (including check point inhibitor) must be at least 3 half-lives or 30 days, whichever is shorter, from the time of enrollment
⁃ At least 30 days from most recent cell infusion prior to enrollment.
‣ All systemically administered corticosteroid therapy must be stable or decreasing for ≥1 week prior to enrollment, with a maximum dexamethasone dose of 2.8 mg/m\^2/day
‣ Meets eligibility for apheresis, or has an apheresis product previously collected at a FACT-accredited program
‣ Adult patient, parent or legal guardian can understand and is willing to sign a written informed consent document according to institutional guidelines
‣ Cohort A
• Relapsed/refractory non-brainstem CNS primary tumor
• Tumor must be considered B7-H3 positive
‣ Cohort B
• Diffuse Midline Glioma - Must meet one of the following criteria
‣ Tumor is considered B7-H3 positive
⁃ H3K27-altered diffuse midline pontine glioma
⁃ Radiographically-confirmed classic/typical DIPG
• Must complete standard radiation prior to Loc3CAR treatment and be a minimum of 6 weeks post-completion of radiation therapy
‣ All participants
⁃ Age ≤ 21 years old
⁃ Primary CNS tumor with measurable or evaluable disease
⁃ Available autologous T-cell product that has met GMP release criteria
⁃ Participant has a CNS reservoir catheter (e.g., Ommaya) or programmable shunt
⁃ First CAR T cell infusion is planned/scheduled ≥ 5 days from CNS surgery, including catheter placement
⁃ The following treatments must be discontinued for the specified duration prior to treatment enrollment:
∙ Radiation therapy: ≥ 6 weeks
‣ Bevacizumab: ≥ 28 days
‣ Cytotoxic chemotherapy: ≥ 21 days
‣ Biologic agents: ≥ 7 days
‣ Antibody therapy: ≥ 3 half-lives or 30 days (whichever is shorter)
‣ Cellular therapy: ≥ 30 days
‣ Investigational agent: ≥ 3 half-lives or 30 days (whichever is shorter)
‣ Corticosteroids: All systemically administered therapy must be stable or decreasing for ≥ 1 week prior to enrollment, with a maximum dexamethasone dose of 2.8 mg/m\^2/day. Corticosteroid physiologic replacement therapy for management of pituitary/adrenal axis insufficiency and/or topical administration (e.g. inhaled or dermatologic) is allowed.
⁃ Estimated life expectancy of \>8 weeks
⁃ Karnofsky or Lansky performance score ≥ 50
⁃ Echocardiogram with a left ventricular ejection fraction ≥ 50%
‣ Adequate renal function defined as calculated creatinine clearance or radioisotope GFR ≥ 50 mL/min/1.73m\^2.
‣ Adequate pulmonary function defined as forced vital capacity (FVC) ≥50% of predicted value or pulse oximetry ≥90% on room air.
‣ Total Bilirubin ≤3 times the upper limit of normal for age.
‣ Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤5 times the upper limit of normal for age.
‣ Hemoglobin \>8.0 g/dL (can be transfused).
‣ Platelet count \>50,000/mm\^3 (can be transfused).
‣ Absolute neutrophil count (ANC) ≥1000/uL.
‣ Taking anti-seizure medication, or agrees to initiate anti-seizure medication prior to starting study therapy.
‣ Has recovered from all NCI CTAE grade III-IV, non-hematologic acute toxicities from prior therapy.
‣ Male participants of child-fathering potential agree to use contraception
‣ Female participants of childbearing potential:
• Negative serum pregnancy test within 7 days prior to infusion
∙ Not lactating with intent to breastfeed
∙ If sexually active, agrees to use birth control until 3 months after T-cell infusion. Male partners should use a condom
‣ Adult patient, parent or legal guardian can understand and is willing to sign a written informed consent document according to institutional guidelines