A Phase 3 Study of Tabelecleucel for Participants With Epstein-Barr Virus-Associated Post-Transplant Lymphoproliferative Disease After Failure With Rituximab or Rituximab and Chemotherapy

Official title

Multicenter, Open-Label, Phase 3 Study of Tabelecleucel for Solid Organ or Allogeneic Hematopoietic Cell Transplant Subjects With Epstein-Barr Virus-Associated Post-Transplant Lymphoproliferative Disease After Failure of Rituximab or Rituximab and Chemotherapy

Overview

The purpose of this study is to determine the clinical benefit and characterize the safety profile of tabelecleucel for the treatment of Epstein-Barr virus-associated post-transplant lymphoproliferative disease (EBV+ PTLD) in the setting of (1) solid organ transplant (SOT) after failure of rituximab (SOT-R) and rituximab plus chemotherapy (SOT-R+C) or (2) allogeneic hematopoietic cell transplant (HCT) after failure of rituximab.

Detailed description

This is a multicenter, open-label, phase 3 study to assess the efficacy and safety of tabelecleucel for the treatment of EBV+ PTLD in the setting of SOT-R and SOT-R+C (Cohort \[C\]-SOT) or HCT after failure of rituximab (C-HCT).

SOT-R further included participants:

1. who did not receive chemotherapy and did not have a documented medical reason not to receive chemotherapy (SOT-Ro) or 2. who were considered chemotherapy ineligible/inappropriate (SOT-R-Ci)

Combined population (SOT-R-Ci, SOT-R+C, and HCT) and (SOT-R-Ci and SOT-R+C) who received commercial product, or a product manufactured using a comparable process version (PV) were also used for analysis of outcomes.

Enrollment will be preceded by confirmation of availability of partially human leukocyte antigen (HLA) matched and restricted tabelecleucel for the participant.

Study procedures and product administration will be the same for each cohort. Tabelecleucel will be administered in cycles lasting 5 weeks (35 days). During each cycle, participants will receive intravenous tabelecleucel at a dose of 2 × 10\^6 cells/kg on Days 1, 8, and 15, followed by observation through Day 35. Treatment will continue until maximal response, unacceptable toxicity, initiation of non protocol therapy, or failure of tabelecleucel with up to 2 different HLA restrictions (C-SOT) or up to 4 different HLA restrictions (C-HCT). The study includes a total of 5 years of follow-up for disease and survival status for participants enrolled before or after 09 October 2023 to reach the initial sample size of 33 participants in both cohorts. For all other participants enrolled after 09 October 2023 and after the initial sample of 33 participants in both cohorts has been reached in both cohorts, the follow-up will be every 3 months, up to 12 months, as assessed on anniversary of Cycle 1 Day 1. For responders, the follow-up will be 12 months from the date of initial response.

Interventions

• Biological tabelecleucel
  Tabelecleucel is being investigated as an off-the-shelf, allogeneic T-cell immunotherapy for the treatment of EBV+ malignancies and diseases.

Primary outcome measures

• Objective Response Rate (ORR) in the Analysis Cohorts C-SOT, C-HCT, and Combined Population (C-SOT-R+C, C-SOT-R-Ci, and C-HCT) Who Received Commercial Product, or a Product Manufactured Using a Comparable PV [Time frame: 2 years]

Secondary outcome measures (9)

• Duration of Response (DOR) in the Analysis Cohorts C-SOT and C-HCT Separately [Time frame: 2 years]
• ORR in the Analysis Cohorts C-SOT and C-HCT Combined [Time frame: 2 years]
• ORR and DOR in Participants who Received Commercial Product or a Product Manufactured Using a Comparable PV in the Analysis Cohorts C-SOT-R-Ci and C-SOT-R+C Separately and Combined, and in the Analysis Cohort C-HCT [Time frame: 2 years]
• DOR in a Combined Population (SOT-R-Ci, SOT-R+C, and HCT) who Received Commercial Product or a Product Manufactured Using a Comparable PV [Time frame: 2 years]
• Rates of Complete Response (CR) and Partial Response (PR) [Time frame: 2 years]
• Time to Response [Time frame: 2 years]
• Time to Best Response [Time frame: 2 years]
• Overall Survival (OS) [Time frame: 2 years]
• Rates of Allograft Loss or Rejection Episodes (Analysis Cohort C-SOT) [Time frame: 2 years]

Eligibility criteria

Inclusion criteria

• Prior SOT of kidney, liver, heart, lung, pancreas, small bowel, or any combination of these (C-SOT); or prior allogeneic HCT (C-HCT).
• A diagnosis of locally assessed, biopsy-proven EBV+ PTLD.
• Availability of appropriate partially HLA-matched and restricted tabelecleucel has been confirmed by the sponsor.
• Measurable, 18F-deoxyglucose (FDG)-avid (Deauville score ≥ 3) systemic disease using Lugano Classification response criteria by positron emission tomography (PET)-diagnostic computed tomography (CT), except when contraindicated or mandated by local practice, then magnetic resonance imaging (MRI) may be used. For participants with treated central nervous system (CNS) disease, a head CT and/or brain/spinal MRI as clinically appropriate will be required to follow CNS disease response per Lugano Classification response criteria.
• Treatment failure of rituximab or interchangeable commercially available biosimilar monotherapy (C-SOT-R or C-HCT) or rituximab plus any concurrent or sequentially administered chemotherapy regimen (C-SOT-R+C) for treatment of PTLD.
• Males and females of any age.
• Eastern Cooperative Oncology Group performance status ≤ 3 for participants aged ≥ 16 years; Lansky score ≥ 20 for participants < 16 years.
• For C-HCT only: If allogeneic HCT was performed as treatment for an acute lymphoid or myeloid malignancy, the underlying primary disease for which the participant underwent transplant must be in morphologic remission.
• Adequate organ function.

• Absolute neutrophil count ≥ 1000/μL, (C-SOT) or ≥ 500/μL (C-HCT), with or without cytokine support.
• Platelet count ≥ 50,000/μL, with or without transfusion or cytokine support. For C-HCT, platelet count < 50,000/μL but ≥ 20,000/μL, with or without transfusion support, is permissible if the participant has not had grade ≥ 2 bleeding in the prior 4 weeks (where grading of the bleeding is determined per the National Cancer Institute's Common Terminology Criteria for Adverse Events \[CTCAE\], version 5.0).
• Alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin each < 5 × the upper limit of normal; however, ALT, AST, and total bilirubin each ≤ 10 × upper limit of normal is acceptable if the elevation is considered by the investigator to be due to EBV and/or PTLD involvement of the liver as long as there is no known evidence of significant liver dysfunction.
• Participant or participant's representative is willing and able to provide written informed consent.

Exclusion criteria

• Currently active Burkitt, T-cell, NK/T-cell lymphoma/LPD, Hodgkin, plasmablastic, transformed lymphoma, active hemophagocytic lymphohistiocytosis, or other malignancies requiring systemic therapy.
• Daily steroids of > 0.5 mg/kg prednisone or glucocorticoid equivalent, ongoing methotrexate, or extracorporeal photopheresis.
• Untreated CNS PTLD or CNS PTLD for which the participant is actively receiving CNS-directed chemotherapy (systemic or intrathecal) or radiotherapy at enrollment. NOTE: Participants with previously treated CNS PTLD may enroll if CNS-directed therapy is complete.
• Suspected or confirmed grade ≥ 2 graft-versus-host disease (GvHD) per the Center for International Blood and Marrow Transplant Research consensus grading system at enrollment.
• Ongoing or recent use of a checkpoint inhibitor agent (eg, ipilimumab, pembrolizumab, nivolumab) within 3 drug half-lives from the most recent dose to enrollment.
• For C-HCT: active adenovirus viremia.
• Need for vasopressor or ventilatory support.
• Antithymocyte globulin or similar anti-T cell antibody therapy ≤ 4 weeks prior to enrollment.
• Treatment with Epstein-Barr virus cytotoxic T lymphocytes or chimeric antigen receptor T cells directed against B cells within 8 weeks of enrollment (C-SOT or C-HCT), or unselected donor lymphocyte infusion within 8 weeks of enrollment (C-HCT only).
• Female who is breastfeeding or pregnant or female of childbearing potential or male with a female partner of childbearing potential unwilling to use a highly effective method of contraception.
• Inability to comply with study-related procedures.
• Any medical condition or organ system dysfunction that in the investigator';s opinion, could compromise the participant's safety or ability to complete the study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Non-randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 40 centers

• City of Hope (Adults and Pediatrics) — Duarte
• University of California San Diego Moores Cancer Center (Adults only) — La Jolla
• Loma Linda University Medical Center (Adults only) — Loma Linda
• Children's Hospital Los Angeles, Div. of Research Immunology/BMT (Adults and Pediatrics) — Los Angeles
• UCLA Medical Center (Adults and Pediatrics) — Los Angeles
• University of California Davis Comprehensive Cancer Center (Adults only) — Sacramento
• Yale University (Adults and Pediatrics) — New Haven
• MedStar Georgetown University Hospital (Adults and Pediatrics) — Washington D.C.
• … and 32 more centers

Australia · 6 centers

• The Children's Hospital at Westmead (Pediatrics only) — Westmead
• Westmead Hospital (Adults only) — Westmead
• The Prince Charles Hospital (Adults only) — Chermside
• Royal Adelaide Hospital (Adults only) — Adelaide
• The Royal Children's Hospital Melbourne (Pediatrics only) — Melbourne
• Fiona Stanley Hospital (Adults only) — Murdoch

Spain · 6 centers

• Hospital Duran i Reynals (Adults and Pediatrics) — Badalona
• Hospital Universitari Vall d'Hebrón - Institut de Recerca (Adults and Pediatrics) — Barcelona
• Hospital Universitario Marqués de Valdecilla (Adults and Pediatrics) — Santander
• Hospital General Universitario Gregorio Marañón (Adults and Pediatrics) — Madrid
• University Hospital Virgen del Rocio (Adults and Pediatrics) — Seville
• Hospital Universitario La Fe (Adults and Pediatrics) — Valencia

France · 5 centers

• Centre Hospitalier Universitaire de Bordeaux (Adults only) — Pessac
• Centre Hospitalier Régional Universitaire de Lille (Adults and Pediatrics) — Lille
• Hôpital Necker-Enfants Malades (Pediatrics only) — Paris
• Hôpital Saint Antoine (Adults only) — Paris
• Hôpital Universitaire Pitié Salpêtrière (Adults only) — Paris

Italy · 5 centers

• Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (Adults only) — Milan
• Fondazione IRCCS Policlinico San Matteo (Adults and Pediatrics) — Pavia
• Fondazione Policlinico Universitario Agostino Gemelli (Adults only) — Roma
• Ospedale Pediatrico Bambino Gesu (Pediatrics only) — Roma
• Azienda Ospedaliera - Universitaria Città della Salute e della Scienza di Torino (Adults o — Torino

Canada · 3 centers

• Alberta Children's Hospital (Adults and Pediatrics) — Calgary
• Sick Kids (Pediatrics only) — Toronto
• Princess Margaret Cancer Centre (Adults only) — Toronto

United Kingdom · 3 centers

• University Hospitals Birmingham NHS Foundation Trust (Adults only) — Birmingham
• King's College Hospital NHS Foundation Trust (Adults only) — London
• Imperial College Healthcare NHS Trust (Adults only) — London

Belgium · 2 centers

• Centre Hospitalier Universitaire de Liège Site Sart Tilman (Adults and Pediatrics) — Liège
• Universitair Ziekenhuis Leuven (Adults and Pediatrics) — Leuven

Austria · 1 center

• Medizinische Universitat Wien (Adults only) — Vienna

Publications

• Mahadeo KM, Baiocchi R, Beitinjaneh A, Chaganti S, Choquet S, Dierickx D, Dinavahi R, Duan X, Gamelin L, Ghobadi A, Guzman-Becerra N, Joshi M, Mehta A, Navarro WH, Nikiforow S, O'Reilly RJ, Reshef R, Ruiz F, Spindler T, Prockop S. Tabelecleucel for allogeneic haematopoietic stem-cell or solid organ transplant recipients with Epstein-Barr virus-positive post-transplant lymphoproliferative disease a PMID 38309282

Identifiers

NCT: NCT03394365 · ATA129-EBV-302/F60085DL302 · 2024-516622-57-00

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗