Study to Evaluate the Safety of UF-KURE-BCMA CAR T-Cells in Advanced Myeloma

Official title

A Phase 1, Single-Arm, Open-Label Study to Evaluate the Safety of UF-KURE-BCMA Cells in Patients With Relapsed or Refractory Multiple Myeloma

Overview

The goal of this study is to evaluate the safety of a new type of CAR T-cell, UF-KURE-BCMA, for the treatment of patients with advanced multiple myeloma that has not responded to other therapies. The main question is whether the use of these new CAR T-cells is safe for patients with this condition. Secondarily, the study will also look at the response of myeloma to this therapy.

Detailed description

This is a Phase I, single-arm, open-label, dose-escalation study using a 3+3 design that evaluates the safety of UF (ultrafast)- KURE-BCMA for patients with relapsed/refractory multiple myeloma. Eligible patients are adults (≥18 years) with relapsed or refractory multiple myeloma after ≥3 prior lines of therapy, including a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 antibody. The study will accrue a total of 12 patients.

The primary objectives of this study are:

* To determine the recommended Phase 2 dose (RP2D) of UF-KURE-BCMA * To establish the safety profile and identify dose-limiting toxicities (DLTs)

The secondary objectives:

* Manufacturing feasibility * Overall response rate (ORR) per IMWG criteria * Duration of response (DOR) * Progression-free survival (PFS) * Overall survival (OS)

The exploratory objectives include:

* CAR-T cell persistence and expansion * Replication-competent lentivirus (RCL) testing * Cytokine profiling * CAR-T cell phenotype characterization * Anti-BCMA CAR antibody development * Spatial multi-omics analysis of the bone marrow microenvironment

The study endpoints include:

Primary Endpoint Incidence of dose-limiting toxicities occurring within 28 days of CAR-T cell infusion Secondary Endpoints

* Manufacturing success rate (≥75%) * Treatment-emergent adverse events * ORR, DOR, PFS, and OS per IMWG criteria

The Investigational Product is UF-KURE-BCMA, an autologous CAR-T cells manufactured using an ultra-fast process (approximately 17-20 hours), that targets specifically BCMA, a marker expressed on the surface of the myeloma cell. The study will evaluate 3 different dose levels:

* Level -1: 3 × 10⁶ cells (≥50 kg) / 2 × 10⁶ cells (\<50 kg) * Level 1 (Starting Dose): 10 × 10⁶ cells (≥50 kg) / 7 × 10⁶ cells (\<50 kg) * Level 2: 15 × 10⁶ cells (≥50 kg) / 10 × 10⁶ cells (\<50 kg) Prior to the cell infusion, the patients will receive a chemotherapy regimen (lymphodepleting regimen) that includes: Cyclophosphamide 300 mg/m² IV plus fludarabine 30 mg/m² IV, administered daily for 3 days (Days -4 to -2) The study will last 28 days, which is Dose-limiting toxicity (DLT) observation period. The follow-up period is 24 months with a long-term safety follow-up of 15 years.

The study endpoints:

Primary Endpoint Incidence of dose-limiting toxicities occurring within 28 days of CAR-T cell infusion Secondary Endpoints

* Manufacturing success rate (≥75%) * Treatment-emergent adverse events * ORR, DOR, PFS, and OS per IMWG criteria

Statistical Methods A standard 3+3 dose-escalation design will be used. Safety and efficacy will be summarized using descriptive statistics. Time-to-event endpoints will be analyzed using the Kaplan-Meier method.

Interventions

• Biological Administration of CAR T-cells at 3 different dose levels
  The patients will receive one of 3 dose levels as outlined above.

Primary outcome measures

• Incidence of dose-limiting toxicities (DLT occurring within 28 days of CAR-T cell infusion) [Time frame: Within 28 days of CAR-T cell infusion]

Secondary outcome measures (6)

• Manufacturing success rate [Time frame: 28 days post infusion]
• Treatment-emergent adverse events [Time frame: At 24 months]
• ORR per IMWG criteria [Time frame: At 24 months]
• DOR [Time frame: At day 24 months]
• PFS [Time frame: At 24 months]
• OS [Time frame: At 24 months]

Eligibility criteria

Inclusion criteria

Subjects must meet ALL of the following criteria to be eligible for study enrollment:

• Age: ≥18 years at time of signing informed consent
• Diagnosis: Documented multiple myeloma meeting one of the following:

• Relapsed disease: Progression after achieving at least minimal response (MR) to prior therapy
• Refractory disease: Non-responsive or progressive disease while on therapy or within 60 days of last treatment (in subjects who achieved ≥MR on prior therapy)
• Prior Therapy:

• Received ≥3 prior lines of anti-myeloma therapy
• Prior therapy must include:

At least one proteasome inhibitor At least one immunomodulatory drug (e.g., lenalidomide, pomalidomide, thalidomide) At least one anti-CD38 monoclonal antibody (e.g., daratumumab, isatuximab) o Prior anti-BCMA CAR-T therapy is permitted if subject achieved PFS ≥6 months post-infusion

• Measurable Disease: At least one of the following at screening (for response assessment eligibility):

• Serum M-protein ≥0.5 g/dL by protein electrophoresis (SPEP)
• Urine M-protein ≥200 mg/24 hours by protein electrophoresis (UPEP)
• Serum free light chain (FLC) difference ≥10 mg/dL with abnormal FLC ratio Note: Subjects with non-measurable disease may enroll for safety assessment
• Performance Status: ECOG Performance Status 0-2 (see Appendix A)
• Organ Function: Adequate organ function as defined by:

Hepatic:

o Total bilirubin ≤2× institutional upper limit of normal (ULN), except subjects with Gilbert's syndrome

• AST and ALT ≤2.5× institutional ULN

Renal:

o Calculated creatinine clearance ≥30 mL/min (Cockcroft-Gault formula)

Cardiac:

o Left ventricular ejection fraction (LVEF) ≥45% by echocardiogram or MUGA

Pulmonary:

o ≤Grade 1 dyspnea

o Oxygen saturation ≥92% on room air

o If PFTs performed: FEV₁ ≥50% predicted and DLCO ≥40% predicted (corrected for hemoglobin)

• Prior Therapy Washout:

o ≥2 weeks since last radiation or systemic anti-myeloma therapy (standard agents)

o ≥4 weeks since last investigational therapy

o ≥6 weeks since autologous stem cell transplant

• Informed Consent: Ability to understand and willingness to provide written informed consent
• Contraception Requirements (for subjects of reproductive potential):

Female subjects:

o Women of childbearing potential must: Have negative serum pregnancy test at screening Agree to use highly effective contraception (failure rate <1% per year) from enrollment through 6 months post-CAR-T infusion

• Acceptable methods: bilateral tubal ligation, male partner sterilization, hormonal contraceptives that inhibit ovulation, hormone-releasing IUD, copper IUD
• Sexual abstinence is acceptable if consistent with subject's preferred lifestyle

Male subjects:

• Must agree to use condom plus effective contraception if partner is of childbearing potential
• Must refrain from sperm donation from enrollment through 6 months post-CAR-T infusion

Exclusion criteria

Subjects meeting ANY of the following criteria will be excluded:

• Disease-Specific Exclusions:

• Active CNS involvement by multiple myeloma
• Plasma cell leukemia
• History of allogeneic hematopoietic stem cell transplantation
• Malignancy Exclusions:

o Second active malignancy, except: Non-melanoma skin cancer Carcinoma in situ (cervix, bladder, breast) Stage 1 uterine cancer Localized prostate cancer

• Cardiovascular Exclusions:

• New York Heart Association (NYHA) Class IV congestive heart failure
• Unstable angina pectoris
• Clinically significant cardiac arrhythmias
• Myocardial infarction, stroke, or TIA within 6 months of enrollment
• Infectious Disease Exclusions:

• Known HIV infection or AIDS-related illness
• Active hepatitis B or C infection:

Positive HBsAg, or Positive anti-HBc or anti-HCV with detectable viral nucleic acid by PCR

• Active infection requiring systemic therapy 5. Neurological Exclusions:
• History of clinically relevant CNS pathology including:

Epilepsy or seizure disorders Paresis, aphasia Uncontrolled cerebrovascular disease Severe brain injury Dementia Parkinson's disease 6. Autoimmune Disease:

• Active autoimmune disease requiring systemic immunosuppression >15 mg/day prednisone equivalent within past 6 months
• Examples: rheumatoid arthritis, lupus

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

Center list to be confirmed — check the primary protocol.

Publications

• Munshi NC, Anderson LD Jr, Shah N, Madduri D, Berdeja J, Lonial S, Raje N, Lin Y, Siegel D, Oriol A, Moreau P, Yakoub-Agha I, Delforge M, Cavo M, Einsele H, Goldschmidt H, Weisel K, Rambaldi A, Reece D, Petrocca F, Massaro M, Connarn JN, Kaiser S, Patel P, Huang L, Campbell TB, Hege K, San-Miguel J. Idecabtagene Vicleucel in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2021 Feb 25;384(8 PMID 33626253
• Hankey BF, Ries LA, Edwards BK. The surveillance, epidemiology, and end results program: a national resource. Cancer Epidemiol Biomarkers Prev. 1999 Dec;8(12):1117-21. No abstract available. PMID 10613347
• San-Miguel J, Dhakal B, Yong K, Spencer A, Anguille S, Mateos MV, Fernandez de Larrea C, Martinez-Lopez J, Moreau P, Touzeau C, Leleu X, Avivi I, Cavo M, Ishida T, Kim SJ, Roeloffzen W, van de Donk NWCJ, Dytfeld D, Sidana S, Costa LJ, Oriol A, Popat R, Khan AM, Cohen YC, Ho PJ, Griffin J, Lendvai N, Lonardi C, Slaughter A, Schecter JM, Jackson CC, Connors K, Li K, Zudaire E, Chen D, Gilbert J, Yeh PMID 37272512
• Shah N, Chari A, Scott E, Mezzi K, Usmani SZ. B-cell maturation antigen (BCMA) in multiple myeloma: rationale for targeting and current therapeutic approaches. Leukemia. 2020 Apr;34(4):985-1005. doi: 10.1038/s41375-020-0734-z. Epub 2020 Feb 13. PMID 32055000
• Ghassemi S, Durgin JS, Nunez-Cruz S, Patel J, Leferovich J, Pinzone M, Shen F, Cummins KD, Plesa G, Cantu VA, Reddy S, Bushman FD, Gill SI, O'Doherty U, O'Connor RS, Milone MC. Rapid manufacturing of non-activated potent CAR T cells. Nat Biomed Eng. 2022 Feb;6(2):118-128. doi: 10.1038/s41551-021-00842-6. Epub 2022 Feb 21. PMID 35190680
• Rodriguez-Otero P, Ailawadhi S, Arnulf B, Patel K, Cavo M, Nooka AK, Manier S, Callander N, Costa LJ, Vij R, Bahlis NJ, Moreau P, Solomon SR, Delforge M, Berdeja J, Truppel-Hartmann A, Yang Z, Favre-Kontula L, Wu F, Piasecki J, Cook M, Giralt S. Ide-cel or Standard Regimens in Relapsed and Refractory Multiple Myeloma. N Engl J Med. 2023 Mar 16;388(11):1002-1014. doi: 10.1056/NEJMoa2213614. Epub 20 PMID 36762851
• Lee DW, Santomasso BD, Locke FL, Ghobadi A, Turtle CJ, Brudno JN, Maus MV, Park JH, Mead E, Pavletic S, Go WY, Eldjerou L, Gardner RA, Frey N, Curran KJ, Peggs K, Pasquini M, DiPersio JF, van den Brink MRM, Komanduri KV, Grupp SA, Neelapu SS. ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells. Biol Blood Marrow Transplant. 2019 Apr;2 PMID 30592986
• Kumar S, Paiva B, Anderson KC, Durie B, Landgren O, Moreau P, Munshi N, Lonial S, Blade J, Mateos MV, Dimopoulos M, Kastritis E, Boccadoro M, Orlowski R, Goldschmidt H, Spencer A, Hou J, Chng WJ, Usmani SZ, Zamagni E, Shimizu K, Jagannath S, Johnsen HE, Terpos E, Reiman A, Kyle RA, Sonneveld P, Richardson PG, McCarthy P, Ludwig H, Chen W, Cavo M, Harousseau JL, Lentzsch S, Hillengass J, Palumbo A, PMID 27511158

Identifiers

NCT: NCT07611149 · HEM02

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗