B7-H3-CAR T Cells for Pediatric CNS Tumors

• Status: Not yet recruiting
• Trial end date: 2028-03-01
• Target enrollment: 0
• Participant gender: All

Summary

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 brainstem high-grade neoplasms. Participants will receive six (6) B7-H3-CAR T cell infusions over an 8 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.

• Phase: Phase 1
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: St. Jude Children's Research Hospital

Criteria

Inclusion Criteria: Screening Eligibility

1. Age ≤ 21 years of age

2. Primary CNS tumor with measurable disease

3. For Cohort A, must have evidence of relapsed or refractory non-brainstem CNS tumor

4. For Cohort B, must meet one of the following criteria:

• Adequate tumor tissue from for central pathology review

• Brainstem high-grade neoplasm with available imaging for central review

5. Life expectancy of > 12 weeks

6. Adult patient, parent or legal guardian can understand and is willing to sign a written informed consent document according to institutional guidelines

Exclusion Criteria: Screening Eligibility All Participants

1. Clinically significant medical disorders that could compromise their ability to tolerate protocol therapy or would interfere with study procedure Inclusion Criteria: Procurement and T-cell Production Eligibility

1. Age ≤ 21 years of age

2. Primary CNS tumor with measurable 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: brainstem high-grade neoplasm AND tumor is:

• B7-H3 positive

• OR H3K27-altered diffuse midline glioma

• OR radiographically-confirmed classic/typical DIPG

3. Estimated life expectancy of >12 weeks

4. Karnofsky or Lansky performance score ≥50

5. Participant of childbearing/child-fathering potential agrees to use contraception

6. For females of childbearing age:

• Not pregnant with negative serum pregnancy test

• Not lactating with intent to breastfeed

7. Chemotherapy/biologic therapy must be discontinued ≥ 7 days prior to enrollment

8. The last dose of antibody therapy (including check point inhibitor) must be at least 3 half-lives or 30 days, whichever is shorter

9. At least 30 days from most recent cell infusion prior to enrollment.

10. 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/m2/day

11. Meets eligibility for apheresis, or has an apheresis product previously collected at a FACT-accredited program

12. Adult patient, parent or legal guardian can understand and is willing to sign a written informed consent document according to institutional guidelines

Exclusion Criteria: Procurement and T-cell Production Eligibility

1. Participant has a non-programmable ventricular shunt that could compromise study therapy

2. Known primary immunodeficiency or acquired immunodeficiency.

3. Known HIV positivity

4. Severe intercurrent bacterial, viral or fungal infection

5. Rapidly progressive disease

6. Known underlying medical condition for which participation in this trial would not be in the best interest of the participant or that could prevent, limit or confound protocol assessments

Inclusion Criteria: Treatment Eligibility

Cohort A

• Relapsed/refractory non-brainstem CNS primary tumor

• Tumor must be considered B7-H3 positive

Cohort B

• Brainstem high-grade neoplasm. Must meet one of the following criteria

• Tumor is considered B7-H3 positive

• H3K27-altered diffuse midline 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

1. Age ≤ 21 years old

2. Primary CNS tumor with measurable disease

3. Available autologous T-cell product that has met GMP release criteria

4. Participant has a CNS reservoir catheter (e.g., Ommaya)

5. Participant is ≥ 5 days from CNS surgery, including catheter placement

6. 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/m2/day

7. Estimated life expectancy of >8 weeks

8. Karnofsky or Lansky performance score ≥ 50

9. Echocardiogram with a left ventricular ejection fraction > 50%

10. Adequate organ function

11. Adequate laboratory values

12. Taking anti-seizure medication, or agrees to initiate anti-seizure medication

13. Recovered from acute toxicities from prior therapy

14. Male participants of child-fathering potential agree to use contraception

15. 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

Exclusion Criteria: Treatment Eligibility

1. Participant has a non-programmable ventricular shunt that could compromise study therapy

2. Known primary immunodeficiency or acquired immunodeficiency.

3. Known HIV positivity

4. Severe intercurrent bacterial, viral or fungal infection

5. Myocardial infarction, unstable angina, New York Heart Association class III and IV congestive heart failure, myocarditis, or ventricular arrhythmias requiring medication within 6 months prior to study entry

6. Receiving therapy outlined above during the 'wash-out' period

7. Rapidly progressing disease

8. Received any live vaccines within 30 days

9. Known underlying medical condition for which participation in this trial would not be in the best interest of the participant or that could prevent, limit or confound protocol assessments