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T-cell Lymphomas | A-dmDT390-bisFv(UCHT1) Immunotoxin Therapy for Patients With Cutaneous T-Cell Lymphoma (CTCL)

T-cell Lymphomas research study

What is the primary objective of this study?

This is a Phase II clinical trial aimed at treating a subgroup of patients with cutaneous T-cell lymphoma. The drug consists of a toxin, called diphtheria toxin, which is attached to an antibody that can specifically target cancerous T-cells. Our primary objectives are, therefore, to determine the patient subgroup with respect to disease burden who best responds to this experimental drug in treating CD3 positive T cell malignancies. We will be determining how the patient and their disease respond to this research agent. The Clinical Response Data analysis from October 2014 done at the completion of the Phase I portion of A-dmT390-bisFv(UCHT1) fusion protein clinical trial showed that there were 25 evaluable patients who received all 8 doses varying between 2.5 and 11.25 µg/kg per dose. There were responses at all the lower dose levels up to 7.5 µg/kg per dose. The overall response rate was 36% and the complete response rate was 16% (when followed for 6 months). We have identified a subgroup of CTCL patients that have a very high response rate. If we exclude patients whose mSWAT scores never exceeded 50 (50% of skin surface area times a multiplier) and who never had lymph node involvement or stage III disease we are left with 9 patients. This subgroup has an overall response rate of 89% and a complete response rate of 50% (when followed for 6 months). Of these 4 patients currently in complete remission, three are long-term responders. Two are over 6 years in duration and one over 5 years duration. These may represent cures. The long time periods in the transition from partial response to complete response without treatment, 6 months to two years, suggests that the study drug in addition to exerting a direct killing effect on tumor also functions as an immunomodulator.

Who is eligible to participate?

Inclusion Criteria: - Patients must have signed the current Institutional Review Board (IRB) approved informed consent prior to registration (see Informed Consent). - All patients must have CTCL diagnosed by morphologic, histochemical or cell surface marker criteria with stage never exceeding IB / IIB disease and mSWAT < 50%. CTCL patients with stage IA disease are not eligible for enrollment. CTCL patients with stage IB disease are eligible provided that they have failed a systemic treatment (this includes radiation). CTCL patients with bone marrow involvement but without lymph node involvement are eligible. Patients with a diagnosis of angioimmunoblastic T cell lymphoma are eligible, even with lymph node involvement. Age ≥ 18 years. Patients must have a performance status of < 2 on Eastern Cooperative Oncology Group scale (see Appendix). Patients must have fully recovered from toxicity of prior chemotherapy or radiation therapy. - Patients must have bilirubin < 1.5 mg/dL, transaminases < 2.5 X ULN, albumin > 3 gm/dL, creatinine < 2.0 mg/dL. Patients who have had albumin < 3 gm/dL boosted by an albumin infusion must be observed to maintain albumin at > 3gm dL for 30 days without an additional infusion. - Patients must have a normal echocardiogram (EF > 50% normal) without any evidence of cardiac chamber hypertrophy, dilatation or hypokinesis. The Sponsor must be provided with copies of these tests BEFORE Sponsor will approve enrollment. In addition, the sponsor must receive a list of current medications taken by the patient before Sponsor will approve enrollment. - Females and males must be willing to use an approved form of birth control while on this study and for 2 weeks after completion. Exclusion Criteria: - Failure to meet any of the criteria set forth in Section 3.1. - Inability to give informed consent because of psychiatric problems, or complicated medical problems. - Allergic to diphtheria toxin a component of the study drug A-dmDT390-bisFv(UCHT1). - Serious concurrent medical problems, uncontrolled infections, or disseminated intravascular coagulopathy (DIC), hepatic cirrhosis, or chronic kidney disease. - CNS leukemia. - Preexisting cardiovascular disease. The only exception being well controlled essential hypertension with a sitting blood pressure (B.P.) of < 160 systolic and < 90 diastolic without any evidence of structural heart disease or one episode of myocardial infarction > 8 months ago. A past history of any of the following conditions is considered as exclusions to study participation: - Congestive heart failure, - Atrial fibrillation, - Pulmonary hypertension, - Anticoagulant drug therapy, - Thromboembolic events, - Cardiomyopathy or a myocardial infarction within the past 8 months. - The PI and the Clinical Coordinator will be asked to verify that their referred patients do not have these exclusionary histories listed in 3.2 and a copy of this verification must be sent to the Sponsor before the Sponsor will approve of enrollment. Referring physicians will not need to sign. (Template for verification letter Appendix C). - Pregnant or nursing women will be excluded from study. - History of cirrhosis of the liver based on the Child-Pugh score of Class B or C are not eligible to participate. (Appendix B.) - Prior treatment with alemtuzumab (Campath) or similar agents or procedures that depress blood T cell counts to below 50% of the lower limit of normal.

Which medical condition, disease, disorder, syndrome, illness, or injury is researched?

T-cell Lymphomas

T-cell Leukemia

Sezary Syndrome

Mycosis Fungoides

Cutaneous T-cell Lymphoma (CTCL)

Study Interventions

Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.

Biological:A-dmDT390-bisFv(UCHT1)A-dmDT390-bisFv(UCHT1) will be administered as 60 μg/kg total given as 7.5 μg/kg/injection twice a day 4-6 hours apart for four consecutive days (days 1-4) into a free flowing IV over a period of approximately 15 minutes

Study Arms

Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.

A-dmDT390-bisFv(UCHT1)anti-T cell immunotoxin (antibody targeting CD3 on T-cells tagged with diptheria toxin)

Study Status

Completed

Start Date: January 2008

Completed Date: November 2016

Phase: Phase 2

Type: Interventional

Design:

Primary Outcome: Remission status (complete, partial, stable disease, progressive disease)

Secondary Outcome:

Study sponsors, principal investigator, and references

Principal Investigator: Arthur E Frankel, MD

Lead Sponsor: Angimmune LLC

Collaborator: James Graham Brown Cancer Center

More information:https://clinicaltrials.gov/show/NCT00611208

Frankel AE, Zuckero SL, Mankin AA, Grable M, Mitchell K, Lee YJ, Neville DM, Woo JH. Anti-CD3 recombinant diphtheria immunotoxin therapy of cutaneous T cell lymphoma. Curr Drug Targets. 2009 Feb;10(2):104-9. Review.

Frankel, Arthur E. Anti-CD3 immunotoxin to induce remissions in cutaneous T-cell lymphoma patients. Poster session presented at: 2012 American Society of Clinical Oncology (ASCO). Oral Abstract Session, Developmental Therapeutics - Clinical Pharmacology and Immunotherapy. 2012 June 1-5; Chicago, IL.

Arthur E. Frankel, Jung H. Woo, Jeremy P. Mauldin, Francine M. Foss, Madeleine Duvic, David M. Neville Jr. An Update On The Clinical Activity Of Resimmune, a Targeted Therapy Directed To CD3 Receptor, In Patients With Cutaneous T Cell Lymphomas—CTCL. Poster session presented at: 2012 American Society of Hematology (ASH). 55th ASH Annual Meeting and Exposition. 2013 December 7-10; New Orleans, LA.

Frankel AE, Woo JH, Ahn C, Foss FM, Duvic M, Neville PH, Neville DM. Resimmune, an anti-CD3ε recombinant immunotoxin, induces durable remissions in patients with cutaneous T-cell lymphoma. Haematologica. 2015 Jun;100(6):794-800. doi: 10.3324/haematol.2015.123711. Epub 2015 Mar 20.

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