TriPRIL CAR T Cell Therapy for Multiple Myeloma

Overseen by Matthew Frigault, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Recruiting

Sponsor: Marcela V. Maus, M.D.,Ph.D.

Must not be taking: Immunosuppressants, Steroids

Disqualifiers: Active infection, Heart failure, CNS pathology, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial is testing TriPRIL CAR T Cells, a new treatment that uses a patient's own immune cells to fight multiple myeloma that has come back or not responded to other treatments. The treatment involves modifying the patient's T cells to better attack cancer cells. About 18 people will participate, receiving one infusion and being monitored for an extended period. This type of therapy has shown promising results in treating various cancers, including multiple myeloma.

Will I have to stop taking my current medications?

The trial protocol does not specify if you must stop taking your current medications. However, you cannot have had any systemic treatment for multiple myeloma within 14 days before a key procedure, and certain medications that interfere with the study may need to be stopped. It's best to discuss your specific medications with the trial's principal investigator.

What data supports the effectiveness of the TriPRIL CAR T Cell treatment for multiple myeloma?

Research shows that CAR T-cell therapies targeting multiple antigens, like BCMA and CS1, can effectively attack multiple myeloma cells and improve survival in animal models. This suggests that targeting multiple antigens may enhance the treatment's effectiveness and reduce the chance of relapse. ^{1 2 3 4 5}

What safety data exists for TriPRIL CAR T Cell Therapy for Multiple Myeloma?

TriPRIL CAR T Cell Therapy, like other CAR T cell therapies, can cause side effects such as cytokine release syndrome (a severe immune reaction) and neurotoxicity (nerve damage). These side effects require careful management, and strategies like premedication and monitoring are recommended to reduce risks. ^{6 7 8 9 10}

How is the TriPRIL CAR T Cell treatment different from other treatments for multiple myeloma?

TriPRIL CAR T Cell treatment is unique because it uses a trimeric APRIL-based design to target two antigens, BCMA and TACI, on multiple myeloma cells, which helps prevent the cancer from escaping treatment by losing BCMA. This dual-targeting approach is different from traditional CAR T therapies that focus only on BCMA, making it potentially more effective in preventing relapses. ^{2 11 12 13 14}

Research Team

Matthew Frigault, MD

Principal Investigator

Massachusetts General Hospital

Eligibility Criteria

This trial is for adults over 18 with relapsed or refractory multiple myeloma who have tried at least three prior treatments, including specific inhibitors and antibodies. They must be in relatively good health (ECOG 0-2), not pregnant, willing to use birth control, and able to consent. People with certain heart conditions, active infections, recent other cancer treatments or stem cell transplants can't join.

Inclusion Criteria

I am 18 years old or older.

I am able to care for myself and perform daily activities.

My organs and bone marrow are working well.

Exclusion Criteria

I have recovered from previous cancer treatment side effects, except for hair loss or mild nerve issues.

I had a stem cell transplant using my own cells within the last 3 months.

My cancer has spread to my brain or spinal cord.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Leukapheresis

White blood cells are collected from participants

1 day

1 visit (in-person)

Lymphodepletion

Participants receive 3 days of chemotherapy to decrease the number of lymphocytes

1 week

3 visits (in-person)

Treatment

Participants receive one infusion of TriPRIL CAR T Cells

1 day

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

24 months

Every 3 months

Treatment Details

Interventions

• Cyclophosphamide (Alkylating agents)
• Fludarabine (Anti-metabolites)
• TriPRIL CAR T Cells (CAR T-cell Therapy)

Trial Overview The study tests TriPRIL CAR T Cells designed to treat multiple myeloma that's come back or hasn't responded to treatment. Participants also receive Fludarabine and Cyclophosphamide chemotherapy drugs as part of the process before getting the new therapy.

Participant Groups

Group I: TriPRIL CAR T Cells-Dose Expansion Experimental Treatment 3 Interventions

Prior to receiving TriPRIL CAR T Cells, participants will undergo two preparatory processes: * Leukapheresis: On day -8 white blood cells will be collected. * Lymphodepletion: On days, -5, -4. -3 participants will receive 3 days of chemotherapy to decrease the number of lymphocytes TriPRIL CAR T Cells will be administered intravenously on day 0 using the respective dose (at or below the Maximum Tolerated Dose-MTD), as determined during the dose escalation part.

Group II: TriPRIL CAR T Cells-Dose Escalation Experimental Treatment 3 Interventions

Prior to receiving TriPRIL CAR T Cells, participants will undergo two preparatory processes: * Leukapheresis: On day -8 white blood cells will be collected. * Lymphodepletion: On days, -5, -4. -3 participants will receive 3 days of chemotherapy to decrease the number of lymphocytes TriPRIL CAR T Cells will be administered intravenously on day 0 using a 3+3 dose escalation design

Who Is Running the Clinical Trial?

Marcela V. Maus, M.D.,Ph.D.

Lead Sponsor

Trials

6

Recruited

110+

Findings from Research

CAR T-cell therapy, specifically BCMA-directed products like idecabtagene vicleucel and ciltacabtagene autoleucel, has been FDA-approved for treating relapsed/refractory multiple myeloma, showing high response rates in patients who have undergone extensive prior treatments.

Despite their effectiveness, these therapies are associated with significant immune-related side effects and relapse rates, highlighting the need for ongoing research to enhance their efficacy and reduce toxicity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy for Multiple Myeloma: A Clinical Practice-Oriented Review. Sadek, NL., Costa, BA., Nath, K., et al.[2023]

CAR T-cell therapy targeting both BCMA and GPRC5D in multiple myeloma shows promise in preventing relapse due to antigen escape, which is a common issue with single-target therapies.

Among different dual-targeting strategies tested, the bicistronic CAR design, which expresses two CARs from a single vector, demonstrated the highest efficacy in combating BCMA-negative disease, enhancing the interaction between CAR T-cells and target cells.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Defining an Optimal Dual-Targeted CAR T-cell Therapy Approach Simultaneously Targeting BCMA and GPRC5D to Prevent BCMA Escape-Driven Relapse in Multiple Myeloma. Fernández de Larrea, C., Staehr, M., Lopez, AV., et al.[2022]

The study introduces a novel CAR T-cell design that targets two different antigens, BCMA and CS1, on multiple myeloma cells, showing consistent and potent anti-tumor activity in mouse models.

This dual-targeting approach resulted in superior survival rates in treated mice compared to traditional CAR T-cells that only target a single antigen, suggesting it could help overcome the issue of relapse due to antigen loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A compound chimeric antigen receptor strategy for targeting multiple myeloma. Chen, KH., Wada, M., Pinz, KG., et al.[2019]

Multiple myeloma remains an incurable disease, and patients often experience relapses after standard treatments, leading to a poor prognosis.

Chimeric antigen receptor (CAR) T-cell therapy shows promise in improving outcomes for relapsed multiple myeloma, although it is not yet approved for this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chimeric Antigen Receptor T Cells for Multiple Myeloma: The Journey So Far-And the Road Ahead. Cowan, AJ., Tuazon, SA., Portuguese, AJ., et al.[2022]

Multiple myeloma often relapses after initial treatment, necessitating new strategies for managing cases that are triple-refractory, meaning they do not respond to three major classes of therapies.

Recent advancements in treating triple-class refractory myeloma include promising options like bispecific antibodies, T cell engagers, and chimeric antigen receptor (CAR) therapies, which offer novel mechanisms to combat this challenging disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Management of Triple-Class Refractory Multiple Myeloma: A Review of Current Strategies and Emerging Therapies. Stalker, ME., Mark, TM.[2022]

Monoclonal antibodies like elotuzumab and daratumumab have advanced the treatment of multiple myeloma, while CAR T cell therapy is emerging as a promising option for patients with relapsed/refractory multiple myeloma, offering hope for those with limited treatment options.

Despite its potential efficacy, CAR T cell therapy can lead to severe adverse events and toxic deaths, highlighting the need for better understanding and management strategies for these toxicities in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toxicities of Chimeric Antigen Receptor T Cell Therapy in Multiple Myeloma: An Overview of Experience From Clinical Trials, Pathophysiology, and Management Strategies. Zhou, X., Rasche, L., Kortüm, KM., et al.[2021]

CAR T-cell therapy targeting B-cell maturation antigen (BCMA) has shown promising results in treating multiple myeloma, with high-quality responses observed in heavily pretreated patients, and ongoing Phase 3 trials are comparing its efficacy against standard treatments.

While CAR T-cell therapy can lead to sustained responses in some patients, most eventually relapse due to factors like loss of CAR T cells or antigen expression, prompting research into improving CAR design and safety measures, such as suicide gene systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR T-cell therapy for multiple myeloma: state of the art and prospects. van de Donk, NWCJ., Usmani, SZ., Yong, K.[2021]

Two CAR T-cell therapies targeting BCMA have been approved for treating relapsed and refractory multiple myeloma, showing excellent efficacy even in patients who have undergone extensive prior treatments.

While these therapies represent a significant advancement in treatment, they are associated with unique adverse events like cytokine release syndrome (CRS) and neurotoxicity, which require specialized management and further research to optimize their use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

T-Cell-Based Cellular Immunotherapy of Multiple Myeloma: Current Developments. Simmons, GL., Castaneda Puglianini, O.[2022]

T-cell redirecting bispecific antibodies and CAR T cells are effective treatments for multiple myeloma but are associated with significant adverse events, including cytokine release syndrome and neurotoxicity.

The European Myeloma Network recommends specific management strategies for these adverse events, such as premedication, corticosteroids, and monitoring for symptoms, to improve patient safety and treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevention and management of adverse events during treatment with bispecific antibodies and CAR T cells in multiple myeloma: a consensus report of the European Myeloma Network. Ludwig, H., Terpos, E., van de Donk, N., et al.[2023]

CAR T cell therapy, particularly with the approval of tisagenlecleucel, has shown remarkable efficacy in treating pediatric and young adult patients with relapsed or refractory acute lymphocytic leukemia, with six therapies approved as of April 2023 for B-cell malignancies and multiple myeloma.

However, the therapy is associated with significant adverse events like cytokine release syndrome, which are more severe with higher pretreatment tumor burdens; thus, initiating therapy early or using a debulking strategy may help mitigate these risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

From bench to bedside: the history and progress of CAR T cell therapy. Mitra, A., Barua, A., Huang, L., et al.[2023]

A novel trimeric APRIL-based CAR T cell therapy shows promise in targeting both BCMA+ and BCMA- multiple myeloma (MM), potentially overcoming the issue of BCMA escape variants seen with traditional CAR T therapies.

The trimeric format enhances binding and T-cell activation compared to monomeric formats, suggesting that this dual-specific approach could improve treatment outcomes for patients with MM.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rational design of a trimeric APRIL-based CAR-binding domain enables efficient targeting of multiple myeloma. Schmidts, A., Ormhøj, M., Choi, BD., et al.[2021]

A newly developed trispecific antibody targeting CD38, CD3, and CD28 has shown promise in enhancing T cell activation and effectively directing T cells to myeloma cells, potentially improving responses to cancer immunotherapy.

In vivo studies in humanized mouse models demonstrated that this trispecific antibody suppressed myeloma growth and stimulated T cell proliferation in non-human primates, indicating its potential safety and efficacy at well-tolerated doses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trispecific antibodies enhance the therapeutic efficacy of tumor-directed T cells through T cell receptor co-stimulation. Wu, L., Seung, E., Xu, L., et al.[2022]

In a phase 1 study involving 57 patients with relapsed/refractory multiple myeloma, LCAR-B38M CAR T cell therapy showed an impressive overall response rate of 88%, with 68% of patients achieving a complete response.

While the therapy had a manageable safety profile, with common adverse events including leukopenia and cytokine release syndrome, it demonstrated durable responses with a median progression-free survival of 15 months.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase 1, open-label study of LCAR-B38M, a chimeric antigen receptor T cell therapy directed against B cell maturation antigen, in patients with relapsed or refractory multiple myeloma. Zhao, WH., Liu, J., Wang, BY., et al.[2020]

B-cell maturation antigen (BCMA) CAR T cells are emerging as a highly effective treatment for multiple myeloma, showing promise for inclusion in first-line therapy based on clinical and preclinical data.

Advancements in patient stratification through genomic analysis and improvements in CAR T-cell manufacturing are enhancing early diagnosis, management of side effects, and overall access to this innovative treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy in Multiple Myeloma: Mission Accomplished? Rasche, L., Hudecek, M., Einsele, H.[2023]

References

1. United States pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy for Multiple Myeloma: A Clinical Practice-Oriented Review. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Defining an Optimal Dual-Targeted CAR T-cell Therapy Approach Simultaneously Targeting BCMA and GPRC5D to Prevent BCMA Escape-Driven Relapse in Multiple Myeloma. [2022]

3. England pubmed.ncbi.nlm.nih.gov

A compound chimeric antigen receptor strategy for targeting multiple myeloma. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Chimeric Antigen Receptor T Cells for Multiple Myeloma: The Journey So Far-And the Road Ahead. [2022]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Clinical Management of Triple-Class Refractory Multiple Myeloma: A Review of Current Strategies and Emerging Therapies. [2022]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Toxicities of Chimeric Antigen Receptor T Cell Therapy in Multiple Myeloma: An Overview of Experience From Clinical Trials, Pathophysiology, and Management Strategies. [2021]

7. England pubmed.ncbi.nlm.nih.gov

CAR T-cell therapy for multiple myeloma: state of the art and prospects. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

T-Cell-Based Cellular Immunotherapy of Multiple Myeloma: Current Developments. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Prevention and management of adverse events during treatment with bispecific antibodies and CAR T cells in multiple myeloma: a consensus report of the European Myeloma Network. [2023]

10. Switzerland pubmed.ncbi.nlm.nih.gov

From bench to bedside: the history and progress of CAR T cell therapy. [2023]

11. United States pubmed.ncbi.nlm.nih.gov

Rational design of a trimeric APRIL-based CAR-binding domain enables efficient targeting of multiple myeloma. [2021]

12. England pubmed.ncbi.nlm.nih.gov

Trispecific antibodies enhance the therapeutic efficacy of tumor-directed T cells through T cell receptor co-stimulation. [2022]

13. England pubmed.ncbi.nlm.nih.gov

A phase 1, open-label study of LCAR-B38M, a chimeric antigen receptor T cell therapy directed against B cell maturation antigen, in patients with relapsed or refractory multiple myeloma. [2020]

14. United States pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy in Multiple Myeloma: Mission Accomplished? [2023]