CRG-022 for Large B-Cell Lymphoma

(FIRCE-1 Trial)

Recruiting in Palo Alto (17 mi)

+31 other locations

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Waitlist Available

Sponsor: CARGO Therapeutics

No Placebo Group

Prior Safety Data

Trial Summary

What is the purpose of this trial?

This is a prospective, open-label, multi-center clinical study designed to evaluate the safety, tolerability, efficacy, pharmacokinetics, pharmacodynamics, and immunogenicity of firicabtagene autoleucel (firi-cel), a CD22-directed autologous Chimeric Antigen Receptor (CAR) T-cell therapy for the treatment of relapsed or refractory large B-cell lymphoma (LBCL).

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify if you need to stop taking your current medications. Please consult with the trial coordinators for more details.

What data supports the idea that CRG-022 for Large B-Cell Lymphoma is an effective treatment?

The available research does not provide specific data on CRG-022 for Large B-Cell Lymphoma. However, it mentions other treatments like axicabtagene ciloleucel, which have shown effectiveness in treating this condition. These treatments have been approved by the U.S. FDA and have demonstrated high response rates in patients who did not respond to traditional treatments. This suggests that similar therapies, like CRG-022, could potentially be effective as well. ^{1 2 3 4 5}

What safety data exists for CRG-022 (firicabtagene autoleucel) in treating large B-cell lymphoma?

The provided research does not mention CRG-022, firicabtagene autoleucel, or firi-cel specifically. It focuses on other CAR-T cell therapies like axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel. These studies highlight safety concerns such as cytokine release syndrome (CRS) and neurologic events, which are common in CAR-T cell therapies. For axicabtagene ciloleucel, grade ≥3 CRS and neurologic events occurred in 8% and 23% of patients, respectively, with no treatment-related grade 5 events. Hematotoxicity is also noted as a frequent adverse event in CAR-T therapies. However, specific safety data for CRG-022 is not available in the provided research. ^{1 3 6 7 8}

Is the treatment CRG-022 a promising treatment for Large B-Cell Lymphoma?

The information provided does not include specific details about CRG-022 or its effectiveness for Large B-Cell Lymphoma. Therefore, we cannot determine if CRG-022 is a promising treatment based on the given data. ^{2 6 9 10 11}

Research Team

Eligibility Criteria

This trial is for adults over 18 with Large B-cell Lymphoma that's come back or hasn't responded to treatment. They must have a certain level of neutrophils, a type of white blood cell, and be well enough for daily activities (ECOG status 0-1). Some need to have tried specific previous therapies like CD19-directed CAR T-cell therapy or bispecific T-cell engaging antibodies.

Inclusion Criteria

My blood, kidney, and liver tests are within normal ranges.

I am fully active or restricted in physically strenuous activity but can do light work.

I am 18 years old or older.

Exclusion Criteria

I am currently on antibiotics for an infection.

I have had a stem cell transplant from a donor.

Clinically significant concurrent medical illness

Treatment Details

Interventions

• CRG-022 (CAR T-cell Therapy)

Trial Overview The study tests CRG-022, an experimental CAR T-cell therapy targeting CD22 in the body. It's given alongside Fludarabine and Cyclophosphamide Monohydrate as conditional treatments. The goal is to see how safe it is, how the body reacts to it, and if it works against relapsed/refractory large B-cell lymphoma.

Participant Groups

Group I: Experimental Drug (Cohort 3) Experimental Treatment 3 Interventions

Patients with relapsed or refractory Large B-cell lymphoma who have previously been treated with bispecific T-cell engaging antibody therapy will receive a single infusion of firi-cel following conditioning chemotherapy.

Group II: Experimental Drug (Cohort 2: non-conforming product) Experimental Treatment 3 Interventions

Single infusion of firi-cel following conditioning chemotherapy (patients in this cohort will receive non-conforming firi-cel that is deemed safe to administer).

Group III: Experimental Drug (Cohort 1) Experimental Treatment 3 Interventions

Single infusion of firi-cel following conditioning chemotherapy

Who Is Running the Clinical Trial?

CARGO Therapeutics

Lead Sponsor

Trials

1

Recruited

100+

Findings from Research

The three CAR-T cell therapies (axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel) show promising efficacy in treating large B cell lymphoma, with overall response rates of nearly 70% and complete response rates exceeding 50% across 33 studies involving 2,172 patients.

However, axicabtagene ciloleucel and tisagenlecleucel are associated with significant risks of severe neurotoxicity and life-threatening cytokine release syndrome, necessitating careful monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of CAR-T Cell Products Axicabtagene Ciloleucel, Tisagenlecleucel, and Lisocabtagene Maraleucel for the Treatment of Hematologic Malignancies: A Systematic Review and Meta-Analysis. Meng, J., Wu, X., Sun, Z., et al.[2022]

In a phase 2 trial involving 111 patients with refractory large B-cell lymphoma, axicabtagene ciloleucel (axi-cel) demonstrated a high objective response rate of 82%, with 54% achieving a complete response, indicating its efficacy as a treatment option.

The treatment was associated with significant adverse events, including neutropenia in 78% of patients and neurologic events in 28%, highlighting the need for careful monitoring of safety during therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma. Neelapu, SS., Locke, FL., Bartlett, NL., et al.[2023]

Axicabtagene ciloleucel (axi-cel) demonstrated impressive efficacy in treating relapsed/refractory large B-cell lymphoma, with overall and complete response rates of 83% and 58%, respectively, in the pivotal ZUMA-1 trial with a median follow-up of 27.1 months.

While axi-cel shows promise, it is associated with significant toxicities, including cytokine release syndrome (CRS) in 7% to 14% of patients and immune effector cell-associated neurotoxicity syndrome (ICANS) in 31% to 55%, highlighting the need for careful patient management and monitoring.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Axicabtagene Ciloleucel: Clinical Data for the Use of CAR T-cell Therapy in Relapsed and Refractory Large B-cell Lymphoma. Halford, Z., Anderson, MK., Bennett, LL.[2021]

In a study of 352 adult patients with aggressive large B-cell lymphoma treated with CAR T-cell therapy, 74.4% developed cytokine release syndrome (CRS), but this did not significantly affect their progression-free or overall survival rates compared to those who did not develop CRS.

High peak ferritin levels (>5000 ng/mL) and elevated lactate dehydrogenase levels before treatment were associated with worse survival outcomes, indicating that these factors may be more critical for predicting patient prognosis than the occurrence of CRS itself.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chimeric antigen receptor T-cell therapy yields similar outcomes in patients with and without cytokine release syndrome. Bhaskar, ST., Patel, VG., Porter, DL., et al.[2023]

In a study of 258 patients receiving CAR T-cell therapy for large B-cell lymphoma, 72% experienced severe neutropenia, with a median duration of 9 days, highlighting the significant risk of hematotoxicity associated with this treatment.

The CAR-HEMATOTOX model was developed to predict the duration of severe neutropenia based on baseline markers like platelet count and inflammation, showing high accuracy (AUC 0.89) and helping to identify patients at greater risk for prolonged cytopenia, which can guide management strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR-HEMATOTOX: a model for CAR T-cell-related hematologic toxicity in relapsed/refractory large B-cell lymphoma. Rejeski, K., Perez, A., Sesques, P., et al.[2022]

In the RELIANCE study involving 68 patients with heavily pre-treated relapsed/refractory large B-cell lymphoma, relmacabtagene autoleucel (relma-cel) showed a high objective response rate of 77.59% and a complete response rate of 53.45% after a median follow-up of 17.9 months.

The treatment demonstrated a manageable safety profile, with only 5.1% of patients experiencing severe cytokine release syndrome and 3.4% experiencing severe neurotoxicity, indicating that relma-cel is both effective and relatively safe for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term outcomes of relmacabtagene autoleucel in Chinese patients with relapsed/refractory large B-cell lymphoma: Updated results of the RELIANCE study. Ying, Z., Yang, H., Guo, Y., et al.[2023]

In a phase 2 trial involving 61 patients with relapsed or refractory large B-cell lymphoma, lisocabtagene maraleucel demonstrated a high overall response rate of 80%, indicating its efficacy as a second-line treatment for patients not intended for stem-cell transplantation.

The treatment was generally safe, with no treatment-related deaths reported; however, common serious side effects included neutropenia and cytokine release syndrome, which occurred in 38% of patients, highlighting the need for monitoring during treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Lisocabtagene maraleucel as second-line therapy in adults with relapsed or refractory large B-cell lymphoma who were not intended for haematopoietic stem cell transplantation (PILOT): an open-label, phase 2 study. Sehgal, A., Hoda, D., Riedell, PA., et al.[2022]

Brexucabtagene autoleucel (KTE-X19) CAR T-cell therapy showed a remarkable 91% objective response rate and 68% complete response rate in 68 patients with relapsed/refractory mantle cell lymphoma after a median follow-up of 35.6 months, indicating its efficacy in this challenging patient population.

The therapy demonstrated durable long-term responses with manageable safety, as late-onset toxicities were infrequent, occurring in only 3% of patients, suggesting that KTE-X19 is a safe and effective treatment option even for those with high-risk characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Three-Year Follow-Up of KTE-X19 in Patients With Relapsed/Refractory Mantle Cell Lymphoma, Including High-Risk Subgroups, in the ZUMA-2 Study. Wang, M., Munoz, J., Goy, A., et al.[2023]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Efficacy and Safety of CAR-T Cell Products Axicabtagene Ciloleucel, Tisagenlecleucel, and Lisocabtagene Maraleucel for the Treatment of Hematologic Malignancies: A Systematic Review and Meta-Analysis. [2022]

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

Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma. [2023]

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

Axicabtagene Ciloleucel: Clinical Data for the Use of CAR T-cell Therapy in Relapsed and Refractory Large B-cell Lymphoma. [2021]

4. England pubmed.ncbi.nlm.nih.gov

A 24-month updated analysis of the comparative effectiveness of ZUMA-5 (axi-cel) vs. SCHOLAR-5 external control in relapsed/refractory follicular lymphoma. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Axicabtagene ciloleucel and brexucabtagene autoleucel in relapsed and refractory diffuse large B-cell and mantle cell lymphomas. [2021]

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

Axicabtagene ciloleucel as first-line therapy in high-risk large B-cell lymphoma: the phase 2 ZUMA-12 trial. [2023]

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

Chimeric antigen receptor T-cell therapy yields similar outcomes in patients with and without cytokine release syndrome. [2023]

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

CAR-HEMATOTOX: a model for CAR T-cell-related hematologic toxicity in relapsed/refractory large B-cell lymphoma. [2022]

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

Long-term outcomes of relmacabtagene autoleucel in Chinese patients with relapsed/refractory large B-cell lymphoma: Updated results of the RELIANCE study. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Lisocabtagene maraleucel as second-line therapy in adults with relapsed or refractory large B-cell lymphoma who were not intended for haematopoietic stem cell transplantation (PILOT): an open-label, phase 2 study. [2022]

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

Three-Year Follow-Up of KTE-X19 in Patients With Relapsed/Refractory Mantle Cell Lymphoma, Including High-Risk Subgroups, in the ZUMA-2 Study. [2023]