PCV13 + CAR T-Cell Therapy for Lymphoma

Overseen by Frederick Locke, MD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Waitlist Available

Sponsor: H. Lee Moffitt Cancer Center and Research Institute

Disqualifiers: Pregnancy, Immunodeficiency, Severe allergy, others

No Placebo Group

Prior Safety Data

Approved in 6 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial tests if a pneumonia vaccine given before and after a special cancer treatment can help patients with difficult-to-treat blood cancers.

Will I have to stop taking my current medications?

The trial protocol does not specify if you need to stop taking your current medications. However, if you are on intravenous immunoglobulin (IVIG), you must not have received it within one month of the planned apheresis for CAR T cell therapy.

What data supports the effectiveness of the treatment PCV13 + CAR T-Cell Therapy for Lymphoma?

Research shows that CD19-targeted CAR T-cell therapies, like axicabtagene ciloleucel and tisagenlecleucel, have significantly improved outcomes for patients with aggressive B-cell lymphomas, increasing cure rates from 10% to 40% and demonstrating durable responses in clinical trials. ^{1 2 3 4 5}

Is CAR T-cell therapy safe for humans?

CAR T-cell therapy, including treatments like tisagenlecleucel and axicabtagene ciloleucel, has been approved for certain types of lymphoma and leukemia, but it can cause significant side effects. Common side effects include cytokine release syndrome (a severe immune reaction) and neurological issues, which require careful management by trained medical teams. ^{1 4 6 7 8}

How does the PCV13 + CAR T-Cell Therapy for Lymphoma differ from other treatments?

This treatment is unique because it combines a vaccine (PCV13) with CAR T-cell therapy, which uses modified immune cells to target and destroy cancer cells. CAR T-cell therapy is particularly novel for its ability to induce long-lasting remissions in patients with aggressive lymphomas that do not respond to traditional chemotherapy. ^{1 3 4 6 9}

Research Team

Frederick Locke, MD

Principal Investigator

Moffitt Cancer Center

Eligibility Criteria

This trial is for adults over 18 with certain types of B-cell lymphoma who are in good health or have relapsed/refractory disease and are candidates for CD19-targeted CAR T cell therapy. They must be willing to use effective contraception if applicable, and cannot participate if they have severe allergies to vaccines, active infections, very low blood counts, recent IVIG treatment, or are pregnant.

Inclusion Criteria

I am willing and able to follow all study rules and be available for its duration.

For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation

I am over 18 years old.

Exclusion Criteria

I do not have any active or uncontrolled infections.

History of severe allergy (e.g., anaphylaxis) to any component of pneumococcal conjugate vaccine 7 valent (PCV7), PCV13, or any diphtheria-toxoid containing vaccine.

Patients with significant psychiatric illness likely to affect compliance, as determined by the treating physician

Treatment Details

Interventions

• CD19 targeted CAR T Cell Therapy (CAR T-cell Therapy)
• Pneumococcal conjugate vaccine (PCV13) (Cancer Vaccine)

Trial Overview The study tests whether the pneumococcal conjugate vaccine (PCV13) given before and after CD19-targeted CAR T cell therapy can improve immune response against pneumococcus in patients with specific types of B-cell lymphoma.

Participant Groups

Group I: Treatment Experimental Treatment 2 Interventions

Pneumococcal conjugate vaccine (PCV13) .5 ml will be administered intramuscularly three times: 7 days (range 4 to 21 days) before apheresis collection and on day +30 (range +21 to +37) and day +90 (range +75 to +115) after CAR T cell infusion.

CD19 targeted CAR T Cell Therapy is already approved in China for the following indications:

Approved in China as CD19-targeted CAR T-cell therapy for:

• B-cell acute lymphoblastic leukemia (B-ALL)

Who Is Running the Clinical Trial?

H. Lee Moffitt Cancer Center and Research Institute

Lead Sponsor

Trials

576

Recruited

145,000+

Patrick Hwu

H. Lee Moffitt Cancer Center and Research Institute

Chief Executive Officer since 2020

MD from The Medical College of Pennsylvania

Wade J. Sexton

H. Lee Moffitt Cancer Center and Research Institute

Chief Medical Officer

MD

Findings from Research

CD19-directed CAR T-cell therapy, particularly axicabtagene ciloleucel, is highly effective for treating relapsed/refractory large B-cell lymphoma, but it comes with significant risks of treatment-emergent toxicities such as cytokine release syndrome and neurotoxicity.

Understanding the safety profile and potential complications of CAR T-cell therapy is crucial for selecting appropriate patients and implementing preventative measures, which can enhance the overall safety and effectiveness of the treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety evaluation of axicabtagene ciloleucel for relapsed or refractory large B-cell lymphoma. Nath, K., Wudhikarn, K., Alarcon Tomas, A., et al.[2023]

CAR T-cell therapy targeting CD19 has significantly improved cure rates for relapsed or refractory aggressive B-cell lymphomas, increasing from 10% to 40% with the use of approved products like axicabtagene ciloleucel and tisagenlecleucel.

There is emerging evidence supporting the use of anti-CD19 CAR T-cell therapy in previously considered incurable conditions like indolent B-cell lymphomas and chronic lymphocytic leukemia, with ongoing trials exploring new treatment strategies and combinations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy for B-Cell non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia: Clinical Trials and Real-World Experiences. Vitale, C., Strati, P.[2023]

In the phase II JULIET trial, the CAR T-cell therapy tisagenlecleucel targeting CD19 demonstrated durable responses in patients with relapsed and refractory diffuse large B-cell lymphoma, with 32% achieving complete responses at 3 months.

The efficacy remained stable at 6 months, with 30% of patients still showing complete responses, indicating the potential long-term effectiveness of this therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Value in Using CAR T Cells for DLBCL. [2019]

Two CAR T cell therapies, Tisagenlecleucel and Axicabtagene ciloleucel, have been approved for treating specific types of blood cancers, including B-cell acute lymphoblastic leukemia and large B-cell lymphoma, in patients who have not responded to other treatments.

This review emphasizes the importance of recognizing and managing the toxicities associated with CAR T cell therapies, while also suggesting future strategies to reduce these side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

CAR T Cell Toxicity: Current Management and Future Directions. Yáñez, L., Sánchez-Escamilla, M., Perales, MA.[2020]

Anti-CD19-directed CAR T cell therapy has shown significant efficacy in treating relapsed or refractory B-cell malignancies, leading to the approval of tisagenlecleucel (Kymriah) for B-ALL in 2018 and for aggressive B-cell lymphoma shortly thereafter.

The review highlights ongoing research into resistance mechanisms and the exploration of new target antigens, indicating a continued effort to improve treatment outcomes for patients with CD19 positive B-cell lymphomas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[CAR T-cell therapy for malignant B-cell lymphoma : A new treatment paradigm]. Balke-Want, H., Borchmann, P.[2021]

Axicabtagene ciloleucel and tisagenlecleucel are FDA-approved CAR T cell therapies specifically designed to target CD19 in patients with relapsed or refractory aggressive B cell non-Hodgkin lymphoma, marking a significant advancement in cellular immunotherapy.

Despite their transformative potential, there are ongoing concerns about the appropriate use and potential short- and long-term toxicities of these therapies, prompting expert consensus to guide clinicians in their application.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of Chimeric Antigen Receptor T Cell Therapy in Clinical Practice for Relapsed/Refractory Aggressive B Cell Non-Hodgkin Lymphoma: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. Jain, T., Bar, M., Kansagra, AJ., et al.[2020]

Tisagenlecleucel, an anti-CD19 CAR-T cell therapy, has been approved for treating pediatric and young adult patients with relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL), showing significant long-term effectiveness and overall survival benefits.

While CAR-T cell therapy can lead to serious adverse events like cytokine release syndrome and neurological toxicities, these effects are manageable with proper medical training and protocols, highlighting the importance of specialized care in administering this innovative treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chimeric Antigen Receptor-T Cell Therapy: Practical Considerations for Implementation in Europe. Buechner, J., Kersten, MJ., Fuchs, M., et al.[2020]

CD19 CAR T cells can lead to long-lasting remissions in patients with relapsed or refractory B-cell malignancies, but they come with unique toxicities that require specialized management.

Currently approved CAR T cell therapies, such as Tisagenlecleucel and Axicabtagene ciloleucel, are effective but necessitate careful monitoring for side effects like cytokine release syndrome and neurotoxicity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Practical aspects of the application of CAR T cells and management of their toxicities]. Bücklein, V., Blumenberg, V., Subklewe, M.[2021]

Anti-CD19 CAR T-cell therapy has shown remarkable efficacy in treating relapsed or refractory aggressive B-cell lymphomas, leading to durable remissions in patients who previously had no effective treatment options.

Three CAR T-cell therapies (axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel) are approved for use, each differing in their design, manufacturing processes, and safety profiles, highlighting the need for personalized approaches in cancer treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Anti-CD19 CAR T-Cell Therapy for B-Cell Non-Hodgkin Lymphoma. Abramson, JS.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Safety evaluation of axicabtagene ciloleucel for relapsed or refractory large B-cell lymphoma. [2023]

2. Switzerland pubmed.ncbi.nlm.nih.gov

CAR T-Cell Therapy for B-Cell non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia: Clinical Trials and Real-World Experiences. [2023]

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

Value in Using CAR T Cells for DLBCL. [2019]

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

CAR T Cell Toxicity: Current Management and Future Directions. [2020]

5. Germany pubmed.ncbi.nlm.nih.gov

[CAR T-cell therapy for malignant B-cell lymphoma : A new treatment paradigm]. [2021]

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

Use of Chimeric Antigen Receptor T Cell Therapy in Clinical Practice for Relapsed/Refractory Aggressive B Cell Non-Hodgkin Lymphoma: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy. [2020]

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

Chimeric Antigen Receptor-T Cell Therapy: Practical Considerations for Implementation in Europe. [2020]

8. Germany pubmed.ncbi.nlm.nih.gov

[Practical aspects of the application of CAR T cells and management of their toxicities]. [2021]

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

Anti-CD19 CAR T-Cell Therapy for B-Cell Non-Hodgkin Lymphoma. [2021]