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This study is an open, single infusion, cell infusion dose /method exploration study. In patients with gastric cancer and gastroesophageal cancer without effective treatment, the safety of UCB-NK cell immunotherapy was evaluated and the preliminary curative effect results were obtained.
1 Experimental design This study is an open, single infusion, cell infusion dose /method exploration study.
1.1 Screening period (28 days) Screening visit completed within 28 days before the start of the study. The following study process must be completed during screening visits to ensure patient compliance with this study (If the subjects are enrolled, the data collected during the screening period will be taken as the baseline data).
10.Cardiac color doppler ultrasound; 11.Laboratory examination (blood routine, blood biochemistry, urine routine, clotting, pregnancy test [women of childbearing age only], infectious diseases); 12.Imaging examination (CT or MRI, enhanced scanning is recommended, MRI is used in patients who are allergic to enhancers); 13.Check inclusion / exclusion criteria; 14.Record adverse events and concomitant medication; 15.Immunogenicity detection; 16.Biomarker detection.
* If these tests have been performed within 28 days prior to the first application, they need not be repeated unless the investigator believes that the patient's tumor load has changed / or the condition requires.
1.2 Pretreatment period (Day - 8 to day - 7)
1.3 Cell infusion stage
4.ECOG scores; 5.Laboratory examination (blood routine, blood biochemistry, urine routine, clotting, pregnancy test [women of childbearing age only], infectious diseases); 6.Imaging examination; 7.Immunogenicity detection; 8.Biomarker detection; 9.Pharmacokinetic blood collection; 10.Administration; 11. Record adverse events and concomitant medication.
1.4 In hospital observation period
1.5 Follow-up (safety and preliminary effectiveness assessment)
After infusion, patients need to return to the hospital for regular examination at the 1st, 2nd, 3rd, 4th, 6th and 12th month (± 7 days), after 12 months, return to hospital for regular inspection every 6 months (±1 month):
1.Record vital signs; 2.Physical examination; 3.12-lead electrocardiogram examination; 4.ECOG scores; 5.Laboratory examination (blood routine, blood biochemistry, urine routine, clotting, pregnancy test [women of childbearing age only], infectious diseases); 6.Imaging examination; 7.Gastroscopy examination (Determine if it is necessary by researchers); 8.Immunogenicity detection; 9.Biomarker detection; 10.Pharmacokinetic blood collection; 11.Record adverse events and concomitant medication.
1.6 Group visit (within 7 days after determination) Regardless of the reasons for the determination of the group, the group visit shall be conducted within 7 days after the determination of the group, and the specific time of the group examination shall be determined by the researcher according to the specific time.
4.ECOG scores; 5.Laboratory examination (blood routine, blood biochemistry, urine routine, clotting, pregnancy test [women of childbearing age only], infectious diseases); 6.Imaging examination; 7.Gastroscopy examination (Determine if it is necessary by researchers); 8.Immunogenicity detection; 9.Biomarker detection; 10.Pharmacokinetic blood collection; 11.Record adverse events and concomitant medication.
2 Research evaluation
2.1 Efficacy endpoint
2.1.1Primary efficacy endpoint
2.1.2 Secondary efficacy endpoint
3 Management of adverse events
3.1 Record
At each visit, all observed or subject mentioned adverse events were accurately recorded by the investigator in the original document and recorded in the "adverse events" page of ECRF. The records include:
The researcher shall take corresponding measures according to the adverse events to ensure the safety of the subjects; the institution shall ensure the supply of relevant rescue equipment and drugs to ensure that the corresponding rescue can be given in case of emergency.
4 Statistics
4.1Sample size and calculation basis 18-21 cases of advanced gastric cancer and gastroesophageal cancer is planned to be selected.
Calculation basis: see study design for details.
4.2 Statistical analysis population Full analysis set (FAS): According to the basic principle of intent to analyze (ITT), all subjects who have received at least one trial drug after randomization, excluding those without all data.
Per Protocol Set (PPS): On the basis of FAS set, subjects who met the inclusion and exclusion criteria, completed the administration, and completed the evaluation of main efficacy indicators, had good compliance and did not seriously violate the clinical trial scheme.
Safey Set (SS): All subjects who completed adjuvant chemotherapy after randomization. Safety data will be analyzed based on the actual treatment received.
In this experiment, the baseline data and validity analysis were analyzed by FAS. The main efficacy indicators were analyzed by PP at the same time, giving priority to FAS. Laboratory examination data, adverse events and adverse reactions data were analyzed by SS. The incidence of adverse reactions was calculated with SS as denominator.
5 Test management
5.1 Management and implementation of GCP
5.2 Supervision system The sponsor will send an inspector to supervise the test together with QA Department of clinical research institution to ensure that the test is carried out in accordance with the scheme and the data recorded in the case record form is the same as the original data. At the same time, the corresponding regulatory agencies may inspect the research center, research database and relevant research documents at their own discretion. The purpose of the audit and inspection is to systematically and independently inspect all research related processes and documents to determine whether the implementation of the clinical study complies with the trial protocol, GCP, declaration of Helsinki and relevant regulatory requirements. The researcher shall inform the sponsor immediately when he receives the inspection notice from the regulatory authority.
5.3 The problems in the research and the countermeasures
5.4 Clinical research data management
5.5 Data record and document retention The data of the subjects on the electronic case report form shall be recorded in code form, and the subjects can only be identified by the number of the subjects or their initials.
All information required by the test scheme must be provided, any omission needs to be justified.
The researcher must keep the original documents of each subject participating in the trial. All information on the electronic case report form must come from these original documents,which should contain all demographic and treatment information, including laboratory test data, ECG, etc., as well as the signed informed consent with test number and subject.
Basic documents must be retained by researchers for the time required by national or international regulations (usually 5 years after the end of clinical study or the final approval of marketing). The sponsor shall inform the research institution of the time when relevant test records are no longer needed.
6 Responsibilities and regulations The sponsor shall provide the researcher with the materials and research funds related to the experiment, such as the researcher's manual, and qualified test drugs and test materials (including: approval documents of drug clinical research, copies of business license, drug production license and GMP certificate of the sponsor, original or copy of drug inspection report). The sponsor and the researcher shall jointly formulate the test scheme, which shall be determined by both parties. According to the test scheme, the researcher conducted the test in accordance with the current national regulations.
The researcher shall keep all information provided by the sponsor strictly confidential, and also require other participants and ethics committee to take the same confidentiality measures. The information provided to the researcher shall not be disclosed to others without the written permission of the sponsor.
All data and results of the test shall be possessed jointly by the researcher and the sponsor. The researcher shall not publish on its own without the consent of the sponsor. Any article to be published shall be submitted to the sponsor before sending out. The sponsor will review its accuracy, confirm that the confidential information has not been disclosed and supplement relevant information.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dose-finding (Group A) | Experimental | In this study, the dose was explored according to the "3+3" mode, in which group A was divided into three dose groups: 1.5*10^9 group, 2*10^9 group and 3*10^9 group. If DLT occurs in one of the first three subjects in each dose group within four weeks after cell infusion, three subjects will continue to be included. If more than 1/6 cases of DLT appear in 6 subjects with 1.5*10^9 dose, the dose level and/or cell infusion frequency and method will be reduced after discussion between the investigator, the collaborator and DMC. If DLT did not occur in the first 3 subjects within 4 weeks after receiving 1.5*10^9 cell infusion,another three subjects were enrolled into the group received 2*10^9 cell infusion. DLT did not occur within 4 weeks after cell infusion, it will increase to 3*10^9 dose group. That is to say, the first three subjects were included for observation for 4 weeks in the 3*10^9 dose group, if DLT did not occur, there will be another 3 cases, reaching to 6 subjects. |
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| Extended research (Group B) | Experimental | If DLT≤1/6, the dose will not be increased. This dose will also be used as the treatment dose of group B. If DLT is more than 1/6 in the 3*10^9 dose group, three subjects will be added in 2*10^9 dose group. If DLT ≤1/6 in 4-week observation, the 2*10^9 will be the maximum tolerable dose, and will be used as the treatment dose of group B. The subjects in group A were enrolled first, after at least 4 weeks of observation for all subjects, six subjects will be included in group B. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cell infusion for Dose-finding (Group A) | Other | Group A:HLA-I and HLA-II molecular typing were performed at the serological and molecular levels, and the HLA-I and HLA-II molecular antigens of donor and subjects match on 3, 4, 5 or 6 / 6. After the successful matching, the non myeloablative immunosuppressive pretreatment with cyclophosphamide (900 mg / m^2 / day) and fludarabine (30 mg / m^2 / day) will be performed 6, 5, 4 and 3 days before the infusion of UCB-NK cells. After the pretreatment, the cell infusion was started on day 0, and the cell infusion could be divided into 50% and 50% for two consecutive days or every other day. To ensure clinical safety, if treatment-related adverse events reach DLT after the first infusion, the cell infusion will stop. |
| Measure | Description | Time Frame |
|---|---|---|
| Safety assessment | Evaluation of adverse events and severity according to CTCAE v5.0 | 4 weeks |
| Hematology toxicity | After 7 days of treatment, the ≥ 4 degree hematotoxicity (excluding lymphocyte reduction) related to UCB-NK treatment could not recover to ≤ 3 degree | 7 days |
| Non hematologic toxicity | Any non hematologic toxic reaction≥4 degree related to UCB-NK treatment cannot be reduced to≤3 degree within 3 days and no further improvement is found; Gastric mucosal injury including gastric hemorrhage≥3 degree related to UCB-NK treatment; Other non hematologic toxicity≥3 degree related to UCB-NK treatment lasted for more than 7 days. | 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| Tumor assessment | Imaging of the chest, abdomen and pelvis (either enhanced CT or MRI) and tumor markers should be obtained at baseline (before the pretreatment of first lymphocyte clearance), this imaging evaluation is the baseline examination of this study. After the infusion, patients need to return to the hospital at the 1st, 2nd, 3rd, 4th, 6th and 12th month (± 7 days) and every 6 months (± 1 month) after the 12th month to check the imaging of chest, abdomen and pelvis and tumor markers. Follow up to the disease progress, unwilling to be followed up, loss of follow-up, death or the end of the study, whichever occurs first. Imaging evaluation is up to the established disease progression (PD) according to the RECIST 1.1. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zhaoyong Yang, MD | Contact | 18513385316 | zhaoyongy@imb.pumc.edu.cn |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Changguo hospital of Zibo | Recruiting | Zibo | China |
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| Cell infusion for Extended research (Group B) | Other | Group B:Non myeloablative immunosuppressive pretreatment and cell transfusion were the same as group A. |
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| 4 years |