CLIC-2201 treatment for relapsed B cell cancers

CLIC-02: A Phase I Trial of CLIC-2201 for the Treatment of Relapsed/Refractory B Cell Malignancies

This study is testing a new CAR-T cell therapy called CLIC-2201 to see if it can help people with relapsed B cell cancers feel better and improve their treatment outcomes.

Quick facts

• Phase: Phase 1
• Study type: Interventional
• Enrollment: 24 (estimated)
• Ages: 1 Year and up
• Sex: All
• Sponsor: British Columbia Cancer Agency (Academic / other)
• Drugs / interventions: ibrutinib, CAR-T, chemotherapy, methotrexate, cyclophosphamide, fludarabine, prednisone, chimeric antigen receptor, Immunotherapy
• Locations: 7 sites (Calgary, Alberta and 6 other locations)
• Trial ID: NCT06208735 on ClinicalTrials.gov

What this trial studies

This phase I trial evaluates the safety and tolerability of CLIC-2201, an autologous CAR-T cell therapy targeting CD22, in patients with relapsed or refractory B cell malignancies. Participants will undergo leukapheresis to collect T cells, which will be modified and expanded in a laboratory before being infused back into the patient after lymphodepleting chemotherapy. The trial aims to determine the maximum tolerated dose of CLIC-2201 and assess its anti-tumor activity and pharmacokinetics. Monitoring will continue for up to 365 days post-infusion to ensure participant safety.

Who should consider this trial

Good fit: Ideal candidates include adults and pediatric patients with relapsed or refractory B cell lymphomas, such as diffuse large B-cell lymphoma or high-grade B cell lymphoma.

Not a fit: Patients with non-B cell malignancies or those who are not relapsed or refractory may not benefit from this treatment.

Why it matters

Potential benefit: If successful, this treatment could provide a new therapeutic option for patients with difficult-to-treat B cell malignancies.

How similar studies have performed: Other studies using CAR-T cell therapies have shown promising results, indicating potential for success with this novel approach.

Eligibility criteria

Inclusion Criteria in Cohort A:

Participants must meet the following criteria to be enrolled on the trial:

1. Participants in the cohort A must be 18 years of age or older of age at time of informed consent.
2. Participants must provide written informed consent.
3. Participants must have a relapsed or refractory B cell lymphoma, including one of the following:

   1. diffuse large B-cell lymphoma (DLBCL) not otherwise specified (NOS),
   2. high grade B cell lymphoma NOS,
   3. high grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements,
   4. primary mediastinal large B-cell lymphoma (PMBCL),
   5. aggressive B cell lymphoma transformed from an indolent lymphoma,
   6. mantle cell lymphoma (MCL),
4. Participants must have refractory or relapsed disease, defined as one of the following:

   1. Relapse or refractory disease after at least 2 lines of therapy, OR
   2. Any relapse after autologous or allogeneic hematopoietic cell transplantation (HCT), OR
   3. Any relapse after CAR-T cell therapy.
5. Participants must have adequate organ function at enrolment, defined as:

   1. Left ventricular ejection fraction (LVEF) ≥40%,
   2. Creatinine clearance using Cockcroft-Gault of \> 30 mL/min, AND
   3. ALP/ALT \< 5X upper limit of normal (ULN), conjugated bilirubin \< 2X ULN, and no evidence or history of liver cirrhosis.
6. Participants must have Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2 or Karnofsky Score ≥50%.
7. Females of child-bearing potential and sexually active males must agree to use a highly effective contraception method (see section 5.4) through to at least one year following administration of the CLIC-2201 product.
8. Participants with accessible disease, must be willing to undergo a tumour biopsy at enrolment. For participants with a recent (within 3 months) tumor biopsy, access to the archival biopsy is acceptable.

Inclusion Criteria in Cohort B:

1. Participants in the cohort B must be between 1-39 years of age at the time of consent.
2. For participants who are under the age of consent as defined by REB requirements, parent or legal guardian of the participant must provide the informed consent and the participant's assent/consent must be obtained (if applicable).
3. Participants must have a relapsed or refractory B cell acute lymphoblastic leukemia (B-ALL).
4. Participants must have refractory or relapsed disease, defined as one of the following:

   1. Relapse or refractory disease after at least 2 lines of therapy, OR
   2. Any relapse after autologous or allogeneic hematopoietic cell transplantation (HCT), OR
   3. Any relapse after CAR-T cell therapy.
5. Participants in cohort B and/or those who have received CD22 targeted therapy must have documentation of CD22 tumour expression within the 6 months prior to study screening, and after any prior CD22 directed therapy (if applicable).
6. Participants must have adequate organ function at enrolment, defined as:

   1. Left ventricular ejection fraction (LVEF) ≥45%,
   2. Creatinine clearance using Cockcroft-Gault or Schwartz equation of \> 30 mL/min, AND
   3. ALP/ALT \< 5X upper limit of normal (ULN), conjugated bilirubin \< 2X ULN, and no evidence or history of liver cirrhosis.
7. Participants must have a Karnofsky or Lansky Score ≥50%.
8. Participants of reproductive age must agree to use a highly effective contraception method (see section 5.4) through to at least one year following administration of the CLIC-2201 product.
9. Participants must be willing to undergo a bone marrow biopsy at enrolment.

Exclusion Criteria:

1. Any uncontrolled or serious active infection at the time of enrolment.
2. Active autoimmune disease requiring immunosuppressive therapy within 4 weeks of enrolment.
3. Live vaccine ≤6 weeks prior to enrolment
4. Active Graft Versus Host Disease (GVHD) requiring systemic immunosuppressive therapy within 4 weeks of enrolment.
5. Diagnosis of primary central nervous system lymphoma (PCNSL)
6. Treatment with any of the following in the specified time period before leukapheresis:

   1. Allogeneic HCT within 3 months,
   2. Autologous HCT within 3 months,
   3. CD19 CAR-T cell infusion within 3 months,
   4. Donor lymphocyte infusion (DLI) within 3 months,
   5. Bendamustine within the last 6 months,
   6. Any investigational agent within 30 days or 5 half-lives (whichever is shorter),
   7. Systemic administration of therapeutic dose corticosteroids (\>20 mg/day prednisone or equivalent for adults and ≥ 12 mg/m2/day for paediatric participants) within 7 days prior to leukapheresis.
   8. Immunosuppressive therapies (i.e., calcineurin inhibitors, methotrexate, mycophenolate, rapamycin) within 4 weeks, unless used as treatment for the B cell malignancy.
   9. Oral chemotherapy agents (i.e., venetoclax) within 5 half-lives. An exception to this is that bruton tyrosine kinase (BTK) inhibitors like ibrutinib can be continued in participants with mantle cell lymphoma throughout the trial period.
7. Other concurrent malignancy or a prior malignancy treated within the past 2 years, except carcinoma in situ of the skin or cervix treated with curative intent and with no evidence of active disease.
8. Concomitant genetic syndrome associated with bone marrow failure such as Fanconi anemia, Kostmann syndrome, Shwachman syndrome or any other known bone marrow failure or immunodeficiency syndrome.
9. Active (confirmed by PCR) hepatitis B or hepatitis C at time of screening confirmed by PCR.
10. Any Human Immunodeficiency Virus (HIV) infection at time of screening.
11. Hypersensitivity to fludarabine or cyclophosphamide.
12. Any allergy to gentamycin or its derivatives
13. Participants who do not meet the minimum weight requirement for the planned dose level.
14. Pregnant or nursing participants.

Where this trial is running

Calgary, Alberta and 6 other locations

• Arthur J.E. Child Comprehensive Cancer Centre — Calgary, Alberta, Canada (Recruiting)
• Alberta Children's Hospital — Calgary, Alberta, Canada (Recruiting)
• Vancouver General Hospital — Vancouver, British Columbia, Canada (Recruiting)
• BC Children's Hospital — Vancouver, British Columbia, Canada (Recruiting)
• The Ottawa Hospital - General Campus — Ottawa, Ontario, Canada (Recruiting)
• Princess Margaret Cancer Centre — Toronto, Ontario, Canada (Recruiting)
• The Hospital for Sick Children — Toronto, Ontario, Canada (Recruiting)

Study contacts

• Principal investigator: Kevin Hay, MD — BC Cancer
• Study coordinator: Kevin Hay, MD

Conditions B-Cell Leukemia; Non-Hodgkin's Lymphoma; B-cell Acute Lymphoblastic Leukemia; Diffuse Large B Cell Lymphoma; High-grade B-cell Lymphoma; Primary Mediastinal Large B-cell Lymphoma; Mantle Cell Lymphoma; B-cell Lymphoma