Remdesivir for RSV in immunocompromised adults

An Open-Label Study to Assess the Safety and Efficacy of Remdesivir for Treatment of Symptomatic Laboratory-Confirmed Respiratory Syncytial Virus Infection of the Upper Respiratory Tract in Patients Receiving Cellular or Bispecific Antibody Therapies

This trial tests whether a short course of intravenous remdesivir can help adults whose immune systems are weakened by cellular or bispecific antibody therapies recover from upper respiratory RSV infection.

Quick facts

• Phase: Phase 2
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Fred Hutchinson Cancer Center (Academic / other)
• Drugs / interventions: Chimeric antigen receptor
• Locations: 3 sites (Duarte, California and 2 other locations)
• Trial ID: NCT06817889 on ClinicalTrials.gov

What this trial studies

This phase II trial enrolls adults with PCR-confirmed symptomatic upper respiratory RSV who are immunocompromised because of cellular or bispecific antibody therapies and gives intravenous remdesivir daily for five days, with an option to extend to ten days at the investigator's discretion. Participants undergo serial nasal swabs and blood draws during treatment to track viral levels and safety, and are monitored for symptoms and adverse events. After finishing treatment, patients are followed up on days 14 and 29 to document recovery and any progression to lower respiratory disease. The trial is conducted at specialized cancer centers experienced in managing immunocompromised patients.

Who should consider this trial

Good fit: Adults (≥18) with symptomatic, PCR-confirmed upper respiratory RSV within five days of planned dosing who have a hematologic malignancy or autoimmune disease and have received cellular or bispecific antibody therapy are the intended participants.

Not a fit: Patients with established lower respiratory tract RSV disease (pneumonia), those more than five days from symptom onset, or people who are not immunocompromised are unlikely to benefit from this protocol.

Why it matters

Potential benefit: If successful, remdesivir could shorten illness, reduce viral levels, and lower the risk of progression to pneumonia or hospitalization in immunocompromised patients with RSV.

How similar studies have performed: Remdesivir has shown antiviral activity against RSV in laboratory studies and limited clinical reports, but randomized evidence for treating RSV in immunocompromised adults is sparse and the approach is not yet proven.

Eligibility criteria

Inclusion Criteria:

* Aged ≥ 18 years
* Willing and able to provide written informed consent, or with a legal representative who can provide informed consent (where locally approved)
* RSV confirmed by local lab testing via nucleic acid amplification test (e.g. polymerase chain reaction \[PCR\] or respiratory viral panel \[RVP\]) using an upper respiratory tract sample collected within the 5 days prior to day 1 (RDV dosing)
* Symptomatic RSV infection of the upper respiratory tract, with symptom onset and positive microbiologic testing within the 5 days prior to day 1 (RDV dosing). Symptomatic RSV infection is defined as having new upper respiratory symptom(s) or worsening of a pre-existing upper respiratory symptom (if chronic and associated with a previously existing diagnosis, such as chronic lung disease, chronic rhinorrhea, or seasonal allergies)
* Have a hematologic malignancy and/or autoimmune disease and received one of the following treatments relative to RSV diagnosis date:

  * Received allogeneic hematopoietic cell transplant (HCT) with any conditioning regimen within 1 year
  * Received autologous HCT with any conditioning regimen within 3 months
  * Received Chimeric antigen receptor T cell therapy (CARTx) within 3 months
  * Received bispecific antibody therapy (bsAb) within 3 months
* Categorized as moderate-risk (overall score 3-6) or high-risk (overall score 7-10) per an adapted version of the Immunodeficiency Scoring Index (ISI) for RSV, as below, relative to the day of RSV diagnosis:

  * 1 point:

    * Recent (within the prior 30 days) allogeneic HCT, autologous HCT, or CARTx
    * Corticosteroids within the prior 30 days for management of graft versus host disease (GVHD) or cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome (ICANS).
  * 2 points:

    * Age ≥ 40 years
  * 3 points:

    * Absolute neutrophil count (ANC) \< 500 cells/μL within the prior 7 days
    * Absolute lymphocyte count (ALC) \< 200 cells/µL within the prior 7 days
* Oxygen saturation (SpO2) 93% or greater on room air and at rest (to be measured after participant has rested in a quiet room for ≥ 2 minutes, with oxygen \[O2\] saturation probe on finger or earlobe for ≥ 1 minute, with saturation reading remaining ≥ 93%) at screening
* Willingness to take study drug and complete necessary study procedures
* Participants of childbearing potential who engage in heterosexual intercourse must agree to use protocol-specified method(s) of contraception as described

Exclusion Criteria:

* Received or receiving an approved or authorized direct-acting antiviral therapy with potential efficacy against RSV (e.g. ribavirin) for ≥ 24 hours within the prior 7 days, and/or expected to receive anti-RSV direct-acting antiviral therapies for RSV during the course of the study at the time of screening
* Received or receiving investigational direct-acting antiviral therapies against RSV for the current RSV episode
* Received any investigational anti-RSV monoclonal antibodies or off-label use of approved anti-RSV monoclonal antibodies within \< 4 months or \< 5 half-lives, whichever is longer, before screening, or expected to receive anti-RSV monoclonal antibodies during the course of the study at the time of screening
* Received an RSV vaccine after cellular therapy or after starting the current antitumor therapeutic regimen
* Participation in any other concurrent clinical trial of an experimental treatment for RSV, including RSV vaccines
* Alanine aminotransferase (ALT) ≥ 5 times the upper limit of normal within 7 days prior to screening
* New lower respiratory tract radiographic abnormalities or clinical symptoms after RSV-associated symptom onset that are suspected to be due to RSV
* Unable to tolerate nasal sampling required for this study, as determined by the investigator (e.g., history of significant epistaxis, nasopharyngeal anatomical abnormalities, nasal or sinus surgery)
* A life expectancy of three months or less, as determined by the investigator
* Pregnant, as determined by a Point-of-Care urine pregnancy test or reported by the patient or their electronic health record within 7 days of screening
* Receiving, requiring, or expected to require supplemental oxygen for RSV-related illness or SpO2 \< 93% at rest \< 24 hours prior to study drug administration
* Previous infection or treatment for RSV, or previous treatment or hospitalization for another respiratory viral infection, \< 28 days before screening
* Documented positive test for other respiratory viruses concomitantly (limited to influenza, parainfluenza, adenovirus, human metapneumovirus, or coronavirus \[including SARS-CoV-2\]) ≤ 7 days prior to screening, as determined by local testing (additional testing not required)
* Clinically significant bacteremia or fungemia ≤ 7 days prior to screening and not adequately treated, as determined by the investigator
* Clinically significant bacterial, fungal, or viral pneumonia within two (2) weeks prior to screening and not adequately treated, as determined by the investigator
* Clinically significant symptoms of CRS or ICANS within the prior 72 hours before screening that is not adequately controlled, as determined by the investigator
* Any inability to take study drug or comply with study procedures that, in the opinion of the investigator, would make the participant unsuitable for the study
* Known hypersensitivity or allergy to the study drug, its metabolites, or formulation excipients

Where this trial is running

Duarte, California and 2 other locations

• City of Hope Comprehensive Cancer Center — Duarte, California, United States (Not_yet_recruiting)
• MD Anderson Cancer Center — Houston, Texas, United States (Recruiting)
• Fred Hutch/University of Washington Cancer Consortium — Seattle, Washington, United States (Recruiting)

Study contacts

• Principal investigator: Joshua Hill, MD — Fred Hutch/University of Washington Cancer Consortium
• Study coordinator: Joshua Hill, MD

Conditions Hematopoietic and Lymphatic System Neoplasm; Autoimmune Disease; Respiratory Syncytial Virus Infection