RecruitingPhase 1

A Study of Mesothelin-Targeted CAR T-Cell Therapy in People With Esophagogastric Cancer or Malignant Peritoneal Mesothelioma

A Phase I Trial of Intraperitoneal Mesothelin-Targeted CAR T Cell Therapy in Patients With Mesothelin-Positive Esophagogastric Adenocarcinoma With Peritoneal Carcinomatosis or Malignant Peritoneal Mesothelioma

Who can join

As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.

Age
18 Years and older
Sex
All sexes
Healthy volunteers
Not accepted
Compensation
Not stated

Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.

What to expect

No one can promise a trial will help you personally — that is what the research is trying to find out.

What participation involves

Not stated in the study description — ask the study team about visits and procedures.

Compensation
Not stated
  • Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
  • Participants are monitored closely by the research team throughout the study.
  • Some participants may receive access to an investigational treatment, which is still being studied.
  • Your participation helps researchers learn whether this approach could help future patients.

About this study

In plain language

This study tests CAR T-cell therapy for adults with cancer of the food pipe or stomach, or mesothelioma in the belly lining. A lab changes a person's T cells, a type of white blood cell, to target a protein called mesothelin on cancer cells. Study treatment takes about 3–4 weeks.

Participants will have a sample of their white blood cells, called T cells, collected using a procedure called leukapheresis. The collected T cells will be sent to a laboratory at Memorial Sloan Kettering to be changed (modified) to become MSLN-targeted CAR T cells, the CAR T-cell therapy that participants will receive during the study. Participant study therapy will take about 3-4 weeks.

Compensation is read from the study's own description and may be missing — always confirm with the study team.

Eligibility

Who can join

  • Age 18 or older, with cancer confirmed by tissue or cell tests: esophagogastric adenocarcinoma or malignant peritoneal mesothelioma.
  • Have stage IV cancer involving the belly lining, with at least one tumor that can be measured or checked.
  • Be fully active or able to do light work, and expected to live at least 4 months.
  • Tests must show that more than 25% of the tumor has mesothelin. A new tumor sample may be needed.
  • Cancer worsened or treatment was not tolerated after at least one treatment for cancer that had spread, or cancer returned within 6 months after treatment meant to cure it. HER2-positive cancer must have had HER2-targeted treatment.
  • Give written consent and meet required breaks from earlier cancer treatments. Most treatment side effects must be mild or gone, except nerve damage and hair loss.
  • Meet blood count, liver, kidney, and infection test requirements. Past hepatitis B or cured hepatitis C may be allowed if no virus is detected.
  • Women who can become pregnant must have negative pregnancy tests and use reliable birth control for at least 12 months after the T-cell treatment.

Who can't join

  • Pregnant or breastfeeding; HIV or active hepatitis B or C; or an active infection needing antibiotics within 7 days before T-cell collection.
  • Treatment for another active cancer, with some exceptions; blood cancer needing treatment within the past 5 years; or any history of cancer of lymph cells.
  • Past CAR T-cell therapy, other cell therapy, or mesothelin-targeted therapy. Major belly surgery within 28 days before joining is not allowed; surgery only to look inside the belly is allowed.
  • Untreated or active cancer in the brain or spinal cord. Previously treated cancer there may be allowed if scans show improvement and no further growth, and radiation ended at least 4 weeks before the screening scan.
  • An autoimmune disease, where the body attacks itself, needing whole-body treatment within the past year; daily prednisone of 10 mg or more, or similar steroids; or other immune-changing drugs. Hormone replacement treatment is allowed.
  • Certain serious heart problems, a heart attack within 6 months, or past heart muscle inflammation. Active lung inflammation, past lung inflammation needing whole-body steroids, or oxygen below 90% while breathing room air also exclude participation.
  • A live, weakened vaccine within 8 weeks before planned chemotherapy that lowers immune cells.
  • Another health problem that could interfere with the study, or the study team's judgment that the person cannot follow treatment and close follow-up requirements.

Simplified for readability. The official criteria below are what the study team uses.

Official eligibility criteria

Inclusion Criteria: * Aged ≥18 years * Diagnosis of pathologically/cytologically confirmed EG adenocarcinoma or MPeM * Diagnosis of metastatic or recurrent disease * ECOG performance status of 0-1 * Life expectancy of ≥4 months Inclusion Criteria for Leukapheresis: * Written informed consent for the study (from participant) * Life expectancy of ≥4 months * ECOG performance status of 0-1 * Histologic diagnosis that \& \>25% of the tumor expresses MSLN by IHC analysis. Archival tissue obtained up to 2 years before study enrollment is acceptable. IHC testing of a cell block from cytology (e.g., ascitic fluid) is acceptable if approved by the study pathologist. If adequate archival tissue is not available at screening, a fresh tumor biopsy should be obtained * Stage IV disease with gross peritoneal carcinomatosis on imaging and/or microscopic peritoneal involvement by cytology or noted during diagnostic laparoscopy * Disease progression or treatment intolerance after receiving at least 1 treatment regimen in the metastatic setting; patients with disease recurrence within 6 months of completing curative systemic therapy (chemotherapy, chemoradiation or adjuvant immunotherapy) are also eligible * Patients with Her2 positive disease must have received ≥1 line of anti-Her2 based therapy * At least 1 measurable or evaluable lesion per RECIST 1.1. Screening imaging must be obtained within 6 weeks of signing the informed consent form * Completion of systemic therapy at least 7 days before leukapheresis o Immune checkpoint inhibitor therapy must be completed at least 14 days before leukapheresis * Lab requirements (hematology): * Absolute neutrophil count ≥1.0 K/mcL * Hemoglobin ≥9 gm/dL * Platelet count ≥75 K/mcL * Blood product transfusion or growth factor support cannot occur within 7 days of testing * Lab requirements (serum chemistry): * Bilirubin ≤1.5× upper limit of normal (ULN) * Serum alanine aminotransferase and serum aspartate aminotransferase (ALT/AST) level ≤3× ULN * Calculated clearance of ≥50 mL/min by Cockcroft-Gault equation * Negative screen for infectious disease markers, including hepatitis B core antibody, hepatitis B surface antigen, hepatitis C antibody, HIV 1-2 antibody, HTLV antibody and syphilis antibody o Note: Patients with a history of hepatitis B virus infection are eligible if the hepatitis B viral load is undetectable. Patients with a history of hepatitis C virus infection who were treated for hepatitis C and cured are eligible if the hepatitis C viral load is undetectable * Serum pregnancy test with negative result at screening and preconditioning and must be willing to use effective and reliable contraception for at least 12 months after T cell infusion (for female participants of childbearing age) * Resolution of all acute toxic effects of any previous therapeutic or palliative chemotherapy, radiotherapy, or surgical procedures to grade ≤1 (CTCAE v5.0), except for neuropathy and alopecia Inclusion Criteria for lymphodepleting chemotherapy/CAR T cell infusion * Life expectancy of ≥4 months * ECOG performance status of 0-1 * At least 1 measurable or evaluable lesion per RECIST 1.1. Screening imaging must be obtained within 4 weeks before the date of lymphodepletion * Completion of systemic therapy at least 14 days before lymphodepleting chemotherapy o Immune checkpoint inhibitor therapy must be completed at least 28 days before lymphodepleting chemotherapy * Lab requirements (hematology): * Absolute neutrophil count ≥1.5 K/mcL * Hemoglobin ≥8 gm/dL * Platelet count ≥75 K/mcL * Lab requirements (serum chemistry): * Bilirubin ≤1.5× upper limit of normal (ULN) * Serum alanine aminotransferase and serum aspartate aminotransferase (ALT/AST) level ≤3× ULN * Calculated clearance of ≥50 mL/min by Cockcroft-Gault equation * Serum pregnancy test with negative result within 7 days of planned lymphodepletion date and must be willing to use effective and reliable contraception for at least 12 months after T cell infusion (for female participants of childbearing age) * Resolution of all acute toxic effects of any previous therapeutic or palliative chemotherapy, radiotherapy, or surgical procedures to grade ≤1 (CTCAE v5.0), except for neuropathy and alopecia Participant Exclusion Criteria Exclusion Criteria for Leukapheresis or Lymphodepleting chemotherapy/CAR T cell infusion: Participants are excluded from enrollment if any of the following criteria apply: * Pregnant or lactating * HIV, active hepatitis C virus, or active hepatitis B virus infection, as determined by quantitative PCR (patients who have undergone negative testing prior to leukapheresis do not require repeat testing) * Receiving therapy for concurrent active malignancy * Note: Patients receiving treatment for in situ skin malignancies are not excluded. * Patients with any malignancy diagnosed \>3 years before that is thought to be curatively treated and/or has a low risk of recurrence are eligible. Patients may continue to receive adjuvant therapy at the time of study enrollment (e.g., adjuvant hormonal therapy for curatively treated breast cancer). * Known hematologic malignancy requiring treatment in the preceding 5 years or a known history of lymphoid malignancy * Previous receipt of CAR T cell therapy or any other cellular therapy * Previous mesothelin-directed therapy Any major abdominal surgery (laparotomy with resection of gastrointestinal tract or organ resection) that is completed \<28 days before study enrollment. Patients who have undergone diagnostic laparoscopy can be included in the study without regard to timing * Untreated or active central nervous system (CNS) metastases (progressing or requiring anticonvulsants or corticosteroids for symptomatic control). Patients with a history of treated CNS metastases are eligible if all of the following criteria are met: * Radiographic demonstration of improvement upon completion of CNS-directed therapy and no evidence of interim progression between completion of CNS-directed therapy and the screening radiographic study * Completion of radiotherapy ≥4 weeks before the screening radiographic study * Active autoimmune disease that has required systemic treatment within 1 year before leukapheresis (with the use of disease-modifying agents, corticosteroids, or immunosuppressive drugs) o Note: Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic treatment and is allowed. * Receiving daily systemic corticosteroids ≥10 mg of prednisone daily or equivalent or receiving immunosuppressive or immunomodulatory treatment * Any of the following cardiac conditions: * New York Heart Association stage III or IV congestive heart failure * Myocardial infarction ≤6 months before enrollment * History of myocarditis * Serious uncontrolled cardiac arrhythmia, unstable angina, or uncontrolled infection * Left ventricular ejection fraction ≤40% * Active interstitial lung disease/pneumonitis or a history of interstitial lung disease/pneumonitis requiring treatment with systemic steroids * Baseline pulse oximetry \<90% on room air at the screening time point * Known active infection requiring antibiotic treatment 7 days before leukapheresis o Note: Treatment can be delayed at the discretion of the treating physician to allow the patient to recover from the infection. * Any other medical condition, e.g. fever \>38.0 degrees C, that, in the opinion of the PI, may interfere with the subject's participation in or compliance with the study * Receipt of live, attenuated vaccine within 8 weeks before the planned lymphodepleting chemotherapy date * Deemed to be noncompliant by the study team for administration of a high-risk treatment agent and for close follow-up after treatment as required by the protocol

Study sites (7)

NJ

NY