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
- Memorial Sloan Kettering Basking Ridge (Limited Protocol Activities) · Basking Ridge, NJ 07920Geoffrey Ku, MD · Study contact · 646-888-4588More trials in Basking Ridge
- Memorial Sloan Kettering Monmouth (Limited protocol activities) · Middletown, NJ 07748Geoffrey Ku, MD · Study contact · 646-888-4588More trials in Middletown
- Memorial Sloan Kettering Bergen (Limited Protocol Activities) · Montvale, NJ 07645Geoffrey Ku, MD · Study contact · 646-888-4588More trials in Montvale
NY
- Memorial Sloan Kettering Suffolk - Commack (Limited Protocol Activities) · Commack, NY 11725Geoffrey Ku, MD · Study contact · 646-888-4588More trials in Commack
- Memorial Sloan Kettering Westchester (Limited Protocol Activities) · Harrison, NY 10604Geoffrey Ku, MD · Study contact · 646-888-4588More trials in Harrison
- Memorial Sloan Kettering Cancer Center (All Protocol Activities) · New York, NY 10065Geoffrey Ku, MD · Study contact · 646-888-4588Geoffrey Ku, MD · Principal investigatorMore trials in New York
- Memorial Sloan Kettering Nassau (Limited Protocol Activities) · Uniondale, NY 11553Geoffrey Ku, MD · Study contact · 646-888-4588More trials in Uniondale