NCT06220097

Mitoxantrone Hydrochloride Liposome Injection-containing Bridging Regimen and CD19-targeting CAR-T Therapies

Study on the Safety and Efficacy of Mitoxantrone Hydrochloride Liposome Injection-containing Bridging Regimen in CD19-targeting CAR-T Therapies

• Status: Active Not Recruiting
• Phase: Phase 2
• Study type: Interventional
• Enrollment: 28 (estimated)
• Sponsor: Union Hospital, Tongji Medical College, Huazhong University of Science and Technology · Academic / Other
• Sex: All
• Age: 18 Years – 75 Years
• Healthy volunteers: Not accepted

Summary

The goal of this open, single-arm practical, phase II, clinical study is to evaluate the efficacy and safety of the mitoxantrone hydrochloride liposome injection-containing regimens in bridging therapies of CD19 CAR-T cells. The main question it aims to answer is: • the efficacy of the mitoxantrone hydrochloride liposome injection-containing combination regimens in bridging therapies of CD19 CAR-T cells. Participants will receive combination bridging regimens including mitoxantrone hydrochloride liposomal injection and CAR-T cell therapy to see if the combination regimens have a positive effect on the efficacy of bridging therapies.

Detailed description

Chimeric antigen receptor T-cell (CAR-T) therapy has been approved for a variety of relapsed/refractory hematologic malignancies and has significantly improved patient outcomes. The preparation of CAR-T cells, including a variety of relevant individual factors, usually takes at least 3-4 weeks, or more, so patients may require bridging therapy (BT) to control disease progression and prevent the rapid exacerbation of systemic cancer. Clinical trial data have shown that about 7% of patients do not survive while waiting for CAR-T cell preparation to be completed, so individual bridging therapy can be given after apheresis and 4-6 weeks before CAR-T infusion to achieve effective CAR-T cell therapy. Mitoxantrone, a traditional anthracycline quinone, is an antibiotic antineoplastic drug. It exerts antitumor effects by interfering with DNA, RNA, and inhibition of topoisomerase II, and is a cell cycle non-specific drug\[\]. Liposomes are excellent carriers of anti-tumor drugs, which can reduce the distribution of drugs in normal tissues and increase the accumulation of drugs in tumor tissues, thereby reducing toxicity and improving treatment efficacy. To reduce the toxicity of mitoxantrone and improve its efficacy, CSPC Pharmaceutical Group has developed the liposomal formulation of mitoxantrone, which is based on liposomal R\&D technology. A new technical upgrade has been carried out on the mitoxantrone liposome, making it the only liposome with a higher dosage than the ordinary preparation, and it is a new anthracycline liposome that has been comprehensively upgraded. In the pivotal phase II study of liposomal mitoxantrone, monotherapy with PTCL was associated with an ORR of 41.7%, a CR rate of 23.1%, a median PFS of 8.5 months, a median OS not reached, and a high incidence of adverse events such as neutropenia and pigmentation, with a good cardiac safety profile and no progression of cardiotoxicity. Single-agent 16mg/m2 and 20mg/m2 doses were also explored in DLBCL, and 35 patients with relapsed and refractory DLBCL were enrolled, with an overall objective response rate of 38.5% in the 26 full analysis sets, which had certain activity in DLBCL.

Conditions

• B-cell Acute Lymphoblastic Leukemia
• B-cell Lymphoma Refractory

Interventions

Type	Name	Description
DRUG	Mitoxantrone hydrochloride liposome Injection-based bridging therapy+ Fludarabine-based chemotherapy +CD19 CAR-T Cells	Bridging therapies from enrollment before CD19 CAR-T infusion. A treatment regimen containing mitoxantrone hydrochloride liposome injection, including but not limited to the following recommended regimens: R-MINE regimen (rituximab + ifosfamide + mitoxantrone hydrochloride liposome + etoposide) G-MINE regimen (obinutuzumab + ifosfamide + mitoxantrone hydrochloride liposome + etoposide) MAE regimen (mitoxantrone liposome hydrochloride + cytarabine + etoposide) . The recommended dose of mitoxantrone liposome hydrochloride is not limited. For patients who achieve SD or better after one cycle of bridging treatment, it is up to the investigator to decide whether to receive CAR-T therapy. Fludarabine-based lymphodepletion chemotherapy was followed by CD19 CAR-T cells (relma-cel, axi-cel or humanized CAR19). Relma-cel and axi-cel will be infused according to the instructions. CART19 infusion is conducted at a dose of 1x10\^6/kg on day 0 and day 1 respectively.

Timeline

• Start date: 2022-02-01
• Primary completion: 2024-08-01
• Completion: 2025-12-30
• First posted: 2024-01-23
• Last updated: 2025-07-17

Locations

1 site across 1 country: China