Overview
This is an open-label, single-arm clinical study designed to evaluate the safety and preliminary efficacy of EphA2-targeted CAR-DC combined with CAR-T cell therapy in patients with non-small cell lung cancer.
Description
Main purpose:
To evaluate the safety of EphA2-targeted CAR-T cells in combination with CAR-DCs in patients with advanced non-small cell lung cancer during the dose-escalation phase.
To determine the maximum tolerated dose of EphA2-targeted CAR-DCs when administered in combination with CAR-T cells.
Secondary purpose:
To assess the overall response rate (ORR), including complete response (CR) and partial response (PR), as well as overall survival (OS) and disease-free survival (DFS) in patients receiving the combination therapy.
To evaluate the in vivo persistence, immunophenotype, and functional activity of CAR-T cells and CAR-DCs following infusion.
Eligibility
Inclusion Criteria:
- Pathologically confirmed stage IV non-small cell lung cancer (NSCLC) with at least one measurable lesion according to RECIST 1.1 criteria (i.e., a lesion with the longest diameter ≥10 mm on spiral CT scan or a lymph node with a short axis ≥15 mm).
- Tumor tissue tested positive for EphA2 expression by immunohistochemistry (≥20%).
- Disease progression after standard treatment or no available standard treatment (patients must have received at least two prior systemic therapies, including but not limited to chemotherapy and immune checkpoint inhibitors; patients with actionable driver mutations must have failed targeted therapy).
- ECOG performance status: 0-1.
- Expected survival ≥6 months.
- Toxicities related to prior anti-tumor treatments must have resolved to baseline levels or ≤ Grade 1 (excluding residual alopecia); Grade ≤2 neurotoxicity is acceptable. Washout periods: 4 weeks for chemotherapy and immunotherapy, 2 weeks for targeted therapy.
- Adequate organ function, including:
- Adequate hematologic function: Absolute neutrophil count (ANC) ≥1.5×10^9/L, platelet count ≥75×10^9/L, hemoglobin ≥9 g/dL. No transfusions, granulocyte colony-stimulating factor (G-CSF), thrombopoietin, or erythropoietin allowed within 14 days before blood tests.
- Adequate hepatic function: Total bilirubin (TBIL) <1.5× upper limit of normal (ULN); AST and ALT <2.5×ULN. For patients with Gilbert's syndrome, TBIL <2×ULN; if liver metastases are present, AST and ALT <5×ULN.
- Adequate renal function: Serum creatinine (Cr) ≤1.5×ULN, or if Cr >1.5×ULN, creatinine clearance (CrCl) ≥60 mL/min calculated using the Cockcroft-Gault formula.
- Adequate coagulation function: Prothrombin time (PT) and activated partial thromboplastin time (APTT) <1.5×ULN; international normalized ratio (INR) <1.5 or within the target range if on anticoagulant therapy.
- Subjects of reproductive potential must be willing to use effective contraception.
- Ability to understand and voluntarily sign the informed consent form.
- Willingness to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.
Exclusion Criteria:
- Pathologically confirmed mixed histology, such as adenosquamous carcinoma of the lung.
- Tumor-related emergencies requiring urgent treatment, such as malignant pericardial effusion or cardiac tamponade, superior vena cava syndrome, or spinal cord compression.
- Significant cardiovascular diseases, including:
- Documented cardiovascular events within the past 6 months, such as myocardial infarction, angina, heart failure, severe arrhythmia, or having undergone angioplasty, stent implantation, or coronary artery bypass surgery.
- Clinically significant QT/QTcF prolongation (QT/QTcF > 470 ms in females or > 450 ms in males).
- Clinically significant bleeding tendency or coagulation disorders, such as
hemophilia.
- HIV or syphilis infection; active hepatitis B or C:
- Hepatitis B: HBV-DNA ≥ 1000 IU/mL.
- Hepatitis C: Positive HCV RNA with abnormal liver function.
- History of involuntary commitment due to psychiatric disorders or other
psychological conditions deemed unsuitable for treatment by the investigator.
- Presence of other autoimmune diseases, or long-term use of immunosuppressive agents or corticosteroids.
- Poor medication compliance.
- Any other condition that the investigator considers grounds for exclusion.