Central Nervous System NeoplasmsPhase 1NCT07390539
B7-H3.CD28Z.CART in CNS Neoplasms
A Phase 1 study testing B7-H3.CD28Z.CART, Fludarabine and Cyclophosphamide in people with Central Nervous System Neoplasms and Brain Tumor, run by Robbie Majzner at 2 sites in United States.
Trial summary
The purpose of this research study is to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. Read more about this study
- Who is it for?
- Ages 2 to 21 years
- Conditions the study is for
- Central Nervous System Neoplasms, Brain Tumor, Brain Tumor, Recurrent
- What is being tested?
- B7-H3.CD28Z.CART, Fludarabine and Cyclophosphamide
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 70 participants
- Where
- 2 sitesUnited States
- Study dates
- Sep 2026to 31 Aug 2032
- Phase
- Phase 1
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 2 to 21 years
- All sexes
- No healthy volunteers
- Child, Adult
Who may be able to join
- Participants must have histologically and/or molecularly confirmed CNS embryonal tumor (see eligible tumor types below), OR ependymoma that is recurrent/progressive following standard of care treatment.
- --Eligible CNS embryonal tumor types include:
- Medulloblastoma
- Atypical Teratoid Rhabdoid Tumor (ATRT)
- Embryonal Tumor with Multilayered Rosettes (ETMR)
- Pineoblastoma
Show all 60Show fewer
- Other CNS embryonal tumor types, at the discretion of the study chair (or designee)
- B7-H3 expression: Demonstration of B7-H3 expression with H score greater than 100 by immunohistochemistry (IHC) is required.
- Age: greater than or equal to two (2) years of age and less than or equal to 21 years of age. The first participant treated at each dose level within each stratum (Standard Risk and High Risk) will be ≥ 6 years of age when feasible.
- Disease status: Participants must have evaluable disease in the central nervous system to be eligible. Evaluable disease includes either measurable OR non-measurable disease, defined as follows:
- --Measurable disease (contrast-enhancing or non-enhancing tumor)
- Clearly defined lesional margins with two perpendicular diameters of at least 10mm, OR
- At least two times (in both perpendicular diameters) the MRI slice thickness, plus the interslice gap
- --Non-measurable disease (tumor that is too small to be accurately measured)
- Lesion that is measurable in only one perpendicular dimension, OR
- Lesion that is less than 10mm in at least one perpendicular dimension, OR
- Lesion that is less than two times the MRI slice thickness, plus the interslice gap
- Note: Leptomeningeal (LM) disease is considered non-measurable but evaluable.
- Performance status: Karnofsky performance status ≥60% for participants ≥16 years of age and Lansky performance status ≥60% for participants <16 years of age (see APPENDIX A PERFORMANCE STATUS CRITERIA). NOTE: Participants with neurologic deficits must have a stable neurologic exam for seven (7) days prior to enrollment. Participants who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
- Life expectancy of greater than 12 weeks
- Prior therapy: Participants must have received prior standard of care therapy, including maximal safe surgical resection, radiation therapy and/or standard chemotherapy, and is recovered from all acute treatment-related toxicities (defined as ≤ Grade 1 or stable) from all prior therapy before entering this study There is no upper limit to the number of prior therapies allowed, but must have received all standard curative options for their tumor type.
- Participants must meet the following washouts prior to enrollment:
- Radiation therapy - Participants must have had their last fraction of:
- ---Craniospinal irradiation, whole brain radiation therapy, or radiation therapy to >50% of the pelvis or spine >28 days prior to enrollment
- ---Focal irradiation (small port) >14 days prior to enrollment
- At least 14 days since any prior cytotoxic chemotherapy
- At least 7 days since any biologic antineoplastics, tyrosine kinase inhibitor, targeted agent
- At least 21 days or 5 half-lives (whichever is shorter) since any investigational antineoplastic or disease-directed agent (but at least 28 days from prior investigational antineoplastic vaccine therapy)
- At least 21 days since any monoclonal antibody therapy
- At least 90 days since any systemic inhibitor/stimulatory immune checkpoint therapy
- At least 28 days from prior autologous stem cell transplantation, with no ongoing toxicities
- At least 14 days after peg-filgrastim and 7 days for hematopoietic growth factor support
- Steroid use: Must not require concurrent systemic steroid therapy, although physiologic corticosteroid replacement therapy for management of pituitary/adrenal insufficiency and/or topical administration (e.g. inhaled or dermatologic) is allowed. Use of topical, ocular, intranasal, or inhaled corticosteroids are permitted per PI
- discretion.
- Participants must have adequate organ function, as defined below
- --Adequate bone marrow function
- Hemoglobin ≥ 8 g/dL
- Absolute neutrophil count (ANC) ≥ 1000 cells/uL
- Absolute lymphocyte count (ALC) ≥ 150 cells/uL
- Platelets ≥100,000/uL (unsupported, defined as no platelet transfusion within 4 days)
- Adequate renal function defined as creatinine within normal limits for age OR creatinine clearance (as estimated by Cockcroft Gault Equation for participants ≥ 18yo and Bedside Schwartz for participants <18yo) ≥70mL/min
- Maximum Serum Creatinine mg/DL ---6 months to 1 year Male 0.5 Female 0.5 ---1 to < 2 years Male 0.6 Female 0.6 ---2 to < 6 years Male 0.8 Female 0.8
- 6 to < 10 years Male 1 Female 1
- 10 to < 13 years Male 1.2 Female 1.2
- 13 years to < 16 years Male 1.5 Female 1.4
- 16 years Male 1.7 Female 1.4
- Adequate hepatic function
- Serum ALT/AST ≤3.0 upper limit of normal (ULN)
- Total bilirubin ≤1.5mg/dL, except in subjects with confirmed Gilbert's syndrome
- Adequate cardiac function
- --Ejection fraction ≥50% or fractional shortening ≥28%, measured by echocardiography
- Adequate pulmonary function
- No evidence of dyspnea at rest
- Pulse oximetry >92% whilst breathing room air
- Adequate neurologic function
- Participants with seizure disorders on anticonvulsants may be enrolled if seizures are well controlled (no seizure activity within 7 days prior to enrollment)
- Nervous system disorders (CTCAE v6.0) resulting from prior therapy must be ≤ Grade 2, with the exception of decreased tendon reflex (DTR; any Grade eligible). Participants with neurological deficits should be stable for a minimum of 7 days prior to enrollment. (A baseline detailed neurological exam should clearly document the neurological status of the participant prior at enrollment).
- Females of childbearing potential must have a negative serum or urine pregnancy test (females who have undergone surgical sterilization are not considered to be of childbearing potential)
- Participants of childbearing or child-fathering potential must be willing to practice birth control from the time of enrollment on this study and for one year after receiving the preparative lymphodepletion regimen, or for as long as B7- H3.CD28Z.CART cells are detectable in peripheral blood or CSF, whichever is later.
- Participant or parent of participant or legally recognized representative must be able to sign a written informed consent document. Pediatric participants will be included in age-appropriate discussion and written assent will be obtained for those ≥10 years of age, where appropriate.
Who cannot join
- Participants with bulky tumor are ineligible. Bulky tumor is defined as:
- Tumor with diameter of >5cm in one dimension on T2/FLAIR sequence
- Tumor with evidence of clinically significant midline shift or uncal herniation
- Tumor that, in opinion of the site investigator, shows significant mass effect in either the brain or spine
- Participants with clinical or radiological evidence of brain herniation.
- Participants who have received other B7-H3 targeted cellular therapies. Other prior cellular therapies are eligible, including immune checkpoint inhibition and vaccine therapy. These prior therapies should be discussed with the study chair (or designee) prior to participant enrollment.
Show all 20Show fewer
- Concurrent illness
- Participants with any prior immunodeficiency or history of autoimmune disease requiring systemic steroids/ immunosuppressive medication/ disease-modifying agents within the last two (2) years.
- Uncontrolled (Grade 3) bacterial, viral, fungal, or other infection.
- Ongoing infection with HIV or hepatitis B (HBsAg positive) or hepatitis C virus (anti-HCV positive). A history of hepatitis B or hepatitis C is permitted if the viral load is undetectable per quantitative PCR and/or nucleic acid testing.
- Evidence of severe or uncontrolled systemic disease (e.g. Grade 3 significant cardiac, pulmonary, hepatic, renal or other organ dysfunction) that in the judgement of the principal investigator is likely to interfere with assessment of safety or efficacy of the investigational regimen and its requirements.
- Known sensitivity or allergy to any of the agents/reagents used in this study (i.e. DSMO, cyclophosphamide, fludarabine)
- History of severe hypersensitivity reaction to compounds of similar chemical or biologic compositions to any agent used in the study or in the manufacturing of cells.
- Concomitant medications
- Current systemic corticosteroid therapy
- Note, physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency will be allowed.
- Participants who are receiving any other anti-cancer or investigational drug therapy are ineligible.
- Participants who have received the last vaccination of a live vaccine ≤ 30 days prior to the start of treatment are ineligible.
- Ongoing use of dietary supplements, alternative therapies or extreme diets, or any medication not approved by the study chair (or designee).
- Any other condition which in the principal investigator's opinion makes the individual clinically unsuitable to participate in this trial, or which would jeopardize compliance with the protocol, or would make it difficult to interpret adverse events or study data.
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
United States2 sites, 2 recruiting
- Recruiting
Boston Children's Hospital
Boston, Massachusetts, 02115
Susan Chi, MD, (617) 632-4386, dfbchpedicelltherapy@dfci.harvard.edu
Susan Chi, MD
- Recruiting
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
Susan Chi, MD, (617) 632-4386, susan_chi@dfci.harvard.edu
Susan Chi, MD
About this study
Official title: A Phase 1/1b Study of Autologous b7-h3 Chimeric Antigen Receptor t Cells (b7-h3.cd28z.Cart) in Children and Young Adults With Recurrent or Progressive Cns Neoplasms Expressing b7-h3 Target
The purpose of this research study is to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. This cell therapy is called B7- H3.CD28Z.CART, referred to as B7-H3 CAR T cells. B7-H3 is a protein that is over-expressed on many tumor cells, making it a good target for cancer cell therapy.
The names of the study investigational therapies involved in this study are:
- Fludarabine (a type of chemotherapy)
- Cyclophosphamide (a type of chemotherapy)
- B7-H3 CAR T cells (a type of cellular therapy)
Read the detailed description
This is a single-institution, Phase 1/1b, open-label study to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. This cell therapy is called B7- H3.CD28Z.CART, referred to as B7-H3 CAR T cells. B7-H3 is a protein that is over-expressed on many tumor cells, making it a good target for cancer cell therapy.
The U.S. Food and Drug Administration (FDA) has not approved B7-H3 CAR T cells as a treatment for any disease.
Fludarabine and cyclophosphamide are standard lymphodepleting chemotherapy medications that are being used in this study to prepare the body for cell therapy. They are approved by the U.S. Food \& Drug Administration (FDA) for this purpose and are not intended to be treatment for recurrent or progressive brain tumors.
The structure of the study will be by dose-escalation using a modified 3+3 design in two risk strata (standard risk, high risk), followed by a two-stage Phase 1b expansion at the recommended Phase 2 dose.
Participation in this study is expected to last up to 15 years.
It is expected that about 70 people will participate in this study.
- Conditions
- Central Nervous System Neoplasms, Brain Tumor, Brain Tumor, Recurrent, Brain Tumor, Pediatric, Brain Tumor Adult, Medulloblastoma
- Being tested
- B7-H3.CD28Z.CART, Fludarabine, Cyclophosphamide
- Keywords
- Central Nervous System Neoplasms, Brain Tumor, Brain Tumor, Pediatric, Brain Tumor, Adult, Brain Tumor Recurrent, Medulloblastoma, Medulloblastoma, Childhood, Medulloblastoma, Adult, Medulloblastoma Recurrent, Ependymoma, Atypical Teratoid/Rhabdoid Tumor, Embryonal Tumor with Multilayered Rosettes, Pineoblastoma, Leptomeningeal Disease
- Medical subject headings
- Central Nervous System Neoplasms, Brain Neoplasms, Medulloblastoma, Ependymoma, Rhabdoid Tumor, Neuroectodermal Tumors, Primitive, Pinealoma, Meningeal Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
B7-H3.CD28Z.CARTBiological
Autologous CAR T cells targeting B7-H3 (CD276), administered intravenously (into the vein) per protocol.
FludarabineDrug
Lymphodepleting chemotherapy administered intravenously per institutional standards.
CyclophosphamideDrug
Lymphodepleting chemotherapy administered intravenously per institutional standards.
| Study group | Role | What they receive |
|---|---|---|
| Dose Escalation for B7-H3.CD28Z.CART in Standard Risk Stratum | Experimental | Participants will be enrolled in a staggered, sequential fashion using a modified 3 + 3 dose escalation design, assigning participants to one of three intravenous dose levels to determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of IV B7-H3.CD28Z.CART. Dose escalation will occur per dose-limiting toxicity rules.
* Baseline visit
* Apheresis to obtain T cells
* Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily
* Day 0: B7-H3 CAR T cell infusion 1x daily
* 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response
* Follow up every 3 months after last infusion up until 2 years
* Long term follow annually for an additional 13 years Receives: Biological: B7-H3.CD28Z.CART; Drug: Fludarabine; Drug: Cyclophosphamide |
| Dose Escalation for B7-H3.CD28Z.CART in High Risk Stratum | Experimental | Participants will be enrolled in a staggered, sequential fashion using a modified 3 + 3 dose escalation design, assigning participants to one of three intravenous dose levels to determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of IV B7-H3.CD28Z.CART. Dose escalation will occur per dose-limiting toxicity rules.
* Baseline visit
* Apheresis to obtain T cells
* Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily
* Day 0: B7-H3 CAR T cell infusion 1x daily
* 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response
* Follow up every 3 months after last infusion up until 2 years
* Long term follow annually for an additional 13 years Receives: Biological: B7-H3.CD28Z.CART; Drug: Fludarabine; Drug: Cyclophosphamide |
| Dose Expansion for B7-H3.CD28Z.CART in Standard Risk Stratum | Experimental | Dose expansion will occur per dose-limiting toxicity rules.
* Baseline visit
* Apheresis to obtain T cells
* Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily
* Day 0: B7-H3 CAR T cell infusion 1x daily
* 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response
* Follow up every 3 months after last infusion up until 2 years
* Long term follow annually for an additional 13 years Receives: Biological: B7-H3.CD28Z.CART; Drug: Fludarabine; Drug: Cyclophosphamide |
| Dose Expansion for B7-H3.CD28Z.CART in High Risk Stratum | Experimental | Dose expansion will occur per dose-limiting toxicity rules.
* Baseline visit
* Apheresis to obtain T cells
* Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily
* Day 0: B7-H3 CAR T cell infusion 1x daily
* 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response
* Follow up every 3 months after last infusion up until 2 years
* Long term follow annually for an additional 13 years Receives: Biological: B7-H3.CD28Z.CART; Drug: Fludarabine; Drug: Cyclophosphamide |
What is being measured
The primary outcome is the main question the study is designed to answer.
Manufacturing Success Rate of Autologous B7-H3.CD28Z CAR T Cells
Each participant's product will be tested for the following criteria: cell viability ≥ 70%; cell number within ± 20% of the planned dose; CD3+ T cells ≥ 80% of leukocytes; CAR-positive cells ≥ 10% of CD3+ T cells; endotoxin ≤ 5 EU/kg; mycoplasma not detected; vector copy number (VCN) per transduced cell ≤ 10; replication-competent retrovirus (RCR) not detected; and sterility confirmed as "No Growth to Date" (NGTD) after a minimum of 5 days in culture. A participant will be classified as a manufacturing success if the final product satisfies all release criteria. If any criterion is not met, the participant will be classified as a manufacturing failure. The manufacturing success rate is defined as the proportion of participants classified as a success.
Measured: Participants will receive the CART cell infusion on Day 0.
Maximum Tolerated Dose (MTD) of B7-H3.CD28Z.CART Cells
The MTD is defined as the highest dose level of B7-H3.CD28Z.CART cells at which the rate of dose-limiting toxicity (DLT) is considered acceptable according to the modified 3+3 rules. Additional details are provided in Protocol Section 13.1. Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Measured: 28 days
Recommended Phase 2 Dose (RP2D) of B7-H3.CD28Z.CART Cells
The recommended phase 2 dose (RP2D) is the dose of B7-H3.CD28Z.CAR T cells selected for Phase 2 based on Phase 1 results, considering safety, tolerability, manufacturing feasibility, and observed clinical activity, and may be at or below the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD).
Measured: 28 days
Secondary outcomes (14)
Number of Participants Experience Dose-Limiting Toxicity (DLT) during Dose Escalation
Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Measured: 28 years
Number of Participants Experience Dose-Limiting Toxicity (DLT) at Maximum Tolerated Dose (MTD) / Recommend Phase 2 Dose (RP2D)
Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Measured: 28 days
Number of Participants with Two Additional ICV B7-H3.CD28Z.CAR T Infusions
The number of participants in the High-Risk Stratum who receive two additional intracerebroventricular (ICV) infusions of B7-H3.CD28Z.CAR T cells following the initial intravenous(IV) infusion.
Measured: From Day 0 (initial IV infusion) through Day 56 (third ICV infusion)
Adverse Events of Special Interest (AESIs) Rate
AESIs rate is defined as the proportion of participants who experience AESIs during treatment period. AESIs is defined in protocol section 7.3. Adverse events will be summarized and graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 6.0.
Measured: From Day 0 (initial IV infusion) through Day 56 (third ICV infusion) plus a 28-day follow-up period, for a total of 74 days.
Complete Response Rate (CRR) at Day 28
CRR is defined as the proportion of participants who achieve complete response (CR) assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Measured: Day 28
Partial Response Rate (PRR) at Day 28
PRR is defined as the proportion of participants who achieve partial response (PR) assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Measured: Day 28
Stable Disease Rate (SDR) at Day 28
SDR is defined as the proportion of participants who achieve stable disease (SD) assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Measured: Day 28
3 Month Complete Response Rate (CRR3)
CRR3 is defined as the proportion of participants who achieve complete response (CR) at 3 months, which assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Measured: 3 months
3 Month Partial Response Rate (PRR3)
PRR3 is defined as the proportion of participants who achieve partial response (PR) at 3 months, which assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Measured: 3 months
3 Month Stable Disease Rate (SDR3)
SDR3 is defined as the proportion of participants who achieve stable disease (SD) at 3 months, which assessed by Response Assessment in Pediatric Neuro-Oncology (RAPNO) response guidelines for medulloblastoma and ependymoma. Immune-related response criteria (irRC) as defined in RANO 2.0 may be used to interpret responses potentially influenced by immune effects.
Measured: 3 months
Best Overall Response Rate (BORR)
BORR is defined as the proportion of participants who achieve a best overall response of complete response (CR), partial response (PR), or stable disease (SD) from the start of treatment until progressive disease (PD) or recurrence, taking as reference for progression the smallest measurements recorded since treatment initiation. Per Pediatric Neuro-Oncology (RAPNO) response guidelines, PD is defined as meeting any of the following criteria: a ≥25% increase in the sum of perpendicular diameters of measurable lesions or clear progression of non-measurable disease on MRI (brain/spine), appearance of any new lesion (biopsy confirmation if feasible), conversion of CSF cytology from negative to positive, clinical deterioration not attributable to other causes, or new extra-CNS disease.
Measured: Treatment duration may be up to 224 days, and disease evaluations will be performed at Day 28 (±4 days), at Months 2 and 3 (±1 week), and every 3 months thereafter through Month 24 (±4 weeks) after the end of treatment.
Median Duration of Response (DOR)
DOR, estimated using the Kaplan-Meier method, is measured from the time when the criteria for complete response (CR) or partial response (PR) are first met until the first documented date of recurrent or progressive disease (PD) or death from any cause, using as reference for progression the smallest measurements recorded since treatment initiation. Participants without events are censored at the date of their last disease evaluation. Per Pediatric Neuro-Oncology (RAPNO) response guidelines, PD is defined as meeting any of the following criteria: a ≥25% increase in the sum of perpendicular diameters of measurable lesions or clear progression of non-measurable disease on MRI (brain/spine), appearance of any new lesion (biopsy confirmation if feasible), conversion of CSF cytology from negative to positive, clinical deterioration not attributable to other causes, or new extra-CNS disease.
Measured: Treatment duration may be up to 224 days, and disease evaluations will be performed at Day 28 (±4 days), at Months 2 and 3 (±1 week), and every 3 months thereafter through Month 24 (±4 weeks) after the end of treatment.
2 Year Progression-Free Survival (PFS2)
PFS2 is the percent probability estimate at 2 years based on the Kaplan-Meier method. PFS is defined as the time from infusion of B7-H3.CD28Z.CART to the first occurrence of an event (progression, relapse, or death due to any cause). Participants alive without an event are censored at date of last disease evaluation. Per Pediatric Neuro-Oncology (RAPNO) response guidelines, PD is defined as meeting any of the following criteria: a ≥25% increase in the sum of perpendicular diameters of measurable lesions or clear progression of non-measurable disease on MRI (brain/spine), appearance of any new lesion (biopsy confirmation if feasible), conversion of CSF cytology from negative to positive, clinical deterioration not attributable to other causes, or new extra-CNS disease.
Measured: 2 years
Median Overall Survival (OS)
OS based on Kaplan-Meier method is defined as the time from infusion of B7-H3.CD28Z.CART to death due to any cause, or censored at date last known alive.
Measured: 15 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Feb 2026
- Study startSep 2026 (estimated)
- Primary completion31 Aug 2030 (estimated)
- Study completion31 Aug 2032 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Central Nervous System NeoplasmsStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Model description
- dose-escalation by modified 3+3 in two risk strata, followed by dose expansion
- Masking
- None (open label)
- Enrolment
- 70 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Robbie Majzner
- Sponsor type
- University, hospital or other
- Collaborators
- National Institutes of Health (NIH)
- Responsible party
- Sponsor-investigator, Robbie Majzner, Dana-Farber Cancer Institute
- Investigators
- Susan Chi, Principal investigator, Dana-Farber Cancer Institute
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07390539
- Sponsor's protocol ID
- 25-642
- Status last verified
- Aug 2026
- First submitted
- 28 Jan 2026
- Last updated
- 3 Sep 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Yes: The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: \[contact information for Sponsor Investigator or designee\]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
Study at a glance
From the registry record, last updated by the sponsor on 3 Sep 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Phase 1/1b Study of Autologous b7-h3 Chimeric Antigen Receptor t Cells (b7-h3.cd28z.Cart) in Children and Young Adults With Recurrent or Progressive Cns Neoplasms Expressing b7-h3 Target
- ClinicalTrials.gov ID
- NCT07390539
- Acronym / sponsor ID
- 25-642
- Conditions
- Central Nervous System Neoplasms, Brain Tumor, Brain Tumor, Recurrent, Brain Tumor, Pediatric, Brain Tumor Adult, Medulloblastoma
- Keywords
- Central Nervous System Neoplasms, Brain Tumor, Brain Tumor, Pediatric, Brain Tumor, Adult, Brain Tumor Recurrent, Medulloblastoma, Medulloblastoma, Childhood, Medulloblastoma, Adult
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 70 participants (estimated)
- Lead sponsor
- Robbie MajznerUniversity, hospital or other
- Collaborators
- National Institutes of Health (NIH)
- Study start
- Sep 2026 (estimated)
- Primary completion
- 31 Aug 2030 (estimated)
- Study completion
- 31 Aug 2032 (estimated)
- First posted
- 5 Feb 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The purpose of this research study is to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. This cell therapy is called B7- H3.CD28Z.CART, referred to as B7-H3 CAR T cells. B7-H3 is a protein that is over-expressed on many tumor cells, making it a good target for cancer cell therapy.
The names of the study investigational therapies involved in this study are:
- Fludarabine (a type of chemotherapy)
- Cyclophosphamide (a type of chemotherapy)
- B7-H3 CAR T cells (a type of cellular therapy)
Detailed description
This is a single-institution, Phase 1/1b, open-label study to test the safety and effectiveness of a cell therapy at different doses for children and young adults with recurrent or progressive brain tumors. Recurrent/recurred means a tumor that has gone away and then came back. This cell therapy is called B7- H3.CD28Z.CART, referred to as B7-H3 CAR T cells. B7-H3 is a protein that is over-expressed on many tumor cells, making it a good target for cancer cell therapy.
The U.S. Food and Drug Administration (FDA) has not approved B7-H3 CAR T cells as a treatment for any disease.
Fludarabine and cyclophosphamide are standard lymphodepleting chemotherapy medications that are being used in this study to prepare the body for cell therapy. They are approved by the U.S. Food \& Drug Administration (FDA) for this purpose and are not intended to be treatment for recurrent or progressive brain tumors.
The structure of the study will be by dose-escalation using a modified 3+3 design in two risk strata (standard risk, high risk), followed by a two-stage Phase 1b expansion at the recommended Phase 2 dose.
Participation in this study is expected to last up to 15 years.
It is expected that about 70 people will participate in this study.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 4
- Model description
- dose-escalation by modified 3+3 in two risk strata, followed by dose expansion
| Arm | Type | Receives |
|---|---|---|
| Dose Escalation for B7-H3.CD28Z.CART in Standard Risk Stratum | Experimental | Biological: B7-H3.CD28Z.CART, Drug: Fludarabine, Drug: CyclophosphamideParticipants will be enrolled in a staggered, sequential fashion using a modified 3 + 3 dose escalation design, assigning participants to one of three intravenous dose levels to determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of IV B7-H3.CD28Z.CART. Dose escalation will occur per dose-limiting toxicity rules. * Baseline visit * Apheresis to obtain T cells * Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily * Day 0: B7-H3 CAR T cell infusion 1x daily * 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response * Follow up every 3 months after last infusion up until 2 years * Long term follow annually for an additional 13 years |
| Dose Escalation for B7-H3.CD28Z.CART in High Risk Stratum | Experimental | Biological: B7-H3.CD28Z.CART, Drug: Fludarabine, Drug: CyclophosphamideParticipants will be enrolled in a staggered, sequential fashion using a modified 3 + 3 dose escalation design, assigning participants to one of three intravenous dose levels to determine the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D) of IV B7-H3.CD28Z.CART. Dose escalation will occur per dose-limiting toxicity rules. * Baseline visit * Apheresis to obtain T cells * Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily * Day 0: B7-H3 CAR T cell infusion 1x daily * 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response * Follow up every 3 months after last infusion up until 2 years * Long term follow annually for an additional 13 years |
| Dose Expansion for B7-H3.CD28Z.CART in Standard Risk Stratum | Experimental | Biological: B7-H3.CD28Z.CART, Drug: Fludarabine, Drug: CyclophosphamideDose expansion will occur per dose-limiting toxicity rules. * Baseline visit * Apheresis to obtain T cells * Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily * Day 0: B7-H3 CAR T cell infusion 1x daily * 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response * Follow up every 3 months after last infusion up until 2 years * Long term follow annually for an additional 13 years |
| Dose Expansion for B7-H3.CD28Z.CART in High Risk Stratum | Experimental | Biological: B7-H3.CD28Z.CART, Drug: Fludarabine, Drug: CyclophosphamideDose expansion will occur per dose-limiting toxicity rules. * Baseline visit * Apheresis to obtain T cells * Days -4, -3, -2: predetermined doses of Fludarabine and Cyclophosphamide 1x daily * Day 0: B7-H3 CAR T cell infusion 1x daily * 2 doses of B7-H3 CAR T cell infusion Intracerebroventricular (ICV) Infusion every 28 days until 8 doses total according to clinical response * Follow up every 3 months after last infusion up until 2 years * Long term follow annually for an additional 13 years |
Who may qualify
- Ages
- 2 to 21 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Key inclusion criteria (60 listed)
- Participants must have histologically and/or molecularly confirmed CNS embryonal tumor (see eligible tumor types below), OR ependymoma that is recurrent/progressive following standard of care treatment.
- B7-H3 expression: Demonstration of B7-H3 expression with H score greater than 100 by immunohistochemistry (IHC) is required.
- Age: greater than or equal to two (2) years of age and less than or equal to 21 years of age. The first participant treated at each dose level within each stratum (Standard Risk and High Risk) will be ≥ 6 years of age when feasible.
- Disease status: Participants must have evaluable disease in the central nervous system to be eligible. Evaluable disease includes either measurable OR non-measurable disease, defined as follows:
- --Measurable disease (contrast-enhancing or non-enhancing tumor)
Key exclusion criteria (20 listed)
- Participants with bulky tumor are ineligible. Bulky tumor is defined as:
- Participants with clinical or radiological evidence of brain herniation.
- Participants who have received other B7-H3 targeted cellular therapies. Other prior cellular therapies are eligible, including immune checkpoint inhibition and vaccine therapy. These prior therapies should be discussed with the study chair (or designee) prior to participant enrollment.
- Concurrent illness
- Concomitant medications
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| B7-H3.CD28Z.CARTAutologous CAR T cells targeting B7-H3 (CD276), administered intravenously (into the vein) per protocol. | Biological | Dose Escalation for B7-H3.CD28Z.CART in High Risk Stratum, Dose Escalation for B7-H3.CD28Z.CART in Standard Risk Stratum, Dose Expansion for B7-H3.CD28Z.CART in High Risk Stratum, Dose Expansion for B7-H3.CD28Z.CART in Standard Risk Stratum |
| FludarabineLymphodepleting chemotherapy administered intravenously per institutional standards. | Drug | Dose Escalation for B7-H3.CD28Z.CART in High Risk Stratum, Dose Escalation for B7-H3.CD28Z.CART in Standard Risk Stratum, Dose Expansion for B7-H3.CD28Z.CART in High Risk Stratum, Dose Expansion for B7-H3.CD28Z.CART in Standard Risk Stratum |
| CyclophosphamideLymphodepleting chemotherapy administered intravenously per institutional standards. | Drug | Dose Escalation for B7-H3.CD28Z.CART in High Risk Stratum, Dose Escalation for B7-H3.CD28Z.CART in Standard Risk Stratum, Dose Expansion for B7-H3.CD28Z.CART in High Risk Stratum, Dose Expansion for B7-H3.CD28Z.CART in Standard Risk Stratum |
Primary outcome
Manufacturing Success Rate of Autologous B7-H3.CD28Z CAR T Cells
Time frame: Participants will receive the CART cell infusion on Day 0.
Each participant's product will be tested for the following criteria: cell viability ≥ 70%; cell number within ± 20% of the planned dose; CD3+ T cells ≥ 80% of leukocytes; CAR-positive cells ≥ 10% of CD3+ T cells; endotoxin ≤ 5 EU/kg; mycoplasma not detected; vector copy number (VCN) per transduced cell ≤ 10; replication-competent retrovirus (RCR) not detected; and sterility confirmed as "No Growth to Date" (NGTD) after a minimum of 5 days in culture. A participant will be classified as a manufacturing success if the final product satisfies all release criteria. If any criterion is not met, the participant will be classified as a manufacturing failure. The manufacturing success rate is defined as the proportion of participants classified as a success.
Maximum Tolerated Dose (MTD) of B7-H3.CD28Z.CART Cells
Time frame: 28 days
The MTD is defined as the highest dose level of B7-H3.CD28Z.CART cells at which the rate of dose-limiting toxicity (DLT) is considered acceptable according to the modified 3+3 rules. Additional details are provided in Protocol Section 13.1. Definition of DLT is outlined in protocol. The definition of DLT uses NCI's Common Terminology Criteria for Adverse Events (CTCAEv6.0).
Recommended Phase 2 Dose (RP2D) of B7-H3.CD28Z.CART Cells
Time frame: 28 days
The recommended phase 2 dose (RP2D) is the dose of B7-H3.CD28Z.CAR T cells selected for Phase 2 based on Phase 1 results, considering safety, tolerability, manufacturing feasibility, and observed clinical activity, and may be at or below the Maximum Tolerated Dose (MTD) or Maximum Administered Dose (MAD).
14 secondary outcomes
Number of Participants Experience Dose-Limiting Toxicity (DLT) during Dose Escalation
Time frame: 28 years
Number of Participants Experience Dose-Limiting Toxicity (DLT) at Maximum Tolerated Dose (MTD) / Recommend Phase 2 Dose (RP2D)
Time frame: 28 days
Number of Participants with Two Additional ICV B7-H3.CD28Z.CAR T Infusions
Time frame: From Day 0 (initial IV infusion) through Day 56 (third ICV infusion)
Adverse Events of Special Interest (AESIs) Rate
Time frame: From Day 0 (initial IV infusion) through Day 56 (third ICV infusion) plus a 28-day follow-up period, for a total of 74 days.
Complete Response Rate (CRR) at Day 28
Time frame: Day 28
Partial Response Rate (PRR) at Day 28
Time frame: Day 28
Stable Disease Rate (SDR) at Day 28
Time frame: Day 28
3 Month Complete Response Rate (CRR3)
Time frame: 3 months
3 Month Partial Response Rate (PRR3)
Time frame: 3 months
3 Month Stable Disease Rate (SDR3)
Time frame: 3 months
Best Overall Response Rate (BORR)
Time frame: Treatment duration may be up to 224 days, and disease evaluations will be performed at Day 28 (±4 days), at Months 2 and 3 (±1 week), and every 3 months thereafter through Month 24 (±4 weeks) after the end of treatment.
Median Duration of Response (DOR)
Time frame: Treatment duration may be up to 224 days, and disease evaluations will be performed at Day 28 (±4 days), at Months 2 and 3 (±1 week), and every 3 months thereafter through Month 24 (±4 weeks) after the end of treatment.
2 Year Progression-Free Survival (PFS2)
Time frame: 2 years
Median Overall Survival (OS)
Time frame: 15 years
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Sep 2026.
- Individual participant dataSharing planned: Yes. The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
Related trials for Central Nervous System Neoplasms
RecruitingObservational study
Tumor Related Epilepsy
Epilepsy, Cancer
Active, not recruitingPhase 2
Nivolumab With or Without Varlilumab in Treating Patients With Relapsed or Refractory Aggressive B-cell Lymphomas
ALK-Positive Large B-Cell Lymphoma, Diffuse Large B-Cell Lymphoma Activated B-Cell Type
Not yet recruitingObservational study
Clinical Outcomes of Stroke in MalIgnanCy
Stroke, Malignancies Multiple
Not yet recruitingObservational study
Twenty-five Years of Advanced RadioTherapy at San Raffaele Hospital
Malignant Tumor, Benign Neoplasm
RecruitingObservational study
International PPB/DICER1 Registry
Pleuropulmonary Blastoma, Sertoli-Leydig Cell Tumor
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Susan Chi principal investigator
Dana-Farber Cancer Institute
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing B7-H3.CD28Z.CART, Fludarabine and Cyclophosphamide in people with Central Nervous System Neoplasms and Brain Tumor, run by Robbie Majzner at 2 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 60 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 3 Sep 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Susan Chi, MD (617-632-3270, dfbchpedicelltherapy@dfci.harvard.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Manufacturing Success Rate of Autologous B7-H3.CD28Z CAR T Cells (time frame: Participants will receive the CART cell infusion on Day 0.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Sep 2026.