50 Participants Needed
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NK Cells + Chemotherapy for Sarcoma

(TINKS Trial)

Recruiting in Dallas (>99 mi)
+17 other locations
CP
JC
Overseen ByJessica Crimella, BSN, RN, CCRP
Age: < 65
Sex: Any
Trial Phase: Phase 1 & 2
Sponsor: Nationwide Children's Hospital
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

Trial Summary

What is the purpose of this trial?

The purpose of this study is to determine if the addition of infusions of a type of immune cell called a "natural killer", or NK cell to the sarcoma chemotherapy regimen GEM/DOX (gemcitabine and docetaxel) can improve outcomes in people with childhood sarcomas that have relapsed or not responded to prior therapies. The goals of this study are: * To determine the safety and efficacy of the addition of adoptive transfer of universal donor, TGFβ imprinted (TGFβi), expanded NK cells to the pediatric sarcoma salvage chemotherapeutic regimen gemcitabine/docetaxel (GEM/DOX) for treatment of relapsed and refractory pediatric sarcomas To determine the 6-month progression free survival achieved with this treatment in patients within cohorts of relapsed or refractory osteosarcoma, Ewing sarcoma, rhabdomyosarcoma and non-rhabdomyosarcoma soft tissue sarcoma. * To identify toxicities related to treatment with GEM/DOX + TGFβi expanded NK cells Participants will receive study drugs that include chemotherapy and NK cells in cycles; each cycle is 21 days long and you can receive up to 8 cycles. * Gemcitabine (GEM): via IV on Days 1 and 8 * Docetaxel (DOX): via IV on Day 8 * Prophylactic dexamethasone: Day 7-9 to prevent fluid retention and hypersensitivity reaction * Peg-filgrastim (PEG-GCSF) or biosimilar: Day 9 to help your white blood cell recover and allow more chemotherapy to be given * TGFβi NK cells: via IV on Day 12

Will I have to stop taking my current medications?

The trial protocol does not specify if you must stop all current medications, but you cannot take other cancer treatments or certain medications like strong CYP3A4 inducers and diazepam. It's best to discuss your specific medications with the study team.

What data supports the effectiveness of the drug combination of gemcitabine and docetaxel for treating sarcoma?

The combination of gemcitabine and docetaxel has shown some effectiveness in treating certain types of sarcoma, such as leiomyosarcoma and pleomorphic sarcomas, with a 3-month progression-free rate of 45.4% in synovial sarcoma. However, the response rate is generally low, and the treatment is associated with significant side effects.12345

Is the combination of gemcitabine and docetaxel safe for treating sarcomas?

The combination of gemcitabine and docetaxel has been used in treating sarcomas, and while it shows limited effectiveness, the safety profile is considered manageable with expected toxicities. No new safety concerns were identified in the studies reviewed.13678

What makes the NK Cells + Chemotherapy treatment for sarcoma unique?

This treatment combines natural killer (NK) cells, which are part of the immune system's first line of defense, with chemotherapy drugs docetaxel and gemcitabine. While docetaxel and gemcitabine are used in other sarcoma treatments, the addition of NK cells is novel and aims to enhance the body's natural ability to fight cancer.478910

Research Team

Bhuvana A. Setty

Bhuvana Setty, M.D.

Principal Investigator

Nationwide Children's Hospital

Eligibility Criteria

This trial is for young people aged 12-40 with relapsed or refractory pediatric bone and soft tissue sarcomas, who've had limited prior treatments. They must have a certain level of physical ability, adequate organ function, controlled seizures if present, no severe allergies to specific drugs used in the study, and agree to use contraception.

Inclusion Criteria

Contraception: Women of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of study participation. Men must also agree to use adequate contraception
Patients must have measurable disease using RECIST 1.1 criteria
I have had 1-4 treatments for sarcoma and surgery or radiation if needed.
See 6 more

Exclusion Criteria

Patients who may not be able to comply with the safety monitoring requirements of the study
My tumor is close to vital body parts where swelling could cause major issues.
My cancer is only in my bone marrow.
See 8 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive up to 8 cycles of gemcitabine, docetaxel, and TGFβi NK cells, each cycle lasting 21 days

24 weeks
Visits on Days 1, 8, 9, and 12 of each cycle

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 year

Treatment Details

Interventions

  • Docetaxel
  • Gemcitabine
  • TGFβi expanded NK cells
Trial OverviewThe study tests whether adding TGFβ imprinted NK cells (a type of immune cell) to standard chemotherapy (gemcitabine and docetaxel) improves outcomes for these sarcoma patients. The treatment involves multiple cycles of chemo plus NK cell infusions over several weeks.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: TreatmentExperimental Treatment1 Intervention
Part 1: Enrollment of 5 patients in each cohort (osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, and non-rhabdomyosarcoma). Part 2: Enrollment of 2 cohorts in 2 stages for a total of 40 patients.

Docetaxel is already approved in United States, European Union, Canada, Japan for the following indications:

🇺🇸
Approved in United States as Taxotere for:
  • Breast Cancer
  • Non-small Cell Lung Cancer
  • Gastric Cancer
  • Head and Neck Cancer
  • Prostate Cancer
🇪🇺
Approved in European Union as Taxotere for:
  • Breast Cancer
  • Non-small Cell Lung Cancer
  • Gastric Cancer
  • Head and Neck Cancer
  • Prostate Cancer
🇨🇦
Approved in Canada as Taxotere for:
  • Breast Cancer
  • Non-small Cell Lung Cancer
  • Gastric Cancer
  • Head and Neck Cancer
  • Prostate Cancer
🇯🇵
Approved in Japan as Taxotere for:
  • Breast Cancer
  • Non-small Cell Lung Cancer
  • Gastric Cancer
  • Head and Neck Cancer
  • Prostate Cancer

Find a Clinic Near You

Who Is Running the Clinical Trial?

Nationwide Children's Hospital

Lead Sponsor

Trials
354
Recruited
5,228,000+

National Pediatric Cancer Foundation

Collaborator

Trials
8
Recruited
300+

Findings from Research

In a review of 21 patients with synovial sarcoma treated with gemcitabine/docetaxel chemotherapy, the treatment showed a low response rate of only 5% and a median progression-free survival of just 2 months, indicating limited efficacy.
Despite the expected toxicities associated with this chemotherapy combination, treatment was tolerated without discontinuation due to toxicity, but the authors recommend that this regimen should not be used outside of clinical trials for this patient group.
Poor treatment outcomes with palliative gemcitabine and docetaxel chemotherapy in advanced and metastatic synovial sarcoma.Pender, A., Davis, EJ., Chauhan, D., et al.[2022]
In a phase II trial involving 53 patients with recurrent Ewing sarcoma, osteosarcoma, or chondrosarcoma, the combination of gemcitabine and docetaxel showed low efficacy, with partial responses observed in only a few patients and no complete responses.
The trial indicated a very low probability of achieving the target response rates for osteosarcoma (less than 5%) and Ewing sarcoma (5.6%), leading to the decision to close these arms due to insufficient efficacy and slow patient enrollment.
Phase II study of sequential gemcitabine followed by docetaxel for recurrent Ewing sarcoma, osteosarcoma, or unresectable or locally recurrent chondrosarcoma: results of Sarcoma Alliance for Research Through Collaboration Study 003.Fox, E., Patel, S., Wathen, JK., et al.[2022]
The combination of gemcitabine and docetaxel has shown effectiveness in treating metastatic sarcomas, particularly in leiomyosarcoma and undifferentiated high-grade pleomorphic sarcoma, expanding treatment options for oncologists.
There is evidence suggesting that the combination may work synergistically, especially since docetaxel alone has a low response rate, indicating that using both drugs together could enhance treatment outcomes.
Gemcitabine and docetaxel in metastatic sarcoma: past, present, and future.Maki, RG.[2022]

References

Poor treatment outcomes with palliative gemcitabine and docetaxel chemotherapy in advanced and metastatic synovial sarcoma. [2022]
Phase II study of sequential gemcitabine followed by docetaxel for recurrent Ewing sarcoma, osteosarcoma, or unresectable or locally recurrent chondrosarcoma: results of Sarcoma Alliance for Research Through Collaboration Study 003. [2022]
Gemcitabine and docetaxel in metastatic sarcoma: past, present, and future. [2022]
Efficacy and Safety of Nanosomal Docetaxel Lipid Suspension-Based Chemotherapy in Sarcoma: A Multicenter, Retrospective Study. [2022]
A phase II study of gemcitabine and docetaxel combination in relapsed metastatic or unresectable locally advanced synovial sarcoma. [2023]
Combination of gemcitabine and docetaxel in the treatment of children and young adults with refractory bone sarcoma. [2022]
Treatment of relapsed/refractory pediatric sarcomas with gemcitabine and docetaxel. [2022]
Randomized Phase 2 Clinical Trial of Olaratumab in Combination with Gemcitabine and Docetaxel in Advanced Soft Tissue Sarcomas. [2023]
Docetaxel suppresses immunotherapy efficacy of natural killer cells toward castration-resistant prostate cancer cells via altering androgen receptor-lectin-like transcript 1 signals. [2020]
Lack of Activity of Docetaxel in Soft Tissue Sarcomas: Results of a Phase II Study of the Italian Group on Rare Tumors. [2021]