30 Participants Needed

Siltuximab for CRS and ICANS Related to CAR-T Therapy

MN
Overseen ByMayur Narkhede
Age: 18+
Sex: Any
Trial Phase: Phase 2
Sponsor: University of Alabama at Birmingham
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 4 JurisdictionsThis treatment is already approved in other countries

Trial Summary

Will I have to stop taking my current medications?

The trial requires a washout period (time without taking certain medications) for some therapies before starting CAR T-cell infusion. Systemic therapy must be stopped 2 weeks before, radiation therapy 1 week before, and corticosteroids 5 days before the infusion. If you are on these treatments, you may need to stop them temporarily.

Is siltuximab safe for treating CRS and ICANS related to CAR-T therapy?

Siltuximab, an IL-6 inhibitor, has been used in some cases to treat cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) related to CAR-T therapy. While reports on its use are limited, it has been administered alongside other treatments like high-dose steroids and anakinra in patients with severe cases, suggesting it is considered safe enough for use in these contexts.12345

How is the drug siltuximab different from other treatments for CRS and ICANS related to CAR-T therapy?

Siltuximab is unique because it directly inhibits IL-6, a protein involved in inflammation, whereas other treatments like tocilizumab target the IL-6 receptor. This direct inhibition may offer an alternative for patients who do not respond to receptor-targeting drugs.12567

What is the purpose of this trial?

This study will evaluate the use of siltuximab to decrease the severity of cytokine release syndrome (CRS) and immune effector cell-associated neurological syndrome (ICANS) in patients who will receive chimeric antigen receptor (CAR) T-cell therapy for the treatment of hematological malignancies.

Research Team

MS

Mayur Narkhede, MD

Principal Investigator

University of Alabama at Birmingham

Eligibility Criteria

This trial is for patients with certain blood cancers who are getting CAR-T cell therapy and can handle a washout period before treatment. They must have good liver, kidney, and blood function, not be pregnant or HIV positive, and agree to use effective contraception.

Inclusion Criteria

I have Hepatitis B but am on treatment with no detectable virus.
I am a man who can father children and will use contraception.
I have hepatitis C but have completed treatment and now have an undetectable viral load.
See 6 more

Exclusion Criteria

I do not have an active autoimmune disease that needs immunosuppressive therapy, or I have discussed it with the PI.
I take more than 10 mg of prednisone daily, not just in short bursts.
I have HIV.
See 2 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive CAR T-cell therapy and are monitored for CRS and ICANS. Siltuximab is administered upon development of these syndromes.

14 days
Frequent monitoring visits

Follow-up

Participants are monitored for resolution of CRS and ICANS, and for adverse events from Siltuximab.

28 days
Regular follow-up visits

Long-term follow-up

Participants are monitored for response to CAR T-cell therapy and overall outcomes.

90 days

Treatment Details

Interventions

  • Siltuximab
Trial Overview The study tests if siltuximab can reduce the severity of CRS and ICANS in patients undergoing CAR-T cell therapy for hematological malignancies like lymphoma or leukemia.
Participant Groups
1Treatment groups
Experimental Treatment
Group I: SiltuximabExperimental Treatment1 Intervention
Patients who experience CRS/ICANS will receive this treatment

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Alabama at Birmingham

Lead Sponsor

Trials
1,677
Recruited
2,458,000+

Findings from Research

A 77-year-old male with relapsed/refractory multiple myeloma experienced cytokine release syndrome (CRS) and neurotoxicity after bispecific antibody therapy, but recovered rapidly after receiving siltuximab, an IL-6 inhibitor.
Siltuximab effectively managed CRS symptoms within 1 hour and neurotoxicity within 7 hours, allowing the patient to tolerate further treatment without recurrence of CRS.
Siltuximab as a primary treatment for cytokine release syndrome in a patient receiving a bispecific antibody in a clinical trial setting.Lipe, BC., Renaud, T.[2023]
A patient with severe cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) related to CAR T-cell therapy was successfully treated with dasatinib, a tyrosine kinase inhibitor, after failing standard treatments like IL-6 blockade and steroids.
This case suggests that dasatinib may be a promising alternative treatment for severe complications from CAR T-cell therapy, highlighting the need for further research into its efficacy and safety in this context.
Dasatinib for treatment of CAR T-cell therapy-related complications.Baur, K., Heim, D., Beerlage, A., et al.[2023]
Chimeric antigen receptor (CAR) T-cell therapy is becoming more widely used due to improved safety measures, including the establishment of diagnostic criteria for cytokine release syndrome (CRS) and neurotoxicity, as well as the use of treatments like tocilizumab and corticosteroids.
Despite these advancements, some patients still experience severe and persistent CRS and neurotoxicity, which can negatively affect outcomes; new strategies, including the use of anakinra, are being explored to manage these refractory cases.
How I treat refractory CRS and ICANS after CAR T-cell therapy.Jain, MD., Smith, M., Shah, NN.[2023]

References

Siltuximab as a primary treatment for cytokine release syndrome in a patient receiving a bispecific antibody in a clinical trial setting. [2023]
Dasatinib for treatment of CAR T-cell therapy-related complications. [2023]
How I treat refractory CRS and ICANS after CAR T-cell therapy. [2023]
Molecular and Clinical Characteristics of Different Toxicity Rates in Anti-CD19 Chimeric Antigen Receptor T Cells: Real-World Experience. [2023]
Early versus standard management of chimeric antigen receptor therapy toxicities and management's impact on safety and efficacy. [2023]
Neurological management and work-up of neurotoxicity associated with CAR T cell therapy. [2022]
Use of long-term corticosteroids in patients treated with CAR T-cell therapy. [2023]
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