A phase I/IIa open label, nonrandomized, multicenter study of CYNK-101 in combination with trastuzumab and pembrolizumab in patients with locally advanced unresectable or metastatic HER2-positive gastric or gastroesophageal junction (G/GEJ) adenocarcinoma

TPS478

Background: CYNK-101 is a human placental hematopoietic stem/progenitor cell derived NK cell product, that is genetically modified to express a variant of CD16, FcγRIII, via lentiviral vector transduction. The CD16 variant has amino acid modifications to enable high affinity and proteolytic cleavage-resistance for ADCC enhancement. Results from preclinical studies demonstrated enhanced ADCC activity of CYNK-101 in combination with trastuzumab against HER2+ gastric cancer cell lines in vitro, ex vivo and in vivo. Methods: A Phase I/IIa study is a first-line treatment of patients with locally advanced unresectable or metastatic HER2 positive gastric or gastroesophageal junction (G/GEJ) adenocarcinoma. Patients are required to have confirmation of HER2 positivity defined as either IHC 3+ or IHC 2+ with a positive FISH or FISH + alone. Following the completion of screening assessments, patients are enrolled to the initial induction period of the trial and receive pembrolizumab, trastuzumab and a fluoropyrimidine/platinum based-chemotherapy for up to six 21-day cycles. In Phase I, patients may skip the initial induction period if they had previously been treated with pembrolizumab or, trastuzumab and a fluoropyrimidine/platinum based-chemotherapy and have not achieved an adequate response. Patients complete a disease assessment and then proceed to a lymphodepletion regimen of cyclophosphamide 900 mg/m2 and fludarabine 30 mg/m2 with MESNA for 3 days. Following 2 days of rest, the NK-cell re-induction period of the study begins with pembrolizumab 200 mg and trastuzumab 6 mg/kg on Day 1 of that cycle and 6M IU of rhIL-2 with CYNK-101 on days 1, 8, 15. CYNK-101 will be administered based on the calculated number of transduced cells per body weight as measured in kilograms (kg). Two dose levels of CYNK-101 (36 x 106 transduced cells/kg, and 72 x 106 transduced cells/kg) will be evaluated for the NK-Cell reinduction period during the Phase 1 portion of the study in a standard “3+3” dose escalation fashion. Once the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) is determined in Phase I, the designated dosing Cohort level of the NK-Cell re-induction period will be used for the Phase IIa Expansion portion of the study. Both study periods will contain maintenance dosing of pembrolizumab 200 mg, trastuzumab 6 mg/kg and 6M IU rhIL-2 with 3.6 x 106 transduced cells/kg of CYNK-101 on Day 1 of a 21-day cycle. Endpoints: Primary endpoints for Phase I, include the incidence of adverse events defined as dose-limiting toxicities (DLTs). Phase IIa will evaluate efficacy as measured by overall response rate and a complete response rate as determined by RECIST 1.1. Approximately 52 patients are planned for this Phase I/IIa study. Clinical trial information: NCT05207722 .

A phase I/IIa, open-label, multicenter, non-randomized clinical trial to assess the safety and efficacy of CYNK-001 in combination with recombinant human interleukin 2 in adults with recurrent resection eligible IDH1 wild-type glioblastoma (GBM)

TPS2080

Background: CYNK-001 is a CD56+CD3- enriched, off-the-shelf, allogeneic natural killer (NK) cell product expanded from placental CD34 cells. CYNK-001 exhibits in vitro cytotoxicity against patient-derived GBM cell lines and secretes cytolytic cytokines during co-culture with cancer cells. CYNK-001 administered via the intracranial (IC) route exhibited in vivo antitumor activity in a U-87MG orthotopic mouse model. Methods: A Phase I/IIa clinical trial is enrolling IDH1 wild-type GBM patients at first or second recurrence with contrast-enhancing measurable disease (per RANO criteria) who are candidate for surgical resection. Screening MRI scans for inclusion are performed within 14 days prior to Day -5 lymphodepletion with Cyclophosphamide 900mg/m2 and fludarabine 30mg/m2 plus mesna. Using a standard 3+3 dose escalation schema, patients will receive the first cycle of CYNK-001 intravenously (IV) at an initial dose of 2.4 x109 cells on Days 1, 8 and 15 after lymphodepletion. Cell supportive IL-2 at 6M IU administered SQ on Days 1, 3, 5, 8, 10, 12, and 15 within 3 hours prior to CYNK-001 IV infusion where applicable. Cycle 2 begins with surgical resection on Day 22 in which CYNK-001 is administered directly into the tumor cavity wall at an initial dose of 100 x106 NK cells and an Ommaya catheter placement. Subsequent CYNK-001 IC administrations via the Ommaya are on days 29 and 36 with 6M IU IL-2 SQ. DLT is evaluated for all dosing cohorts from day 1 to 7 days post last dose of cycle 2. Once a maximum tolerated dose is identified, a safety lead-in cohort with an additional 3 cycles of CYNK-001 IC will be administered prior to initiating the Phase IIa portion of the study. Endpoints: The primary endpoint is dose-limiting toxicity for the Phase I analysis and 6-month progression free survival post tumor resection for the Phase IIa component. Post-resected tumor tissue will be characterized for effector immune cell function and immune suppression with assessments directed at CYNK-001 tumor distribution using methodology developed at Celularity Inc. Approximately 66 patients are planned for this Phase I/IIa study. Approximately 66 patients are planned for this Phase I/IIa study. Clinical trial information: NCT05218408.

Abstract CT201: Early report of a phase I/II study of human placental hematopoietic stem cell derived natural killer cells (CYNK-001) for the treatment of adults with COVID-19 (NCT04365101)

Background CYNK-001 is a cryopreserved, allogeneic, off-the-shelf natural killer (NK) cell investigational product derived from placental CD34+ cells. CYNK-001 exhibits cytotoxicity against various cancer cell types as well as virally infected cells and secretes immunomodulatory cytokines upon target activation. This is the first study to evaluate the safety and potential efficacy of CYNK-001 to treat patients (pts) with SARS-CoV-2, previously investigated in only solid tumor and hematologic malignancies. Methods Placental CD34+ cells were cultured in the presence of cytokines for 35 days to generate CYNK-001 under the cGMP conditions. Pts with a positive RT-PCR test for SARS-CoV-2 from the nasopharynx and having moderate to severe illness, not requiring intensive care support or mechanical ventilation, were eligible. All enrolled pts received best supportive care. In the Phase 1 trial focused on safety of administration, a total of 14 pts will receive up to 3 CYNK-001 infusions on Days 1 (1.5e8 cells), 4 (6e8 cells), 7 (6e8 cells). Efficacy was measured by SARS-CoV-2 clearance as measured by RT-PCR testing and clinical measures of improvement, including pulmonary status, and inflammatory marker changes. Results Four of 6 pts treated to date were evaluable at the time of submission. All had multiple medical co-morbidities. Peripheral oxygen saturation (Sp02) ranged between 88-92% on up to 8L of supplemental oxygen and all had evidence of multilobar pneumonia on chest radiography. Two pts had received no prior therapy for COVID-19. The other 2 pts received remdesivir and dexamethasone, with the 4th pt also receiving convalescent plasma. In all 4 pts, all infusions were well tolerated. In 3 of 4 pts, oxygenation improved after the first infusion of CYNK-001 and radiographic improvement was noted. The 4th pt developed progressive hypoxemia prior to the administration of the first dose of CYNK-001, requiring more than 30L of supplemental oxygen delivered by facemask to support a Sp02>90%. All 3 doses of CYNK-001 were administered, but oxygen requirements increased. Twelve days after first CYNK-001 dose, the pt declined mechanical ventilation and died of respiratory failure. Attribution to CYNK-001 could not be ruled out. The remaining 3 pts were discharged with an average follow-up of 16 (9-32) days after first infusion. Conclusion In the first study to measure the safety and potential efficacy of CYNK-001 infusions to treat pts with COVID-19 disease, infusions were generally well tolerated with one Grade 5 event of hypoxic respiratory failure. Early efficacy has been seen in 3 of 4 pts with improvement of oxygenation, inflammatory markers, and radiographic findings. Once Phase 1 is completed, the Phase 2 portion of the study will test this approach in a randomized fashion compared to best available therapy to confirm efficacy of this approach.

Citation Format: Corey Casper, Leonid Groysman, Vinay Malhotra, Eric Whitman, Stacy Herb, Erica Rave, Alan Lew, Cristina Goman, Zachary Sagawa, Monica Thakar, Victoria Lacasse, Cherie Daly, Shuyang He, Lin Kang, Sharmila Koppisetti, Tanel Mahlakõiv, Sunday Osokoya, William van der Touw, Junhong Zhu, Greg Berk, Xiaokui Zhang, Andrew Pecora, Robert Hariri. Early report of a phase I/II study of human placental hematopoietic stem cell derived natural killer cells (CYNK-001) for the treatment of adults with COVID-19 (NCT04365101) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT201.

RTID-07. HUMAN PLACENTAL HEMATOPOIETIC STEM CELL DERIVED NATURAL KILLER CELLS (CYNK-001) FOR TREATMENT OF RECURRENT GLIOBLASTOMA

Glioblastoma (GBM) is the most aggressive primary brain tumor with dismal prognosis. Recent advances of immunotherapy in cancer have sparked interest in the use of cell therapy for treatment of GBM. Active transfer of Natural Killer (NK) cells is of particular interest in GBM because NK cells are capable of exerting anti-tumor cytotoxicity without the need for antigen presentation and sensitization, processes that are impaired in GBM. CYNK-001 is an allogeneic, off-the-shelf product enriched for CD56+/CD3- NK cells expanded from placental CD34+ cells manufactured by Celularity. Here, we demonstrate in vitro cytotoxicity of CYNK-001 against several GBM lines and its in vivo anti-tumor activity in a U87MG orthotopic mouse model via intracranial administration resulting in 94.5% maximum reduction in tumor volume. We have developed a phase I window-of-opportunity trial of CYNK-001 in recurrent GBM via intravenous (IV) and intratumoral (IT) routes. In the IV cohort, subjects receive cyclophosphamide for lymphodepletion followed by 3-doses of IV CYNK-001 weekly. In the IT cohort, subjects undergo placement of an IT catheter with an ommaya reservoir followed by 3-doses of IT CYNK-001 weekly. Patients are monitored for 28-days after last infusion for toxicity. Once maximum safe dose (MSD) is determined, patients undergo IV or IT treatments at MSD followed by surgical resection and the tumor tissue will be analyzed for NK cell engraftment and persistence. We will utilize a 3 + 3 dose de-escalation design (maximum n=36). Primary endpoint is safety and feasibility. Secondary endpoints are overall response rate, duration of response, time to progression, progression free survival and overall survival. Main eligibility criteria include age ≥18, KPS ≥60, GBM at first or second relapse with a measurable lesion on ≤2mg dexamethasone. This is the first clinical trial to investigate CYNK-001 in GBM and will lay the foundation for future NK cell therapy in solid tumors.