Dual-Target Nectin-4/HER2 CAR-NK Cells in Advanced Urothelial Carcinoma

About this trial

Last updated 2 months ago

Study ID

EB-DT-NK-UC-105

Status

Recruiting

Type

Interventional

Phase

Phase 1

Placebo

Accepting

18 to 75 Years

All Sexes

Trial Timing

Started 3 months ago

What is this trial about?

This hypothetical first-in-human study is designed to evaluate the safety, feasibility, and preliminary anti-tumor activity of an allogeneic dual-target Nectin-4/HER2 CAR-NK cell product in adults with relapsed/refractory locally advanced or metastatic urothelial carcinoma. Based on public urothelial-cancer evidence, Nectin-4 was selected as the lead antigen because it has the strongest disease-specific clinical validation; HER2/ERBB2 was chosen as the secondary co-target to broaden tumor coverage and reduce antigen-escape risk. EpCAM is not selected as a therapeutic co-target in this example because of broader normal epithelial expression and weaker tumor specificity in urothelial carcinoma.

What are the participation requirements?

Inclusion Criteria

* Age 18-75 years at consent.

* Histologically confirmed urothelial carcinoma of the bladder, ureter, renal pelvis, or urethra that is unresectable locally advanced or metastatic.

* Disease progression after, intolerance to, or ineligibility for standard therapy, including platinum-based chemotherapy and PD-1/PD-L1 blockade when appropriate for the patient and region. Prior enfortumab vedotin and prior HER2-directed therapy are allowed, but a fresh biopsy is strongly preferred after the latest systemic regimen.

* At least one measurable lesion per RECIST v1.1.

* Tumor tissue available for central review demonstrating Nectin-4 positivity (for example, IHC ≥1+ in ≥10% tumor cells) and HER2 status assessed by IHC/ISH. At least one of the selected therapeutic targets must be present; dose expansion preferentially enrolls Nectin-4-positive disease.

* ECOG performance status 0-1.

* Adequate bone marrow, hepatic, renal, and coagulation function.

* Life expectancy of at least 12 weeks.

* Negative pregnancy test for women of childbearing potential and agreement to use highly effective contraception during study treatment and follow-up as defined in the protocol.

* Ability to understand and sign informed consent.

Exclusion Criteria

* Active or untreated central nervous system metastases or leptomeningeal disease. Previously treated CNS disease is allowed if clinically stable and off escalating corticosteroids.

* Prior allogeneic hematopoietic stem cell transplant, prior solid-organ transplant, or active graft-versus-host disease.

* Clinically significant autoimmune disease requiring systemic immunosuppression within the defined washout window.

* Uncontrolled infection, including uncontrolled hepatitis B, hepatitis C, HIV, sepsis, or active tuberculosis.

* Clinically significant cardiac disease, active myocarditis, unstable angina, recent myocardial infarction, uncontrolled arrhythmia, or clinically meaningful decline in left ventricular ejection fraction that would increase risk from HER2-directed cell therapy.

* Clinically significant pulmonary disease (for example, uncontrolled interstitial lung disease or oxygen-dependent respiratory compromise).

* Use of systemic corticosteroids or other immunosuppressive medications above protocol-allowed limits within the washout window.

* History of severe hypersensitivity to fludarabine, cyclophosphamide, or cell-product excipients.

* Pregnancy or breastfeeding.

* Another active malignancy requiring systemic therapy or likely to interfere with protocol assessments, except for protocol-allowed low-risk cancers.