Pragmatic approach to Adoptive Cell Therapy (ACT) using Tumor Infiltrating Lymphocytes (TIL) in selected solid tumors

Project Information

PragmaTIL

Grant agreement ID: 101104684

DOI

10.3030/101104684

EC signature date 28 April 2023

Start date 1 April 2023

End date 31 March 2028

Funded under

• Health

Total cost

€ 5 998 839,75

EU contribution

€ 5 998 839,75

Coordinated by

FUNDACIO PRIVADA INSTITUT D'INVESTIGACIO ONCOLOGICA DE VALL-HEBRON (VHIO)
Spain

Periodic Reporting for period 1 - PragmaTIL (Pragmatic approach to Adoptive Cell Therapy (ACT) using Tumor Infiltrating Lymphocytes (TIL) in selected solid tumors)

Reporting period: 2023-04-01 to 2024-09-30

Summary of the context and overall objectives of the project

The PragmaTIL project aims to make Tumor Infiltrating Lymphocytes Adoptive Cell Therapy, (TIL-ACT), a promising cancer treatment, available to more patients. Currently, access to this therapy is limited because of serious side effects and challenges in providing it in hospitals. Our goal is to improve how this therapy is used in hospitals and make it safer and easier for patients to receive.
One of the biggest issues with TIL-ACT is the high toxicity caused by a drug called high-dose interleukin-2 (HD-IL-2), which is used after TIL therapy to activate immune cells. These side effects can be severe and make the treatment risky for patients. PragmaTIL project focuses on reducing these toxic effects while keeping the therapy effective. This will improve patients’ quality of life during treatment, make hospital stays more manageable, and help more hospitals offer this therapy. Ultimately, this will allow more patients to benefit, especially those with certain cancers that don’t respond to other treatments.
TIL-ACT has already shown promising results for some cancers, like metastatic melanoma, in clinical studies worldwide. However, it’s not yet fully approved as a standard treatment, partly because of the severe side effects of HD-IL-2. If we can make the treatment safer, more hospitals and clinics will be able to offer it, giving patients more options.
Here are the main goals of the PragmaTIL project:
1. Reduce Side Effects: We will test whether using a new drug, ANV419, instead of HD-IL-2 can reduce moderate-to-severe side effects by at least 35%. This will make the therapy safer for patients.
2. Improve Quality of Life: We will measure how the new approach affects patients’ quality of life during treatment. This includes using patient feedback through questionnaires and digital tools to track their experiences, both during and after treatment. We will work closely with patients and their caregivers to ensure the treatment addresses their needs.
3. Analyze Costs and Accessibility: We will study the cost, budget impact, and practicality of offering this improved therapy in healthcare systems. This includes analyzing whether it’s affordable, how it can be reimbursed, and its overall benefits to society. This will help governments and healthcare providers decide if and how they can make the treatment widely available.
By achieving these goals, the PragmaTIL project will help make TIL-ACT a safer and more accessible treatment option for patients across Europe and beyond, giving more people hope for better outcomes in battling hard-to-treat cancers.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

First Objective: to determine whether TIL-ACT using IL-2 analogue ANV419 reduces the frequency of Grade 2-4 toxicities (based on Common Terminology Criteria for Adverse Events v5.0 - CTCAE v5.0) which are associated to the study therapy and which are non-haematological events by at least 35% as compared to TIL-ACT using HD-IL-2. In case this objective is achieved, the co-primary objective will be to assess the non-inferiority of ANV419 vs HD-IL-2 in overall survival rate at 1 year (OS-1y) after TIL infusion.

Status of the objective
To progress in this objective, we conducted all essential clinical trial preparations:
- Agreement on IMPD submission strategy
- Clinical Trial Design & Documentation:
- Created comprehensive trial documents including the protocol, IMPD, patients' information sheets, investigator brochure, and pharmacy and laboratory manuals.
Approval Process:
Submitted through CTIS and achieved approvals in Denmark, the Netherlands, and Spain. Sweden will be included at a later stage, once they receive approval of their new IMPD.
For this, it was crucial to reach agreements in two key areas: (i) the clinical trial design and toxicity evaluation, and (ii) the IMPD submission strategy.

Second Objective: to compare quality of life (QoL) of patients during their hospitalization period, using ANV419 vs HD-IL-2. To measure patient QoL, we will use several standardized QoL questionnaires that were selected with patients representatives. Additionally, we plan to capture and compare short and long-term measurements of treatment-related toxicities focusing on key QoL domains co-defined by patients and healthcare providers (HCPs). This objective will include the collection of QoL and treatment toxicity data using validated patient-reported outcomes and passively sensed data via wearable technology. In addition, an in-depth qualitative evaluation of patient experience will be performed.

Status of the Objective
- Patient Advisory Committee

During PragmaTIL’s first reporting period several actions related to the second objective have taken place, coordinated by WP3 and WP1 leaders. In M3 a Patient Advisory Committee (PAC) was created, including six patient representatives from different participating countries (Spain, Israel, Denmark, Netherlands). The aim of the PAC is to inegrate the patient perspective, voice and needs into the trial design and activities to make the trial as well-designed and effective for patients and HCPs as possible. The PAC and experiential expertise of HCP and patients within the PAC has been and will continue to be leveraged at key points throughout the trial pathway (protocol development, trial execution, results communication).

The PAC participation has been organized by workshops following the System Oriented Dialogue Model (SODM). The PAC has held a total of 4 workshops.
- PRO Selection
Within the second objective, one of the main tasks has been the selection of measures of treatment related toxicities and QoL through the selection of patient reported outcomes (PRO) questionnaires. PRO measurement needs were identified after a complete literature review and collaboration with the PAC to understand key QoL domains and important toxicities. After further discussion with WP3 and WP1 participants, a final chart of PRO measures and validated questionnaires were selected to measure QoL in the PragmaTIL clinical trial. Patients will also participate in qualitative interviews to provide a more in-depth understanding of the patient experience in this clinical trial. A standard interview guide has been developed to guide qualitative interviews. All information regarding the PRO selection is described in the progress report of WP3.

Third Objective: to develop the health technology assessment (HTA) of TIL-ACT using ANV419, via the analysis of cost-effectiveness, budget impact, reimbursement strategies, user acceptance, and technical feasibility.
Status of the Objective
The work regarding this objective has partially started. To achieve this objective, we need the clinical trial to have concluded.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

PragmaTIL clinical trial has been approved by the regulatory authorities. However, as patient inclusion has not started yet, no results beyond the state of the art have been achieved.

PragmaTIL Annual Meeting - April 2024