Cyclophosphamide and Fludarabine Followed By Interleukin-2 Gene-Modified Tumor Infiltrating Lymphocytes in Treating Patients With Metastatic Melanoma
Study Details
Study Description
Brief Summary
RATIONALE: Drugs used in chemotherapy such as cyclophosphamide and fludarabine use different ways to stop tumor cells from dividing so they stop growing or die. Inserting the gene for interleukin-2 into a person's tumor infiltrating lymphocytes may make the body build an immune response to kill tumor cells. Combining cyclophosphamide and fludarabine with gene-modified tumor cells may kill more cancer cells.
PURPOSE: This phase I/II trial is studying the side effects and best dose of gene-modified tumor infiltrating lymphocytes when given together with cyclophosphamide and fludarabine and to see how well they work in patients with metastatic melanoma (phase I is closed to accrual 3/29/06).
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 1/Phase 2 |
Detailed Description
OBJECTIVES:
Primary
-
Determine the survival of patients with metastatic melanoma administered interleukin-2 gene-modified tumor infiltrating lymphocytes after cyclophosphamide and fludarabine.
-
Compare survival results with prior Surgery Branch studies using adoptive cell therapy without the interleukin-2 retroviral vector (SBIL-2) gene.
Secondary
-
Determine clinical tumor regression in patients administered interleukin-2 gene-modified TIL after cyclophosphamide and fludarabine followed by interleukin-2.
-
Determine the toxicity profile of this regimen in these patients.
OUTLINE:
-
Phase I (closed to accrual as of 3/29/06):
-
Harvest: TIL are harvested, transduced with IL-2 gene, and expanded in vitro over a period of approximately 4 weeks.
-
Nonmyeloablative preparative regimen (chemotherapy): Patients receive cyclophosphamide IV over 1 hour on days -7 and -6 and fludarabine IV over 30 minutes on days -5 to -1.
-
Lymphocyte administration: Patients receive IL-2 gene-transduced TIL IV over 20-30 minutes on day 0. They also receive high-dose IL-2 IV over 15 minutes every 8 hours on days 0 -5 (maximum 15 doses). Beginning 1-2 days after lymphocyte administration, patients receive filgrastim (G-CSF) subcutaneously (SC) daily, , until blood counts recover.
-
Retreatment: Patients are re-evaluated every 4-6 weeks. Retreatment depends on disease status after each regimen. Patients with dose-limiting toxicity do not receive further treatment.
-
No response: Patients with stable disease or disease progression after the initial treatment are followed or removed from the study.
-
Partial response: Patients with a partial or minor response after the initial treatment may receive retreatment, approximately 2-4 weeks later, with chemotherapy, IL-2 gene-transduced TIL, immunization, and high-dose IL-2 as above, every 4-6 weeks for up to 2 courses provided at least a partial response is documented after each regimen.
-
Complete response: Patients with a complete response receive no further treatment.
-
Phase II: Patients receive treatment and retreatment as in phase I with the MTD of IL-2 gene-transduced TIL.
Patients are followed every 3-6 weeks in the absence disease progression.
PROJECTED ACCRUAL: A total of 33 patients will be accrued for this study.
Study Design
Outcome Measures
Primary Outcome Measures
- Survival []
Secondary Outcome Measures
- Clinical tumor regression []
- Toxicity profile []
Eligibility Criteria
Criteria
DISEASE CHARACTERISTICS:
-
Diagnosis of melanoma
-
Metastatic disease
-
Refractory to standard therapy including high-dose interleukin-2 (IL-2) therapy
-
Evaluable disease
-
Patients may enroll at the cell infusion stage provided they have tumor available for biopsy OR expandable SBIL-2-transduced tumor infiltrating lymphocytes available
-
Progressive disease during prior immunization to melanoma antigens or cellular therapy, with or without myeloablation, allowed
-
Symptomatic CNS lesions allowed provided immediate active treatment for symptomatic lesions has been completed
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- ECOG 0-1
Life expectancy
- More than 3 months
Hematopoietic
-
Absolute neutrophil count greater than 1,000/mm^3
-
WBC greater than 3,000/mm^3
-
Lymphocyte count greater than 500/mm^3
-
Platelet count greater than 100,000/mm^3
-
Hemoglobin greater than 8.0 g/dL
-
No coagulation disorder
Hepatic
-
Bilirubin no greater than 2.0 mg/dL (less than 3.0 mg/dL in patients with Gilbert's syndrome)
-
AST/ALT less than 3 times upper limit of normal
-
Hepatitis B surface antigen negative
-
Hepatitis C virus negative
Renal
- Creatinine no greater than 1.6 mg/dL
Cardiovascular
-
No myocardial infarction
-
No cardiac arrhythmias
-
No abnormal stress thallium or comparable test
-
LVEF > 45% and normal stress cardiac test in patients with the following criteria:
-
50 years old or greater
-
History of EKG abnormalities, symptoms of cardiac ischemia or arrhythmias
-
No major cardiovascular illness
Pulmonary
-
No obstructive or restrictive pulmonary disease
-
No major respiratory illness
-
FEV_1 > 60% predicted in patients with prolonged history of cigarette smoking or symptoms of respiratory dysfunction
Immunologic
-
HIV negative
-
No prior severe immediate hypersensitivity reaction
-
No primary or secondary immunodeficiency
-
No active systemic infection
-
No concurrent opportunistic infection
-
No major immune system illness
Other
-
Not pregnant or nursing
-
Negative pregnancy test
-
Fertile patients must use effective contraception during and for 4 months after study therapy
-
Must sign a durable power of attorney
PRIOR CONCURRENT THERAPY:
Biologic therapy
-
See Disease Characteristics
-
No prior anti-cytotoxic T-lymphocyte antibody-4 antibody (CTLA-4) allowed unless post-MDX010 treatment and colonoscopy with colonic biopsies are normal
Chemotherapy
- Recovered from prior chemotherapy
Endocrine therapy
- No concurrent steroids
Radiotherapy
- Recovered from prior radiotherapy
Surgery
- Not specified
Other
- More than 4 weeks since prior systemic therapy
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office | Bethesda | Maryland | United States | 20892-1182 |
2 | NCI - Center for Cancer Research | Bethesda | Maryland | United States | 20892 |
Sponsors and Collaborators
- National Institutes of Health Clinical Center (CC)
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Steven A. Rosenberg, MD, PhD, NCI - Surgery Branch
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 030162
- 03-C-0162
- NCI-5855
- CDR0000304438
- NCT00059163