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Cyclophosphamide and Fludarabine Followed By Interleukin-2 Gene-Modified Tumor Infiltrating Lymphocytes in Treating Patients With Metastatic Melanoma

Primary Purpose

Melanoma (Skin)

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
aldesleukin
filgrastim
incomplete Freund's adjuvant
interleukin-2 gene
therapeutic tumor infiltrating lymphocytes
cyclophosphamide
fludarabine phosphate
Sponsored by
National Institutes of Health Clinical Center (CC)
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Melanoma (Skin) focused on measuring stage IV melanoma, recurrent melanoma

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

Sites / Locations

  • Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
  • NCI - Center for Cancer Research

Outcomes

Primary Outcome Measures

Survival

Secondary Outcome Measures

Clinical tumor regression
Toxicity profile

Full Information

First Posted
June 5, 2003
Last Updated
June 30, 2017
Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00062036
Brief Title
Cyclophosphamide and Fludarabine Followed By Interleukin-2 Gene-Modified Tumor Infiltrating Lymphocytes in Treating Patients With Metastatic Melanoma
Official Title
Tumor Infiltrating Lymphocytes (TIL Cells) Transduced With An Interleukin-2 (SBIL-2) Gene Following The Administration Of A Nonmyeloablative But Lymphocyte Depleting Regimen in Metastatic Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
March 2012
Overall Recruitment Status
Completed
Study Start Date
June 2003 (undefined)
Primary Completion Date
February 2007 (Actual)
Study Completion Date
September 2008 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. 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).
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Melanoma (Skin)
Keywords
stage IV melanoma, recurrent melanoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Masking
None (Open Label)
Enrollment
33 (Anticipated)

8. Arms, Groups, and Interventions

Intervention Type
Biological
Intervention Name(s)
aldesleukin
Intervention Type
Biological
Intervention Name(s)
filgrastim
Intervention Type
Biological
Intervention Name(s)
incomplete Freund's adjuvant
Intervention Type
Biological
Intervention Name(s)
interleukin-2 gene
Intervention Type
Biological
Intervention Name(s)
therapeutic tumor infiltrating lymphocytes
Intervention Type
Drug
Intervention Name(s)
cyclophosphamide
Intervention Type
Drug
Intervention Name(s)
fludarabine phosphate
Primary Outcome Measure Information:
Title
Survival
Secondary Outcome Measure Information:
Title
Clinical tumor regression
Title
Toxicity profile

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility 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
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven A. Rosenberg, MD, PhD
Organizational Affiliation
NCI - Surgery Branch
Official's Role
Principal Investigator
Facility Information:
Facility Name
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892-1182
Country
United States
Facility Name
NCI - Center for Cancer Research
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Cyclophosphamide and Fludarabine Followed By Interleukin-2 Gene-Modified Tumor Infiltrating Lymphocytes in Treating Patients With Metastatic Melanoma

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