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Prospective Randomized Study of Cell Transfer Therapy for Metastatic Melanoma Using Tumor Infiltrating Lymphocytes Plus IL-2 Following Non-Myeloablative Lymphocyte Depleting Chemo Regimen Alone or in Conjunction With 12Gy Total Body Irradiation (TBI...

Primary Purpose

Metastatic Melanoma, Skin Cancer

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Aldesleukin
Cyclophosphamide
Fludarabine
Young TIL
Total Body Irradiation (TBI)
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Melanoma focused on measuring Young TIL, Metastatic Melanoma, Immunotherapy, Adoptive Cell Therapy, Skin Cancer

Eligibility Criteria

18 Years - 66 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:

    1. Measurable metastatic melanoma with at least one lesion that is resectable for TIL generation. The lesion must be of at least 1cm in diameter that can be surgically removed with minimal morbidity (defined as any operation for which expected hospitalization less than or equal to 7 days).
    2. Patients with 3 or less brain metastases are eligible. Note: If lesions are symptomatic or greater than or equal to 1 cm each, these lesions must have been treated and stable for 3 months for the patient to be eligible.
    3. Greater than or equal to 18 years of age and less than or equal to 66 years of age.
    4. Willing to practice birth control during treatment and for four months after receiving all protocol related therapy.
    5. Life expectancy of greater than three months
    6. Willing to sign a durable power of attorney.
    7. Able to understand and sign the Informed Consent Document
    8. Clinical performance status of ECOG 0 or 1.
    9. Hematology:
  • Absolute neutrophil count greater than 1000/mm(3)
  • Hemoglobin greater than 8.0 g/dl
  • Platelet count greater than 100,000/mm(3)

    j. Serology:

  • Seronegative for HIV antibody. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who are HIV seropositive can have decreased immune competence and thus be less responsive to the experimental treatment and more susceptible to its toxicities.)
  • Seronegative for hepatitis B antigen, or hepatitis C antibody or antigen.

    k. Chemistry:

  • Serum ALT/AST less than three times the upper limit of normal.
  • Calculated creatinine clearance (eGFR) > 50 ml/min.
  • Total bilirubin less than or equal to 2 mg/dl, except in patients with

Gilbert s Syndrome who must have a total bilirubin less than 3 mg/dl.

l. More than four weeks must have elapsed since any prior systemic therapy at the time of randomization, and patients toxicities must have recovered to a grade 1 or less (except for alopecia or vitiligo). Patients must have stable or progressing disease after prior treatment.

Note: Patients may have undergone minor surgical procedures within the past 3 weeks, as long as all toxicities have recovered to grade 1 or less or as specified in the inclusion criteria.

m. Six weeks must have elapsed since any prior anti-CTLA4 antibody therapy to allow antibody levels to decline.

Note: Patients who have previously received ipilimumab or tremelimumab, anti- PD1 or anti-PD-L1 antibodies, and have documented GI toxicity must have a normal colonoscopy with normal colonic biopsies.

EXCLUSION CRITERIA:

  1. Prior cell transfer therapy which included a non-myeloablative or myeloablative chemotherapy regimen.
  2. Women of child-bearing potential who are pregnant or breastfeeding because 10 of the potentially dangerous effects of the preparative chemotherapy on the fetus or infant.
  3. Systemic steroid therapy requirement.
  4. Active systemic infections, coagulation disorders or other active major medical illnesses of the cardiovascular, respiratory or immune system, as evidenced by a positive stress thallium or comparable test, myocardial infarction, cardiac arrhythmias, obstructive or restrictive pulmonary disease.
  5. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease and AIDS).
  6. Opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have decreased immune competence may be less responsive to the experimental treatment and more susceptible to its toxicities.)
  7. History of severe immediate hypersensitivity reaction to any of the agents used in this study.
  8. History of coronary revascularization or ischemic symptoms.
  9. Any patient known to have an LVEF less than or equal to 45%.
  10. In patients > 60 years old, documented LVEF of less than or equal to 45%.
  11. Documented FEV1 less than or equal to 60% predicted tested in patients with:

    • A prolonged history of cigarette smoking (20 pk/year of smoking within the past 2 years)
    • Symptoms of respiratory dysfunction
  12. Prior radiation therapy that, in the judgment of the radiation oncologist, precludes the administration of total body irradiation.

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

1/ACT

2/ACT + TBI

Arm Description

Non-myeloablative lymphodepleting preparative regimen of cyclophosphamide and fludarabine + young TIL + highdose aldesleukin

Non-myeloablative lymphodepleting preparative regimen of cyclophosphamide and fludarabine + young TIL + highdose aldesleukin + TBI

Outcomes

Primary Outcome Measures

Response rate
Percentage of patients who have a clinical response to treatment (objective tumor regression)
Overall survival
Time to death following the start of treatment

Secondary Outcome Measures

Progression-free survival
Time to disease progression following the start of treatment
Frequency and severity of treatment-related adverse events
Aggregate of all adverse events, as well as their frequency and severity

Full Information

First Posted
March 18, 2011
Last Updated
September 23, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01319565
Brief Title
Prospective Randomized Study of Cell Transfer Therapy for Metastatic Melanoma Using Tumor Infiltrating Lymphocytes Plus IL-2 Following Non-Myeloablative Lymphocyte Depleting Chemo Regimen Alone or in Conjunction With 12Gy Total Body Irradiation (TBI...
Official Title
A Prospective Randomized Study of Cell Transfer Therapy for Metastatic Melanoma Using Short-Term Cultured Tumor-Infiltrating Lymphocytes Plus IL-2 Following Either a Non-Myeloablative Lymphocyte Depleting Chemotherapy Regimen Alone or in Conjunction With 12Gy Total Body Irradiation (TBI)
Study Type
Interventional

2. Study Status

Record Verification Date
January 26, 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
March 24, 2011 (Actual)
Primary Completion Date
June 1, 2024 (Anticipated)
Study Completion Date
June 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: - An experimental treatment for metastatic melanoma involves cell therapy, in which researchers take white blood cells (lymphocytes) from the tumor tissue, grow them in the laboratory in large numbers, and then use the cells to attack the tumor tissue. Before receiving the cells, chemotherapy is needed to temporarily suppress the immune system to improve the chances that the tumor-fighting cells will be able to survive in the body. In some studies of cell therapy, individuals who have received total body irradiation (TBI) in addition to the chemotherapy (in order to increase the length of time that they do not produce white blood cells) seem to have a slightly better response to the treatment, but it is not known if adding radiation to the cell therapy will cause a better response for all individuals. Researchers are interested in comparing cell therapy given with the usual chemotherapy to cell therapy given with the usual chemotherapy and TBI. Objectives: - To compare the effectiveness of cell therapy given with chemotherapy to cell therapy given with chemotherapy and total body irradiation in individuals with metastatic melanoma. Eligibility: - Individuals at least 18 years of age who have been diagnosed with metastatic melanoma. Design: Participants will be screened with a physical examination, medical history, blood tests, and tumor imaging studies. Participants will be divided into two groups: cell therapy with chemotherapy alone (group 1) or cell therapy with chemotherapy plus TBI (group 2). All participants will provide a tumor sample from either surgery or a tumor biopsy for white blood cell collection. Participants will have leukapheresis to collect additional white blood cells for cell growth and future testing, and TBI group participants will also provide stem cells to help them recover after radiation. (TBI participants who cannot provide enough stem cells will be moved to the non-radiation treatment group.) Participants will have chemotherapy with cyclophosphamide (two treatments over 2 days) and fludarabine (five treatments over 5 days) starting 7 days before the cell therapy. Participants in the TBI group will also have TBI for the 3 days immediately before the cell therapy. All participants will receive the white blood cells, followed by high-dose aldesleukin every 8 hours for up to 5 days after the cell infusion to help keep the therapy cells alive and active. Participants will also have injections of filgrastim to stimulate blood cell production, and participants in the TBI group will also receive their stem cells. Participants will take an antibiotic for at least 6 months after treatment to prevent pneumonia, and will be asked to return for regular monitoring and followup visits for at least 5 years to evaluate the tumor s response to treatment.
Detailed Description
Background: Adoptive cell therapy (ACT) using autologous tumor infiltrating lymphocytes can mediate the regression of bulky metastatic melanoma when administered along with high-dose aldesleukin (IL-2) following a non-myeloablative lymphodepleting chemotherapy preparative regimen consisting of cyclophosphamide and fludarabine. In a series of consecutive trials using this chemotherapy preparative regimen alone or with 2 Gy or 12 Gy total body irradiation (TBI) objective response rates using RECIST criteria were 49%, 52%, and 72%, respectively. Complete regression rates in these three consecutive trials were 12%, 20%, and 40%, respectively strongly suggesting that the addition of TBI could improve the complete regression rate. Of the 20 complete regressions seen in this trial, 19 are on-going at 37 to 82 months. Because of the complexity of developing selected TIL for use in adoptive transfer, we have recently developed a simplified method for producing TIL that is more applicable to use in outside institutions. Utilizing young TIL cells (sometimes with CD8 purification) in 105 patients, the objective response rate was 34% with a 6.6 % incidence of complete regressions. All patients in this trial received the cyclophosphamide fludarabine regimen alone. Because of the strong suggestion that the addition of TBI to the chemotherapy regimen could increase durable, complete regression rates in patients with metastatic melanoma, we are now attempting to definitively determine whether the addition of TBI to the chemotherapy preparative regimen can improve complete response rates, and overall survival in patients receiving young TIL . Objectives: -To determine, in a prospective randomized trial, the complete response rate and survival of patients with metastatic melanoma receiving ACT using young TIL plus aldesleukin treatment following either a chemotherapy preparative regimen alone, or the same chemotherapy preparative regimen plus TBI. Eligibility: -Patients who are 18 years or older must have: Evaluable metastatic melanoma; Metastatic melanoma lesion suitable for surgical resection for the preparation of TIL; No contraindications to high-dose aldesleukin administration or total body irradiation; No concurrent major medical illnesses or any form of immunodeficiency Design: -Patients with metastatic melanoma will have lesions resected and after TIL growth is established patients with will be prospectively randomized to receive ACT with young TIL plus aldesleukin following either a non-myeloablative chemotherapy preparative regimen or this same regimen plus TBI.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Melanoma, Skin Cancer
Keywords
Young TIL, Metastatic Melanoma, Immunotherapy, Adoptive Cell Therapy, Skin Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
102 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1/ACT
Arm Type
Experimental
Arm Description
Non-myeloablative lymphodepleting preparative regimen of cyclophosphamide and fludarabine + young TIL + highdose aldesleukin
Arm Title
2/ACT + TBI
Arm Type
Experimental
Arm Description
Non-myeloablative lymphodepleting preparative regimen of cyclophosphamide and fludarabine + young TIL + highdose aldesleukin + TBI
Intervention Type
Drug
Intervention Name(s)
Aldesleukin
Intervention Description
Arm 1 and Arm 2 - Days 1 to 4: Aldeskeukin 720,000 IU/kg IV (based on total body weight) over 15 minutes every eight hours (+/- 1 hour) for up to 5 days (maximum 15 doses).
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Intervention Description
Arm 1 and Arm 2 - Days -7 and -6: Cyclophosphamide 60 mg/kg/day X 2 days IV in 250 mL D5W with Mesna 15 mg/kg/day X 2 days over 1 hr.
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Intervention Description
Arm 1 and Arm 2 - Days -7 to -3: Fludarabine 25 mg/m2/day IVPB daily over 15-30 minutes for 5 days.
Intervention Type
Biological
Intervention Name(s)
Young TIL
Intervention Description
Arm 1 and Arm 2 - Day 0: Cells will be infused intravenously (IV) on the Patient Care Unit over 20-30 minutes.
Intervention Type
Radiation
Intervention Name(s)
Total Body Irradiation (TBI)
Intervention Description
Arm 2 - Days -3 to -1: Ondansetron 0.15 mg/kg IV x 1 dose pre-TBI. Patients will then receive 2 Gy TBI twice a day for 3 days (total dose 12 Gy) using a linear accelerator in Radiation Oncology.
Primary Outcome Measure Information:
Title
Response rate
Description
Percentage of patients who have a clinical response to treatment (objective tumor regression)
Time Frame
6 and 12 weeks after cell infusion, then every 3 months x3, every 6 months x5 years, then per PI discretion
Title
Overall survival
Description
Time to death following the start of treatment
Time Frame
Time to death
Secondary Outcome Measure Information:
Title
Progression-free survival
Description
Time to disease progression following the start of treatment
Time Frame
Time to progression
Title
Frequency and severity of treatment-related adverse events
Description
Aggregate of all adverse events, as well as their frequency and severity
Time Frame
30 days after end of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
66 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Measurable metastatic melanoma with at least one lesion that is resectable for TIL generation. The lesion must be of at least 1cm in diameter that can be surgically removed with minimal morbidity (defined as any operation for which expected hospitalization less than or equal to 7 days). Patients with 3 or less brain metastases are eligible. Note: If lesions are symptomatic or greater than or equal to 1 cm each, these lesions must have been treated and stable for 3 months for the patient to be eligible. Greater than or equal to 18 years of age and less than or equal to 66 years of age. Willing to practice birth control during treatment and for four months after receiving all protocol related therapy. Life expectancy of greater than three months Willing to sign a durable power of attorney. Able to understand and sign the Informed Consent Document Clinical performance status of ECOG 0 or 1. Hematology: Absolute neutrophil count greater than 1000/mm(3) Hemoglobin greater than 8.0 g/dl Platelet count greater than 100,000/mm(3) j. Serology: Seronegative for HIV antibody. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who are HIV seropositive can have decreased immune competence and thus be less responsive to the experimental treatment and more susceptible to its toxicities.) Seronegative for hepatitis B antigen, or hepatitis C antibody or antigen. k. Chemistry: Serum ALT/AST less than three times the upper limit of normal. Calculated creatinine clearance (eGFR) > 50 ml/min. Total bilirubin less than or equal to 2 mg/dl, except in patients with Gilbert s Syndrome who must have a total bilirubin less than 3 mg/dl. l. More than four weeks must have elapsed since any prior systemic therapy at the time of randomization, and patients toxicities must have recovered to a grade 1 or less (except for alopecia or vitiligo). Patients must have stable or progressing disease after prior treatment. Note: Patients may have undergone minor surgical procedures within the past 3 weeks, as long as all toxicities have recovered to grade 1 or less or as specified in the inclusion criteria. m. Six weeks must have elapsed since any prior anti-CTLA4 antibody therapy to allow antibody levels to decline. Note: Patients who have previously received ipilimumab or tremelimumab, anti- PD1 or anti-PD-L1 antibodies, and have documented GI toxicity must have a normal colonoscopy with normal colonic biopsies. EXCLUSION CRITERIA: Prior cell transfer therapy which included a non-myeloablative or myeloablative chemotherapy regimen. Women of child-bearing potential who are pregnant or breastfeeding because 10 of the potentially dangerous effects of the preparative chemotherapy on the fetus or infant. Systemic steroid therapy requirement. Active systemic infections, coagulation disorders or other active major medical illnesses of the cardiovascular, respiratory or immune system, as evidenced by a positive stress thallium or comparable test, myocardial infarction, cardiac arrhythmias, obstructive or restrictive pulmonary disease. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease and AIDS). Opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have decreased immune competence may be less responsive to the experimental treatment and more susceptible to its toxicities.) History of severe immediate hypersensitivity reaction to any of the agents used in this study. History of coronary revascularization or ischemic symptoms. Any patient known to have an LVEF less than or equal to 45%. In patients > 60 years old, documented LVEF of less than or equal to 45%. Documented FEV1 less than or equal to 60% predicted tested in patients with: A prolonged history of cigarette smoking (20 pk/year of smoking within the past 2 years) Symptoms of respiratory dysfunction Prior radiation therapy that, in the judgment of the radiation oncologist, precludes the administration of total body irradiation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven A Rosenberg, M.D.
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.All IPD recorded in the medical record will be shared with intramural investigators upon request.
IPD Sharing Time Frame
Clinical data available during the study and indefinitely.
IPD Sharing Access Criteria
Clinical data will be made available via subscription to BTRIS and with the permission of the study PI.
Citations:
PubMed Identifier
18809613
Citation
Dudley ME, Yang JC, Sherry R, Hughes MS, Royal R, Kammula U, Robbins PF, Huang J, Citrin DE, Leitman SF, Wunderlich J, Restifo NP, Thomasian A, Downey SG, Smith FO, Klapper J, Morton K, Laurencot C, White DE, Rosenberg SA. Adoptive cell therapy for patients with metastatic melanoma: evaluation of intensive myeloablative chemoradiation preparative regimens. J Clin Oncol. 2008 Nov 10;26(32):5233-9. doi: 10.1200/JCO.2008.16.5449. Epub 2008 Sep 22.
Results Reference
background
PubMed Identifier
10561265
Citation
Atkins MB, Lotze MT, Dutcher JP, Fisher RI, Weiss G, Margolin K, Abrams J, Sznol M, Parkinson D, Hawkins M, Paradise C, Kunkel L, Rosenberg SA. High-dose recombinant interleukin 2 therapy for patients with metastatic melanoma: analysis of 270 patients treated between 1985 and 1993. J Clin Oncol. 1999 Jul;17(7):2105-16. doi: 10.1200/JCO.1999.17.7.2105.
Results Reference
background
PubMed Identifier
8028037
Citation
Rosenberg SA, Yannelli JR, Yang JC, Topalian SL, Schwartzentruber DJ, Weber JS, Parkinson DR, Seipp CA, Einhorn JH, White DE. Treatment of patients with metastatic melanoma with autologous tumor-infiltrating lymphocytes and interleukin 2. J Natl Cancer Inst. 1994 Aug 3;86(15):1159-66. doi: 10.1093/jnci/86.15.1159.
Results Reference
background
PubMed Identifier
25432172
Citation
Crompton JG, Sukumar M, Roychoudhuri R, Clever D, Gros A, Eil RL, Tran E, Hanada K, Yu Z, Palmer DC, Kerkar SP, Michalek RD, Upham T, Leonardi A, Acquavella N, Wang E, Marincola FM, Gattinoni L, Muranski P, Sundrud MS, Klebanoff CA, Rosenberg SA, Fearon DT, Restifo NP. Akt inhibition enhances expansion of potent tumor-specific lymphocytes with memory cell characteristics. Cancer Res. 2015 Jan 15;75(2):296-305. doi: 10.1158/0008-5472.CAN-14-2277. Epub 2014 Nov 28.
Results Reference
derived
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_2011-C-0123.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Prospective Randomized Study of Cell Transfer Therapy for Metastatic Melanoma Using Tumor Infiltrating Lymphocytes Plus IL-2 Following Non-Myeloablative Lymphocyte Depleting Chemo Regimen Alone or in Conjunction With 12Gy Total Body Irradiation (TBI...

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