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Gene-Modified White Blood Cells Followed By Interleukin-2 and Vaccine Therapy in Treating Patients With Metastatic Melanoma

Primary Purpose

Melanoma (Skin)

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
aldesleukin
filgrastim
gp100-fowlpox vaccine
therapeutic autologous lymphocytes
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 recurrent melanoma, stage IV melanoma

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Diagnosis of melanoma Metastatic disease Measurable disease Refractory to standard therapy, including high-dose interleukin-2 therapy HLA-A*0201 positive Progressive disease during prior immunization to melanoma antigens OR prior treatment with anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) cellular therapy with or without myeloablation allowed provided toxicity resolved to ≤ grade 2 (except vitiligo) AND patient does not require systemic steroids No brain metastases PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-1 Life expectancy More than 3 months Hematopoietic Absolute neutrophil count > 1,000/mm^3 Platelet count > 100,000/mm^3 Hemoglobin > 8.0 g/dL Lymphocyte count > 500/mm^3 WBC > 3,000/mm^3 No coagulation disorders Hepatic AST and ALT < 3 times upper limit of normal (ULN) Bilirubin ≤ 2.0 mg/dL (3.0 mg/dL in patients with Gilbert's syndrome) Hepatitis B surface antigen negative Hepatitis C antibody negative (unless antigen negative) Renal Creatinine ≤ 1.6 mg/dL Cardiovascular LVEF ≥ 45% by cardiac stress test No LVEF < 45% in patients ≥ 50 years of age No myocardial infarction No cardiac arrhythmias No symptomatic cardiac ischemia No prior EKG abnormalities No other major cardiovascular illness Pulmonary FEV_1 ≥ 60% of predicted AND no obstructive or restrictive pulmonary disease No symptoms of respiratory dysfunction No other major respiratory illness Immunologic HIV negative Epstein-Barr virus positive No active systemic infections (including opportunistic infections) No form of primary (e.g., autoimmune colitis or Crohn's disease) or secondary immunodeficiency (due to chemotherapy or radiotherapy) No prior severe immediate hypersensitivity reaction to any of the study agents including eggs No other major illness of the immune system Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 4 month after study participation Willing to complete a durable power of attorney (DPA) PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics More than 6 weeks since prior MDX-010 Chemotherapy Not specified Endocrine therapy See Disease Characteristics No concurrent systemic steroid therapy Radiotherapy Not specified Surgery Not specified Other More than 4 weeks since other prior systemic therapy and recovered

Sites / Locations

  • Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office
  • NCI - Surgery Branch

Outcomes

Primary Outcome Measures

Secondary Outcome Measures

Full Information

First Posted
June 10, 2004
Last Updated
June 21, 2012
Sponsor
National Institutes of Health Clinical Center (CC)
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00085462
Brief Title
Gene-Modified White Blood Cells Followed By Interleukin-2 and Vaccine Therapy in Treating Patients With Metastatic Melanoma
Official Title
Treatment of Patients With Metastatic Melanoma by Lymphodepleting Conditioning Followed by Infusion of TCR-Gene Engineered Lymphocytes and Subsequent Fowlpox gp100 Vaccination
Study Type
Interventional

2. Study Status

Record Verification Date
June 2012
Overall Recruitment Status
Completed
Study Start Date
May 2004 (undefined)
Primary Completion Date
May 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: Inserting a gene that has been created in the laboratory into a person's white blood cells may make the body build an immune response to kill tumor cells. Interleukin-2 may stimulate a person's white blood cells to kill tumor cells. Vaccines may make the body build an immune response to kill tumor cells. Combining gene-modified white blood cell infusions with interleukin-2 and vaccine therapy may kill more tumor cells. PURPOSE: This phase I trial is studying how well giving gene-modified white blood cells when given together with interleukin-2 and vaccine therapy works in treating patients with metastatic melanoma.
Detailed Description
OBJECTIVES: Primary Determine, preliminarily, any clinical tumor regression in lymphodepleted patients with metastatic melanoma treated with fowlpox gp100 antigen immunization and antitumor antigen T-cell receptor (TCR)-engineered tumor infiltrating lymphocytes or CD8+ autologous peripheral blood lymphocytes followed by interleukin-2. Secondary Determine the in vivo survival of TCR gene-engineered cells in patients treated with this regimen. OUTLINE: Patients are stratified according to their ability to produce tumor-infiltrating lymphocytes (TIL) (yes vs no). Patients receive lymphodepleting chemotherapy comprising cyclophosphamide IV over 1 hour on days -7 and -6 and fludarabine IV over 30 minutes on days -5 to -1. Stratum 1 (TIL): Patients receive TIL retrovirally transduced with gp100 antigen TCR gene IV over 20-30 minutes on day 0*. Stratum 2 (CD8+peripheral blood lymphocytes [PBL]): Patients receive CD8+PBL retrovirally transduced with gp100 antigen TCR gene IV over 20-30 minutes on day 0*. NOTE: *Day 0 is 1-4 days after the last dose of fludarabine. Patients in both strata also receive fowlpox-gp100 vaccine (before TIL/PBL infusion) IV over 1-2 minutes on days 0 and 28 and high-dose interleukin-2 (IL-2) IV over 15 minutes every 8 hours on days 0-4 and days 28-32. Patients also receive G-CSF SC once daily beginning on day 0 and continuing until blood counts recover. Treatment continues in the absence of disease progression or unacceptable toxicity. Beginning 6-8 weeks after the last dose of vaccine and high-dose IL-2, patients with stable or responding disease may receive 1 retreatment course. Responding patients are followed at 1, 3, 6, and 12 months and then annually thereafter. PROJECTED ACCRUAL: A total of 61 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
recurrent melanoma, stage IV melanoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Masking
None (Open Label)
Enrollment
61 (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)
gp100-fowlpox vaccine
Intervention Type
Biological
Intervention Name(s)
therapeutic autologous lymphocytes
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

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of melanoma Metastatic disease Measurable disease Refractory to standard therapy, including high-dose interleukin-2 therapy HLA-A*0201 positive Progressive disease during prior immunization to melanoma antigens OR prior treatment with anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-010) cellular therapy with or without myeloablation allowed provided toxicity resolved to ≤ grade 2 (except vitiligo) AND patient does not require systemic steroids No brain metastases PATIENT CHARACTERISTICS: Age 18 and over Performance status ECOG 0-1 Life expectancy More than 3 months Hematopoietic Absolute neutrophil count > 1,000/mm^3 Platelet count > 100,000/mm^3 Hemoglobin > 8.0 g/dL Lymphocyte count > 500/mm^3 WBC > 3,000/mm^3 No coagulation disorders Hepatic AST and ALT < 3 times upper limit of normal (ULN) Bilirubin ≤ 2.0 mg/dL (3.0 mg/dL in patients with Gilbert's syndrome) Hepatitis B surface antigen negative Hepatitis C antibody negative (unless antigen negative) Renal Creatinine ≤ 1.6 mg/dL Cardiovascular LVEF ≥ 45% by cardiac stress test No LVEF < 45% in patients ≥ 50 years of age No myocardial infarction No cardiac arrhythmias No symptomatic cardiac ischemia No prior EKG abnormalities No other major cardiovascular illness Pulmonary FEV_1 ≥ 60% of predicted AND no obstructive or restrictive pulmonary disease No symptoms of respiratory dysfunction No other major respiratory illness Immunologic HIV negative Epstein-Barr virus positive No active systemic infections (including opportunistic infections) No form of primary (e.g., autoimmune colitis or Crohn's disease) or secondary immunodeficiency (due to chemotherapy or radiotherapy) No prior severe immediate hypersensitivity reaction to any of the study agents including eggs No other major illness of the immune system Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 4 month after study participation Willing to complete a durable power of attorney (DPA) PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics More than 6 weeks since prior MDX-010 Chemotherapy Not specified Endocrine therapy See Disease Characteristics No concurrent systemic steroid therapy Radiotherapy Not specified Surgery Not specified Other More than 4 weeks since other prior systemic therapy and recovered
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 - Surgery Branch
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892-1201
Country
United States

12. IPD Sharing Statement

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Gene-Modified White Blood Cells Followed By Interleukin-2 and Vaccine Therapy in Treating Patients With Metastatic Melanoma

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