Melanoma Treatment With White Blood Cells That Destroy MART Expressing Tumor Cells

This is an interventional treatment trial for Metastatic Melanoma focused on measuring Malignant Melanoma, Immunotherapy, Cell Therapy, HLA-A2 Positive, Skin Cancer Read More

-INCLUSION CRITERIA:

1. Measurable metastatic melanoma.
2. Confirmation of diagnosis of metastatic melanoma and positivity for melanoma antigens recognized by T cells (MART) confirmed by the Laboratory of Pathology of the National Cancer Institute (NCI).
3. 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.

4. Patients must be refractory to high dose aldesleukin treatment.

   NOTE: This is not required for patients with non-cutaneous melanoma, patients for whom high dose aldesleukin is medically contraindicated or for patients who are unwilling to receive high dose aldesleukin.

5. MART-1:27-35 reactive peripheral blood lymphocytes derived from a leukapheresis.
6. Human leukocyte antigens (HLA-A) 0201 positive.
7. Greater than or equal to 18 years of age and less than or equal to age 70.
8. Both genders must be willing to practice birth control during treatment and for four months after receiving the preparative regimen.
9. Life expectancy of greater than three months.
10. Willing to sign a durable power of attorney.
11. Able to understand and sign the Informed Consent Document.
12. Clinical performance status of Eastern Cooperative Oncology Group (ECOG) 0 or 1 for the high-dose aldesleukin cohort or ECOG 0, 1 or 2 for no aldesleukin cohort.

13. Hematology:

    • Absolute neutrophil count greater than 1000/mm^3 without support of filgrastim
    • Normal white blood cell (WBC) (> 3000/mm^3).
    • Hemoglobin greater than 8.0 g/dl
    • Platelet count greater than 100,000/mm^3.

14. Serology:

    • Seronegative for human immunodeficiency virus (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 or hepatitis C. If hepatitis C antibody test is positive, the patients must be tested for the presence of antigen by reverse transcription polymerase chain reaction (RT-PCR) and be hepatitis C virus ribonucleic acid (HCV RNA) negative

15. Chemistry:

    • Serum alanine aminotransaminase (ALT)/aspartate aminotransaminase (AST) less than less or equal to 3 times the upper limit of normal.
    • Serum creatinine less than or equal to 1.6 mg/dl.
    • Total bilirubin less than or equal to 2.0 mg/dl, except in patients with Gilbert s Syndrome who must have a total bilirubin less than 3 mg/dl.
16. More than four weeks must have elapsed since any prior systemic therapy, including chemotherapy, immunotherapy, and/or other targeted therapies, at the time the patient receives the preparative regimen, and patients toxicities must have recovered to a grade 1 or less (except for toxicities such as alopecia or vitiligo). Patients may have undergone minor surgical procedures within the past 3 weeks, as long as patients meet eligibility criteria
17. Six weeks must have elapsed from the time of any antibody therapy that could affect an anti cancer immune response, including anti-cytotoxic T-lymphocyte antigen 4 (CTLA4) antibody therapy, so at the time the patient receives the preparative regimen to allow antibody levels to decline.
18. Patients who have previously received ipilimumab and have documented gastrointestinal (GI) toxicity must have a normal colonoscopy with normal colonic biopsies.

NOTE: this is only required for patients who will receive high dose aldesleukin.

EXCLUSION CRITERIA:

1. Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the treatment on the fetus or infant.
2. Systemic steroid therapy required.
3. 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.
4. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease).
5. 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.)
6. History of severe immediate hypersensitivity reaction to any of the agents used in this study.

7. The following patients will be excluded from the high-dose aldesleukin arm (but may be eligible for cells alone arm):

   1. History of coronary revascularization or ischemic symptoms
   2. Any patient known to have an left ventricular ejection fraction (LVEF) less than or equal to 45 percent.

   3. Documented LVEF of less than or equal to 45 percent tested in patients with:

      • Clinically significant atrial and/or ventricular arrhythmias including but not limited to: atrial fibrillation, ventricular tachycardia, second or third degree heart block
      • Age greater than or equal to 60 years old

   4. Documented forced expiratory volume in 1 second (FEV1) less than or equal to 60 percent predicted tested in patients with:

      • A prolonged history of cigarette smoking (20 pk/yrs of smoking within the past 2 years)
      • Symptoms of respiratory dysfunction
   5. Clinically significant patient history which in the judgment of the Principal Investigator would compromise the patients ability to tolerate aldesleukin