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Tumor-Infiltrating Lymphocytes And Low-Dose Interleukin-2 Therapy Following Cyclophosphamide And Fludarabine In Patients With Melanoma

Primary Purpose

Metastatic, Stage III or Stage IV, Melanoma

Status
Completed
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Cyclophosphamide
Fludarabine
Tumor-Infiltrating Lymphocytes
Low-Dose Interleukin
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic, Stage III or Stage IV, Melanoma focused on measuring Measurable, Unresectable, Stage III, Stage IV, Metastatic, Melanoma, Tumor-Infiltrating Lymphocytes, Low-Dose Interleukin-2, Cyclophosphamide, Fludarabine

Eligibility Criteria

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

Inclusion Criteria (Eligibility for TIL Evaluation):

  • Must have measurable, unresectable stage III or stage IV melanoma
  • Suitable tumor for collection
  • If tumor is suitable for collection, patient must be suitable for surgery
  • Patient must be 18 years of age or older
  • Performance status of ECOG 0 or 1
  • Life expectancy > 5 months from date of consent of TIL evaluation
  • Willing to be tested for transmissible diseases
  • For patients with a history of allergy to penicillin, gentamycin, streptomycin, or anti-fungals, the ability to generate TILs will be confirmed with the cell manufacturing laboratory

Inclusion Criteria (Eligibility for Treatment):

  • Signed and dated the informed consent
  • No brain metastases or stable brain metastases for 3 months following definitive treatment.
  • Life expectancy > 3 months from the date of consent for TILs treatment
  • TILs are suitable for use as determined by laboratory
  • More than 30 days since any prior systemic therapy at the time of the cell infusion, or more than six weeks since prior nitrosurea therapy. For patients with prior ipilimumab therapy, at least six weeks must elapse between the last ipilimumab dose and the start of study treatment. All side effects from previous treatment must have recovered to an acceptable grade level.
  • Adequate organ function
  • Must have positive EBV titres
  • Women of child-bearing potential must have a negative pregnancy test. Patients of both genders must be willing to practice birth control during treatment and for 6 months post completion of IL-2 treatment.

Exclusion Criteria:

  • Requiring systemic steroid therapy
  • HIV positive
  • With active hepatitis B or hepatitis C, syphilis, or HTLV
  • Must not have any active systemic infections, coagulation disorders or other active major medical illnesses of the cardiovascular, respiratory or immune system, uncontrolled psychiatric disorders, or other conditions that may affect following study procedures.
  • Have no active underlying cardiac illnesses defined by positive stress test, LVEF<40% or ongoing life-threatening arrhythmias
  • Abnormal lung function test

Sites / Locations

  • Princess Margaret Cancer Centre

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cyclophosphamide and Fludarabine followed by TILs and IL-2

Arm Description

Cyclophosphamide, i.v., 60mg/kg per day for 2 days and Fludarabine, i.v., 25mg/m2 per day for 5 days; then Tumor-Infiltrating Lymphocytes, i.v., 1x10^10 - 1.6x10^11 cells and Low-Dose Interleukin, i.v., 125,000 IU/kg subcut per day, for 2 weeks (2 days rest between each week)

Outcomes

Primary Outcome Measures

Clinical response to treatment

Secondary Outcome Measures

Number occurrences and severity of side effects
Number of patients with an immunity and no immunity to the study treatment

Full Information

First Posted
June 11, 2013
Last Updated
November 7, 2019
Sponsor
University Health Network, Toronto
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1. Study Identification

Unique Protocol Identification Number
NCT01883323
Brief Title
Tumor-Infiltrating Lymphocytes And Low-Dose Interleukin-2 Therapy Following Cyclophosphamide And Fludarabine In Patients With Melanoma
Official Title
Phase II Study Evaluating The Infusion Of Autologous Tumor-Infiltrating Lymphocytes (TILs) And Low-Dose Interleukin-2 (IL-2) Therapy Following A Preparative Regimen Of Non-Myeloablative Lymphodepletion Using Cyclophosphamide And Fludarabine In Patients With Metastatic Melanoma
Study Type
Interventional

2. Study Status

Record Verification Date
November 2019
Overall Recruitment Status
Completed
Study Start Date
June 2013 (undefined)
Primary Completion Date
April 2018 (Actual)
Study Completion Date
April 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Health Network, Toronto

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase II clinical study for patients with metastatic (the cancer has spread to other parts of the body) melanoma. Patients will receive an infusion (given by vein) of autologous tumor infiltrating lymphocytes (TILs). TILs are a type of white blood cells that recognizes tumor cells and enter them which causes the tumor cells to break down. Prior to the cell infusion, patients will receive a two drugs cyclophosphamide and fludarabine to prepare the body to receive the TILs. After cell infusion, patients will receive low-dose interleukin-2 therapy which is an approved drug to treat melanoma. This study will see how useful this regimen is in treating metastatic melanoma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic, Stage III or Stage IV, Melanoma
Keywords
Measurable, Unresectable, Stage III, Stage IV, Metastatic, Melanoma, Tumor-Infiltrating Lymphocytes, Low-Dose Interleukin-2, Cyclophosphamide, Fludarabine

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cyclophosphamide and Fludarabine followed by TILs and IL-2
Arm Type
Experimental
Arm Description
Cyclophosphamide, i.v., 60mg/kg per day for 2 days and Fludarabine, i.v., 25mg/m2 per day for 5 days; then Tumor-Infiltrating Lymphocytes, i.v., 1x10^10 - 1.6x10^11 cells and Low-Dose Interleukin, i.v., 125,000 IU/kg subcut per day, for 2 weeks (2 days rest between each week)
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
CYTOXAN, PROCYTOX
Intervention Description
i.v., 60mg/kg per day for 2 days
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Other Intervention Name(s)
FLUDARA
Intervention Description
i.v., 25mg/m2 per day for 5 days
Intervention Type
Biological
Intervention Name(s)
Tumor-Infiltrating Lymphocytes
Intervention Description
i.v., 1x10^10 - 1.6x10^11 cells
Intervention Type
Biological
Intervention Name(s)
Low-Dose Interleukin
Other Intervention Name(s)
Aldesleukin, Proleukin, Recombinant Human Interleukin 2
Intervention Description
i.v., 125,000 IU/kg subcut per day, for 2 weeks (2 days rest between each week)
Primary Outcome Measure Information:
Title
Clinical response to treatment
Time Frame
6 weeks after treatment
Secondary Outcome Measure Information:
Title
Number occurrences and severity of side effects
Time Frame
Starting at first dose of study treatment up to 10 years
Title
Number of patients with an immunity and no immunity to the study treatment
Time Frame
From start of study up to 10 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria (Eligibility for TIL Evaluation): Must have measurable, unresectable stage III or stage IV melanoma Suitable tumor for collection If tumor is suitable for collection, patient must be suitable for surgery Patient must be 18 years of age or older Performance status of ECOG 0 or 1 Life expectancy > 5 months from date of consent of TIL evaluation Willing to be tested for transmissible diseases For patients with a history of allergy to penicillin, gentamycin, streptomycin, or anti-fungals, the ability to generate TILs will be confirmed with the cell manufacturing laboratory Inclusion Criteria (Eligibility for Treatment): Signed and dated the informed consent No brain metastases or stable brain metastases for 3 months following definitive treatment. Life expectancy > 3 months from the date of consent for TILs treatment TILs are suitable for use as determined by laboratory More than 30 days since any prior systemic therapy at the time of the cell infusion, or more than six weeks since prior nitrosurea therapy. For patients with prior ipilimumab therapy, at least six weeks must elapse between the last ipilimumab dose and the start of study treatment. All side effects from previous treatment must have recovered to an acceptable grade level. Adequate organ function Must have positive EBV titres Women of child-bearing potential must have a negative pregnancy test. Patients of both genders must be willing to practice birth control during treatment and for 6 months post completion of IL-2 treatment. Exclusion Criteria: Requiring systemic steroid therapy HIV positive With active hepatitis B or hepatitis C, syphilis, or HTLV Must not have any active systemic infections, coagulation disorders or other active major medical illnesses of the cardiovascular, respiratory or immune system, uncontrolled psychiatric disorders, or other conditions that may affect following study procedures. Have no active underlying cardiac illnesses defined by positive stress test, LVEF<40% or ongoing life-threatening arrhythmias Abnormal lung function test
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Butler Marcus, M.D.
Organizational Affiliation
Princess Margaret Cancer Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Princess Margaret Cancer Centre
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
30747243
Citation
Nguyen LT, Saibil SD, Sotov V, Le MX, Khoja L, Ghazarian D, Bonilla L, Majeed H, Hogg D, Joshua AM, Crump M, Franke N, Spreafico A, Hansen A, Al-Habeeb A, Leong W, Easson A, Reedijk M, Goldstein DP, McCready D, Yasufuku K, Waddell T, Cypel M, Pierre A, Zhang B, Boross-Harmer S, Cipollone J, Nelles M, Scheid E, Fyrsta M, Lo CS, Nie J, Yam JY, Yen PH, Gray D, Motta V, Elford AR, DeLuca S, Wang L, Effendi S, Ellenchery R, Hirano N, Ohashi PS, Butler MO. Phase II clinical trial of adoptive cell therapy for patients with metastatic melanoma with autologous tumor-infiltrating lymphocytes and low-dose interleukin-2. Cancer Immunol Immunother. 2019 May;68(5):773-785. doi: 10.1007/s00262-019-02307-x. Epub 2019 Feb 11.
Results Reference
derived

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Tumor-Infiltrating Lymphocytes And Low-Dose Interleukin-2 Therapy Following Cyclophosphamide And Fludarabine In Patients With Melanoma

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