| Original Study ID : CDR0000304438 |
| Secondary ID : Array |
| NCT ID : 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 |
| 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). |
| Source : National Cancer Institute (NCI) |
| 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. |
| Overall Status : Completed |
| Start Date : June 2003 |
| Official Title : Phase 1/Phase 2 |
| Phase : Interventional |
| Study Design : Treatment, Open Label |
| Enrollment : 33 |
| Verification Date : February 2007 |
| First Received Date : June 5, 2003 |
| Trial 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 |
| Gender : Both |
| Minimum Age : 18 Years |
| Maximum Age : N/A |
| Healthy Volunteers : No |
| Facilities |
| Facility Name : NCI - Center for Cancer Research |
| City : Bethesda |
| State : Maryland |
| Zip Code : 20892 |
| Country : United States |
| Facility Name : Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office |
| City : Bethesda |
| State : Maryland |
| Zip Code : 20892-1182 |
| Country : United States |
| OutComes |
| Primary OutComes |
| Measure : Survival |
| Safety issue : No |
| Secondary OutComes |
| Measure : Clinical tumor regression |
| Safety issue : No |
| Measure : Toxicity profile |
| Safety issue : Yes |
| Interventions |
| Type : Biological |
| Name : aldesleukin |
| Type : Biological |
| Name : filgrastim |
| Type : Biological |
| Name : incomplete Freund's adjuvant |
| Type : Biological |
| Name : interleukin-2 gene |
| Type : Biological |
| Name : therapeutic tumor infiltrating lymphocytes |
| Type : Drug |
| Name : cyclophosphamide |
| Type : Drug |
| Name : fludarabine phosphate |
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