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Clinical Trial Name - Cyclophosphamide and Fludarabine Followed By Interleukin-2 Gene-Modified Tumor Infiltrating Lympho

 
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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