Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer

Status: Active

Description

Background: The NCI Surgery Branch has developed an experimental therapy that involves taking white blood cells from patients' tumors, growing them in the laboratory in large numbers, and then giving the cells back to the patient. These cells are called Tumor Infiltrating Lymphocytes, or TIL and we have given this type of treatment to over 200 patients with melanoma. Researchers want to know if TIL shrink s tumors in people with digestive tract, urothelial, breast, or ovarian / endometrial cancers. In this study, we are selecting a specific subset of white blood cells from the tumor that we think are the most effective in fighting tumors and will use only these cells in making the tumor fighting cells. Objective: The purpose of this study is to see if these specifically selected tumor fighting cells can cause digestive tract, urothelial, breast, or ovarian / endometrial tumors to shrink and to see if this treatment is safe. Eligibility: - Adults age 18-70 with upper or lower gastrointestinal, hepatobiliary, genitourinary, breast, ovarian / endometrial cancer, or glioblastoma refractory to standard chemotherapy. Design: Work up stage: Patients will be seen as an outpatient at the NIH clinical Center and undergo a history and physical examination, scans, x-rays, lab tests, and other tests as needed. Surgery: If the patients meet all of the requirements for the study they will undergo surgery to remove a tumor that can be used to grow the TIL product. Leukapheresis: Patients may undergo leukapheresis to obtain additional white blood cells. {Leukapheresis is a common procedure, which removes only the white blood cells from the patient.} Treatment: Once their cells have grown, the patients will be admitted to the hospital for the conditioning chemotherapy, the TIL cells and aldesleukin. They will stay in the hospital for about 4 weeks for the treatment. Follow up: Patients will return to the clinic for a physical exam, review of side effects, lab tests, and scans about every 1-3 months for the first year, and then every 6 months to 1 year as long as their tumors are shrinking. Follow up visits will take up to 2 days.

Eligibility Criteria

Inclusion Criteria

  • - INCLUSION CRITERIA: - Measurable (per RECIST v1.0 criteria), metastatic cancer of one of the following types: upper or lower gastrointestinal, hepatobiliary, genitourinary, breast, ovarian/endometrial, or glioblastoma. Patients must have at least one lesion that is resectable for TIL generation with minimal morbidity, preferentially using minimal invasive laparoscopic or thoracoscopic surgery for removal of superficial tumor deposit. - Confirmation of diagnosis of metastatic cancer by the NCI Laboratory of Pathology. - Refractory to approved standard systemic therapy. Specifically: - Patients with metastatic colorectal cancer must have received oxaliplatin or irinotecan. - Patients with Hepatocellular carcinoma patients must have received sorafenib (Nexavar ), since level 1 data support a survival benefit with this agent. - Patients with breast and ovarian cancer must be refractory to both first and second line treatments and must have received at least one second-line chemotherapy regimen. - Patients with glioblastoma must have received standard surgery, radiation therapy, and chemotherapy for their primary tumors and require resection of their tumors for palliative or other clinical indications. These patients will not undergo surgery solely for treatment on this protocol. - Patients with 3 or fewer brain metastases that are less than or equal to 1 cm in diameter and asymptomatic are eligible. Lesions that have been treated with stereotactic radiosurgery must be clinically stable for one month after treatment for the patient to be eligible. - Age greater than or equal to 18 years and less than or equal to 70 years. - Clinical performance status of ECOG 0 or 1. - Patients of both genders must be willing to practice birth control from the time of enrollment on this study and for four months after treatment. - Women of child-bearing potential must have a negative pregnancy test because of the potentially dangerous effects of the treatment on the fetus. Serology - Seronegative for HIV antibody. (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who are HIV seropositive may have decreased immune-competence and thus may be less responsive to the experimental treatment and more susceptible to its toxicities.) - Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then the patient must be tested for the presence of antigen by RT-PCR and be HCV RNA negative. Hematology - ANC > 1000/mm3 without the support of filgrastim - WBC greater than or equal to 3000/mm3 - Platelet count greater than or equal to 100,000/mm3 - Hemoglobin > 8.0 g/dL. Subjects may be transfused to reach this cut-off. Chemistry - Serum ALT/AST less than or equal to 5.0 x ULN - 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 < 3.0 mg/dL. - More than four weeks must have elapsed since any prior systemic therapy at the time the patient receives the preparative regimen, and patients toxicities must have recovered to a grade 1 or less. Note: Patients may have undergone minor surgical procedures within the past three weeks, as long as all toxicities have recovered to grade 1 or less. - Ability of subject to understand and the willingness to sign a written informed consent document. - Willing to sign a durable power of attorney. - Subjects must be co-enrolled on protocol 03-C-0277. Exclusion Criteria: - Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the treatment on the fetus or infant. - Concurrent systemic steroid therapy, except for patients with recurrent glioblastoma who require steroids for clinical indications. - Active systemic infections requiring anti-infective treatment, coagulation disorders, or any other active or uncompensated major medical illnesses. - Advanced primary with impeding occlusion, perforation or bleeding, dependent on transfusion. - Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease and AIDS). - History of major organ autoimmune disease. - Grade 3 or 4 major organ irAEs following treatment with anti-PD-1/PD-L1. - Concurrent opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have decreased immunecompetence may be less responsive to the experimental treatment and more susceptible to its toxicities.) - History of severe immediate hypersensitivity reaction to cyclophosphamide, fludarabine, or aldesleukin. - History of coronary revascularization or ischemic symptoms. - Documented LVEF less than or equal to 45% tested in patients: - Age greater than or equal to 65 years - With clinically significant atrial and/or ventricular arrhythmias, including but not imited to: atrial fibrillation, ventricular tachycardia, second- or third-degree heart block, or have a history of ischemic heart disease and/or chest pain. - Documented Child-Pugh score of B or C for hepatocellular carcinoma patients with known underlying liver dysfunction. - Documented FEV1 less than or equal to 60% predicted tested in patients with: - A prolonged history of cigarette smoking (greater than or equal to 20 pack-year smoking history within the past two years). - Symptoms of respiratory dysfunction - Patients who are receiving any other investigational agents.

Locations & Contacts

Maryland

Bethesda
National Cancer Institute Surgery Branch
Status: Active
Contact: Steven A. Rosenberg
Phone: 866-820-4505
Email: IRC@nih.gov
National Institutes of Health Clinical Center
Status: Active
Contact: Steven A. Rosenberg
Phone: 866-820-4505
Email: IRC@nih.gov

Trial Objectives and Outline

Background: - Metastatic digestive tract cancers, in particular esophageal, gastric, pancreatic and hepatobiliary carcinomas, are associated with poor survival beyond five years and poor response to existing therapies. - Data from the National Cancer Institute Surgery Branch (NCI-SB) and from the literature support that metastatic cancers are potentially immunogenic and that tumor-infiltrating lymphocytes (TIL) can be grown and expanded from these tumors. - In metastatic melanoma, TIL can mediate the regression of bulky disease at any site when administered to an autologous patient with high-dose aldesleukin (IL-2) following a nonmyeloablative, lymphodepleting preparative regimen. - The recent young-TIL approach, in which TIL are minimally cultured in vitro, not selected for tumor recognition, before rapid expansion and infusion to metastatic melanoma patients, has lead to objective response rates comparable to previous trials relying on TIL screened for tumor recognition, with no added toxicities. - In pre-clinical models, the administration of an anti-PD-1 antibody enhances the anti-tumor activity of transferred T-cells. - We propose to investigate the feasibility, safety, and efficacy of TIL adoptive transfer therapy in combination with pembrolizumab, administered either prior to cell administration or at the time of progressive disease, for metastatic cancers. Objectives: -Primary objective: --With Amendment BB, to determine the rate of tumor regression in patients with metastatic cancer who receive autologous, minimally cultured TIL in conjunction with a non-myeloablative, lymphodepleting preparative regimen, high-dose aldesleukin, and anti-PD-1. Eligibility: Patients must be/have: - Age greater than or equal to 18 years and less than or equal to 70 years - Metastatic upper or lower gastrointestinal, hepatobiliary, genitourinary, breast, ovarian/endometrial cancer, or glioblastoma refractory to standard chemotherapy - Normal basic laboratory values Patients may not have: - Concurrent major medical illnesses - Severe hepatic function impairment due to liver metastatic burden - Unpalliated biliary or bowel occlusion, cholangitis, or digestive tract bleeding - Any form of immunodeficiency - Severe hypersensitivity to any of the agents used in this study Design: - Patients may undergo resection or biopsy to obtain tumor for generation of autologous TIL cultures and autologous cancer cell lines, and for frozen tissue archive. Lymph nodes, ascites,peritoneal implants, and normal tissue adjacent to metastatic deposit will also be obtained when possible for ongoing and future research as described in the NCI-SB cell harvest protocol 03-C-0277 (Cell Harvest and Preparation for Surgery Branch Adoptive Cell Therapy Protocols). - With the approval of Amendment BB, patients will be enrolled on Arm 3 or Arm 4. All patients will receive a non-myeloablative, lymphodepleting preparative regimen consisting of cyclophosphamide and fludarabine followed by the infusion of autologous TIL and high-dose aldesleukin. Patients enrolled on Arm 3 will receive pembrolizumab prior to cell administration and three additional doses every three weeks following the cell infusion. Patients enrolled on Arm 4 will receive pembrolizumab within four weeks after meeting progressive disease by RECIST criteria, continuing for up to 8 doses every 3 weeks. - Clinical and immunologic response will be evaluated about 6 weeks after cell infusion and periodically thereafter. - Twenty-one patients will initially be enrolled in each group to assess toxicity and tumor responses. If two or more of the first 21 patients per groups shows a clinical response (partial response or complete response), accrual will continue to 41 patients, targeting a 20% goal for objective response. - Up to 332 patients may be enrolled.

Trial Phase & Type

Trial Phase

Phase II

Trial Type

Treatment

Lead Organization

Lead Organization
National Cancer Institute

Trial IDs

Primary ID 100166
Secondary IDs 10-C-0166, NCI-2019-00142, NCI-2013-01461, 10-C-0166
Clinicaltrials.gov ID NCT01174121