Description:
To determine the feasibility and safety of administering a regimen of TIL/IL-2, using a cell
product manufactured in the Yale Advanced Cell Therapy Laboratories, in subjects with
metastatic melanoma who are not responding or have progressed after receiving prior therapy
with a PD-1/PD-L1 antagonist used alone or in combination with anti-CTLA-4. Additionally, a
second cohort of patients with metastatic melanoma who are not responding or have progressed
after receiving prior therapy with a PD-1/PD-L1 antagonist alone or in combination with
anti-CTLA-4 will receive anti-PD-1 and anti-CTLA-4 therapy with Nivolumab and Ipilimumab.
Title
- Brief Title: A Pilot Study Using Short-Term Cultured Anti-Tumor Autologous Lymphocytes
- Official Title: A Pilot Study Using Short-Term Cultured Anti-Tumor Autologous Lymphocytes Following a Lymphocyte Depleting Regimen in Metastatic Melanoma
Clinical Trial IDs
- ORG STUDY ID:
2000020477
- NCT ID:
NCT03526185
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Tumor Infiltrating Lymphocytes | Autologous TIL, Unselected TIL, Young TIL | Cohort 1 |
Nivolumab and Ipilimumab | | Cohort 2 |
Purpose
To determine the feasibility and safety of administering a regimen of TIL/IL-2, using a cell
product manufactured in the Yale Advanced Cell Therapy Laboratories, in subjects with
metastatic melanoma who are not responding or have progressed after receiving prior therapy
with a PD-1/PD-L1 antagonist used alone or in combination with anti-CTLA-4. Additionally, a
second cohort of patients with metastatic melanoma who are not responding or have progressed
after receiving prior therapy with a PD-1/PD-L1 antagonist alone or in combination with
anti-CTLA-4 will receive anti-PD-1 and anti-CTLA-4 therapy with Nivolumab and Ipilimumab.
Detailed Description
The objectives of this study have been expanded since its original registration to inlcude an
additional cohort of patients (now designated Cohort 1 and Cohort 2). Cohort 1 is the
original group of patients described in the initial registration of the study.
Cohort 1 Objectives:
- To determine the feasibility and safety of administering a regimen of TIL/IL-2, using a
cell product manufactured in the Yale Advanced Cell Therapy Laboratories, in subjects
with metastatic melanoma who are not responding or have progressed after receiving prior
therapy with a PD-1/PD-L1 antagonist used alone or in combination with anti-CTLA-4.
- To assess for evidence of clinical activity.
- To conduct a preliminary assessment of the TCR clonotypes present in marker positive
CD8+ cells (4-1BB, LAG-3, TIM-3, PD-1) versus marker-negative CD8+ T-cells early in the
expansion cultures and compare to clonotypes late in the final product and in peripheral
blood lymphocytes (PBL) 1 and 2 months post infusion.
Cohort 2 Objectives:
- To determine the feasibility and safety of administering a regimen of TIL/IL-2, using a
cell product manufactured in the Yale Advanced Cell Therapy Laboratories, followed by
anti-PD-1 and anti-CTLA-4 therapy with Nivolumab and Ipilimumab in subjects with
metastatic melanoma who are not responding or have progressed after receiving prior
therapy with a PD-1/PD-L1 antagonist alone or in combination with anti-CTLA-4.
- To evaluate the efficacy of TIL/IL-2 therapy in combination with subsequent anti-PD-1
Nivolumab and anti-CTLA-4 Ipilimumab by assessing the objective response rate by
immune-related RECIST (irRECIST).
- To conduct a preliminary assessment of the TCR clonotypes present in marker positive
CD8+ cells (e.g. 4-1BB, LAG-3, TIM-3, PD-1) versus marker-negative CD8+ T-cells early in
the expansion cultures and compare to clonotypes late in the final product and in
peripheral blood lymphocytes (PBL) 1 and 2 months post infusion.
Trial Arms
Name | Type | Description | Interventions |
---|
Cohort 1 | Experimental | Subjects will receive a non-myeloablative lymphocyte depleting preparative regimen of cyclophosphamide (60 mg/kg/day IV) on days -7 and -6 and fludarabine (25 mg/m2/day) on days -5 through -1.
Prophylactic antibiotics will be administered as medically indicated until recovery of ANC to > 500 and recovery of ALC to > 400
On day 0 subjects will receive the infusion of autologous TIL and one hour later (but can be delayed up to 24 hours) will begin low-dose aldesleukin (IL-2) (72,000 IU/kg IV every 12 hours for up to 10 doses). | - Tumor Infiltrating Lymphocytes
|
Cohort 2 | Experimental | Subjects will receive a non-myeloablative lymphocyte depleting preparative regimen of cyclophosphamide (60 mg/kg/day IV) on days -7 and -6 and fludarabine (25 mg/m2/day) on days -5 through -1.
Prophylactic antibiotics will be administered as medically indicated until recovery of ANC to > 500 and recovery of ALC to > 400
On day 0 subjects will receive the infusion of autologous TIL and one hour later (but can be delayed up to 24 hours) will begin low-dose aldesleukin (IL-2) (72,000 IU/kg IV every 12 hours for up to 10 doses).
Within 1 week post discharge subjects will be treated with Nivolumab 1 mg/kg and Ipilimumab 3 mg/kg every 3 weeks for 4 doses. Following this, patients will receive Nivolumab 480 mg every 4 weeks. Adjuvant Nivolumab will continue until evidence of disease progression or inability to tolerate treatment. | - Tumor Infiltrating Lymphocytes
- Nivolumab and Ipilimumab
|
Eligibility Criteria
Inclusion Criteria:
For Cohorts 1 and 2:
- Metastatic melanoma;
- A metastatic lesion at least 1.5 cm in diameter that can be removed surgically
- Measurable or evaluable disease not including the resected lesion
- ECOG PS of 0 or 1 prior to cell harvest
- Assessment by the treating physician that ECOG performance status of no higher than 2
can be maintained at least for the period of cell generation, lymphoablation, cell
infusion and IL-2 administration (for at least 6 weeks following cell harvest)
- Tumor refractory to or progressing following prior PD-1/PD-L1 therapy alone or in
combination with an anti-CTLA-4 agent
- Ability to understand risks and benefits of the treatment and to give informed consent
Exclusion Criteria:
For Cohorts 1 and 2:
- Received prior cell transfer therapy that included non-myeloablative or ablative
chemotherapy
- Any significant major organ dysfunction (see protocol)
- Residual toxicity > gr1 from immune checkpoint inhibitor other than persistent
endocrinopathy on hormone replacement; all symptoms of prior colitis and enteritis
must have resolved completely as assessed by history
- Any contraindication to neutropenia or thrombocytopenia for up to 2 weeks (no active
major infection, no site of active, clinically significant bleeding)
- Concurrent major medical illnesses
- Any form of immunodeficiency
- Requirement for steroids > 10 mg prednisone daily or equivalent
- Severe hypersensitivity to any of the agents used in this study
- Contraindications for IL-2 administration
At the time of lymphoablation subjects must meet baseline eligibility criteria with the
following additions and exceptions:
• Confirmation by lab that cell product can be ready for harvest and infusion within 7 days
For Cohort 2 only:
At the time of the start of anti-PD-1/anti-CTLA-4 therapy, subjects must meet baseline
eligibility criteria with the following additions and exceptions:
- Patient cannot have a steroid requirement > 10 mg prednisone daily or equivalent
- Patients who have received prior PD-1/PD-L1 antagonist therapy and developed severe
autoimmune disease precluding further immune checkpoint therapy
- Any organ dysfunction that makes the subject ineligible for anti-PD1 and anti-CTLA-4
treatment as deemed by the treating investigator
- ECOG PS of 0-2
- Hgb of at least 8.0 gm/dl (may be transfused to this level)
- Creatinine not greater than 2.5 mg/dl
- AST or ALT not > 5x ULN and total bilirubin not > 2.5 mg/dl
- No clinically significant change in major organ function compared to initial
eligibility evaluation
- Prior to initiating the lymphoablation regimen, there can be no untreated brain lesion
> 1.0 cm, and/or with significant evidence of hemorrhage. Subjects may begin
lymphoablation no less than 1 full day after completing WBRT or stereotactic
radiotherapy for brain lesions.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Adverse Events |
Time Frame: | up to 12 months |
Safety Issue: | |
Description: | To determine the safety of administering a regimen of TIL/IL-2, incidence of drug-related adverse events (AEs) will be summarized across adverse event type in terms of frequency by event type. |
Secondary Outcome Measures
Measure: | Objective response rate to TIL |
Time Frame: | up to 12 months |
Safety Issue: | |
Description: | Objective response rate (ORR) of the TIL/IL-2 regimen based on investigator review of radiographic images using RECIST 1.1 criteria |
Details
Phase: | Early Phase 1 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Yale University |
Last Updated
October 23, 2020