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Cyclophosphamide and Fludarabine Followed By Laboratory-Treated Donor Lymphocytes and High-Dose Aldesleukin in Treating Patients With Metastatic Melanoma That Did Not Respond to Previous Treatment
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), October 2008
First Received: September 27, 2007   Last Updated: April 9, 2009   History of Changes
Sponsored by: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00537069
  Purpose

RATIONALE: Giving chemotherapy, such as cyclophosphamide and fludarabine, before a donor lymphocyte infusion helps stop the growth of tumor cells. It also helps stop the patient's immune system from rejecting the donor's lymphocytes. Giving an infusion of donor lymphocytes that have been treated in the laboratory after chemotherapy may help destroy any remaining tumor cells. Aldesleukin may stimulate the lymphocytes to kill tumor cells. Giving chemotherapy followed by laboratory-treated donor lymphocytes and high-dose aldesleukin may be an effective treatment for metastatic melanoma.

PURPOSE: This phase I/II trial is studying the side effects and best dose of laboratory-treated donor lymphocytes when given together with cyclophosphamide, fludarabine, and high-dose aldesleukin and to see how well they work in treating patients with metastatic melanoma that did not respond to previous treatment.


Condition Intervention Phase
Melanoma (Skin)
Biological: aldesleukin
Biological: therapeutic allogeneic lymphocytes
Drug: cyclophosphamide
Drug: fludarabine phosphate
Phase I
Phase II

MedlinePlus related topics: Cancer Melanoma
Drug Information available for: Cyclophosphamide Fludarabine Fludarabine monophosphate Aldesleukin
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled
Official Title: Phase I/II Study Using a Non-Myeloablative Lymphocyte Depleting Regimen of Chemotherapy Followed by Infusion of Allogeneic Tumor-Reactive Lymphocyte Cell Line DMF5 in Metastatic Melanoma

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Safety [ Designated as safety issue: Yes ]
  • Tumor regression [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • In vivo survival of infused allogeneic DMF5 cells [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: June 2007
Estimated Primary Completion Date: May 2009 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To evaluate the safety of the administration of the DMF5 allogeneic T-cell product in patients receiving the nonmyeloablative conditioning regimen and aldesleukin.
  • To determine whether the allogeneic tumor-specific lymphocyte cell line, hereafter referred to as DMF5 and infused in conjunction with the administration of high-dose aldesleukin, may result in objective clinical tumor regression in eligible HLA-A*0201+ patients with metastatic melanoma receiving a nonmyeloablative lymphoid-depleting preparative regimen.

Secondary

  • To determine the in vivo survival of the infused cells following the nonmyeloablative regimen via analysis of the sequence of the variable region of the T-cell receptor or flow cytometry (FACS).

OUTLINE: This is a phase I dose-escalation study of allogeneic DMF5 cells followed by an open-label phase II study.

  • Phase I:

    • Nonmyeloablative lymphocyte-depleting preparative regimen: Patients receive cyclophosphamide IV over 1 hour on days -7 and -6 and fludarabine IV over 30 minutes on days -5 to -1.
    • Allogeneic tumor-reactive lymphocyte (DMF5 cells) infusion: Patients receive allogeneic DMF5 cells IV over 20-30 minutes on day 0. Patients receive filgrastim (G-CSF) subcutaneously once daily beginning after the DMF5 cell infusion and continuing until blood counts recover.
    • Consolidation therapy: Beginning within 24 hours after the DMF5 cell infusion, patients receive high-dose aldesleukin IV over 15 minutes 3 times daily on days 0-4 (maximum of 15 doses).
  • Phase II: Patients receive treatment as in phase I. Allogeneic DMF5 cells are administered at the maximum tolerated dose (MTD) determined in phase I. After completion of study treatment, patients are followed at 4-6 weeks, once a month for 3 months, and then every 6 months for 2 years.
  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of melanoma, meeting both of the following criteria:

    • Metastatic disease
    • Refractory to standard treatment (including high-dose aldesleukin)
  • Measurable disease
  • HLA-A*0201 positive
  • Autologous cells unsuitable for IRB approved Surgery Branch adoptive cell therapy studies
  • No positive allo-specific reactivity of the DMF5 cells to the patient's peripheral blood mononuclear cells
  • No symptomatic CNS lesions (may be eligible after treatment of symptomatic lesions)

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1
  • Life expectancy > 3 months
  • ANC > 1,000/mm³ (without filgrastim [G-CSF] support)
  • WBC < 3,000/mm³
  • Hemoglobin > 8.0 g/dL
  • Platelet count > 100,000/mm³
  • ALT and AST < 3 times upper limit of normal
  • Total bilirubin ≤ 2.0 mg/dL (≤ 3.0 mg/dL in patients with Gilbert syndrome)
  • Creatinine ≤ 1.6 mg/dL
  • HIV negative
  • Hepatitis B antigen negative
  • Hepatitis C antibody or antigen negative
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 4 months after receiving the preparative regimen
  • No active systemic or opportunistic infections
  • No coagulation disorders
  • LVEF > 45% by ECHO or MUGA scan (required for patients ≥ 60 years OR who have a cardiac abnormality)
  • FEV_1 > 60% of predicted (for patients with a prolonged history of cigarette smoking [i.e., more than 20 pack years] or symptoms of respiratory dysfunction)
  • No other major medical illness of the cardiovascular, respiratory, or immune system as evidenced by any of the following:

    • Myocardial infarction or cardiac arrhythmias
    • History of coronary revascularization or ischemic symptoms
    • History of clinically significant atrial and/or ventricular arrhythmias including, but not limited to, atrial fibrillation, ventricular tachycardia, or heart block
    • Respiratory disease
    • Obstructive or restrictive pulmonary disease
    • Primary immunodeficiency or immune system disease (i.e., severe combined immunodeficiency disease)
  • No history of severe immediate hypersensitivity reaction to any of the agents used in this study
  • No allergy to penicillin

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • More than 4 weeks since prior systemic therapy and recovered

    • Toxicity ≤ grade 1 (except for alopecia or vitiligo)
  • More than 6 weeks since prior ipilimumab (MDX-010)

    • Patients who received prior MDX-010 must have a normal colonoscopy (colonic biopsies normal)
  • No concurrent systemic steroid therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00537069

Locations
United States, Maryland
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office Recruiting
Bethesda, Maryland, United States, 20892-1182
Contact: Clinical Trials Office - Warren Grant Magnusen Clinical Center     888-NCI-1937        
Sponsors and Collaborators
Investigators
Principal Investigator: Steven A. Rosenberg, MD, PhD NCI - Surgery Branch
  More Information

Additional Information:
No publications provided

Responsible Party: NCI - Surgery Branch ( Steven A. Rosenberg )
Study ID Numbers: CDR0000565964, NCI-07-C-0210
Study First Received: September 27, 2007
Last Updated: April 9, 2009
ClinicalTrials.gov Identifier: NCT00537069     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent melanoma
stage IV melanoma

Study placed in the following topic categories:
Antimetabolites
Anti-HIV Agents
Immunologic Factors
Cyclophosphamide
Fludarabine monophosphate
Antiviral Agents
Immunosuppressive Agents
Recurrence
Melanoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Aldesleukin
Anti-Retroviral Agents
Neoplasms, Germ Cell and Embryonal
Nevus, Pigmented
Neuroepithelioma
Antineoplastic Agents, Alkylating
Nevus
Fludarabine
Antirheumatic Agents
Alkylating Agents

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Antimetabolites, Antineoplastic
Immunologic Factors
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Cyclophosphamide
Melanoma
Anti-Retroviral Agents
Neoplasms, Germ Cell and Embryonal
Therapeutic Uses
Nevi and Melanomas
Alkylating Agents
Anti-HIV Agents
Neoplasms by Histologic Type
Fludarabine monophosphate
Antiviral Agents
Immunosuppressive Agents
Pharmacologic Actions
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms
Aldesleukin
Myeloablative Agonists
Fludarabine
Antineoplastic Agents, Alkylating
Antirheumatic Agents

ClinicalTrials.gov processed this record on May 06, 2009