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Gene-Modified Lymphocytes, High-Dose Aldesleukin, and Vaccine Therapy in Treating Patients With Progressive or Recurrent Metastatic Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), October 2008
First Received: June 24, 2008   Last Updated: April 9, 2009   History of Changes
Sponsored by: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00704938
  Purpose

RATIONALE: Gene-modified lymphocytes may stimulate the immune system in different ways and stop tumor cells from growing. High-dose aldesleukin may stimulate lymphocytes to kill tumor cells. Vaccines made from a gene modified virus and a person's dendritic cells may help the body build an effective immune response to kill tumor cells. Giving gene-modified lymphocytes together with high-dose aldesleukin and vaccine therapy may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving gene-modified lymphocytes together with high-dose aldesleukin and vaccine therapy works in treating patients with progressive or recurrent metastatic cancer.


Condition Intervention Phase
Kidney Cancer
Melanoma (Skin)
Unspecified Adult Solid Tumor, Protocol Specific
Biological: aldesleukin
Biological: anti-p53 T-cell receptor-transduced peripheral blood lymphocytes
Biological: autologous dendritic cell-adenovirus p53 vaccine
Biological: filgrastim
Drug: cyclophosphamide
Drug: fludarabine phosphate
Phase II

MedlinePlus related topics: Cancer Kidney Cancer Melanoma
Drug Information available for: Cyclophosphamide Fludarabine Fludarabine monophosphate Aldesleukin Filgrastim
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled
Official Title: Phase II Study of Metastatic Cancer That Overexpresses p53 Using Lymphodepleting Conditioning Followed by Infusion of Anti-P53 TCR-Gene Engineered Lymphocytes and Dendritic Cell Vaccination

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

Primary Outcome Measures:
  • Clinical tumor regression [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • In vivo survival of T-cell receptor (TCR) gene-engineered cells [ Designated as safety issue: No ]
  • Ability of a dendritic cell vaccine to restimulate TCR gene-engineered cells in vivo [ Designated as safety issue: No ]
  • Toxicity [ Designated as safety issue: Yes ]

Estimated Enrollment: 82
Study Start Date: June 2008
Estimated Primary Completion Date: June 2010 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Determine if the administration of anti-p53 T-cell receptor (TCR) gene-engineered peripheral blood lymphocytes, high-dose aldesleukin, and adenovirus p53 dendritic cell (DC) vaccine after a nonmyeloablative, but lymphoid-depleting, preparative regimen will result in clinical tumor regression in patients with metastatic cancer that overexpresses p53.

Secondary

  • Determine the in vivo survival of TCR gene-engineered cells.
  • Determine the ability of a DC vaccine to restimulate TCR gene-engineered cells in vivo.
  • Determine the toxicity profile of this treatment regimen.

OUTLINE: Patients are stratified according to type of metastatic cancer (melanoma or renal cell cancer vs all other cancers).

  • Peripheral blood mononuclear cell (PBMC) collection: Patients undergo PBMC collection via leukapheresis for the generation of the adenovirus p53 dendritic cell vaccine as well as anti-p53 T-cell receptor (TCR) gene-engineered peripheral blood lymphocytes.
  • Nonmyeloablative lymphocyte-depleting preparative regimen: Patients receive cyclophosphamide IV over 1 hour on days -7 and -6 and fludarabine phosphate IV over 30 minutes on days -5 to -1.
  • Peripheral blood lymphocyte infusion: Patients receive anti-p53 TCR gene-engineered peripheral blood lymphocytes IV over 20-30 minutes on day 0.

Patients receive filgrastim (G-CSF) subcutaneously (SC) once daily beginning on day 1 or 2 and continuing until blood counts recover.

  • High-dose aldesleukin: Patients receive high-dose aldesleukin IV over 15 minutes three times daily on days 0-4 for up to 15 doses.
  • Dendritic cell vaccine: Patients receive adenovirus p53 dendritic cell vaccine SC on days 0, 7, 14, and 28.

Patients may receive one re-treatment course as above (nonmyeloablative preparative regimen, peripheral blood lymphocyte infusion, high-dose aldesleukin, and dendritic cell vaccinations) beginning 6-8 weeks after the last dose of high-dose aldesleukin.

After completion of study treatment, patients are followed periodically for up to 15 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Diagnosis of metastatic cancer
  • Tumor overexpresses p53 as assessed by immunohistochemistry (i.e., ≥ 5% tumor cells stain positive for p53)

    • Biopsy must be available to evaluate p53 expression
  • HLA-A*0201 positive
  • Progressive or recurrent disease after prior standard therapy for metastatic disease

    • Patients with melanoma or renal cell cancer must have previously received aldesleukin
    • Patients with other histologies, not including hematologic malignancies, must have previously received first-line and second-line or higher systemic standard therapy (or effective salvage chemotherapy regimens)

PATIENT CHARACTERISTICS:

  • ECOG performance status 0 or 1
  • Life expectancy > 3 months
  • Absolute neutrophil count > 1,000/mm^3
  • WBC > 3,000/mm^3
  • Platelet count > 100,000/mm^3
  • Hemoglobin > 8.0 g/dL
  • Serum ALT/AST ≤ 2.5 times upper limit of normal
  • Serum creatinine ≤ 1.6 mg/dL
  • Total bilirubin ≤ 2.0 mg/dL (< 3.0 mg/dL in patients with Gilbert's syndrome)
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 4 months after completion of study treatment
  • Patients who have previously received ipilimumab or ticilimumab must have a normal colonoscopy with normal colonic biopsies
  • HIV antibody negative
  • Hepatitis B antigen and hepatitis C antibody negative (unless antigen negative)
  • No primary immunodeficiency (e.g., severe combined immunodeficiency disease)
  • No active systemic infections
  • No history of severe immediate hypersensitivity reaction to any of the agents used in this study
  • No coagulation disorders
  • No myocardial infarction or cardiac arrhythmias
  • No history of coronary revascularization
  • No obstructive or restrictive pulmonary disease
  • No contraindications for high-dose aldesleukin administration
  • LVEF ≥ 45% in patients meeting any of the following criteria:

    • History of ischemic heart disease, chest pain, or clinically significant atrial and/or ventricular arrhythmias including, but not limited to, atrial fibrillation, ventricular tachycardia, or second- or third-degree heart block
    • At least 60 years of age
  • FEV_1 > 60% predicted in patients meeting any of the following criteria:

    • Prolonged history of cigarette smoking (> 20 pack/year within the past 2 years)
    • Symptoms of respiratory dysfunction
  • No other major medical illness of the cardiovascular, respiratory, or immune system

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from prior therapy
  • More than 4 weeks since prior and no concurrent systemic steroid therapy
  • More than 4 weeks since other prior systemic therapy
  • More than 6 weeks since prior ipilimumab
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00704938

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: CDR0000598419, NCI-08-C-0155, NCI-P07215
Study First Received: June 24, 2008
Last Updated: April 9, 2009
ClinicalTrials.gov Identifier: NCT00704938     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
recurrent renal cell cancer
stage IV renal cell cancer
recurrent melanoma
stage IV melanoma
unspecified adult solid tumor, protocol specific

Study placed in the following topic categories:
Antimetabolites
Urinary Tract Neoplasm
Immunologic Factors
Urogenital Neoplasms
Cyclophosphamide
Urologic Neoplasms
Melanoma
Renal Cancer
Anti-Retroviral Agents
Urologic Diseases
Kidney Neoplasms
Neoplasms, Germ Cell and Embryonal
Nevus, Pigmented
Neoplasm Metastasis
Neuroepithelioma
Kidney Diseases
Alkylating Agents
Kidney Cancer
Anti-HIV Agents
Fludarabine monophosphate
Antiviral Agents
Immunosuppressive Agents
Recurrence
Neuroendocrine Tumors
Carcinoma
Neuroectodermal Tumors
Aldesleukin
Carcinoma, Renal Cell
Antineoplastic Agents, Alkylating
Nevus

Additional relevant MeSH terms:
Antimetabolites
Anti-Infective Agents
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Physiological Effects of Drugs
Neoplasms, Nerve Tissue
Urogenital Neoplasms
Cyclophosphamide
Urologic Neoplasms
Melanoma
Neoplastic Processes
Neoplasms by Site
Pathologic Processes
Anti-Retroviral Agents
Urologic Diseases
Kidney Neoplasms
Therapeutic Uses
Neoplasms, Germ Cell and Embryonal
Neoplasm Metastasis
Nevi and Melanomas
Kidney Diseases
Alkylating Agents
Anti-HIV Agents
Neoplasms by Histologic Type
Fludarabine monophosphate
Antiviral Agents
Immunosuppressive Agents
Pharmacologic Actions

ClinicalTrials.gov processed this record on May 06, 2009