This is a single center, single arm phase I trial to test the feasibility and safety of Tumor- Infiltrating Lymphocyte-Adoptive Cell Therapy (TIL-ACT) followed by nivolumab rescue in unresectable locally advanced or metastatic melanoma patients. The trial is based on lymphodepleting chemotherapy followed by ACT, utilizing ex vivo expanded TILs in combination with high dose interleukin-2 (IL-2) (optional, depending on patient's tolerance), followed by nivolumab rescue (if indicated) for a maximum duration of 2 years.
The objective of the trial is to define the feasibility and safety of TIL-ACT in metastatic melanoma patients. In addition, the feasibility and safety of nivolumab rescue in patients with advanced metastatic disease is examined. Study treatment will begin with intravenous non-myeloablative (NMA) lymphodepleting chemotherapy composed by fludarabine and cyclophosphamide. Both treatments will be started on the same day. Fludarabine will be administered for five days, and cyclophosphamide for two days. TILs will be infused intravenously over a period of 20-30 minutes. Between 3 and 24 hours after the infusion of TILs, optional IL-2 will be started as a bolus administration every eight hours at minimum form the start of each administration, for a maximum of eight doses, with a maximum interval of 24 hours. In order to avoid profound and long-lasting neutropenia, pegfilgrastim will be given subcutaneously. Supportive care will be given during the recovery phase from immune depletion and IL-2 therapy. Nivolumab rescue will be initiated for eligible patients. For all patients, the first on-treatment radiological assessment will be performed 30 days after the TIL infusion, and then at month 3, and then every 12 weeks for the first 3 years of follow-up and every 4-6 months for the next 2 years, until progression. Two Positron Emission Tomography-Computed Tomography (PET-CT) (18FDG (Fludeoxyglucose (F18)) and 68Ga-NODAGA-RGD ((68)Ga-labelled NOTA-conjugated RGD peptide) will be performed at baseline, following chemotherapy, and between 22-30 days after the TIL infusion. The safety assessment for TIL-ACT (TLT (treatment-limiting toxicity) period) will extend from day -7 (when NMA chemo starts) till 30 days after TIL infusion. The first three evaluable patients will be enroled no less than 2 weeks apart from each other. An interim analysis of safety at our center will be performed at the completion of the TLT period of the third evaluable patient.
Study Type
INTERVENTIONAL
Allocation
Adoptive transfer of Autologous Tumor-Infiltrating Lymphocytes
Cyclophosphamide will be administered as an intravenous (IV) infusion for two days.
Fludarabine will be administered as an intravenous (IV) infusion for five days.
CHUV Oncology Department
Lausanne, Canton of Vaud, Switzerland
Feasibility of TIL-ACT - successful Rapid Expansion Protocol (REP)
Number of patients for whom TIL cultures after REP achieve the required cell number and release criteria to start TIL-ACT infusion
Time frame: Evaluated for each patient at day 0 (5-10 days after chemotherapy start). After day 0 of the last patient, the number of patients with successful REP/ start of TIL-ACT infusion will be calculated.
Feasibility of TIL-ACT - successful infusion
Number of patients receiving a complete TIL-ACT infusion (full NMA chemo and at least partial TIL infusion; no minimum IL-2 required)
Time frame: Evaluated for each patient at day 0 (5-10 days after chemotherapy start), up to 60 mins after start of TIL-ACT infusion. At day 0 of the last patient, the number of patients with successful TIL-ACT infusion will be calculated.
Toxicity of TIL-ACT
Number of patients with adverse events as assessed by CTCAE version 5
Time frame: 37 days after chemotherapy start (TLT period)
Feasibility of nivolumab rescue following TIL-ACT
Number of patients included in the 'nivolumab rescue' population
Time frame: 6 months from nivolumab start/ 100 days after end of nivolumab treatment
Toxicity of nivolumab rescue
Number of patients receiving nivolumab with adverse events as assessed by CTCAE version 5.0
Time frame: 6 months from nivolumab start/ 100 days after end of nivolumab treatment
Objective response rate (ORR)
Best overall response
Time frame: 6, 12, 24, 36, 48 and 60 months
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NA
Purpose
TREATMENT
Masking
NONE
Enrollment
18
After TIL infusion, IL-2 (optional) will be started as a bolus administration every eight hours, for a maximum of eight doses.
Nivolumab will be administered for maximum 24 months as follows: first year: 240 mg every 2 weeks; second year: 480 mg every 4 weeks.
Progression free survival (PFS) for TIL-ACT
Time from start of NMA chemotherapy until objective tumor progression (using RECIST criteria and iRECIST) or death if not documented progression.
Time frame: 5 years
Progression free survival (PFS) in the nivolumab rescue phase
Time from start of nivolumab treatment until objective tumor progression (using RECIST criteria and iRECIST) or death if not documented progression.
Time frame: 5 years
Overall survival (OS)
Time from start of NMA chemotherapy until death
Time frame: 5 years