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Phase II Study of Metastatic Melanoma Using Lymphodepleting Conditioning Followed by Infusion of Anti-gp100:154-162 TCR-Gene Engineered Lymphocytes

Phase 2
18 Years
Not Enrolling
Skin Cancer, Melanoma

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Trial Information

Phase II Study of Metastatic Melanoma Using Lymphodepleting Conditioning Followed by Infusion of Anti-gp100:154-162 TCR-Gene Engineered Lymphocytes


- We have engineered human tumor infiltrating lymphocytes (TIL) and peripheral blood
lymphocytes (PBLs) to express a T-cell receptor that recognizes an HLAA 0201 restricted
epitope derived from the gp100 protein.

- We constructed a single retroviral vector that contains both Alpha and Beta chains and
can mediate genetic transfer of this TCR with high efficiency (greater than 30 percent)
without the need to perform any selection.

- In co-cultures with HLA-A*0201 positive melanoma gp100:154-162 TCR transduced T cells
secreted significant amount of IFN-Beta (but no significant secretion was observed in
control co-cultures with cell lines.

- gp100:154-162 TCR transduced T-cells could efficiently kill HLA-A*0201 positive tumors.
There was little or no recognition of normal fibroblasts cells.

- This TCR is over 10 times more reactive with melanoma cells than the MART-1 TCR that
mediated tumor regression in two patients with metastatic melanoma.


Primary objectives:

-Determine if the administration of anti-gp100:154-162 TCR-engineered peripheral blood
lymphocytes (PBL) or tumor infiltrating lymphocytes (TIL) and aldesleukin to patients
following a nonmyeloablative but lymphoid depleting preparative regimen will result in
clinical tumor regression in patients with metastatic melanoma.

Secondary objectives:

- Determine the in vivo survival of TCR gene-engineered cells.

- Determine the toxicity profile of this treatment regimen.

- Determine whether treated patients develop anti-mouse TCR antibody.


Patients who are HLA-A*0201 positive and 18 years of age or older must have

- metastatic melanoma;

- previously received and have been a non-responder to or recurred after aldesleukin

- normal values for basic laboratory values.

Patients may not have:

- concurrent major medical illnesses;

- any form of primary or secondary immunodeficiency;

- severe hypersensitivity to any of the agents used in this study;

- contraindications for high dose aldesleukin administration.


- If TIL can be obtained and grown but are non-reactive, patients will be assigned to
receive TIL transduced with the anti-gp100:154-162 TCR retroviral vector. If TIL cannot
be obtained, peripheral blood mononuclear cells (PBMC) will be obtained by
leukapheresis (approximately 5 times 10(9) cells) and cultured in the presence of
anti-CD3 (OKT3) and aldesleukin and transduced with the antigp100:154-162 TCR
retroviral vector. If TIL cells are reactive to autologous tumor or major
histocompatibility complex (MHC)-matched tumor cells or PBL cannot be grown, patients
will not be treated on this protocol.

- Transduction is initiated by exposure of approximately 10(8) to 5 times 10(8) cells to
supernatant containing the anti-gp100:154-162 TCR retroviral vector. These transduced
cells will be expanded and tested for their anti-tumor activity.

- Once engineered lymphocytes are demonstrated to be biologically active according to the
strict criteria outlined in the Certificate of Analysis, patients will receive a
nonmyeloablative but lymphocyte depleting preparative regimen consisting of
cyclophosphamide and fludarabine followed by intravenous infusion of ex vivo tumor
reactive, TCR gene-transduced PBMC plus IV aldesleukin (720,000 IU/kg q8h for a maximum
of 15 doses).

- Patients will undergo complete evaluation of tumor with physical examination, CT
(computed tomography) of the chest, abdomen and pelvis and clinical laboratory
evaluation four to six weeks after treatment and then monthly for approximately 3 to 4
months or until off study criteria are met.

- The study will be conducted using a phase II optimal design where initially 21
evaluable patients will be enrolled into each of two cohorts. If 0 or 1 of the 21
patients per cohort experiences a clinical response, then no further patients will be
enrolled but if 2 or more of the first 21 evaluable patients enrolled in that cohort
have a clinical response, then accrual to that cohort will continue until a total of 41
evaluable patients have been enrolled in that cohort.

- The objective will be to determine in two cohorts if the combination of high dose
aldesleukin, lymphocyte depleting chemotherapy, and anti-gp100:154-162 TCR-gene
engineered lymphocytes (TIL and PBL) is able to be associated with a clinical response
rate that can rule out 5 percent (p0=0.05) in favor of a modest 20 percent PR (partial
response) plus CR (complete response) rate (p1=0.20).

Inclusion Criteria


1. Metastatic melanoma with measurable disease.

2. Previously received high dose aldesleukin (IL-2) and have been either
non-responders (progressive disease) or have recurred.

3. Positive for gp100 by immunohistochemistry (IHC).

4. Greater than or equal to 18 years of age.

5. Willing to sign a durable power of attorney.

6. Able to understand and sign the Informed Consent Document.

7. Clinical performance status of Eastern Cooperative Oncology Group (ECOG) 0 or 1.

h Life expectancy of greater than three months.

i. Patients of both genders must be willing to practice birth control for four
months after receiving the preparative regimen.

j. Must be human leukocyte antigen (HLA-A 0201) positive

k. Serology:

1. Seronegative for human immunodeficiency virus (HIV) antibody. (The experimental
treatment being evaluated in this protocol depends on an intact immune system.
Patients who are HIV seropositive can have decreased immune -competence and thus
be less responsive to the experimental treatment and more susceptible to its

2. Seronegative for hepatitis B antigen and hepatitis C antibody unless antigen

l. Hematology:

1. Absolute neutrophil count greater than 1000/mm^3.

2. White blood cell (WBC) (greater than 3000/ mm^3).

3. Platelet count greater than 100,000/ mm^3.

4. Hemoglobin greater than 8.0 g/dl.

m. Chemistry:

1. Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) less than
or equal to 2.5 times the upper limit of normal.

2. Serum creatinine less than or equal to 1.6 mg/dl.

3. Total bilirubin less than or equal to 1.5 mg/dl, except in patients with
Gilbert's Syndrome who must have a total bilirubin less than 3.0 mg/dl.

n. Women of child-bearing potential must have a negative pregnancy test because of
the potentially dangerous effects of the preparative chemotherapy on the fetus.

o. 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 (except for toxicities such as alopecia or vitiligo).

p. Six weeks must have elapsed since prior cytotoxic T-lymphocyte antigen 4
(anti-CTLA4) antibody therapy to allow antibody levels to decline, and patients who
have previously received must have a normal colonoscopy with normal colonic


1. Patients with reactive TIL (interferon (IFN)- gamma release greater than 200 pg/mL)
available based on overnight co-culture assay with autologous tumor or MHC-matched
tumor cells.

2. Women of child-bearing potential who are pregnant or breastfeeding because of the
potentially dangerous effects of the preparative chemotherapy on the fetus or infant.

3. Active systemic infections, coagulation disorders or other major medical illnesses of
the cardiovascular, respiratory or immune system, myocardial infarction, cardiac
arrhythmias, obstructive or restrictive pulmonary disease.

4. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency

5. Opportunistic infections (The experimental treatment being evaluated in this protocol
depends on an intact immune system. Patients who have decreased immune competence
may be less responsive to the experimental treatment and more susceptible to its

6. Systemic steroid therapy.

7. History of severe immediate hypersensitivity reaction to any of the agents used in
this study.

8. History of coronary revascularization.

9. Documented left ventricular ejection faction (LVEF) of less than 45 percent in
patients with:

a. Clinically significant atrial and/or ventricular arrhythmias including but not limited
to: atrial fibrillation, ventricular tachycardia, 2 degree or 3 degree heart block.

b. Age greater than or equal to 60 years old.

j. Documented forced expiratory volume 1 (FEV1) greater than or equal to 60 percent
predicted for patients with:

1. A prolonged history of cigarette smoking (greater than 20 pack/year within the past 2

2. Symptoms of respiratory distress.

Type of Study:


Study Design:

Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Clinical Tumor Regression.

Outcome Description:

Clinical tumor regression was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). Complete response (CR) is a disappearance of all target lesions. Partial response (PR) is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum LD. Progressive disease (PD) is at least a 20% increase in the sum of LD of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Stable disease (SD)is neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD taking as references the smallest sum LD.

Outcome Time Frame:

20 months

Safety Issue:



United States: Federal Government

Study ID:




Start Date:

June 2007

Completion Date:

July 2012

Related Keywords:

  • Skin Cancer
  • Melanoma
  • Refractory
  • Gene Therapy
  • HLA-A2 Positive
  • Stage IV Melanoma
  • Melanoma
  • Skin Cancer
  • Malignant Melanoma
  • Skin Neoplasms
  • Melanoma



National Institutes of Health Clinical Center, 9000 Rockville Pike Bethesda, Maryland  20892