Phase I/II Study of Cellular Adoptive Immunotherapy Using Autologous CD8+ Antigen-Specific T Cells and Anti-CTLA4 For Patients With Metastatic Melanoma
Inclusion Criteria:
- Histopathologic documentation of melanoma concurrent with the diagnosis of metastatic
disease
- Expression of human leukocyte antigen (HLA)-A2
- Eastern Cooperative Oncology Group (ECOG)/Zubrod performance status of 0-1
- Women of childbearing potential (WOCBP) must be using an adequate method of
contraception to avoid pregnancy throughout the study in such a manner that the risk
of pregnancy is minimized; suggested precautions should be used to minimize the risk
or pregnancy for at least 1 month before start of therapy, and while women are on
study for up to 3 months after T cell infusion, and at least 8 weeks after the study
drug is stopped; WOCBP include any female who has experienced menarche and who has
not undergone successful surgical sterilization (hysterectomy, bilateral tubal
ligation or bilateral oophorectomy) or is not postmenopausal
- Men must be willing and able to use an acceptable method of birth control, for at
least 3 months after completion of the study, if their sexual partners are WOCBP
- Willing and able to give informed consent
- Adequate venous access-consider peripherally inserted central catheter (PICC) or
central line
- Bi-dimensionally measurable disease by palpation on clinical exam, or radiographic
imaging (X-ray, computed tomography [CT] scan)
- At least 4 weeks must have elapsed since the last chemotherapy, radiotherapy or major
surgery; at least 6 weeks for nitrosoureas, mitomycin C and liposomal doxorubicin; if
started before T-cell administration, Ipilimumab infusions must be least 21 days
apart
- Toxicity related to prior therapy must either have returned to =< grade 1, baseline,
or been deemed irreversible
- Persons of reproductive potential must agree to use and utilize an adequate method of
contraception throughout treatment and for at least 8 weeks after study drug is
stopped
Exclusion Criteria:
- Patients with active infections or oral temperature > 38.2 C within 72 hours prior to
planned leukapheresis; the procedure may be deferred
- Patients with hematocrit (Hct) < 30%, white blood cells (WBC) < 2500/uL and platelets
< 50,000 immediately prior to leukapheresis; the procedure may be deferred
- Any other malignancy from which the patient has been disease-free for less than 5
years, with the exception of adequately treated and cured basal or squamous cell skin
cancer, superficial bladder cancer, carcinoma in situ of the cervix
- White blood cell count (WBC) < 2000/uL
- Hematocrit (Hct) < 24% or hemoglobin (Hb) < 8 g/dL
- Absolute neutrophile count (ANC) < 1000
- Platelets < 50,000
- Creatinine > 3.0 x upper limit normal (ULN)
- Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) > 2.5 x ULN
- Bilirubin > 3 x ULN
- Pregnant women, nursing mothers, men or women of reproductive ability who are
unwilling to use effective contraception; women of childbearing potential with a
positive pregnancy test within 3 days prior to entry
- Clinically significant pulmonary dysfunction, as determined by medical history and
physical exam; patients so identified will undergo pulmonary functions testing and
those with forced expiratory volume in one second (FEV1) < 2.0 L or diffusion
capacity of carbon monoxide (DLco) (corr for Hgb) < 50% will be excluded
- Significant cardiovascular abnormalities as defined by any one of the following:
- Congestive heart failure
- Clinically significant hypotension
- Symptoms of coronary artery disease
- Presence of cardiac arrhythmias on electrocardiogram (EKG) requiring drug
therapy
- Ejection fraction < 50 % (echocardiogram or multi gated acquisition [MUGA] scan)
- Active and untreated central nervous system (CNS) metastasis (including metastasis
identified during screening magnetic resonance imaging [MRI] or contrast CT)
- Autoimmune disease: Patients with a history of Inflammatory Bowel Disease are
excluded from this study, as are patients with a history of autoimmune disease (e.g.
systemic lupus erythematosus, vasculitis, infiltrating lung disease) whose possible
progression during treatment would be considered by the Investigator to be
unacceptable
- Any underlying medical or psychiatric condition, which in the opinion of the
Investigator, will make the administration of study drug hazardous or obscure the
interpretation of adverse events, such as a condition associated with frequent
diarrhea
- Positive screening tests for human immunodeficiency virus (HIV), hepatitis (Hep) B,
and Hep C; if positive results are not indicative of true active or chronic
infection, the patient can be treated
- Steroids are not permitted 3 days prior to T cell infusion and concurrently during
therapy
- No prisoners or children will be enrolled on this study
- Any non-oncology vaccine therapy used for the prevention of infectious disease within
1 month before or after any ipilimumab dose
- Patients may not be on any other treatments for their cancer aside from those
included in the protocol; patients may not undergo another form of treatment
concurrently with this study