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Phase II Study of Metastatic Cancer That Overexpresses P53 Using Lymphodepleting Conditioning Followed by Infusion of Anti-P53 TCR-Gene Engineered Lymphocytes
This study has been completed.

First Received on October 25, 2006.   Last Updated on August 10, 2011   History of Changes
Sponsor: National Cancer Institute (NCI)
Information provided by: National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier: NCT00393029
  Purpose

Background:

The p53 gene normally suppresses tumor growth, but when it is mutated, or damaged, tumors can grow unchecked.

In cancers where the p53 gene has mutated, an increased level of p53(overexpression of p53) can be measured in the tumor.

Objectives To determine whether advanced cancers that overexpress p53 can be treated effectively with lymphocytes (white blood cells) that have been genetically engineered to contain an anti-p53 protein.

Eligibility Patients 18 years of age and older with metastatic cancer (cancer that has spread beyond the original site) Patient's tumor overexpresses p53 Patient's leukocyte antigen type is HLA-A 0201 Design

Patients undergo the following procedures:

Leukapheresis (on two occasions). This is a method of collecting large numbers of white blood cells. The cells obtained in the first leukapheresis procedure are grown in the laboratory, and the anti-p53 protein is inserted into the cells using an inactivated (harmless)virus in a process called transduction. Cells collected in the second leukapheresis procedure are used to evaluate the effectiveness of the study treatment.

Chemotherapy. Patients are given chemotherapy through a vein (intravenously, IV) for 1 week to suppress the immune system so that the patients immune cells do not interfere with the treatment.

Treatment with anti-p53 cells. Patients receive an IV infusion of the transduced cells containing anti-p53 protein, followed by infusions of a drug called IL-2, which helps boost the effectiveness of the transduced white cells.

Patients may undergo a tumor biopsy (removal of a small piece of tumor tissue). Patients are evaluated with laboratory tests and imaging tests, such as computed tomography (CT) scans 4 to 6 weeks after treatment and then once a month 3 to 4 months to determine the response to treatment.

Patients have blood tests at 1, 3, 6 and 12 months and then annually for the next 10 years.


Condition Intervention Phase
Anti-p53 TCR-Gene
Biological: anti-protein 53 or tumor protein 53 (p53) T-cell receptor transduced peripheral blood lymphocytes
Biological: aldesleukin
Biological: filgrastim
Drug: cyclophosphamide
Drug: fludarabine phosphate
Phase II

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase II Study of Metastatic Cancer That Overexpresses p53 Using Lymphodepleting Conditioning Followed by Infusion of Anti-p53 T Cell Receptor (TCR)-Gene Engineered Lymphocytes

Resource links provided by NLM:


Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:
  • Clinical Tumor Regression [ Time Frame: 1-11 months ] [ Designated as safety issue: No ]

    Response Evaluation Criteria In Solid Tumors (RECIST).

    See the protocol Link module for full criteria if desired.


  • The Number of Participants With Adverse Events [ Time Frame: events related to all components of the treatment regimen were reported from the start of the non-myeloablative conditioning regiment through 30 days following treatment or resolution. ] [ Designated as safety issue: Yes ]
    Here are the total number of participants with adverse events. Adverse events were described using the Common Terminology Criteria for Adverse Events (CTCAE) version 3. For the detailed list of adverse events see the adverse event module.


Secondary Outcome Measures:
  • In Vivo Survival of T-cell Receptor (TCR) Gene-engineered Cells in Participants [ Time Frame: 3-12 months ] [ Designated as safety issue: No ]
    Survival of TCR gene-engineered cells is defined as >10% murine TCR positive cells.


Enrollment: 12
Study Start Date: October 2006
Study Completion Date: November 2008
Primary Completion Date: November 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Patients with metastatic melanoma
Melanoma is a serious form of skin cancer that develops in the skin cells that make our skin color (melanocytes).
Biological: anti-protein 53 or tumor protein 53 (p53) T-cell receptor transduced peripheral blood lymphocytes
Peripheral blood lymphocytes are harvested by lymphapheresis and engineered to express a T cell receptor that binds to P53.
Other Names:
  • Tumor protein 53
  • Anti-protein 53
Biological: aldesleukin
720,000 IU/kg intravenously over 15 minutes every 8 hours for up to 5 days
Other Names:
  • Interleukin-2 (IL-2)
  • Proleukin
  • Recombinant human interleukin-2
Biological: filgrastim
Beginning on day 1 or 2, administered subcutaneously at a dose of 5 mcg/kg/day (not to exceed 300 mcg/day); continue daily until neutrophil count > 1.0 x 10^9/L x 3 days or > 5.0 x 10^9/L.
Other Names:
  • Granulocyte colony stimulating factor (GCSF)
  • Neupogen
Drug: cyclophosphamide
60 mg/kg/day x 2 days intravenously in 250ml dextrose 5% in water (D5W) with mesna 15 mg/kg/day x 2 days over 1 hour.
Other Names:
  • Cytoxan
  • Endoxan
  • Neosar
  • Procytox
  • Revimmune
Drug: fludarabine phosphate
25 mg/m2/day intravenously piggyback (IVPB) daily over 30 minutes for 5 days.
Other Names:
  • Fludara
  • Fludarabine phosphate
Experimental: Patients with other metastatic cancers Biological: anti-protein 53 or tumor protein 53 (p53) T-cell receptor transduced peripheral blood lymphocytes
Peripheral blood lymphocytes are harvested by lymphapheresis and engineered to express a T cell receptor that binds to P53.
Other Names:
  • Tumor protein 53
  • Anti-protein 53
Biological: aldesleukin
720,000 IU/kg intravenously over 15 minutes every 8 hours for up to 5 days
Other Names:
  • Interleukin-2 (IL-2)
  • Proleukin
  • Recombinant human interleukin-2
Biological: filgrastim
Beginning on day 1 or 2, administered subcutaneously at a dose of 5 mcg/kg/day (not to exceed 300 mcg/day); continue daily until neutrophil count > 1.0 x 10^9/L x 3 days or > 5.0 x 10^9/L.
Other Names:
  • Granulocyte colony stimulating factor (GCSF)
  • Neupogen
Drug: cyclophosphamide
60 mg/kg/day x 2 days intravenously in 250ml dextrose 5% in water (D5W) with mesna 15 mg/kg/day x 2 days over 1 hour.
Other Names:
  • Cytoxan
  • Endoxan
  • Neosar
  • Procytox
  • Revimmune
Drug: fludarabine phosphate
25 mg/m2/day intravenously piggyback (IVPB) daily over 30 minutes for 5 days.
Other Names:
  • Fludara
  • Fludarabine phosphate

  Show Detailed Description

  Eligibility

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

Inclusion Criteria:

  • Patients must have metastatic cancer that overexpresses p53 as assessed by immunohistochemistry, as determined by positive staining of tumor sample. when compared to negative controls per procedure in Appendix 1. The immunohistochemical staining will be performed in the Pathology Laboratory Center for Cancer Research (CCR), National Cancer Institute (NCI) on fresh or archival tissue and will be supervised by Dr. Maria Merino. The criteria used to determine overexpression will be that used in the Laboratory of Dr. Curt Harris. Ten fields will be evaluated at 40 X magnification and if greater than 5% of cells stain positive, the tumor will be categorized as an overexpressor.
  • Patients with melanoma or renal cell cancer must have previously received interleukin-2 (IL-2) and have been either non-responders (progressive disease) or have recurred. Patients with other histologies,not including hematologic malignancies, must have previously received first line and second line or higher systemic standard care(or effective salvage chemotherapy regimens) for metastatic disease,if known to be effective for that disease and have been either non-responders (progressive disease) or have recurred.
  • Age greater than or equal to 18 years.
  • Clinical performance status of Eastern Cooperative Oncology Group (ECOG) 0 to 1.
  • Life expectancy of greater than three months.
  • 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 and more susceptible to its toxicities).
  • Seronegative for hepatitis B antigen and hepatitis C antibody unless antigen negative.
  • Patients must be human leukocyte antigen A(HLA-A) 0201 positive.
  • Patients of both genders must be willing to practice birth control for four months after receiving the preparative regimen.
  • Absolute neutrophil count greater than 1000/mm^3, and normal white blood cells (WBC) (greater than 3000/mm^3).
  • Platelet count greater than 100,000/mm^3.
  • Hemoglobin greater than 8.0 g/dl.
  • Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) less than the upper limit of normal.
  • Serum creatinine less than or equal to 1.6 mg/dl.
  • 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.
  • 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). Six weeks must have elapsed since prior Ipilimumab (MDX-010) therapy to allow antibody levels to decline, and patients who have previously received MDX-010 must have a normal colonoscopy with normal colonic biopsies.
  • Women of child-bearing potential must have a negative pregnancy test because of the potentially dangerous effects of the preparative chemotherapy on the fetus.
  • A biopsy must be evaluable to evaluate p53 expression and to confirm the diagnosis by the Laboratory of Pathology, CCR, NCI.

Exclusion Criteria:

  • Patients requiring systemic steroid therapy
  • Patients with 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.
  • Patients with any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease and acquired immune deficiency syndrome (AIDS)). Patients with opportunistic infections will be excluded. (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 toxicities).
  • Patients with history of severe immediate hypersensitivity reaction to any of the agents used in this study.
  • Patient is not willing to sign a durable power of attorney.
  • Patient is not able to understand and sign the Informed Consent Document.
  • Since aldesleukin will be excluded if they have a history of electrocardio- gram (EKG) abnormalities, symptoms of cardiac ischemia or arrhythmias and have a left ventricular ejection fraction (LVEF) less than 45% on a cardiac stress test (stress thallium, stress multi-gated acquisition scan (MUGA), dobutamine echocardiogram, or other stress test).
  • Similarly, patients who are greater than or equal to 50 years old with a LVEF less than 45% will be excluded.
  • Patients with a prolonged history of cigarette smoking (greater than 20 pack/year within the past 2 years) or symptoms of respiratory dysfunction (e.g. grade 2 dyspnea or hypoxia) who do not have a normal pulmonary function test as evidenced by a FEV(1) less than 60% predicted will be excluded.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00393029

Locations
United States, Maryland
National Institutes of Health
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
Investigators
Principal Investigator: Steven A Rosenberg, M.D., Ph.D NCI, NIH
  More Information

Additional Information:
Publications:
Responsible Party: Steven A. Rosenberg, M.D., Ph.D., National Cancer Institute, National Institutes of Health
ClinicalTrials.gov Identifier: NCT00393029     History of Changes
Other Study ID Numbers: 070003, 070003, 07-C-0003
Study First Received: October 25, 2006
Results First Received: June 1, 2011
Last Updated: August 10, 2011
Health Authority: United States: Food and Drug Administration;   United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):
Tumor Regression
In Vivo Cell Survival
Toxicity Profile
Metastatic Renal Cell Cancer
Cancer
Metastatic Cancer

Additional relevant MeSH terms:
Neoplasm Metastasis
Neoplasms
Neoplasms, Second Primary
Neoplastic Processes
Pathologic Processes
Cyclophosphamide
Fludarabine monophosphate
Fludarabine
Aldesleukin
Interleukin-2
Lenograstim
Vidarabine
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents
Therapeutic Uses
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Myeloablative Agonists
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Central Nervous System Agents
Antimetabolites, Antineoplastic
Antimetabolites

ClinicalTrials.gov processed this record on February 09, 2012