Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer

Last updated: May 15, 2025
Sponsor: National Cancer Institute (NCI)
Overall Status: Active - Recruiting

Phase

2

Condition

Neoplasm Metastasis

Digestive System Neoplasms

Colorectal Cancer

Treatment

Pembrolizumab (Keytruda)

Cyclophosphamide

Aldesleukin

Clinical Study ID

NCT01174121
100166
10-C-0166
  • Ages 18-72
  • All Genders

Study Summary

Background:

The NCI Surgery Branch has developed an experimental therapy that involves taking white blood cells from patients' tumors, growing them in the laboratory in large numbers, and then giving the cells back to the patient. These cells are called Tumor Infiltrating Lymphocytes, or TIL and we have given this type of treatment to over 200 patients with melanoma. Researchers want to know if TIL shrink s tumors in people with digestive tract, urothelial, breast, or ovarian/endometrial cancers. In this study, we are selecting a specific subset of white blood cells from the tumor that we think are the most effective in fighting tumors and will use only these cells in making the tumor fighting cells.

Objective:

The purpose of this study is to see if these specifically selected tumor fighting cells can cause digestive tract, urothelial, breast, or ovarian/endometrial tumors to shrink and to see if this treatment is safe.

Eligibility:

  • Adults age 18-72 with upper or lower gastrointestinal, hepatobiliary, genitourinary, breast, ovarian/endometrial cancer, or glioblastoma refractory to standard chemotherapy.

Design:

Work up stage: Patients will be seen as an outpatient at the NIH clinical Center and undergo a history and physical examination, scans, x-rays, lab tests, and other tests as needed.

Surgery: If the patients meet all of the requirements for the study they will undergo surgery to remove a tumor that can be used to grow the TIL product.

Leukapheresis: Patients may undergo leukapheresis to obtain additional white blood cells. (Leukapheresis is a common procedure, which removes only the white blood cells from the patient.)

Treatment: Once their cells have grown, the patients will be admitted to the hospital for the conditioning chemotherapy, the TIL cells and aldesleukin. They will stay in the hospital for about 4 weeks for the treatment.

Follow up: Patients will return to the clinic for a physical exam, review of side effects, lab tests, and scans about every 1-3 months for the first year, and then every 6 months to 1 year as long as their tumors are shrinking. Follow up visits will take up to 2 days.

Eligibility Criteria

Inclusion

  • INCLUSION CRITERIA:

  • Measurable (per RECIST v1.0 criteria), metastatic cancer of one of the followingtypes: upper or lower gastrointestinal, hepatobiliary, genitourinary, breast,ovarian/endometrial, or endocrine tumors including neuroendocrine tumors. Patientsmust have at least one lesion that is resectable for TIL generation with minimalmorbidity, preferentially using minimal invasive laparoscopic or thoracoscopicsurgery for removal of superficial tumor deposit.

  • Confirmation of diagnosis of metastatic cancer by the NCI Laboratory of Pathology.

  • Refractory to approved standard systemic therapy. Specifically:

  • Patients with metastatic colorectal cancer must have received oxaliplatin oririnotecan.

  • Patients with hepatocellular carcinoma must have received sorafenib (Nexavar(R)), since level 1 data support a survival benefit with this agent.

  • Patients with breast and ovarian cancer must be refractory to both first- andsecond-line treatments and must have received at least one second-linechemotherapy regimen.

  • Patients with 3 or fewer brain metastases that are < 1 cm in diameter andasymptomatic are eligible. Lesions that have been treated with stereotacticradiosurgery must be clinically stable for one month after treatment for the patientto be eligible. Patients with surgically resected brain metastases are eligible.

  • Age greater than or equal to 18 years and less than or equal to 72 years.

  • Clinical performance status of ECOG 0 or 1.

  • Patients of both sexes must be willing to practice birth control from the time ofenrollment on this study and 12 months after the last dose of combined chemotherapyfor individuals of child-bearing potential (IOCBP) and for four months aftertreatment for individuals that can father children.

  • IOCBP must have a negative pregnancy test be a pregnancy test prior to the start oftreatment because of the potentially dangerous effects of the treatment on thefetus.

Serology

  • Seronegative for HIV antibody. (The experimental treatment being evaluated in thisprotocol depends on an intact immune system. Patients who are HIV seropositive mayhave decreased immune-competence and thus may be less responsive to the experimentaltreatment and more susceptible to its toxicities.)

  • Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody. Ifhepatitis C antibody test is positive, then the patient must be tested for thepresence of antigen by RT-PCR and be HCV RNA negative.

Hematology

  • ANC > 1000/mm^3 without the support of filgrastim

  • WBC greater than or equal to 2500/mm^3

  • Platelet count greater than or equal to 80,000/mm^3

  • Hemoglobin > 8.0 g/dL. Subjects may be transfused to reach this cut-off.

Chemistry

  • Serum ALT/AST less than or equal to 5.0 x ULN

  • Serum creatinine less than or equal to 1.5 x ULN

  • Total bilirubin less than or equal to 2.0 mg/dL, except in patients with Gilbert sSyndrome, who must have a total bilirubin < 3.0 mg/dL.

  • Patients must have completed any prior systemic therapy at the time of enrollment.

Note: Patients may have undergone minor surgical procedures or limited field radiotherapy within the four weeks prior to enrollment, as long as related major organ toxicities have recovered to less than or equal to grade 1.

  • Ability of subject to understand and the willingness to sign a written informedconsent document.

  • Willing to sign a durable power of attorney.

  • Subjects must be co-enrolled on protocol 03-C-0277.

Exclusion

EXCLUSION CRITERIA:

  • Participants who are pregnant or nursing because of the potentially dangerouseffects of the treatment on the fetus or infant.

  • Concurrent systemic steroid therapy.

  • Active systemic infections requiring anti-infective treatment, coagulationdisorders, or any other active or uncompensated major medical illnesses.

  • Advanced primary with impeding occlusion, perforation or bleeding, dependent ontransfusion.

  • Any form of primary immunodeficiency (such as Severe Combined ImmunodeficiencyDisease and AIDS).

  • History of major organ autoimmune disease.

  • Grade 3 or 4 major organ irAEs clinically attributed to anti-PD-1/PD-L1 therapy.

  • Concurrent opportunistic infections (The experimental treatment being evaluated inthis protocol depends on an intact immune system. Patients who have decreasedimmunecompetence may be less responsive to the experimental treatment and moresusceptible to its toxicities.)

  • History of severe immediate hypersensitivity reaction to cyclophosphamide,fludarabine, or aldesleukin.

  • History of coronary revascularization or ischemic symptoms.

  • For select patients with a clinical history prompting cardiac evaluation: last knownLVEF less than or equal to 45%.

  • Documented Child-Pugh score of B or C for hepatocellular carcinoma patients withknown underlying liver dysfunction.

  • For select patients with a clinical history prompting pulmonary evaluation: knownFEV1 less than or equal to 50%.

  • Patients who are receiving any other investigational agents.

Study Design

Total Participants: 332
Treatment Group(s): 5
Primary Treatment: Pembrolizumab (Keytruda)
Phase: 2
Study Start date:
August 26, 2010
Estimated Completion Date:
December 27, 2029

Study Description

Background:

  • Metastatic digestive tract cancers, in particular esophageal, gastric, pancreatic, and hepatobiliary carcinomas, are associated with poor survival beyond five years and poor response to existing therapies.

  • Data from the National Cancer Institute Surgery Branch (NCI-SB) and from the literature support that metastatic cancers are potentially immunogenic and that tumor-infiltrating

lymphocytes (TIL) can be grown and expanded from these tumors.

  • In metastatic melanoma, TIL can mediate the regression of bulky disease at any site when administered to an autologous patient with high-dose aldesleukin (IL-2) following a nonmyeloablative, lymphodepleting preparative regimen.

  • The recent young-TIL approach, in which TIL are minimally cultured in vitro, not selected for tumor recognition, before rapid expansion and infusion to metastatic melanoma patients, has led to objective response rates comparable to previous trials relying on TIL screened for tumor recognition, with no added toxicities.

  • In pre-clinical models, the administration of an anti-PD-1 antibody enhances the anti-tumor activity of transferred T-cells.

  • We propose to investigate the feasibility, safety, and efficacy of TIL adoptive transfer therapy in combination with pembrolizumab, administered either prior to cell administration or at the time of progressive disease, for metastatic cancers.

Objectives:

-Primary objective:

--With Amendment BB, to determine the rate of tumor regression in patients with metastatic cancer who receive autologous, minimally cultured TIL in conjunction with a non-myeloablative, lymphodepleting preparative regimen, high-dose aldesleukin, and anti-PD-1.

Eligibility:

Patients must be/have:

  • Age greater than or equal to 18 years and less than or equal to 72 years

  • Metastatic upper or lower gastrointestinal, hepatobiliary, genitourinary, breast, ovarian/endometrial cancer, or endocrine tumors including neuroendocrine tumors refractory to standard chemotherapy

Patients may not have:

  • Concurrent major medical illnesses

  • Severe hepatic function impairment due to liver metastatic burden

  • Unpalliated biliary or bowel occlusion, cholangitis, or digestive tract bleeding

  • Any form of immunodeficiency

  • Severe hypersensitivity to any of the agents used in this study

Design:

  • Patients may undergo resection or biopsy to obtain tumor for generation of autologous TIL cultures and autologous cancer cell lines, and for frozen tissue archive. Lymph nodes, ascites,peritoneal implants, and normal tissue adjacent to metastatic deposit will also be obtained when possible for ongoing and future research as described in the NCI-SB cell harvest protocol 03-C-0277 (Cell Harvest and Preparation for Surgery Branch Adoptive Cell Therapy Protocols).

  • With the approval of Amendment BB, patients will be enrolled on Arm 3 or Arm 4. All patients will receive a non-myeloablative, lymphodepleting preparative regimen consisting of cyclophosphamide and fludarabine followed by the infusion of autologous TIL and high-dose aldesleukin. Patients enrolled on Arm 3 will receive pembrolizumab prior to cell administration and three additional doses every three weeks following the cell infusion. Patients enrolled on Arm 4 will receive pembrolizumab within four weeks after meeting progressive disease by RECIST criteria, continuing for up to 8 doses every 3 weeks.

  • Clinical and immunologic response will be evaluated about 6 weeks after cell infusion and periodically thereafter.

  • Twenty-one patients will initially be enrolled in each group to assess toxicity and tumor responses. If two or more of the first 21 patients per groups shows a clinical response (partial response or complete response), accrual will continue to 41 patients, targeting a 20% goal for objective response.

  • Up to 332 patients may be enrolled.

Connect with a study center

  • National Institutes of Health Clinical Center

    Bethesda, Maryland 20892
    United States

    Active - Recruiting

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