T Cell Receptor Immunotherapy for Patients With Metastatic Non-Small Cell Lung Cancer
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ClinicalTrials.gov Identifier: NCT02133196 |
Recruitment Status :
Recruiting
First Posted : May 7, 2014
Last Update Posted : June 24, 2022
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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 100 patients. 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 non-small cell lung cancer (NSCLC) tumors to shrink and to see if this treatment is safe.
Eligibility:
- Adults age 18-70 with NSCLC who have a tumor that can be safely removed.
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 take up to 2 days.
Condition or disease | Intervention/treatment | Phase |
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Advanced Non-Small Cell Lung Cancer Squamous Cell Carcinoma Advanced NSCLC Adenosquamous Carcinoma Adenocarcinoma | Drug: Aldesleukin Drug: Fludarabine Drug: Cyclophosphamide Biological: Young TIL | Phase 2 |

Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 85 participants |
Allocation: | Non-Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | A Phase II Study Using Autologous Young Tumor-Infiltrating Lymphocytes Derived From Patients With Non-Small Cell Lung Cancer Following Non-Myeloablative Lymphocyte Depleting Preparative Regimen |
Actual Study Start Date : | October 23, 2014 |
Estimated Primary Completion Date : | October 23, 2024 |
Estimated Study Completion Date : | October 23, 2025 |

Arm | Intervention/treatment |
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Experimental: 1/High-Dose Aldesleukin
Non-myeloablative lymphodepleting preparative regimen of cyclophosphamide and fludarabine plus young TIL plus high-dose Aldesleukin
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Drug: Aldesleukin
Aldesleukin 720,000 (Arm 1) or 72,000 (Arm 2) IU/kg IV (based on total body weight) over 15 minutes every 8 hours (+/- 1 hour) beginning within 24 hours of cell infusion and continuing for up to a maximum of 9 doses in Arm 1 and 12 doses in Arm 2. Drug: Fludarabine Days -7 to -3: Fludarabine 25 mg/m2/day IVPB daily over 30 minutes for 5 days. Drug: Cyclophosphamide Days -7 and -6: Cyclophosphamide 60 mg/kg/day X 2 days IV in 250 ml D5W with Mesna 15 mg/kg/day X 2 days over 1 hour. Biological: Young TIL Day 0: Cells will be infused intravenously (IV) on the Patient Care Unit over 20-30 minutes. |
Experimental: 2/Low-Dose Aldesleukin
Non-myeloablative lymphodepleting preparative regimen of cyclophosphamide and fludarabine plus young TIL plus low-dose Aldesleukin
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Drug: Aldesleukin
Aldesleukin 720,000 (Arm 1) or 72,000 (Arm 2) IU/kg IV (based on total body weight) over 15 minutes every 8 hours (+/- 1 hour) beginning within 24 hours of cell infusion and continuing for up to a maximum of 9 doses in Arm 1 and 12 doses in Arm 2. Drug: Fludarabine Days -7 to -3: Fludarabine 25 mg/m2/day IVPB daily over 30 minutes for 5 days. Drug: Cyclophosphamide Days -7 and -6: Cyclophosphamide 60 mg/kg/day X 2 days IV in 250 ml D5W with Mesna 15 mg/kg/day X 2 days over 1 hour. Biological: Young TIL Day 0: Cells will be infused intravenously (IV) on the Patient Care Unit over 20-30 minutes. |
- Response rate [ Time Frame: 6 and 12 weeks after cell infusion, then every 3 months x3, then every 6 months x 2 years, then per PI discretion ]Percentage of patients who have a clinical response to treatment (objective tumor regression)
- Phenotypic and functional characteristics of TIL [ Time Frame: 2-4 years post cell infusion ]Find in vitro characteristics of the infused cells which correlate with in vivo antitumor activity. Evaluation of the activity, specificity, and telomere length of infused TIL.
- Frequency and severity of treatment-related adverse events [ Time Frame: 30 days after end of treatment ]Aggregate of all adverse events, as well as their frequency and severity
- Feasibility of generating TIL from patients with NSCLC [ Time Frame: 3-6 months post cell harvest ]

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
Ages Eligible for Study: | 18 Years to 70 Years (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
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INCLUSION CRITERIA:
- Measurable metastatic (stage IV) or unresectable non-small cell lung cancer (including but not limited to squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinomas) with at least one lesion that is resectable for TIL generation. (Note: neuroendocrine tumors are not eligible.)
- Patients with 3 or fewer brain metastases that are less than 1 cm in diameter and asymptomatic are eligible. Lesions that have been treated with stereotactic radiosurgery must be clinically stable for 1 month after treatment for the patient to be eligible. Patients with surgically resected brain metastases are eligible.
- All patients must have had at least one appropriate first line systemic therapy and progressed.
- Clinical performance status of ECOG 0 or 1.
- Age Greater than or equal to 18 years of age and less than or equal to 70 years of age.
- Patients of both genders must be willing to practice birth control from the time of enrollment on this study and for four months after treatment.
- Willing to sign a durable power of attorney
- Able to understand and sign the Informed Consent Document
I. Hematology:
- Absolute neutrophil count greater than 1000/mm3 without support of filgrastim
- Normal WBC (> 2500/mm3).
- Hemoglobin greater than 8.0 g/dl. Subjects may be transfused to reach this cut-off.
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Platelet count greater than 80,000/mm3
j. Serology:
- Seronegative for 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 may be less responsive to the experimental treatment and more susceptible to its toxicities.)
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Seronegative for active hepatitis B, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then patient must be tested for the presence of antigen by RTPCR and be HCV RNA negative.
k. Chemistry:
- Serum ALT/AST less than or equal to2.5 times the upper limit of normal.
- Serum creatinine less than or equal to 1.6 mg/dl.
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Total bilirubin less than or equal to 2 mg/dl, except in patients with Gilbert s Syndrome, who must have a total bilirubin less than or equal to 3 mg/dl.
l.Women of child-bearing potential must be willing to undergo a pregnancy testprior to the start of treatment because of the
potentially dangerous effects of the treatment on the fetus.
m. Patients must have completed any prior systemic therapy at the time of enrollment.
Note: Patients may have undergone minor surgical procedures or local radiotherapy within the past 4 weeks, as long as related major organ toxicities have recovered to grade 1 or less.
n. More than two weeks must have elapsed since any prior palliation for major bronchial occlusion or bleeding at the time the patient receives the preparative regimen, and patient s toxicities must have recovered to a grade 1 or less.
o. Subjects must be co-enrolled in protocol 03-C-0277
EXCLUSION CRITERIA:
- Women who are breastfeeding because of the potentially dangerous effects of the treatment on infant.
- Ongoing need for pharmacological immunosuppression, including steroids
- Active systemic infections (e.g.: requiring anti-infective treatment), coagulation disorders or any other active or uncompensated major medical illnesses.
- Major bronchial occlusion or bleeding not amenable to palliation.
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Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency
Disease and AIDS).
- Concurrent 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 toxicities.)
- History of severe immediate hypersensitivity reaction to any of the agents used in this study.
- For select patients with a clinical history prompting cardiac evaluation: last known LVEF less than or equal to 45%.
- For select patients with a clinical history prompting pulmonary evaluation: known FEV1 less than or equal to 50%
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Any of the following will exclude patients from the high-dose aldesleukin arm, but may be eligible for the low-dose aldesleukin arm:
- Greater than 2 invasive thoracic procedures
- Poor exercise tolerance
- Greater than 66 years of age
- Clinically significant patient history which in the judgment of the Principal Investigator would compromise the patient s ability to tolerate high-dose.
- Patients who are receiving any other investigational agents.

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02133196
Contact: NCI SB Immunotherapy Recruitment Center | (866) 820-4505 | irc@nih.gov |
United States, Maryland | |
National Institutes of Health Clinical Center | Recruiting |
Bethesda, Maryland, United States, 20892 | |
Contact: For more information at the NIH Clinical Center contact NCI/Surgery Branch Recruitment Center 866-820-4505 irc@nih.gov |
Principal Investigator: | James C Yang, M.D. | National Cancer Institute (NCI) |
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: | National Cancer Institute (NCI) |
ClinicalTrials.gov Identifier: | NCT02133196 |
Other Study ID Numbers: |
140104 14-C-0104 |
First Posted: | May 7, 2014 Key Record Dates |
Last Update Posted: | June 24, 2022 |
Last Verified: | May 27, 2022 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | Yes |
Plan Description: | .All IPD recorded in the medical record will be shared with intramural investigators upon request. |
Supporting Materials: |
Study Protocol Statistical Analysis Plan (SAP) Informed Consent Form (ICF) |
Time Frame: | Clinical data will be available during the study and indefinitely. |
Access Criteria: | Clinical data will be made available via subscription to BTRIS and with the permission of the study PI. |
Studies a U.S. FDA-regulated Drug Product: | Yes |
Studies a U.S. FDA-regulated Device Product: | No |
Metastatic Non-Small Cell Lung Cancer NSCLC Lung Cancer |
Carcinoma Lung Neoplasms Carcinoma, Non-Small-Cell Lung Carcinoma, Adenosquamous Neoplasms, Glandular and Epithelial Neoplasms by Histologic Type Neoplasms Respiratory Tract Neoplasms Thoracic Neoplasms Neoplasms by Site Lung Diseases Respiratory Tract Diseases Carcinoma, Bronchogenic Bronchial Neoplasms Neoplasms, Complex and Mixed |
Aldesleukin Cyclophosphamide Fludarabine Immunosuppressive Agents Immunologic Factors Physiological Effects of Drugs Antirheumatic Agents Antineoplastic Agents, Alkylating Alkylating Agents Molecular Mechanisms of Pharmacological Action Antineoplastic Agents Myeloablative Agonists Anti-HIV Agents Anti-Retroviral Agents Antiviral Agents |