A New Way to Fight Melanoma in the Liver: Training Your Own Immune Cells to Attack Cancer
Hepatic Arterial Infusion of Autologous Tumor Infiltrating Lymphocytes Preconditioned With Percutaneous Hepatic Perfusion With Melphalan in Patients With Melanoma and Liver Metastases
In Plain English
This trial is testing a new treatment for melanoma that has spread to your liver. Here's how it works: Doctors will remove immune cells called T cells from your tumor, grow millions more of them in the lab, and then put them back into your body in a very targeted way. Before they do this, they'll use a special procedure to weaken the cancer cells in your liver with a chemotherapy drug called melphalan. Then they'll inject your trained immune cells directly into the blood vessels feeding your liver tumor, so they can attack the cancer where it lives. You'll also get small doses of a drug called interleukin-2 to help your immune cells work better. This is an early-stage trial (Phase 1), which means doctors are mainly checking if this treatment is safe and what side effects to expect. If you have melanoma that started in your eye (uveal melanoma) or on your skin and has spread to your liver, this trial might be for you.
What This Trial Does
Evaluate the safety and tolerability of treatment with autologous tumor infiltrating lymphocytes (TIL) administered via hepatic arterial infusion and preconditioning with percutaneous hepatic perfusion in patients with liver metastases (but not restricted to) of malignant melanoma
Who Can Join
Inclusion Criteria
- Patient is willing and able to provide written informed consent and comply with study procedures. Written informed consent must be signed and dated before the start of specific protocol procedures.
- Patient must have a histologically/cytologically confirmed diagnosis of:
- stage IV uveal melanoma with or without any previous systemic therapy OR
- stage IV cutaneous melanoma with confirmed progression following at least one or two prior systemic therapies including a programmed cell death protein-1 (PD-1) inhibitor with or without a CTLA-4 inhibitor; and if BRAF V600 mutation-positive, also a BRAF inhibitor or a BRAF inhibitor in combination with a MEK inhibitor.
- Measurable disease by computed tomography (CT) per RECIST 1.1 criteria with at least one target lesion identified in the liver and where the distribution pattern of metastasis is predominantly engaging the liver as judged by the investigator.
- At least one resectable lesion in the liver (or aggregate of lesions resected) of a minimum size of 0.5 cm in diameter post- resection to generate TILs.
- ECOG performance status of 0 - 1.
Exclusion Criteria
- Life expectancy of less than 3 months.
- Reduced renal function defined as S-Creatinine \>=1.5xULN or Creatinine Clearance \< 40 mL/min, calculated using the Cockroft and Gault formula.
- Reduced hepatic function (defined as ASAT, ALAT, bilirubin \> 3\*ULN and PK- INR \> 1.5) or medical history of liver cirrhosis or portal hypertension.
- Hemoglobin \<90 g/L or platelets \<100x109/L or neutrophils \<1.5x109/L
- Use of live vaccines four weeks before or after the start of study.
- Infection of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), hepatitis B or hepatitis C.
- Active autoimmune disease.
- A condition requiring systemic treatment with either corticosteroids (\>10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration. Inhaled or topical steroids and adrenal replacement doses \>10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
- Concomitant therapy with any other anti- cancer therapy, concurrent medical conditions requiring use of immunosuppressive medications or use of other investigational drugs.
- Has a known additional malignancy of other diagnosis that is progressing or requires active treatment.
- A history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the study, interfere with the patient's participation for the full duration of the study, or is not in the best interest of the patient to participate, in the opinion of the treating Investigator
Treatments
Autologous Tumor Infiltrating Lymphocytes (DRUG)
Administered via hepatic arterial infusion (HAI)
Melphalan (DRUG)
Administered via isolated hepatic perfusion
Interleukin-2 (DRUG)
low-dose, administered s.c.