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Cyclophosphamide and Fludarabine Followed By an Autologous Lymphocyte Infusion and Interleukin-2 in Treating Patients With Refractory or Recurrent Metastatic Melanoma - Article


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Fludarabine Phosphate

Fludara



Clinical Trial: Cyclophosphamide and Fludarabine Followed By an Autologous Lymphocyte Infusion and Interleukin-2 in Treating Patients With Refractory or Recurrent Metastatic Melanoma

This study is currently recruiting patients.
Verified by National Cancer Institute (NCI) August 2005

Sponsored by: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00138229

Purpose

RATIONALE: An infusion of a patient''''s lymphocytes that have been treated in the laboratory to remove certain immune cells may be an effective treatment for melanoma. Drugs such as cyclophosphamide and fludarabine, may suppress the immune system so that the patient''''s immune cells allow the infused lymphocytes to work. Interleukin-2 may help the lymphocytes kill more tumor cells when they are put back in the body. Giving cyclophosphamide and fludarabine followed by autologous lymphocyte infusion and interleukin-2 may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving cyclophosphamide and fludarabine followed by an autologous lymphocyte infusion and interleukin-2 works in treating patients with refractory or recurrent melanoma.

Condition Intervention Phase
Recurrent Melanoma
Stage IV Melanoma
 Drug: autologous lymphocytes
 Drug: cyclophosphamide
 Drug: filgrastim
 Drug: fludarabine
 Drug: interleukin-2
 Procedure: biological response modifier therapy
 Procedure: chemotherapy
 Procedure: colony-stimulating factor therapy
 Procedure: cytokine therapy
 Procedure: interleukin therapy
 Procedure: leukocyte therapy
 Procedure: peripheral blood lymphocyte therapy
Phase II

MedlinePlus related topics:  Melanoma

Study Type: Interventional
Study Design: Treatment

Official Title: Phase II Study of Nonmyeloablative Lymphodepleting Chemotherapy Comprising Cyclophosphamide and Fludarabine Followed By Autologous CD25-Positive-T-Regulatory-Cell-Depleted Lymphocyte Reinfusion and High-Dose Interleukin-2 in Patients With Refractory or Recurrent Metastatic Melanoma

Further Study Details: 

OBJECTIVES:

Primary

Secondary

  • Determine the rate of repopulation of CD25-positive T-regulatory cells in patients treated with this regimen.
  • Determine the toxicity of this regimen in these patients.

OUTLINE:

  • Apheresis and CD25-positive T-regulatory cell depletion: Patients undergo 1-2 aphereses to collect peripheral blood mononuclear cells (PBMC). CD25-positive T-regulatory cells are depleted from the collected PBMC in vitro.
  • Nonmyeloablative lymphodepleting chemotherapy: Patients receive cyclophosphamide IV over 1 hour on days -8 and -7 and fludarabine IV over 15-30 minutes on days -6 to -2.
  • Autologous CD25-positive-T-regulatory-cell-depleted lymphocyte reinfusion: Patients receive autologous lymphocytes IV over 20-30 minutes on day 0.
  • Filgrastim (G-CSF) and high-dose interleukin-2 (IL-2) therapy: Patients receive G-CSF subcutaneously (SC) daily beginning on day 0 and continuing until blood counts recover. Patients also receive high-dose IL-2 IV over 15 minutes 3 times daily on days 0-4 and 14-18. Patients are reevaluated 3-4 weeks after completion of high-dose IL-2 therapy. Patients achieving stable disease or a partial response receive additional high-dose IL-2 as above for up to 2 retreatment courses in the absence of disease progression or unacceptable toxicity. Retreatment begins at least 6 weeks after autologous lymphocyte reinfusion.

After completion of study treatment, patients are followed at 4-6 weeks and then every 1-2 months thereafter.

PROJECTED ACCRUAL: A total of 16-29 patients will be accrued for this study within 1-1.5 years.

Eligibility

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both
Criteria

DISEASE CHARACTERISTICS:

  • Diagnosis of melanoma
  • Metastatic disease
  • Measurable disease
  • HLA-A2 negative disease
  • Disease did not respond to OR recurred after completion of prior high-dose interleukin-2 (IL-2)
  • Eligible to receive high-dose IL-2
  • No tumor reactive cells available for cell transfer therapy

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-1

Life expectancy

  • At least 3 months

Hematopoietic

  • Absolute neutrophil count > 1,000/mm^3
  • Platelet count > 100,000/mm^3
  • Hemoglobin > 8.0 g/dL
  • No coagulation disorders

Hepatic

  • ALT and AST < 3 times upper limit of normal
  • Bilirubin ≤ 2.0 mg/dL (< 3.0 mg/dL if due to Gilbert''''s syndrome)
  • Hepatitis B surface antigen negative
  • Hepatitis C antigen negative

Renal

  • Creatinine ≤ 2.0 mg/dL
  • No renal failure requiring dialysis due to toxic effects of prior IL-2 administration

Cardiovascular

  • No myocardial infarction
  • No cardiac arrhythmias
  • No other major cardiovascular illness as evidenced by a positive stress thallium or comparable test
  • Normal cardiac stress test (e.g., stress thallium, stress MUGA, dobutamine echocardiogram) AND LVEF ≥ 45% (for patients ≥ 50 years of age or who have a history of EKG abnormalities, symptoms of cardiac ischemia, or arrhythmias)

Pulmonary

  • No obstructive or restrictive pulmonary disease
  • No other major respiratory illness
  • FEV1 ≥ 60% of predicted (for patients with a prolonged history of cigarette smoking or symptoms of respiratory dysfunction)

Immunologic

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 4 months after completion of study treatment
  • No other toxic effects during prior IL-2 administration that would preclude redosing with IL-2, including the following:
  • Mental status changes that would require intubation
  • Bowel peroration

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • See Disease Characteristics

Chemotherapy

  • At least 6 weeks since prior nitrosoureas

Endocrine therapy

Radiotherapy

  • Not specified

Surgery

  • Not specified

Other

  • At least 4 weeks since prior systemic therapy

Location and Contact Information

Please refer to this study by ClinicalTrials.gov identifier  NCT00138229


Maryland
      Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support, Bethesda,  Maryland,  20892-1182,  United States; Recruiting
NCI Clinical Studies Support  888-NCI-1937 

Study chairs or principal investigators

Steven A. Rosenberg, MD, PhD,  Principal Investigator,  NCI - Surgery Branch   

More Information

Clinical trial summary from the National Cancer Institute''''s PDQ® database

Study ID Numbers:  CDR0000440165; NCI-05-C-0194; NCI-P6573
Last Updated:  August 29, 2005
Record first received:  August 29, 2005
ClinicalTrials.gov Identifier:  NCT00138229
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-08-30

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November 18, 2008



Page Updated: June 1, 2005
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