Patient case: 74-year-old female with melanoma; genetic feature: no tumor infiltrating lymphocytes

Clinical trial: Fludarabine Followed By Adoptive Immunotherapy in Treating Patients With Stage IV Melanoma

Summary: RATIONALE: Biological therapies such as cellular adoptive immunotherapy use different ways to stimulate the immune system and stop cancer cells from growing. Fludarabine may help the immune system kill more cancer cells.
  PURPOSE: Phase I trial to study the effectiveness of fludarabine followed by cellular adoptive immunotherapy in treating patients who have metastatic melanoma.

Detailed description: OBJECTIVES:
  Primary
  -  Determine the safety and toxicity of adoptive immunotherapy comprising autologous CD8+ antigen-specific cytotoxic T-lymphocyte (CTL) clones after fludarabine in patients with stage IV melanoma.
  -  Determine the duration of in vivo persistence of these CTL clones in these patients.
  Secondary
  -  Determine the antitumor effect of this regimen in these patients.
  OUTLINE: This is an open-label, nonrandomized study.
  Patients undergo leukapheresis or weekly phlebotomy for the collection of peripheral blood mononuclear cells from which autologous antigen-specific CD8+ cytotoxic T-lymphocyte (CTL) clones are generated. Patients receive autologous antigen-specific CD8+ CTL clones IV over 30-60 minutes on days 0 and 21 in the absence of rapid disease progression or unacceptable toxicity. Patients also receive fludarabine IV once daily on days 14-18.
  Patients are followed for up to 1 year.
  PROJECTED ACCRUAL: A total of 12 patients will be accrued for this study within 3 years.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed metastatic melanoma
  -  Stage IV disease
  -  HLA-A2 or -A3-expressing disease
  -  Bidimensionally measurable residual disease by palpation or radiographic imaging (e.g., x-ray or CT scan)
  -  No CNS metastases
  -  Previously treated CNS involvement allowed provided there is no evidence of CNS disease at least 2 months after completion of therapy
  PATIENT CHARACTERISTICS:
  Age
  -  18 to 75
  Performance status
  -  Karnofsky 80-100%
  Life expectancy
  -  More than 6 months
  Hematopoietic
  -  Platelet count > 100,000/mm^3
  -  Absolute neutrophil count > 2,000/mm^3
  Hepatic
  -  SGOT no greater than 3 times upper limit of normal
  -  Bilirubin no greater than 1.6 mg/dL
  -  INR no greater than 1.5 times normal
  Renal
  -  Creatinine no greater than 2.0 mg/dL OR
  -  Creatinine clearance at least 60 mL/min
  Cardiovascular
  -  No congestive heart failure
  -  No clinically significant hypotension
  -  No symptoms of coronary artery disease
  -  No cardiac arrhythmia by EKG requiring drug therapy
  Pulmonary
  -  No clinically significant pulmonary dysfunction
  -  FEV_1 at least 1.0 L*
  -  DLCO at least 45%* NOTE: *For patients with a history of pulmonary dysfunction
  Immunologic
  -  No active infection
  -  No oral temperature greater than 38.2°C within the past 48 hours
  -  No systemic infection requiring chronic maintenance or suppressive therapy
  Other
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  No concurrent immunotherapy (e.g., interleukins, interferons, melanoma vaccines, IV immunoglobulins, expanded polyclonal tumor-infiltrating lymphocytes, or lymphokine-activated killer therapy)
  Chemotherapy
  -  At least 3 weeks since prior chemotherapy (standard or experimental)
  Endocrine therapy
  -  No concurrent steroids
  Radiotherapy
  -  At least 3 weeks since prior radiotherapy
  Surgery
  -  Not specified
  Other
  -  At least 3 weeks since prior immunosuppressive therapy
  -  No concurrent pentoxifylline
  -  No other concurrent investigational agents

Relevance to patient case: not relevant