Patient case: 86-year-old female with melanoma; genetic feature: high tumor mutational burden

Clinical trial: TAA-Specific CTLS for Solid Tumors (TACTASOM)

Summary: This is a clinical trial for patients with a solid tumor which has come back, or may come back, or has not gone away after treatment, including the standard treatment we know for these diseases. This is a study using special immune system cells called tumor-associated antigen (TAA)-specific cytotoxic T lymphocytes, a new experimental therapy.
  The proteins that the investigators are targeting in this study are called tumor-associated antigens (TAAs). These are cell proteins that are specific to the cancer cell, so they either do not show or show up in low quantities on normal human cells. In this study, the investigators target five common TAAs called NY-ESO-1, MAGEA4, PRAME, Survivin and SSX. On a different study, patients have been treated and so far this treatment has shown to be safe.
  The investigators now want to try this treatment in patients with solid tumors.
  This protocol is designed as a Phase I dose-escalation study.

Detailed description: Blood will be collected from the patient and TAA-specific CTLs will be made.
  The cells will be injected by IV into the patient over 1 - 10 minutes. The patient may be pre-treated with acetaminophen (Tylenol) and diphenhydramine (Benadryl). Acetaminophen (Tylenol) and diphenhydramine (Benadryl) are given to prevent a possible allergic reaction to the T cell infusion. Initially, two doses of T cells will be given two weeks apart. The patient's disease will be assessed pre-infusion and then 6 weeks after the second infusion. If after the second infusion there is a reduction in the size of the patient's tumor on CT or MRI scan as assessed by a radiologist, the patient can receive up to six (6) additional doses of the T cells at monthly intervals if they wish. All of the treatments will be given by the Center for Cell and Gene Therapy at Houston Methodist Hospital or Texas Children's Hospital.
  In between the first and second T cell infusions, and for 6 weeks after the last infusion, the investigators ask that the patient not receive any other anti-cancer treatments, such as radiation therapy or chemotherapy, except PD1/PDL1 inhibitors as clinically indicated. If the patient does receive any other therapies in-between the first and second infusion of T cells, they will be taken off treatment and will not be able to receive the second infusion of T cells.
  This is a dose escalation study. This means that at the beginning, patients will be started on the lowest dose (1 of 4 different levels) of T cells. Once that dose schedule proves safe, the next group of patients will be started at a higher dose. This process will continue until all 4 dose levels are studied. If the side effects are too severe, the dose will be lowered or the T cell injections will be stopped.
  Medical tests before treatment:
  Physical exam. Blood tests to measure blood cells, kidney and liver function. Measurements of the patient's tumor by routine imaging studies. The investigators will use the imaging study that was previously performed to follow the patient's tumor: Computer Tomogram (CT), Magnetic Resonance Imaging (MRI), or Positron Emission Tomography (PET).
  Pregnancy test if the patient is a female who can have children.
  Medical tests during and after treatment:
  Blood tests to measure blood cells, kidney and liver function. Imaging study 8 weeks after the 1st CTL infusion.
  To learn more about the way the T cells are working in the patient's body, an extra 20-40 mL (4-8 teaspoons) of blood will be taken before each infusion, and at Weeks 1, 2, 4 and 6. Afterwards, blood will be collected at 3, 6, 9 and 12 months after the last infusion. The investigators will use this blood to see how long the T cells last, and to look at the immune response to the patient's response to cancer. Patients will then be contacted once a year for up to 4 additional years (total of 5 years follow-up) to evaluate their disease response long-term.

Eligibility: THIS PROTOCOL IS CURRENTLY NOT RECRUITING ADULTS.
  Procurement Inclusion Criteria:
  1. Any patient regardless of sex with a solid tumor expressing any of the following antigens (PRAME, SSX2, MAGEA4, NY-ESO1-1 and/or Survivin) with:
  1. Active disease after first line therapy;
  2. Refractory disease;
  3. As adjuvant therapy for high risk disease (high risk disease is a disease that has a >50% risk of progression within 5 years)
  2. Patients with life expectancy at least 6 weeks.
  3. Age greater than or equal to 2 and less than or equal to 80 years old.
  4. Hgb >8.0
  5. Informed Consent explained to, understood by and signed by patient/guardian. Patient/guardian given copy of informed consent.
  Procurement Exclusion Criteria:
  1. Diagnosis of primary CNS tumor.
  2. Patients with severe intercurrent infection.
  3. Patients with active HIV infection at time of procurement (can be pending at the time of blood draw).
  4. Patients in remission who are enrolled on another study where time to progression or disease-free survival is a primary endpoint.
  Treatment Inclusion Criteria:
  1. Any patient regardless of sex with a solid tumor expressing any of the following antigens (PRAME, SSX2, MAGEA4, NY-ESO1-1 and/or Survivin) with:
  1. Active disease after first line therapy;
  2. Refractory disease;
  3. As adjuvant therapy for high risk disease (high risk disease is a disease that has a >50% risk of progression within 5 years)
  2. Patients with life expectancy at least 6 weeks.
  3. Age greater than or equal to 2 and less than or equal to 80 years old.
  4. Pulse oximetry of >95% on room air in patients who previously received radiation therapy.
  5. Patients with a Karnofsky/Lansky score of greater than or equal to 50.
  6. Patients with bilirubin less than or equal to 2x upper limit of normal, AST less than or equal to 3x upper limit of normal, and Hgb >8.0
  7. Patients with a creatinine less than or equal to 2x upper limit of normal for age.
  8. Patients should have been off other investigational therapy for one month prior to entry in this study.
  9. Patients should have been off conventional therapy for at least 1 week prior to entry in this study. PD1/PDL1 inhibitors will be allowed if medically indicated.
  10. Informed Consent explained to, understood by and signed by patient/guardian. Patient/guardian given copy of informed consent.
  11. Due to unknown effects of this therapy on a fetus, pregnant women are excluded from this research. The male partner should use a condom Females of child-bearing potential must be willing to utilize one of the more effective birth control methods during the study unless female has had a hysterectomy or tubal ligation.
  Treatment Exclusion Criteria:
  1. Diagnosis of primary CNS tumor.
  2. Patients with severe intercurrent infection.
  3. Patients receiving systemic corticosteroids (patients off steroids for at least 48 hours are eligible).
  4. Pregnant or breastfeeding
  5. HIV positive.
  6. Patients in remission who are enrolled on another study where time to progression or disease-free survival is a primary endpoint.

Relevance to patient case: not relevant