Patient case: 48-year-old female with melanoma; genetic feature: tumor cells with >50% membranous PD-L1 expression

Clinical trial: Tumor Infiltrating Lymphocytes Adjuvant Therapy of Melanoma

Summary: The objective of this multicentric Phase III study is to confirm the results of the phase I-II study (Dreno B & Al. Cancer Immunol Immunother 2002; 51: 539-456) which demonstrated the preventive effect of a treatment by TIL (Tumor Infiltrating Lymphocytes) combined with IL2 (Interleukin 2; low dose injected subcutaneously) on the metastatic relapse in the stage III melanoma patients with only one invaded lymphnode.

Detailed description: In this open, multicentric (Grenoble, Montpellier, Nantes, Angers, Caen, Le Mans, Poitiers, Rennes, Tours) randomized study, selected patients with only one invaded lymphnode confirmed by anatomopathological exam will be randomized to one of the following arms: 1-Control group: patients of this group will not receive any treatment and will have the same clinical follow-up as the treated group. 2- TIL-IL2 group: treated patients will receive two injections of TIL combined with IL2. Tumor Infiltrating Lymphocytes will be obtained from a small piece of tumour tissue removed from the invaded lymphnode after surgery. TIL will be grown in larger number in laboratory during 6 weeks. Patients randomized in treatment arm will receive two injection of TIL (the first about 6 and the second about 10 weeks post-surgery). Administration of TIL will be combined with a low dose of IL2 (6 million U.I. per day) injected subcutaneously from J1 to J5 and J8 to J12 following the day of TIL infusion. The same dose and duration of IL2 treatment will be used for the second injection of TIL performed one month later. After 2 months adjuvant therapy, patients received no other treatment. Only a regular follow-up was performed.

Eligibility: Inclusion Criteria:
  -  Melanoma stage III (regional lymph node recurrence). Will be selected the patients with only one invaded lymph node confirmed by anatomopathological exam after lymph nodes excision.
  -  Absence of visceral metastases verified by physical examination, chest radiography, liver echography and brain-chest-liver CT-Scan.
  -  Age < 75 years, both genders
  -  ECOG 0-2, Karnofsky > 80%.
  -  Negative pregnancy test performed at the screening visit for fertile women.
  -  The potentially fertile women must use an oral contraception or an intra-uterine device (IUD) until three months following the last injection of the study treatment.
  -  The patients must have fully recovered from surgery.
  -  HIV 1/2: The patients must be negative for antibodies HIV 1 and HIV 2 and for Ag P24 or DGV HIV.
  -  HBV: The patients must be negative for the antigen, but can be positive for the antibodies but with a negative DNA PCR.
  -  HCV: The patients must be negative for the antibodies.
  -  HTLV ½: The patients must be negative for the antibodies.
  -  Following laboratory results:
  -  Hemoglobin: ≥ 10 g/dl
  -  WBC: ≥ 4000/µl
  -  Lymphocytes: ≥ 700/µl
  -  Platelet count: ≥ 100.000/µl
  -  Serum creatinine: < 2.0 mg/dl or £ 177 mmol/l
  -  Serum Bilirubin: < 2.0 mg/dl or £ 34.2 mmol/l
  -  ASAT and ALAT: < 2.5 x the upper limit of normal.
  Exclusion criteria:
  -  Patient with more than one invaded lymph node confirmed by anatomopathological exam.
  -  Presence of melanoma metastases discovered by clinical or radiological examination at the screening visit.
  -  Patients must not have received any Chemotherapy, immunotherapy or radiotherapy within the preceding 4 weeks (6 weeks since prior nitrosurea and mitomycin C therapies).
  -  Presence of cardiac affections (congestive cardiac insufficiency, coronaropathy, not controlled HTA).
  -  Any serious active medical illnesses, for example: Active systemic infections requiring of antibiotics, coagulation disorders or any other condition which requires concomitant medications not allowed during this study.
  -  Presence of the second active cancer other than surgically cured non-melanoma skin cancer or cervical carcinoma in-situ.
  -  Any affection requiring a systemic corticotherapy or a treatment by Interferon A.
  -  Any active auto-immune disease including the insulin-dependent diabetes or a immunodeficiency. The vitiligo is not an exclusion criteria.
  -  Thyroid dysfunction not responsive to therapy.
  -  Positive Serology for HIV, HVB, HVC or HTLV1/2.
  -  Woman pregnant or nursing or without an effective contraception.
  -  Incapacity to give written consent.

Relevance to patient case: not relevant