T Cell Receptor Immunotherapy Targeting HPV-16 E6 for HPV-Associated Cancers
Condition: Vaginal Cancer; Cervical Cancer; Anal Cancer; Penile Cancer; Oropharyngeal Cancer
MeSH terms: Anus Neoplasms; Oropharyngeal Neoplasms; Vaginal Neoplasms; Penile Neoplasms
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Background:

      The National Cancer Institute (NCI) Surgery Branch has developed an experimental therapy for
      treating patients with cancer that involves taking white blood cells from the patient,
      growing them in the laboratory in large numbers, genetically modifying these specific cells
      with a type of virus (retrovirus) to attack only the tumor cells, and then giving the cells
      back to the patient. This type of therapy is called gene transfer. Researchers want to test
      this on human papilloma virus (HPV)-associated cancers.

      Objective:

      - The purpose of this study is to determine a safe number of these cells to infuse and to see
      if these particular tumor-fighting cells (Anti-HPV E6) can shrink tumors associated with HPV
      and test the toxicity of this treatment.

      Eligibility:

      - Adults age 18-66 with an HPV-16-associated cancer.

      Design:

        -  Work up stage: Patients will be seen as an outpatient at the National Institutes of
           Health (NIH) clinical Center and undergo a history and physical examination, scans,
           x-rays, lab tests, and other tests as needed

        -  Leukapheresis: If the patients meet all of the requirements for the study they will
           undergo leukapheresis to obtain white blood cells to make the anti HPV E6 cells.
           {Leukapheresis is a common procedure, which removes only the white blood cells from the
           patient.}

        -  Treatment: Once their cells have grown, the patients will be admitted to the hospital
           for the conditioning chemotherapy, the anti HPV E6 cells and aldesleukin. They will stay
           in the hospital for about 4 weeks for the treatment.

      Follow up: Patients will return to the clinic for a physical exam, review of side effects,
      lab tests, and scans about every 1-3 months for the first year, and then every 6 months to 1
      year as long as their tumors are shrinking. Follow up visits take up to 2 days.
    

Detailed description: 
      BACKGROUND:

        -  Metastatic or refractory/recurrent human papillomavirus (HPV)-16+ cancers (cervical,
           vulvar, vaginal, penile, anal, and oropharyngeal cancers) are incurable and poorly
           palliated by standard therapies.

        -  HPV-16+ cancers constitutively express the HPV-16 E6 oncoprotein, which is absent from
           healthy human tissues.

        -  Administration of T cell receptor (TCR) gene engineered T cells can induce objective
           tumor responses in certain malignancies.

        -  T cells genetically engineered with a TCR targeting HPV-16 E6 (E6 TCR) display specific
           reactivity against human leukocyte antigen serotype within HLA-A A serotype group
           (HLA-A2+), HPV-16+ target cells.

      OBJECTIVES:

      Primary Objective

        -  To determine a safe dose of administration of autologous T cells transduced with an
           anti-HPV-16 E6 TCR and aldesleukin to patients following a nonmyeloablative but
           lymphodepleting preparative regimen.

        -  To determine the objective tumor response rate (Complete or Partial Response) and
           duration in patients with metastatic or recurrent/refractory HPV-16+ cancers treated
           with this regimen.

      ELIGIBILITY:

        -  Patients greater than or equal to 18 years old and less than or equal to 70 years old
           with metastatic or refractory/recurrent HPV-16+ cancer.

        -  Prior first line systemic therapy is required unless the patient declines standard
           treatment.

        -  Patients must be HLA-A 02:01-positive.

      DESIGN:

        -  Patients will receive a non-myeloablative lymphocyte-depleting preparative regimen of
           cyclophosphamide and fludarabine

        -  On day 0 patients will receive transduced lymphocytes and then begin high dose
           aldesleukin

        -  The study will begin with a phase I dose escalation. After the maximum tolerated dose
           (MTD) cell dose has been determined, the patients will be enrolled into the phase II
           portion of the study.

        -  Clinical and immunologic response will be evaluated about 4 to 6 weeks after treatment
           and then about every 1-6 months until disease progression

        -  Following a dose escalation phase of 9 to 18 patients, initially 21 evaluable patients
           will be enrolled in the phase II portion of the study. If 0 to 1 of the 21 patients
           experiences a clinical response, then no further patients will be enrolled. If 2 or more
           of the first 21 evaluable patients enrolled have a clinical response, then accrual will
           continue until a total of 41 evaluable patients have been enrolled. The accrual ceiling
           will be set at 61 patients. Provided that about 1 patient every 6 weeks will be enrolled
           onto this trial, approximately 4 years may be needed to accrue the maximum number of
           patients.
    

Intervention name(s): Fludarabine; Cyclophosphamide; E6 TCR; Aldesleukin
Intervention type(s): Drug; Drug; Biological; Drug
Intervention description(s): Patients will receive Fludarabine 25 mg/m^2/day for 5 days.; Patients will receive Cyclophosphamide 60 mg/kg/day x 2 days; On day 0, cells will be infused intravenously (IV) over 20-30 minute (between 1 and 4 days after the last dose of fludarabine); Aldesleukin 720,000 IU/kg IV (based on total body weight) over 15 minutes approximately every 8 hours beginning within 24 hours of cell infusion and continuing for up to 5 days (maximum of 15 doses).
Other intervention name(s): Fludara; Cytoxan; IL-2
Intervention MeSH terms: Aldesleukin; Cyclophosphamide; Fludarabine
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: HPV positive; Metastatic; Diet; Screening; Risk Factors; Colorectal adenoma; Refractory; Immunotherapy; Reproductive Cancers