Gemcitabine and Carboplatin Followed By Laboratory-Treated T Lymphocytes in Treating Patients With Metastatic or Locally Recurrent Epstein-Barr Virus-Positive Nasopharyngeal Cancer

Study Overview
=================
Brief Summary
-----------------
RATIONALE: Drugs used in chemotherapy, such as gemcitabine and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving an infusion of a person's T lymphocytes that have been treated in the laboratory may help the body build an effective immune response to kill tumor cells. Giving combination chemotherapy together with laboratory-treated T lymphocytes may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving gemcitabine and carboplatin together with laboratory-treated T lymphocytes works in treating patients with metastatic or locally recurrent Epstein-Barr virus-positive nasopharyngeal cancer.

Detailed Description
-----------------
OBJECTIVES: Primary To determine progression-free survival (PFS 1) of patients with metastatic or locally recurrent Epstein-Barr virus (EBV)-positive nasopharyngeal carcinoma treated with gemcitabine hydrochloride and carboplatin followed EBV-specific cytotoxic T-lymphocytes (CTL). Secondary To determine progression-free survival (PFS 2) of these patients during the immunotherapy portion of this study. To determine the clinical benefit rate of EBV-specific CTL in these patients. To determine the tolerability of EBV-specific CTL therapy in these patients. To demonstrate persistence of EBV-specific immune response in these patients. OUTLINE: Patients undergo collection of peripheral blood mononuclear cells (PBMC) from which T cells are purified, co-cultured with irradiated autologous Epstein-Barr virus (EBV)-specific cytotoxic T-lymphocytes (CTLs), and expanded in vitro for the establishment of cytotoxic T-cell lines. Chemotherapy: Patients receive gemcitabine hydrochloride IV over 30 minutes and carboplatin IV over 60 minutes on days 1, 8, and 15. Treatment repeats every 28 days for up to 4 courses in the absence of disease progression or unacceptable toxicity. After completion of course 2, patients undergo evaluation for response. Patients with progressive disease proceed directly to induction immunotherapy. Patients with stable disease (SD), partial response (PR), or complete response (CR) receive 2 additional courses of chemotherapy and then proceed to induction immunotherapy. Induction immunotherapy: Beginning 14-28 days after the completion of chemotherapy, patients receive EBV-specific CTLs IV over 1-10 minutes on days 1 and 14. Six weeks after the second infusion, patients undergo evaluation for response. Patients who demonstrate clinical benefit (i.e., CR, PR, SD) to induction immunotherapy proceed to maintenance immunotherapy. Maintenance immunotherapy: Patients receive EBV-specific CTLs IV over 1-10 minutes. Treatment repeats every 1-3 months for up to 4 courses in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection at baseline and prior to each course of induction immunotherapy and maintenance immunotherapy. Samples are analyzed for EBV CTL frequency by immune function assays (i.e., tetramer analysis, enzyme-linked immunospot, and cytotoxic T-lymphocyte precursor assays); for specificity of response by cytotoxicity assays (in patients for whom the appropriate reagents are available); and for evaluation of EBV DNA by polymerase chain reaction. In addition, T-cells are isolated from blood samples for fluorescence-activated cell sorter analysis and for extraction of RNA. After completion of study therapy, patients are followed at least every 2 months until disease progression.

Official Title
-----------------
Phase II Trial Evaluating Efficacy of a Strategy Employing Combination Gemcitabine and Carboplatin Chemotherapy Followed by EBV-Specific Cytotoxic T-Lymphocytes in Patients With Metastatic or Locally Recurrent EBV-Positive Nasopharyngeal Carcinoma

Conditions
-----------------
Head and Neck Cancer

Intervention / Treatment
-----------------
* Biological: autologous Epstein-Barr virus-specific cytotoxic T lymphocytes
* Drug: carboplatin
* Drug: gemcitabine hydrochloride
* Genetic: polymerase chain reaction
* Other: fluorescence activated cell sorting
* Other: immunoenzyme technique


Participation Criteria
=================
Eligibility Criteria
-----------------
DISEASE CHARACTERISTICS: Biopsy-proven nasopharyngeal carcinoma (NPC) WHO type 2/3 disease Metastatic or locally recurrent disease Epstein-Barr virus (EBV)-positive disease as confirmed by in situ hybridization assay or PCR amplification for EBV-encoded RNA expression Radiologically measurable disease PATIENT CHARACTERISTICS: ECOG performance status 0-2 Life expectancy > 3 months ANC > 1,200/mm^3 Platelet count ≥ 100,000/mm^3 Hemoglobin ≥ 8 g/dL Bilirubin < 2 times upper limit of normal (ULN) AST and ALT < 3 times ULN Creatinine clearance ≥ 40 mL/min Corrected calcium normal Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No concurrent severe illness, including any of the following: Chronic obstructive pulmonary disease Ischemic heart disease Active congestive cardiac failure Active angina pectoris Uncontrolled arrhythmia Uncontrolled hypertension No concurrent severe infections HIV negative PRIOR CONCURRENT THERAPY: No more than one line of prior chemotherapy for metastatic disease No prior gemcitabine hydrochloride Prior platinum agents allowed At least 1 month since prior investigational therapy

Ages Eligible for Study
-----------------
Minimum Age: 21 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Biological: autologous Epstein-Barr virus-specific cytotoxic T lymphocytes|nan|
|Drug: carboplatin|nan|
|Drug: gemcitabine hydrochloride|nan|
|Genetic: polymerase chain reaction|nan|
|Other: fluorescence activated cell sorting|nan|
|Other: immunoenzyme technique|nan|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Median progression-free survival (PFS 1), defined as the time from study enrollment to the time of radiological disease progression or death from any cause |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Median PFS 2, defined as the time from the start of induction immunotherapy to radiological disease progression or death from any cause |  |  | 
| Response rate, defined as the proportion of patients who achieve a complete response (CR) or partial response (PR) after 4 courses of chemotherapy and the proportion of patients who achieve a further response after immunotherapy |  |  | 
| Clinical benefit rate of immunotherapy, defined as the proportion of patients who achieve CR, PR, or stable disease |  |  | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
recurrent lymphoepithelioma of the nasopharynx, recurrent squamous cell carcinoma of the nasopharynx, stage IV lymphoepithelioma of the nasopharynx, stage IV squamous cell carcinoma of the nasopharynx