Biological Therapy in Treating Patients With Metastatic Melanoma

Phase I Study to Evaluate the Safety of Cellular Adoptive Immunotherapy Using Autologous CD4+ Antigen-Specific T Cell Clones for Patients With Metastatic Melanoma

RATIONALE: Biological therapies use different ways to stimulate the immune system and stop tumor cells from growing. Treating a person's white blood cells in the laboratory and reinfusing them may cause a stronger immune response and kill more tumor cells.

PURPOSE: Phase I trial to study the effectiveness of biological therapy in treating patients who have metastatic melanoma.

OBJECTIVES:

Primary

• Determine the maximum tolerated dose of autologous CD4+ antigen-specific T-cells for cellular adoptive immunotherapy in patients with metastatic melanoma.
• Determine the safety and toxicity of this regimen in these patients.
• Determine the duration of in vivo persistence of adoptively transferred CD4+ antigen-specific T-cell clones in these patients.

Secondary

• Determine the antitumor effects of this regimen in these patients.

OUTLINE: This is a dose-escalation study.

Patients undergo leukapheresis to collect peripheral blood mononuclear cells. CD4+ antigen-specific T-cell clones are generated over the next 2-3 months using immunogenic peptides MART1, tyrosinase, or gp100.

Patients receive autologous CD4+ antigen-specific T-cells IV over 30 minutes.

Cohorts of 3-6 patients receive escalating doses of autologous CD4+ antigen-specific T-cells until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Patients are followed on days 1 and 3 post T-cell infusion, and then once weekly for 12 weeks.

PROJECTED ACCRUAL: A total of 3-18 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Histologically confirmed metastatic melanoma

• HLA type expressing one of the following class II alleles:

  • DRB1*0401
  • DRB1*0404
  • DRB1*1501
  • DPB1*0401
  • DPB1*0402

• Tumor expresses tyrosinase

• Tumor expressing NY-ESO-1 and are HLA type DP4, DP2, or DR7 allowed

• No CNS metastases

  • Prior CNS involvement allowed provided there is no evidence of CNS disease at least 2 months after treatment

PATIENT CHARACTERISTICS:

Age

• 18 to 75

Performance status

• Karnofsky 70-100%

Life expectancy

• More than 16 weeks

Hematopoietic

• WBC greater than 4,000/mm^3
• Absolute neutrophil count greater than 2,000/mm^3
• Platelet count greater than 100,000/mm^3
• Hematocrit greater than 30%

Hepatic

• SGOT no greater than 3 times upper limit of normal
• INR no greater than 1.5 due to hepatic dysfunction
• No significant hepatic dysfunction, defined as hepatic toxicity grade 2 or greater

Renal

• Creatinine no greater than 2.0 mg/dL OR
• Creatinine clearance at least 60 mL/min
• Calcium no greater than 12 mg/dL

Cardiovascular

• No significant cardiac abnormalities*, defined by any 1 of the following:

  • Congestive heart failure
  • Clinically significant hypotension
  • Symptoms of coronary artery disease
  • Cardiac arrhythmias present on EKG requiring drug therapy NOTE: *Patients with a history of cardiovascular disease or any of the above abnormalities undergo a cardiac evaluation, including a cardiac stress test and/or echocardiogram

Pulmonary

• No clinically significant pulmonary dysfunction
• FEV1 at least 1.0 L OR
• FEV1 at least 60%
• DLCO at least 55% (corrected for hemoglobin)

Immunologic

• No acquired or hereditary immunodeficiency
• No autoimmune disease
• No active infection
• No oral temperature greater than 38.2 degrees C within the past 72 hours
• No systemic infection requiring chronic maintenance or suppressive therapy
• HIV negative

Other

• No retinitis or choroiditis
• No history of seizures
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 3 months after study

PRIOR CONCURRENT THERAPY:

Biologic therapy

• No other concurrent immunotherapy (e.g., interleukins, interferons, melanoma vaccines, IV immunoglobulin, or expanded polyclonal tumor-infiltrating lymphocytes or lymphokine-activated killer therapy)

Chemotherapy

• At least 4 weeks since prior chemotherapy (standard or experimental) and recovered

Endocrine therapy

• No concurrent systemic steroids except for toxicity management

Radiotherapy

• At least 4 weeks since prior radiotherapy

Surgery

• Not specified

Other

• At least 4 weeks since prior immunosuppressive therapy
• More than 4 weeks since prior experimental drugs and recovered
• No concurrent pentoxifylline
• No other concurrent investigational agents