Stage IV Skin Melanoma Clinical Trial
Official title:
Multicenter Phase I/IIa Study Using T-cell Receptor Gene Therapy in Metastatic Melanoma
Patients with stage IV melanoma (also eye melanoma) will be treated with TCR transduced cells.
In this multicenter phase I/IIa trial 25 patients will be treated with non-myeloablative
chemotherapy followed by adoptive transfer of autologous TCR transduced T cells, to study the
feasibility, safety and efficacy of this treatment.
Patients will receive a non-myeloablative lymphocyte-depleting preparative regimen consisting
of cyclophosphamide (60 or 30 mg/kg/day x 2 days i.v.) and fludarabine (25 mg/m2/day i.v. x 5
days). Following this regimen, patients will receive one single intravenous adoptive transfer
of transduced T cells starting with the first dose level.
- Dose level 1: 5x10^7 transduced T cells, cyclophosphamide 60 mg/kg/day
- Dose level 1a: 1,0x10^8 transduced T cells, cyclophosphamide 30 mg/kg/day
- Dose level 2: 2,5x10^8 transduced T cells, cyclophosphamide 60 mg/kg/day
- Dose level 3: maximum 1x10^9 transduced T cells (depending on production yield). At time
points 4, 8, and 12 weeks and every 3 months thereafter patients will be evaluated for
response to treatment. After 3 patients have been treated in each dose level, but not
before 8 weeks after the last patient has been infused with transduced T cells, the DSMB
will be informed about the observed toxicity and efficacy within this cohort and decide,
based on this information, whether the trial will be continued to the next dose level or
will continue in the current dose level. The study will continue as the first stage
(2-stage Simon), until a total of 16 patients have been enrolled and treated: if less
than 2 responses are observed, the trial will be stopped and the conclusion will be that
TCR lacks efficacy. Otherwise, the trial will continue its second stage. In addition,
safety data after these first 16 patients will be evaluated by the DSMB. Any unexpected
or serious (grade 3/4 or higher) toxicities during the trial, will be reported
immediately to the DSMB and CCMO. Second stage: overall 25 patients will be enrolled
(including the first stage): if the total number of responses for the two stages
combined is less than 5, the trial will be stopped as soon as this is evident and the
conclusion will be that TCR lacks efficacy.
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