Medical Oncology Department, Catalan Institute of Oncology (ICO), L'hospitalet De Llobregat, Spain
Juan Martin-Liberal , Elena Garralda , Jesus Garcia Donas , Juan Jose Soto , Carles Codony , Silvia Martín-Lluesma , Susana Muñoz , Vladimir Galvao , M. Julia Lostes-Bardaji , Marta Rotxés , Sergio Querol , Luciano Rodriguez , Ainhoa Muñoz , Rafael Moreno , Xavier Garcia del Muro , Ramón Alemany , Alena Gros , Josep M. Piulats
Background: Tumors associated with SWI/SNF complex (SWI/SNFc) mutations, mainly SMARCA4 and SMARCB1 loss, are a heterogeneous group of malignancies with rhabdoid features that typically affect young patients (pts). These are aggressive malignancies with poor prognosis for which no standard treatment is available. Despite not having a high tumor mutation burden, tumor infiltrating lymphocytes (TILs) are usually present in high numbers. The biologic reasons for this feature are not clearly understood but might be associated to changes in gene expression due to aberrant chromatin remodeling. However, these TILs indicate that tumor antigens are recognized by lymphocytes unveiling a vulnerability that can be exploited by immunotherapy. The objective of the TILTS study is to develop a personalized adoptive cell therapy using TILs in pts affected by these tumors. Methods: Single arm, multi center, phase 2 study of TILs in pts with advanced tumors associated with SWI/SNFc mutations. Pts are treated at 3 centers in Spain: Catalan Institute of Oncology (ICO), Barcelona, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, and Centro Integral Oncológico Clara Campal (HM CIOCC), Madrid. Primary endpoint is overall response rate (ORR) by RECIST 1.1. Secondary endpoints include toxicity evaluation, duration of response (DOR), progression-free survival (PFS) or overall survival (OS). After informed consent is obtained, tumor resection is performed. Total volume of tumor resected should be at least 1.5 cc to assure TIL isolation. Eligible pts enter the treatment phase. TILs are produced under GMP conditions. During the TILs manufacturing process, pts are allowed to receive standard treatment if clinically indicated. Before TIL infusion, pts receive non-myeloablative preconditioning lymphodepletion with daily intravenous (IV) cyclophosphamide (60 mg/kg; IV x2 doses) and daily fludarabine (25 mg/m2; IV x5 doses). Infusion of autologous TILs is given on Day 0 followed by administration of IL-2 at 600,000 international units (IU)/kg every 8-12 hours for a maximum of 6 doses. After 4 weeks, a new tumor biopsy is optional. First image evaluation is performed after 8 weeks from TIL infusion. Pts without progression enter the follow-up phase. An ancillary translational study will explore mechanisms of immunogenicity, antigen recognition, TILs anti-tumor activity, and changes in the stool microbiome and specific TCR population during treatment. Also, tumor immune microenvironment will be analyzed. Clinical trial information: 2023-504632-17-00.
Eligible Tumor Types |
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Epithelioid sarcoma |
Malignant rhabdoid tumor |
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) |
Renal medullary carcinoma |
Epithelioid malignant peripheral nerve sheath tumor (EMPNST) |
Myoepithelial carcinoma |
Extra-skeletal myxoid chondrosarcoma |
Poorly differentiated chordoma |
Sinonasal basaloid carcinoma |
Other tumors associated with SWI/SNFc mutations |
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Abstract Disclosures
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