Study of Autologous Tumor Infiltrating Lymphocytes in Patients With Solid Tumors

Iovance Biotherapeutics

Status and phase: Enrolling; Phase 2

Conditions: Squamous Cell Carcinoma of the Head and Neck; Non-small Cell Lung Cancer; Metastatic Melanoma

Treatments: Drug: Nivolumab; Drug: Nab-Paclitaxel; Drug: Carboplatin; Drug: Pembrolizumab; Biological: LN-145-S1; Drug: Paclitaxel; Drug: Nivolumab-relatlimab; Biological: Lifileucel; Drug: Cisplatin; Drug: Pemetrexed; Biological: LN-145; Drug: Ipilimumab

Study type: Interventional

Funder types: Industry

Identifiers

NCT03645928

2024-510779-39-00 (EU Trial (CTIS) Number)

2018-001608-12 (EudraCT Number)

IOV-COM-202

Details and patient eligibility

About

A prospective, open-label, multi-cohort, non-randomized, multicenter Phase 2 study evaluating adoptive cell therapy (ACT) with TIL [LN-144/LN-145 (lifileucel)] in combination with immune checkpoint inhibitors or TIL [LN-144/LN-145 (lifileucel) and LN-145-S1] as a single agent therapy.

Full description

TIL [LN-144/LN-145 (lifileucel) and LN-145-S1] is an adoptive cell transfer therapy that utilizes an autologous TIL for the treatment of patients with unresectable or metastatic melanoma, advanced, recurrent, or metastatic squamous cell carcinoma of the head and neck, and locally advanced or metastatic non-small cell lung cancer. The adoptive cell transfer therapy used in this study involves patients receiving a nonmyeloablative (NMA) lymphodepletion regimen, followed by infusion of autologous TIL followed by the administration of aldesleukin. Patients in Cohorts 1A, 1D, 2A, 3A, 3C, 3D, and 3E will receive TIL plus immune checkpoint inhibitors. Patients in Cohorts 1B, 1C, and 3B will receive autologous TIL as a single therapy.

Enrollment: 245 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria

• Must have a confirmed diagnosis of malignancy of their receptive histologies: unresectable or metastatic melanoma Stage IIIC to IV (Cohorts 1A,1B and 1C), advanced, recurrent or metastatic HNSCC (Cohort 2A), or Stage III or Stage IV non-small cell lung cancer (Cohorts 3A, 3B, and 3C). Stage IV NSCLC with no actionable mutations (EGFR, ALK, ROS1) with effective targeted therapy (Cohorts 3D and 3E).
• Cohorts 1A, 1D, 2A, 3A, 3D and 3E: If previously treated, patients must have progressed on or after most recent therapy and must not have received ICIs as part of one of the counted lines of prior therapy. Patients must have radiologically documented disease progression while receiving or after the completion of the most recent prior treatment. Patients may have received up to 3 prior systemic anticancer therapies (except for Cohort 3A, where patients whose tumors harbor actionable mutations may have received up to 4 prior systemic therapies). Patients in Cohort 1D may have had no prior therapy for advanced disease. Patients in Cohorts 3D and 3E may have had no prior systemic therapy for Stage IV disease.
• Cohorts 1B, 1C, 3B, and 3C: Unresectable or metastatic melanoma patients in Cohorts 1B or 1C must have previously received systemic therapy with a PD-1 blocking antibody. NSCLC patients in Cohort 3B must have previously received systemic therapy with any ICI (except for those patients with known oncogene driver mutations that are sensitive to targeted therapies) as part of 1 - 3 prior lines of therapy. NSCLC patients in Cohort 3C must have previously received 1 line of ICI monotherapy. No other systemic therapy for metastatic disease is allowed. Prior chemoradiation and/or chemotherapy in the adjuvant and/or neoadjuvant settings are allowed.
• Must have at least 1 resectable lesion
• Must have remaining measurable disease as defined by RECIST 1.1 following tumor resection
• Must be ≥ 18 years at the time of consent for Cohorts 1A, 1C, 1D, 2A, 3A, 3B, 3C, 3D and 3E. Patients must be ≥ 12 years at the time of consent for Cohort 1B. Enrollment of patients > 70 years of age may be allowed after consultation with the Medical Monitor.
• Must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and an estimated life expectancy of ≥ 6 months.
• Patients of childbearing potential or those with partners of childbearing potential must be willing to practice an approved method of birth control during treatment and for 12 months after their last dose of aldesleukin, 4 months after their last dose of pembrolizumab, 5 months after their last dose of ipilimumab or nivolumab, or nivolumab-relatlimab; 6 months after the last dose of carboplatin; 14 months after the last dose of cisplatin; and 6 months after the last dose of pemetrexed, paclitaxel, or nab-paclitaxel, whichever occurs later.

Exclusion Criteria

• Patients with melanoma of uveal/ocular origin.
• Patients who have a history of allogeneic organ transplant or any form of cell therapy involving prior conditioning chemotherapy within the past 20 years. Patients being retreated with TIL, as part of this study are not excluded.
• Patients who have symptomatic, untreated brain metastases or history of leptomeningeal metastases.
• Patients who are on systemic steroid therapy > 10 mg/day of prednisone or other steroid equivalent. Patients receiving steroids as replacement therapy for adrenocortical insufficiency at ≤ 10 mg/day of prednisone or other steroid equivalent may be eligible.
• Patients who are pregnant or breastfeeding.
• Patients who have an active medical illness(es), which in the opinion of the Investigator, would pose increased risks for study participation
• Cohort 1A, 1D, 2A, 3A, 3C, 3D and 3E patients may not have a medical history of autoimmune disorders (including pneumonitis) requiring treatment or active management.
• Patients who have received a live or attenuated vaccination within 28 days prior to the start of treatment
• Patients who have any form of primary immunodeficiency
• Patients with a history of hypersensitivity to any component of the study drugs to be administered in the pertinent cohort(s).
• Patients who have a left ventricular ejection fraction (LVEF) < 45% or who are New York Heart Association Class II or higher. A cardiac stress test demonstrating any irreversible wall movement abnormality in any patients ≥60 years of age or in patients who have a history of ischemic heart disease, cardiac chest pain, or clinically significant atrial and/or ventricular arrhythmias.
• Patients with respiratory dysfunction or history of smoking are excluded if not meeting either of forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) > 0.7 or FEV1 > 50%.
• Patients who have had another primary malignancy within the previous 3 years
• Participation in another interventional clinical study within 21 days prior to the initiation of treatment.
• Patients in Cohorts 1D, 3D, or 3E who previously received adjuvant or neoadjuvant ICI(s) for non-metastatic disease and had an immune-related AE(s) requiring systemic steroid treatment or discontinuation of immune checkpoint inhibitor therapy.

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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245 participants in 10 patient groups

Cohort 1A

Experimental group

Description:

LN-144 therapy in combination with pembrolizumab in patients with Stage IIIC to IV unresectable or metastatic melanoma with ≤ 3 prior lines of systemic therapy, excluding immune checkpoint inhibitors (ICI).

Treatment:

Biological: Lifileucel

Drug: Pembrolizumab

Cohort 1B

Experimental group

Description:

LN-145-S1 therapy as a single agent in patients with Stage IIIC or Stage IV unresectable or metastatic melanoma, who have previously received systemic therapy with a PD-1 blocking antibody. If the tumor is proto-oncogene B-Raf (BRAF) V600 mutation positive, patients must have received a BRAF inhibitor with or without a mitogen-activated extracellular signal-related kinase (MEK) inhibitor.

Treatment:

Biological: LN-145-S1

Cohort 1C

Experimental group

Description:

LN-144 Generation 3 (Gen 3) therapy as a single agent in patients with Stage IIIC or Stage IV unresectable or metastatic melanoma, who have previously received systemic therapy with a PD-1 blocking antibody. If the tumor is BRAF V600 mutation positive, patients must have received BRAF inhibitor with or without a MEK inhibitor.

Treatment:

Biological: Lifileucel

Cohort 2A

Experimental group

Description:

LN-145 therapy in combination with pembrolizumab in patients with advanced, recurrent, or metastatic HNSCC, with ≤ 3 prior lines of systemic therapy, excluding ICIs.

Treatment:

Biological: LN-145

Drug: Pembrolizumab

Cohort 3A

Experimental group

Description:

LN-145 therapy in combination with pembrolizumab in patients with locally advanced or metastatic (Stage III or Stage IV) non-small-cell lung cancer (NSCLC) with ≤ 3 prior lines of systemic therapy, excluding ICIs, or ≤ 4 lines if 2 or more of the lines are TKI therapy for those with tumors that harbored actionable mutations (eg, EGFR, ALK, ROS).

Treatment:

Biological: LN-145

Drug: Pembrolizumab

Cohort 3B

Experimental group

Description:

LN-145 therapy as a single agent in patients with Stage III or Stage IV NSCLC, who have previously received 1-3 lines of prior systemic therapy. Patients with known oncogene drivers (eg, EGFR, ALK, ROS) who have mutations that are sensitive to targeted therapies are not required to have received prior systemic therapy with ICIs.

Treatment:

Biological: LN-145

Cohort 3C

Experimental group

Description:

LN-145 therapy in combination with ipilimumab and nivolumab in patients with Stage III or Stage IV NSCLC who have previously received 1 line of ICI monotherapy. No other systemic therapy for metastatic disease is allowed. Prior chemoradiation and/or chemotherapy in the adjuvant and/or neo-adjuvant settings are allowed.

Treatment:

Drug: Ipilimumab

Biological: LN-145

Drug: Nivolumab

Cohort 1D

Experimental group

Description:

The lifileucel regimen in combination with nivolumab-relatlimab in patients with Stage IIIC to IV unresectable or metastatic (advanced) melanoma who have had no prior therapy for advanced disease.

Treatment:

Biological: Lifileucel

Drug: Nivolumab-relatlimab

Cohort 3D

Experimental group

Description:

The lifileucel regimen in combination with pembrolizumab with or without pemetrexed, after tumor resection before 4 cycles of frontline platinum doublet chemotherapy plus pembrolizumab, in patients with Stage IV NSCLC without EGFR, ALK, or ROS1 driver mutations, who have had no prior therapy for advanced disease.

Treatment:

Drug: Pemetrexed

Drug: Cisplatin

Biological: Lifileucel

Drug: Carboplatin

Drug: Pembrolizumab

Drug: Nab-Paclitaxel

Drug: Paclitaxel

Cohort 3E

Experimental group

Description:

The lifileucel regimen in combination with pembrolizumab with or without pemetrexed, after tumor resection during 4 cycles of frontline platinum doublet chemotherapy plus pembrolizumab, in patients with Stage IV NSCLC without EGFR, ALK, or ROS1 driver mutations.

Treatment:

Drug: Pemetrexed

Drug: Cisplatin

Biological: Lifileucel

Drug: Carboplatin

Drug: Pembrolizumab

Drug: Nab-Paclitaxel

Drug: Paclitaxel