Wednesday, February 15, 2017

TIL with Vemurafenib in melanoma - Good showing in small Pilot trial

A Pilot Trial of the Combination of Vemurafenib with Adoptive Cell Therapy in Patients with Metastatic Melanoma.  Deniger, Kwonf, Pasetto, et al.  Clin Cancer Res. 2017 Jan 15.

This pilot feasibility clinical trial evaluated the coadministration of vemurafenib, a small-molecule antagonist of BRAFV600 mutations, and tumor-infiltrating lymphocytes (TIL) for the treatment of metastatic melanoma.

A metastatic tumor was resected for growth of TILs, and patients were treated with vemurafenib for 2 weeks, followed by resection of a second lesion. Patients then received a nonmyeloablative preconditioning regimen, infusion of autologous TILs, and high-dose interleukin-2 administration. Vemurafenib was restarted at the time of TIL infusion and was continued for 2 years or until disease progression. Clinical responses were evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0. Metastases resected prior to and after 2 weeks of vemurafenib were compared using TCRB deep sequencing, immunohistochemistry, proliferation, and recognition of autologous tumor.

The treatment was well tolerated and had a safety profile similar to that of TIL or vemurafenib alone. Seven of 11 patients (64%) experienced an objective clinical response, and 2 patients (18%) had a complete response for 3 years (one response is ongoing at 46 months). Proliferation and viability of infusion bag TILs and peripheral blood T cells were inhibited in vitro by research-grade vemurafenib (PLX4032) when approaching the maximum serum concentration of vemurafenib. TCRB repertoire (clonotypes numbers, clonality, and frequency) did not significantly change between pre- and post-vemurafenib lesions. Recognition of autologous tumor by T cells was similar between TILs grown from pre- and post-vemurafenib metastases.

Coadministration of vemurafenib and TILs was safe and feasible and generated objective clinical responses in this small pilot clinical trial.

Granted, this requires being BRAF positive...but may be a good option for those peeps. Questions I do have:  Are these folks EVER going to get to come off BRAF....even with their complete response?  One would think so...but this study comes to mind:   Stopping BRAF/MEKi after a complete response? Case study of 12 melanoma patients...     
There is also this:  How are these patients dealing with side effects if they are given only a BRAFi, rather than BRAF/MEK, since we have learned that, oddly enough, the combo causes not only less resistance, but fewer side effects as well?  Guess the ratties will teach us all.  - c

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