Adoptive immunotherapy with anti-CD3-expanded lymphocytes from lymph nodes draining
alloantigen gene-modified autologous
tumor vaccines is an effective treatment of poorly immunogenic murine
tumors. This phase I/II study was performed to determine the feasibility and toxicity of combining ex vivo gene transfer of autologous
tumor cells and adoptive immunotherapy with anti-CD3-expanded
tumor vaccine draining lymph node lymphocytes (TVDLN) in patients with metastatic
melanoma and
renal cell cancer (RCC). To facilitate the generation of
tumor-specific lymphocytes in the TVDLN, autologous
tumor cells were modified by gene transfer ex vivo to express the
alloantigen HLA-B7, a modification that has the potential to enhance the immunogenicity of the
tumor cells. After vaccination with gene-modified
tumor cells, patients' lymph nodes were harvested; TVDLN lymphocytes were activated and expanded ex vivo with anti-CD3 and
interleukin-2 (IL-2), and adoptively transferred to patients in combination with systemic
IL-2. Twenty patients, nine with
melanoma and 11 with RCC were treated.
Tumor was harvested successfully in all 20 patients. Ex vivo gene transfer was performed using lipofection with a
lipid:
DNA plasmid complex containing the genes for
HLA-B7 and beta2-microglobulin. The mean expression of
HLA-B7 by autologous
tumor cells after gene transfer was 4.53% (range 0.3%-12.1%). Lymph nodes were harvested from all 20 patients with a mean of 53 x 107 and 60 x 107 cells obtained from the gene-modified and unmodified
tumor vaccine sites, respectively. Successful expansion of adequate TVDLN was accomplished in 19 of 20 harvests of unmodified
vaccines and in 18 of 20 gene-modified
vaccines. No major toxicities were noted after vaccination with autologous
tumor cells or adoptive transfer of ex vivo activated TVDLN lymphocytes. Typical IL-2-related toxicities were observed in all patients. No objective
tumor regressions were observed. MHC class I restricted,
tumor-specific
cytokine secretion was observed in lymphocytes from TVDLN and the peripheral blood of vaccinated patients.