Thoracic metastasectomy for adoptive immunotherapy of melanoma

A single-institution experience

Jacob A. Klapper, Jeremy L. Davis, R. Taylor Ripley, Franz O. Smith, Dao Nguyen, King F. Kwong, Leandro Mercedes, Clinton D. Kemp, Aarti Mathur, Donald E. White, Mark E. Dudley, John R. Wunderlich, Steven A. Rosenberg, David S. Schrump

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives: Although refractory to chemotherapy, metastatic melanoma may respond to adoptive immunotherapy. As novel treatments evolve, surgeons may be asked to perform metastasectomy not only for palliation or potential cure but also for isolation of tumor-infiltrating lymphocytes. This study was undertaken to examine outcomes of patients with melanoma undergoing thoracic metastasectomy in preparation for investigational immunotherapy. Methods: A retrospective review identified 107 consecutive patients who underwent 116 thoracic metastasectomy procedures from April 1998 to July 2009. Indications for surgical intervention included procurement of tumor-infiltrating lymphocytes, rendering of patients to no evaluable disease status, palliation, and diagnosis. Response Evaluation Criteria in Solid Tumors criteria were used to assess tumor response. Results: Thoracotomy, lobectomy, and video-assisted thoracoscopic surgery with nonanatomic resection were the most common procedures. Major complications included 1 death and 1 coagulopathy-induced hemothorax. Seventeen patients were rendered to no evaluable disease status. Virtually all patients with residual disease had tumor specimens cultured for tumor-infiltrating lymphocytes; approximately 70% of tumor-infiltrating lymphocyte cultures exhibited antitumor reactivity. Of the 91 patients with residual or recurrent disease, 24 (26%) underwent adoptive cell transfer of tumor-infiltrating lymphocytes, of whom 7 exhibited objective responses (29% response rate and 8% based on intent to treat). Rapid disease progression precluded tumor-infiltrating lymphocyte therapy in most cases. Actuarial 1- and 5-year survival rates for patients rendered to no evaluable disease status or receiving or not receiving tumor-infiltrating lymphocytes were 93% and 76%, 64% and 33%, and 43% and 0%, respectively. Conclusions: Relatively few patients currently having thoracic metastasectomy undergo adoptive cell transfer. Continued refinement of tumor-infiltrating lymphocyte expansion protocols and improved patient selection might increase the number of patients with melanoma benefiting from these interventions.

Original languageEnglish
Pages (from-to)1276-1282
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number6
DOIs
StatePublished - Dec 1 2010
Externally publishedYes

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Metastasectomy
Adoptive Immunotherapy
Tumor-Infiltrating Lymphocytes
Melanoma
Thorax
Adoptive Transfer
Hemothorax
Video-Assisted Thoracic Surgery
Thoracotomy
Immunotherapy
Patient Selection
Disease Progression
Neoplasms
Survival Rate

Keywords

  • ACT
  • Adoptive cell transfer
  • IL-2
  • Interleukin 2
  • NED
  • NMA
  • No evaluable disease
  • Nonmyeloablation
  • TBI
  • TIL
  • Total-body irradiation
  • Tumor-infiltrating lymphocyte

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Thoracic metastasectomy for adoptive immunotherapy of melanoma : A single-institution experience. / Klapper, Jacob A.; Davis, Jeremy L.; Ripley, R. Taylor; Smith, Franz O.; Nguyen, Dao; Kwong, King F.; Mercedes, Leandro; Kemp, Clinton D.; Mathur, Aarti; White, Donald E.; Dudley, Mark E.; Wunderlich, John R.; Rosenberg, Steven A.; Schrump, David S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 140, No. 6, 01.12.2010, p. 1276-1282.

Research output: Contribution to journalArticle

Klapper, JA, Davis, JL, Ripley, RT, Smith, FO, Nguyen, D, Kwong, KF, Mercedes, L, Kemp, CD, Mathur, A, White, DE, Dudley, ME, Wunderlich, JR, Rosenberg, SA & Schrump, DS 2010, 'Thoracic metastasectomy for adoptive immunotherapy of melanoma: A single-institution experience', Journal of Thoracic and Cardiovascular Surgery, vol. 140, no. 6, pp. 1276-1282. https://doi.org/10.1016/j.jtcvs.2010.05.020
Klapper, Jacob A. ; Davis, Jeremy L. ; Ripley, R. Taylor ; Smith, Franz O. ; Nguyen, Dao ; Kwong, King F. ; Mercedes, Leandro ; Kemp, Clinton D. ; Mathur, Aarti ; White, Donald E. ; Dudley, Mark E. ; Wunderlich, John R. ; Rosenberg, Steven A. ; Schrump, David S. / Thoracic metastasectomy for adoptive immunotherapy of melanoma : A single-institution experience. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 140, No. 6. pp. 1276-1282.
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abstract = "Objectives: Although refractory to chemotherapy, metastatic melanoma may respond to adoptive immunotherapy. As novel treatments evolve, surgeons may be asked to perform metastasectomy not only for palliation or potential cure but also for isolation of tumor-infiltrating lymphocytes. This study was undertaken to examine outcomes of patients with melanoma undergoing thoracic metastasectomy in preparation for investigational immunotherapy. Methods: A retrospective review identified 107 consecutive patients who underwent 116 thoracic metastasectomy procedures from April 1998 to July 2009. Indications for surgical intervention included procurement of tumor-infiltrating lymphocytes, rendering of patients to no evaluable disease status, palliation, and diagnosis. Response Evaluation Criteria in Solid Tumors criteria were used to assess tumor response. Results: Thoracotomy, lobectomy, and video-assisted thoracoscopic surgery with nonanatomic resection were the most common procedures. Major complications included 1 death and 1 coagulopathy-induced hemothorax. Seventeen patients were rendered to no evaluable disease status. Virtually all patients with residual disease had tumor specimens cultured for tumor-infiltrating lymphocytes; approximately 70{\%} of tumor-infiltrating lymphocyte cultures exhibited antitumor reactivity. Of the 91 patients with residual or recurrent disease, 24 (26{\%}) underwent adoptive cell transfer of tumor-infiltrating lymphocytes, of whom 7 exhibited objective responses (29{\%} response rate and 8{\%} based on intent to treat). Rapid disease progression precluded tumor-infiltrating lymphocyte therapy in most cases. Actuarial 1- and 5-year survival rates for patients rendered to no evaluable disease status or receiving or not receiving tumor-infiltrating lymphocytes were 93{\%} and 76{\%}, 64{\%} and 33{\%}, and 43{\%} and 0{\%}, respectively. Conclusions: Relatively few patients currently having thoracic metastasectomy undergo adoptive cell transfer. Continued refinement of tumor-infiltrating lymphocyte expansion protocols and improved patient selection might increase the number of patients with melanoma benefiting from these interventions.",
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T1 - Thoracic metastasectomy for adoptive immunotherapy of melanoma

T2 - A single-institution experience

AU - Klapper, Jacob A.

AU - Davis, Jeremy L.

AU - Ripley, R. Taylor

AU - Smith, Franz O.

AU - Nguyen, Dao

AU - Kwong, King F.

AU - Mercedes, Leandro

AU - Kemp, Clinton D.

AU - Mathur, Aarti

AU - White, Donald E.

AU - Dudley, Mark E.

AU - Wunderlich, John R.

AU - Rosenberg, Steven A.

AU - Schrump, David S.

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N2 - Objectives: Although refractory to chemotherapy, metastatic melanoma may respond to adoptive immunotherapy. As novel treatments evolve, surgeons may be asked to perform metastasectomy not only for palliation or potential cure but also for isolation of tumor-infiltrating lymphocytes. This study was undertaken to examine outcomes of patients with melanoma undergoing thoracic metastasectomy in preparation for investigational immunotherapy. Methods: A retrospective review identified 107 consecutive patients who underwent 116 thoracic metastasectomy procedures from April 1998 to July 2009. Indications for surgical intervention included procurement of tumor-infiltrating lymphocytes, rendering of patients to no evaluable disease status, palliation, and diagnosis. Response Evaluation Criteria in Solid Tumors criteria were used to assess tumor response. Results: Thoracotomy, lobectomy, and video-assisted thoracoscopic surgery with nonanatomic resection were the most common procedures. Major complications included 1 death and 1 coagulopathy-induced hemothorax. Seventeen patients were rendered to no evaluable disease status. Virtually all patients with residual disease had tumor specimens cultured for tumor-infiltrating lymphocytes; approximately 70% of tumor-infiltrating lymphocyte cultures exhibited antitumor reactivity. Of the 91 patients with residual or recurrent disease, 24 (26%) underwent adoptive cell transfer of tumor-infiltrating lymphocytes, of whom 7 exhibited objective responses (29% response rate and 8% based on intent to treat). Rapid disease progression precluded tumor-infiltrating lymphocyte therapy in most cases. Actuarial 1- and 5-year survival rates for patients rendered to no evaluable disease status or receiving or not receiving tumor-infiltrating lymphocytes were 93% and 76%, 64% and 33%, and 43% and 0%, respectively. Conclusions: Relatively few patients currently having thoracic metastasectomy undergo adoptive cell transfer. Continued refinement of tumor-infiltrating lymphocyte expansion protocols and improved patient selection might increase the number of patients with melanoma benefiting from these interventions.

AB - Objectives: Although refractory to chemotherapy, metastatic melanoma may respond to adoptive immunotherapy. As novel treatments evolve, surgeons may be asked to perform metastasectomy not only for palliation or potential cure but also for isolation of tumor-infiltrating lymphocytes. This study was undertaken to examine outcomes of patients with melanoma undergoing thoracic metastasectomy in preparation for investigational immunotherapy. Methods: A retrospective review identified 107 consecutive patients who underwent 116 thoracic metastasectomy procedures from April 1998 to July 2009. Indications for surgical intervention included procurement of tumor-infiltrating lymphocytes, rendering of patients to no evaluable disease status, palliation, and diagnosis. Response Evaluation Criteria in Solid Tumors criteria were used to assess tumor response. Results: Thoracotomy, lobectomy, and video-assisted thoracoscopic surgery with nonanatomic resection were the most common procedures. Major complications included 1 death and 1 coagulopathy-induced hemothorax. Seventeen patients were rendered to no evaluable disease status. Virtually all patients with residual disease had tumor specimens cultured for tumor-infiltrating lymphocytes; approximately 70% of tumor-infiltrating lymphocyte cultures exhibited antitumor reactivity. Of the 91 patients with residual or recurrent disease, 24 (26%) underwent adoptive cell transfer of tumor-infiltrating lymphocytes, of whom 7 exhibited objective responses (29% response rate and 8% based on intent to treat). Rapid disease progression precluded tumor-infiltrating lymphocyte therapy in most cases. Actuarial 1- and 5-year survival rates for patients rendered to no evaluable disease status or receiving or not receiving tumor-infiltrating lymphocytes were 93% and 76%, 64% and 33%, and 43% and 0%, respectively. Conclusions: Relatively few patients currently having thoracic metastasectomy undergo adoptive cell transfer. Continued refinement of tumor-infiltrating lymphocyte expansion protocols and improved patient selection might increase the number of patients with melanoma benefiting from these interventions.

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KW - Interleukin 2

KW - NED

KW - NMA

KW - No evaluable disease

KW - Nonmyeloablation

KW - TBI

KW - TIL

KW - Total-body irradiation

KW - Tumor-infiltrating lymphocyte

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