Minimally invasive liver resection to obtain tumor-infiltrating lymphocytes for adoptive cell therapy in patients with m
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Minimally invasive liver resection to obtain tumor-infiltrating lymphocytes for adoptive cell therapy in patients with metastatic melanoma Melissa M Alvarez-Downing, Suzanne M Inchauste, Mark E Dudley, Donald E White, John R Wunderlich, Steven A Rosenberg and Udai S Kammula*
Abstract Background: Adoptive cell therapy (ACT) with tumor-infiltrating lymphocytes (TIL) in patients with metastatic melanoma has been reported to have a 56% overall response rate with 20% complete responders. To increase the availability of this promising therapy in patients with advanced melanoma, a minimally invasive approach to procure tumor for TIL generation is warranted. Methods: A feasibility study was performed to determine the safety and efficacy of laparoscopic liver resection to generate TIL for ACT. Retrospective review of a prospectively maintained database identified 22 patients with advanced melanoma and visceral metastasis (AJCC Stage M1c) who underwent laparoscopic liver resection between 1 October 2005 and 31 July 2011. The indication for resection in all patients was to receive postoperative ACT with TIL. Results: Twenty patients (91%) underwent resection utilizing a closed laparoscopic technique, one required hand-assistance and another required conversion to open resection. Median intraoperative blood loss was 100 mL with most cases performed without a Pringle maneuver. Median hospital stay was 3 days. Three (14%) patients experienced a complication from resection with no mortality. TIL were generated from 18 of 22 (82%) patients. Twelve of 15 (80%) TIL tested were found to have in vitro tumor reactivity. Eleven patients (50%) received the intended ACT. Two patients were rendered no evidence of disease after surgical resection, with one undergoing delayed ACT with generated TIL after relapse. Objective tumor response was seen in 5 of 11 patients (45%) who received TIL, with one patient experiencing an ongoing complete response (32+ months). Conclusions: Laparoscopic liver resection can be performed with minimal morbidity and serve as an effective means to procure tumor to generate therapeutic TIL for ACT to patients with metastatic melanoma. Keywords: adoptive cell therapy, advanced melanoma, hepatobiliary, laparoscopy, tumor infiltrating lymphocytes
Background In 2010, the estimated incidence of melanoma was 68,130 with approximately 8,700 deaths [1]. The annual incidence of melanoma continues to increase [1,2]. Metastatic melanoma has a poor prognosis with a median survival of 6 to 8 months and a 5-year survival of approximately 6% [3,4]. Liver metastases are diagnosed in 10 to 20% of patients with metastatic melanoma and are associated * Correspondence: [email protected] Surgery Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Building 10 Hatfield CRC, Room 3-5930, Bethesda, MD 20892-1201, USA
with a poor prognosis and decreased mean survival of 4.4 months [5]. The Food and Drug Administration (FDA) has approved four system
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