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. 2012 Jun 22:10:113.
doi: 10.1186/1477-7819-10-113.

Minimally invasive liver resection to obtain tumor-infiltrating lymphocytes for adoptive cell therapy in patients with metastatic melanoma

Melissa M Alvarez-Downing  1 , Suzanne M Inchauste, Mark E Dudley, Donald E White, John R Wunderlich, Steven A Rosenberg, Udai S Kammula
Affiliations

Minimally invasive liver resection to obtain tumor-infiltrating lymphocytes for adoptive cell therapy in patients with metastatic melanoma

Melissa M Alvarez-Downing et al. World J Surg Oncol. .

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.

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Figures

Figure 1
Figure 1
Position of ports for laparoscopic liver resection. The 30 degree laparoscope was inserted via a 12-mm periumbilical incision (1). A subxiphoid 5-mm port was used for liver retraction (2). Two working ports, one 5-mm and one 12-mm port, were placed along the right mid-abdomen (3, 4).
Figure 2
Figure 2
Flow diagram of patients undergoing laparoscopic liver metastasectomy for tumor-infiltrating lymphocyte therapy. Fifty percent of patients received the intended tumor-infiltrating lymphocyte (TIL) therapy. *Of the three patients without reactive TIL, one patient was rendered no evidence of disease and did not require treatment, the remaining two patients received other therapies.
Figure 3
Figure 3
Overall survival of patients (n = 11) undergoing laparoscopic liver resection who received postoperative tumor-infiltrating lymphocytes. Median survival was 21.7 months.
See this image and copyright information in PMC

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