The online version of this article (doi:10.1186/1477-7819-10-113) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MMA is the principle investigator who prepared and wrote the manuscript. SMI provided documentation of data, literature analysis and supported the work of the principle investigator in preparing the manuscript. MED performed documentation of data and provided revisions to the manuscript. DEW performed statistical analysis and documentation of data. JRW participated in documentation of data and provided revisions to the manuscript. SAR supported the work of the principle investigator by providing revisions to the manuscript. USK conceived the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
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.
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.
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).
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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- 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
Udai S Kammula
- BioMed Central
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