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Exploratory Clinical Safety and Efficacy Study of Adoptive Transfer of Tumor Infiltration Lymphocytes in Patients with Refractory Malignant Ascites

Objective: To study the safety and clinical efficacy of intraperitoneal transfer of autologous tumor infiltrating lymphocytes (TIL) in the treatment of recurrent and refractory malignant ascites. Methods: A single-arm, open-label study, 9 patients with previously unsatisfied ascites treated had been enrolled to receive both intraperitoneal and intravenous or intraperitoneal alone transfer of TILs in Beijing Zhongguancun Hospital, Chinese Academy of Sciences from December 2019 to October 2021, and the complete record including efficacy and adverse reactions of the treatment were observed. Results: Of those nine patients, including 1 case of liver cancer, 1 case of esophageal cancer, 1 case of lung cancer and 1 case of ovarian cancer, 2 cases of rectal cancer and 3 cases of gastric cancer, all with multiple site metastases. Six patients (66.7%) were diagnosed with omental, mesenteric or peritoneal metastases by CT. Both pleural effusion and ascites were found in 8 cases (88.9%). The median maximum fluid depth of peritoneal effusion was 7.8 cm (3.9-12cm) and the median maximum fluid depth of pleural effusion was 6.2cm (0.1-12.8cm) measured by ultrasonography. All patients received other treatments before TILs transfer: intraperitoneal chemotherapy in 7 cases (77.8%), peritoneal drainage in 6 cases (66.7%), and systemic chemotherapy in 4 cases (44.4%). TIL transfer was performed 19 times, including 11 times of intraperitoneal and 8 times of intravenous transfer. One patient had fever (39.3°C) and chills during intravenous transfer, which was relieved after intravenous injection of dexamethasone. Median survival time of patients at post- adoptive transfer was 12.3 weeks (0.5-29.2 weeks), and one patient was still alive at 29.2 weeks. Conclusion: Most patients with malignant ascites have multiple metastases and pleural effusion. Combined with supportive treatment, multidisciplinary comprehensive treatment can still be carried out. After proper screening for patients, the success rate of preparing TILs from malignant ascites was high, and the completion rate of transfer was high. The adverse reactions of intraperitoneal and intravenous transfer were minimal. Further study of treatment efficacy is warranted.

Ascites, Peritoneal Metastasis, Tumor Infiltrating Lymphocytes, Adoptive Cell Transfer, Adverse Event

Tiecheng Wu, Ping Lin, Xiumei Rong, Zhenying Geng, Feifei Huo, et al. (2022). Exploratory Clinical Safety and Efficacy Study of Adoptive Transfer of Tumor Infiltration Lymphocytes in Patients with Refractory Malignant Ascites. International Journal of Chinese Medicine, 6(3), 40-45.

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