Gene-Modified T Cells, Vaccine Therapy, and Nivolumab in Treating Patients With Stage IV or Locally Advanced Solid Tumors Expressing NY-ESO-1

PRIMARY OBJECTIVES:

I. To determine the safety of the addition of the PD-1 blocking monoclonal antibody,
nivolumab, to NY-ESO TCR-transduced autologous peripheral blood lymphocyte (PBL) adoptive
cell transfer (ACT) in a dose escalation scheme in two study cohorts at 1 mg/kg and 3 mg/kg
of nivolumab intravenous (i.v.) every two weeks for up to 2 years.

SECONDARY OBJECTIVES:

I. To determine the feasibility of delivering the TCR transgenic cell dose and PD-1 blockade
to patients.

II. To determine the persistence of NY-ESO-1 TCR-engineered peripheral blood mononuclear cell
(PBMC) in serial peripheral blood samples and in biopsies of accessible metastatic lesions.

EXPLORATORY OBJECTIVES:

I. To determine whether blocking PD-1 will maintain the antitumor functionality of adoptively
transferred TCR transgenic lymphocytes.

II. To explore the use of positron emission tomography (PET)-based imaging using the PET
tracer (18F) fluorodeoxy-glucose ([18F]FDG) with the goal of determining if the adoptively
transferred NY-ESO-1 TCR-engineered PBMC when administered with nivolumab home and expand in
secondary lymphoid organs and tumor deposits.

III. Clinical antitumor activity recording objective response rate.

OUTLINE: This is a dose-escalation study of nivolumab.

CONDITIONING REGIMEN: Patients receive cyclophosphamide intravenously (IV) over 1 hour on
days -5 to -4 and fludarabine phosphate IV over 15-30 minutes on days -4 to -1.

NY-ESO-1 TCR PBMC INFUSION: Patients receive NY-ESO-1 TCR PBMC IV on day 0.

NIVOLUMAB: Patients receive nivolumab IV over 60 minutes on day 0 or 1. Treatment repeats
every 2 weeks for up to 2 years in the absence of disease progression or unacceptable
toxicity.

NY-ESO-1(157-165) PEPTIDE PULSED DENDRITIC CELL (DC): Patients receive NY-ESO-1(157-165)
peptide pulsed DC intradermally (ID) on days 1, 14, and 28.

LOW DOSE ALDESLEUKIN ADMINISTRATION: Patients receive aldesleukin subcutaneously (SC) twice
daily (BID) for 7 days beginning on day 1 for a maximum of 14 doses.

After completion of study treatment, patients are followed up at least every 6 months for 3
years and then at least every 12 months for up to 15 years.

Inclusion Criteria:

- Stage IV or locally advanced histologically confirmed solid tumors for which no
alternative therapies with proven survival advantage are available

- At least 1 lesion amenable for outpatient biopsies; this should be a cutaneous or
palpable metastatic site or a deeper site accessible by image-guided biopsy that is
deemed safe to access by the treating physicians and interventional radiologists;
patients without accessible lesions for biopsy but with prior tissue available from
metastatic disease would be eligible at the investigator's discretion

- NY-ESO-1 positive malignancy by immunohistochemistry (IHC) utilizing commonly
available NY-ESO-1 antibodies

- Human leukocyte antigen (HLA)-A*0201 (HLA-A2.1) positivity by molecular subtyping

- Age greater than or equal to 16 years old

- A minimum of one measurable lesion defined as:

- Meeting the criteria for measurable disease according to Response Evaluation
Criteria In Solid Tumors (RECIST)

- Skin lesion(s) selected as non-completely biopsied target lesion(s) that can be
accurately measured and recorded by color photography with a ruler to document
the size of the target lesion(s)

- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1

- Absolute neutrophil count >= 1.5 x 10^9 cells/L

- Platelets >= 100 x 10^9/L

- Hemoglobin >= 9 g/dL

- Aspartate and alanine aminotransferases (AST, ALT) =< 2.5 x upper limit of normal
(ULN) (=< 5 x ULN, if documented liver metastases are present)

- Total bilirubin =< 2 x ULN (except patients with documented Gilbert's syndrome)

- Creatinine < 2 mg/dl (or a glomerular filtration rate > 60)

- Must be willing and able to accept two leukapheresis procedures

- Must be willing and able to provide written informed consent

Exclusion Criteria:

- Previously known hypersensitivity to any of the agents used in this study

- Received systemic treatment for cancer, including immunotherapy, within one month
prior to initiation of dosing within this protocol

- History of, or significant evidence of risk for, chronic inflammatory or autoimmune
disease (eg, Addison's disease, multiple sclerosis, Graves disease, Hashimoto's
thyroiditis, inflammatory bowel disease, psoriasis, rheumatoid arthritis, systemic
lupus erythematosus, hypophysitis, pituitary disorders, etc.); patients will be
eligible if prior autoimmune disease is not deemed to be active (e.x. fibrotic damage
of the thyroid after thyroiditis or its treatment, with stable thyroid hormone
replacement therapy); vitiligo will not be a basis for exclusion

- History of inflammatory bowel disease, celiac disease, or other chronic
gastrointestinal conditions associated with diarrhea or bleeding, or current acute
colitis of any origin

- Potential requirement for systemic corticosteroids or concurrent immunosuppressive
drugs based on prior history or received systemic steroids within the last 2 weeks
prior to enrollment (inhaled or topical steroids at standard doses are allowed)

- Human immunodeficiency virus (HIV) seropositivity or other congenital or acquired
immune deficiency state; if there is a positive result in the infectious disease
testing that was not previously known, the patient will be referred to their primary
physician and/or infectious disease specialist

- Hepatitis B or C seropositivity with evidence of ongoing liver damage; if there is a
positive result in the infectious disease testing that was not previously known, the
patient will be referred to their primary physician and/or infectious disease
specialist

- Dementia or significantly altered mental status that would prohibit the understanding
or rendering of informed consent and compliance with the requirements of this protocol

- Known clinically active brain metastases; prior evidence of brain metastasis
successfully treated with surgery or radiation therapy will not be exclusion for
participation as long as they are deemed under control at the time of study enrollment
and there are no neurological signs of potential brain metastases

- Pregnancy or breast-feeding; female patients must be surgically sterile or be
postmenopausal for two years, or must agree to use effective contraception during the
period of treatment and 6 months after; all female patients with reproductive
potential must have a negative pregnancy test (serum/urine) within 24 hours from
starting the conditioning chemotherapy; the definition of effective contraception will
be based on the judgment of the study investigators; patients who are breastfeeding
are not allowed on study

- Since IL-2 is administered following cell infusion:

- Patients will be excluded if they have a history of clinically significant
electrocardiogram (ECG) abnormalities, symptoms of cardiac ischemia or
arrhythmias and have a left ventricular ejection fraction (LVEF) < 45% on a
cardiac stress test (stress thallium, stress multi gated acquisition scan [MUGA],
dobutamine echocardiogram, or other stress test)

- Similarly, patients who are >= 50 years old with a baseline LVEF < 45% will be
excluded

- Patients with ECG results of any conduction delays (PR interval > 200 ms,
corrected QT interval [QTC] > 480 ms), sinus bradycardia (resting heart rate < 50
beats per minute), sinus tachycardia (heart rate > 120 beats per minute) will be
evaluated by a cardiologist prior to starting the trial; patients with any
arrhythmias, including atrial fibrillation/atrial flutter, excessive ectopy
(defined as > 20 premature ventricular contractions [PVCs] per minute),
ventricular tachycardia, third (3rd) degree heart block will be excluded from the
study unless cleared by a cardiologist

- Patients with pulmonary function test abnormalities as evidenced by a forced
expiration volume in one second (FEV1)/forced vital capacity (FVC) < 70% of
predicted for normality will be excluded

- Evidence of diverticulitis at baseline, including evidence limited to computed
tomography (CT) scan only

- Received 3 or more prior myelotoxic treatment regimens

- Bone marrow involvement based on CT or PET scan at screening