Nivolumab and Tumor Infiltrating Lymphocytes (TIL) in Advanced Non-Small Cell Lung Cancer

In this study, these special immune T-cells will be taken from a sample of the participant's
tumor tissue that will be surgically removed. Certain parts of these cells will be
multiplied, or grown, in the laboratory, using the drug interleukin-2 (IL-2) during part of
the process. They will then be given back to the participant by an infusion in their veins.
These cells are called tumor- infiltrating lymphocytes (TILs). The use of TILs involves a
combination of drugs, including the following:

- Fludarabine and cyclophosphamide - two types of chemotherapy drugs. These drugs will be
used for what is called lymphodepletion. The purpose of lymphodepletion in this study is
to temporarily reduce the number of normal lymphocytes circulating in the participant's
body before they are given the TILs that were grown in the lab. This is so that there
will be more "space" for the lymphocytes (TILs) that will be infused in their veins.

- Interleukin-2 (IL-2) - a drug used to help the body's response to treatment on the
immune system. A high dose regimen of IL-2 will be given after the participant receives
the infusion of the T-cells.

Inclusion Criteria:

- Age >18 years

- Able to understand and give written informed consent

- Confirmed or suspected diagnosis of stage IV or recurrent non-small cell lung cancer
(NSCLC). For suspected NSCLC, diagnosis must be histologically or cytologically
confirmed prior to start of nivolumab treatment. Neuroendocrine cancers, or mixed
neuroendocrine features in >10% of tumor cells, are excluded.

- Tumor deemed accessible by metastasectomy (TIL harvest) which expects to yield >1.5
cm^3 of resectable tumor amount.

- Measurable disease, even after resection of applicable lesion for TIL harvest. Defined
as ≥1 lesion that is ≥10 mm in one dimension by CT scan, MRI, or calipers on clinical
exam.

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

- Expected survival > 6 months

- Patients with activating Epidermal Growth Factor Receptor (EGFR) mutation or
Anaplastic Lymphoma Kinase (ALK) rearrangement which is expected to be responsive to
available tyrosine kinase inhibitor therapy, must have been previously treated with an
applicable tyrosine kinase inhibitor.

- Adequate normal organ and marrow function in an assessment performed within 7 days (+
3 day window) of enrollment, defined as: Hemoglobin ≥ 9.0 g/dL; Absolute neutrophil
count (ANC) ≥ 1.0 x 10^9/L (> 1000 per mm^3); Platelet count ≥ 100 x 10^9/L (>100,000
per mm^3); Prothrombin Time (PT) and Partial Thromboplastin Time (PTT) ≤ 1.5x the
institutional upper limit of normal (ULN), (This will not apply to patients with
confirmed Factor XII deficiency.); Serum bilirubin ≤ 1.5x the institutional ULN, or ≤
3x ULN if confirmed Gilbert's syndrome (persistent or recurrent hyperbilirubinemia
that is predominantly unconjugated in the absence of hemolysis or hepatic pathology);
Aspartate Aminotransferase (AST) (SGOT)/Alanine Aminotransferase (ALT) (SGPT) ≤ 2.5x
institutional ULN unless liver metastases are present, in which case it must be ≤ 5x
ULN; Serum creatinine of ≤ 1.5x institutional ULN; Albumin ≥ 2.5 g/dl.

- Positive screening Epstein Barr Virus (EBV) antibody titer on screening test.

- Cardiac stress test within past 6 months without evidence of reversible ischemia.

- Cardiac echocardiogram, stress test, or Multigated Acquisition Scan (MUGA) within past
6 months with demonstrated left ventricular ejection fraction (LVEF) > 50%

- Pulmonary function tests within past 6 months showing Diffusion Lung Capacity for
Carbon Monoxide (DLCO) >50% of predicted

Exclusion Criteria:

- More than 5 lines of prior systemic therapy in the preceding 3 years.

- Any previous treatment with a PD-1 or PD-L1 inhibitor, including but not limited to:
nivolumab, atezolizumab, pembrolizumab, or durvalumab.

- Current or prior use of any immunosuppressive medications, such as corticosteroids,
within 14 days before enrollment. a.) Oral hydrocortisone, only for the purposes of a
documented and confirmed adrenal insufficiency diagnosis, is permitted if ≤ 25 mg
daily total dose. b.) Inhaled, intranasal, or topical corticosteroids are permitted.

- Patients with untreated brain metastases. Treated brain metastases with radiation or
surgery are allowed if: ≤ 3 cm in size AND ≤ 4 in number AND there is no evidence of
progressive disease, on brain imaging ≥ 28 days after last day of central nervous
system (CNS) treatment.

- History of leptomeningeal metastases.

- Current or prior use of anticancer therapy before TIL collection: a.) Chemotherapy
within the past 4 weeks; b.) Tyrosine kinase inhibitor (TKI) within the past 1 week;
c.) Investigational therapy within the past 4 weeks or 4 half-lives, whichever is
shorter.

- Uncontrolled intercurrent illness including, but not limited to, symptomatic
congestive heart failure, unstable angina pectoris, cardiac arrhythmia (other than
stable atrial fibrillation).

- Known to be HIV positive, hepatitis B or C positive, or both Rapid Plasma Reagin (RPR)
and Fluorescent Treponemal Antibody (FTA positive). (Hepatitis B surface or core
antibody alone is not indicative of Hepatitis B Virus (HBV) infection).

- Patients with rapidly progressing tumors, as judged by the investigator.

- Mean QT interval corrected for heart rate (QTc) ≥470 ms calculated from
electrocardiograms (ECGs) using Bazett's Correction

- Known history of previous tuberculosis

- Receipt of live attenuated vaccination within 30 days prior to first anticipated dose
of nivolumab.

- History of allogeneic organ transplant

- History of primary immunodeficiency

- History of severe hypersensitivity to nivolumab, cyclophosphamide, fludarabine,
interleukin-2, or any excipient

- Any condition that, in the opinion of the investigator, would interfere with
evaluation of study treatment or interpretation of patient safety or study results

- Patients with active systemic infections requiring intravenous antibiotics within 1
week prior to enrollment.

- Any unresolved toxicity (>CTCAE v4 grade 2) from previous anti-cancer therapy.
Patients with irreversible toxicity that is not reasonably expected to be exacerbated
by the investigational product may be included (e.g., hearing loss, peripheral
neuropathy).

- History of pneumonitis or drug-related inflammatory lung disease

- Have a significant history of pulmonary disease that necessitates the use of
supplemental oxygen, and patients with resting pulse oximetry less than 92% on room
air.

- Active or prior documented autoimmune disease within the past 2 years. NOTE: Patients
with vitiligo, Grave's disease, limited site eczema, or limited site plaque psoriasis
not requiring systemic treatment (within the past 2 years), or other autoimmune
conditions which are not expected to recur, are allowed after approval from the
medical monitor or Principal Investigator (PI).

- Patients with other prior malignancies must have had a ≥ 2-year disease-free interval,
except for: in situ carcinoma of the cervix, in situ ductal carcinoma of the breast,
in situ prostate cancer, in situ bladder cancer. These must have been deemed stable
and not expected to relapse. In addition, early stage skin cancers, including basal,
squamous cell cutaneous carcinoma, and melanoma, are permitted if previously treated
with curative intent and not expected to relapse.

- Women who are pregnant or lactating.

- Women of childbearing potential and fertile men unwilling to use effective
contraception during study until 4 months after conclusion of the treatment period.