Intratumoral Injection of Standard Universal Donor Expanded Natural Killer Cells and TGF-beta Imprinted Natural Killer Cells for the Treatment of Skin Squamous Cell Carcinoma and Basal Cell Carcinoma

PRIMARY OBJECTIVE:

I. To determine the persistence of NK cell infiltration within biopsy-proven keratinocyte carcinomas following intra-tumoral injection of universal donor NK cells versus (vs) TGFbeta-resistant NK cells in a cohort of patients prior to their standard of care excision.

SECONDARY OBJECTIVES:

I. To assess the tolerability of NK cell cutaneous intra-tumoral injection measured by adverse events, described using Common Terminology for Cancer Related Adverse Events (CTCAE version [v] 5).

II. To test the feasibility of a larger study using intra-tumorally injected NK cells.

EXPLORATORY/CORRELATIVE OBJECTIVES:

I. To assess clinical outcomes including size, area change, and visual appearance in clinical detection of keratinocyte carcinomas between injection and excision.

II. To compare NK and other immune cell presence within the tumor/tumor microenvironment (TME) in cutaneous basal cell carcinomas (BCCs) vs squamous cell carcinomas (SCCs) injected with NK vs TGFbetai cells prior to excision.

OUTLINE: Patients are randomized to 1 of 2 cohorts.

COHORT I: Patients undergo standard of care (SOC) biopsy on day 0 and within 4 weeks (days 10-28) receive UD expanded NK cells intratumorally. Patients undergo SOC excision 4-8 weeks (days 28-56) after biopsy.

COHORT II: Patients undergo SOC biopsy on day 0 and within 4 weeks (days 10-28) receive UD expanded TGF-beta-i NK cells intratumorally. Patients undergo SOC excision 4-8 weeks (days 28-56) after biopsy.

Inclusion criteria

• Ohio State University patients > 18 years old
• Diagnosis of ≥ 1cm keratinocyte carcinoma, accessible by intra-tumoral injection
• Confirmation of cutaneous SCC (cSCC) (10 patients total) or BCC (10 patients total) via diagnostic biopsy

• BCC: Nodular or aggressive subtype
• SCC: Well-differentiated or aggressive subtype with T1 or T2 staging by American Joint Committee on Cancer (AJCC) criteria
• Patient meets criteria for standard of care surgical treatment with either wide local excision or Moh's surgery
• Presence of residual clinical cancer ≥ 1cm at the time of baseline
• Willingness to follow up for residual cancer extirpation between 2-8 weeks after the injection

Exclusion criteria

• Planned or concurrent radiation or systemic treatment for solid tumor or hematologic malignancy including chemotherapies or immunotherapies received within 6 weeks of trial enrollment. These include but are not limited to methotrexate, 5-fluorouracil, vismodegib, cepilimumab, pembrolizumab, nivolumab, ipilimumab for any skin malignancy
• < 18 years old
• A negative deep and peripheral margin status from the diagnostic biopsy
• Diagnostic biopsy with the following histopathologic characteristics:

• BCC: Superficial subtype
• SCC: SCC in situ (SCCIS)/Bowen disease, basosquamous, keratoacanthoma (KA)-type SCC, or tumor with > T2 staging by AJCC criteria
• Any skin disease or active infection in the same area that may confound assessments
• Inability to follow-up for definitive treatment (surgical excision)
• Any other comorbidity or complication that in the opinion of the investigator could make the patient unsafe to participate in the study, such as:

• Active infection
• Pregnant women, women who are likely to become pregnant or are breastfeeding
• Patients who received any other investigational drugs within the 30 days prior to screening visit