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Vaccination of Stage IV Cutaneous Melanoma Patients With Mature, Autologous Monocyte-Derived Dendritic Cells Transfected With RNAs Encoding for Mage-3, MelanA, and Survivin Antigens


Phase 1/Phase 2
18 Years
N/A
Open (Enrolling)
Both
Melanoma (Skin)

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Trial Information

Vaccination of Stage IV Cutaneous Melanoma Patients With Mature, Autologous Monocyte-Derived Dendritic Cells Transfected With RNAs Encoding for Mage-3, MelanA, and Survivin Antigens


OBJECTIVES:

Primary

- Determine the safety and tolerability of vaccination with autologous monocyte-derived
dendritic cells (DC) transfected with RNAs encoding Melan-A, MAGE-3, and survivin
antigens in patients with stage IV cutaneous melanoma.

- Determine whether tumor antigen-specific T-cell responses are induced in patients
treated with this vaccine.

- Determine whether simultaneous loading of DC with keyhole limpet hemocyanin (KLH)
significantly enhances induction of the Melan-A, MAGE-3, and survivin antigens in these
patients.

Secondary

- Determine clinical antitumor activity (e.g., objective tumor response, time to tumor
progression, progression-free interval, and overall survival) in patients treated with
this vaccine.

OUTLINE: This is an open-label, nonrandomized study.

- Phase I: Beginning 9-11 days before vaccination, patients undergo leukapheresis for
collection of peripheral blood mononuclear cells (PBMCs). PBMCs are processed for the
generation of dendritic cells (DC) to be used for vaccinations. PBMCs are transfected
with RNAs encoding for Melan-A, MAGE-3, and survivin antigens. DC are pulsed with
keyhole limpet hemocyanin (KLH) for some patients.

Patients receive antigen-pulsed (with or without KLH) DC vaccination subcutaneously (SC) on
days 1, 15, 43, and 71 in the absence of disease progression or unacceptable toxicity.
Patients with stable or responding disease may proceed to the phase II portion of the study.

- Phase II: Patients undergo leukapheresis as in phase I on days 102, 354, and 690.
Patients receive up to 6 additional booster vaccinations SC as in phase I on days 127,
185, 269, 356, 521, and 692.

Patients are followed for 10 years.

PROJECTED ACCRUAL: A total of 8-30 patients will be accrued for this study within 6-12
months.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed cutaneous* melanoma

- Stage IV

- Incurable by surgical resection

- Progressive disease after at least 1 standard chemotherapy or chemoimmunotherapy
regimen (e.g., dacarbazine or cisplatin monotherapy)

- Unidimensionally or bidimensionally measurable disease by physical examination (e.g.,
cutaneous metastases) and/or noninvasive radiological procedures

- No active CNS metastases by CT scan or MRI

- Previously treated (e.g., excision of a single metastasis) CNS metastases are
allowed provided there are no signs of active CNS metastases NOTE: *Metastatic
melanoma with unidentified primary tumor allowed provided an ocular melanoma can
be definitely excluded and origin from the skin is likely

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- Karnofsky 60-100%

Life expectancy

- At least 4 months

Hematopoietic

- WBC greater than 2,500/mm^3

- Neutrophil count greater than 1,000/mm^3

- Lymphocyte count greater than 700/mm^3

- Platelet count greater than 75,000/mm^3

- Hemoglobin greater than 9 g/dL

- No bleeding disorder

Hepatic

- Bilirubin less than 2.0 mg/dL

- No evidence of hepatitis B or C infection

Renal

- Creatinine less than 2.5 mg/dL

Cardiovascular

- No clinically significant heart disease

Pulmonary

- No respiratory disease

Immunologic

- HIV-1 and HIV-2 negative

- HTLV-1 negative

- No active systemic infection

- No immunodeficiency disease

- No active autoimmune disease (e.g., lupus erythematosus, autoimmune thyroiditis or
uveitis, multiple sclerosis, or inflammatory bowel disease)

- Vitiligo allowed

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for at least 4 weeks
after study participation

- Stable medical condition

- No other major serious illness

- No contraindication to leukapheresis

- No organic brain syndrome or significant psychiatric abnormality that would preclude
study participation or follow-up

- No other active malignant neoplasm

PRIOR CONCURRENT THERAPY:

Biologic therapy

- More than 4 weeks since prior immunotherapy

- No other concurrent immunotherapy during and for 2 weeks after study participation

Chemotherapy

- More than 4 weeks since prior systemic chemotherapy (6 weeks for nitrosoureas [e.g.,
fotemustine])

- No concurrent chemotherapy during and for 2 weeks after study participation

Endocrine therapy

- No concurrent corticosteroids during and for 2 weeks after study participation

Radiotherapy

- More than 2 weeks since prior radiotherapy

- No prior radiotherapy to the spleen

- Concurrent palliative radiotherapy to selected metastases (e.g., due to pain or local
complications such as compression) is allowed

Surgery

- Recovered from prior surgery

- No prior splenectomy

- No prior organ allografts

- Concurrent surgical therapy to selected metastases (e.g., due to pain or local
complications such as compression) is allowed

- Selected accessible metastases may be removed for tumor infiltrating lymphocyte
assay or other immunomonitoring investigations (e.g., expression of tumor
antigens and HLA molecules)

Other

- No other concurrent investigational drug or paramedical substance during and for 2
weeks after study participation

- No concurrent participation in another clinical trial

- Concurrent palliative medication allowed (e.g., acetaminophen, indomethacin, or
opiates)

Type of Study:

Interventional

Study Design:

Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Safety and tolerability at every visit

Safety Issue:

Yes

Principal Investigator

Gerold Schuler

Investigator Role:

Principal Investigator

Investigator Affiliation:

Dermatologische Klinik MIT Poliklinik-Universitaetsklinikum Erlangen

Authority:

Unspecified

Study ID:

CDR0000343699

NCT ID:

NCT00074230

Start Date:

July 2003

Completion Date:

Related Keywords:

  • Melanoma (Skin)
  • stage IV melanoma
  • recurrent melanoma
  • Melanoma
  • Skin Neoplasms

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