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Injection Of AJCC Stage IIB, IIC, III And IV Melanoma Patients With A Multi-Epitope Peptide Vaccine Using GM-CSF DNA As An Adjuvant: A Pilot Trial To Assess Safety And Immunity


Phase 0
N/A
N/A
Not Enrolling
Both
Melanoma

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Trial Information

Injection Of AJCC Stage IIB, IIC, III And IV Melanoma Patients With A Multi-Epitope Peptide Vaccine Using GM-CSF DNA As An Adjuvant: A Pilot Trial To Assess Safety And Immunity


This is a pilot trial to investigate the use of GM-CSF DNA as an adjuvant for peptide
vaccination in patients with metastatic melanoma. The objective of this study is to
determine the safety and adjuvant effect of vaccination with the gene coding for human
GM-CSF with a multi-epitope melanoma peptide vaccine (tyrosinase and gp100 peptides) in
patients with AJCC stage IIB, IIC, III and IV melanoma who are HLA-A2+. We will assess
whether use of GM-CSF DNA is safe and generates an immune response to peptides derived from
antigens on melanoma cells.

In the Dose Ranging part of the study, cohorts of 3 patients will be treated at increasing
dose levels of GM-CSF DNA delivered subcutaneously (100, 400, or 800 ug), followed by
administration of both peptides subcutaneously to the same site on day 5 or day 6. Patients
will be treated monthly for three immunizations. Pharmacokinetic studies will be performed
during the first cycle. Patients' peripheral blood mononuclear cells will be collected in
order to measure the T cell responses induced by the vaccines. Toxicity will be assessed
during this part of the study, although we do not expect to achieve a dose limiting toxicity
(DLT). The dose for the second part of the study will be the maximum tolerated dose.

The second part of the study will assess the immunological efficacy of the vaccine. Nine
patients will receive GM-CSF DNA delivered subcutaneously at one site, followed by
administration of both peptides to the same site on day 5 or day 6, every month for three
immunizations. A total of at least 18 patients is planned for both phases of the study.
Patients' peripheral blood mononuclear cells will be collected in order to measure the T
cell responses induced by the vaccines. Specifically, Elispot assays for CD8+ T cells
responses against the peptides will be assessed, and will be the primary method to determine
the generation of a specific immune response to the peptide antigens.


Inclusion Criteria:



- Patients must have documented malignant melanoma, American Joint Commission on Cancer
(AJCC) stage IIB, IIC, III or IV (54). Patients with resectable stage IIB, IIC and
III disease must have undergone surgical resection before participating in this
study.

- Patients with choroidal melanoma may participate if they fulfill one of the following
criteria: Basal diameter > or = 16 mm; Height > or = 8 mm or involvement of ciliary
body with tumor.

- For all patients, pathology slides must be reviewed by the Pathology Department of
Memorial Sloan-Kettering Cancer Center for confirmation of melanoma diagnosis.

- Patients must be HLA-A2 positive.

- Patients must weigh at least 25 kg to be eligible. Patients must be able to read the
consent form and give informed consent. Parent or legal guardians of patients who are
minors will sign the informed consent form.

- Patients must have a Karnofsky performance status of at least 80.

- LDH ≤ 2x upper limit of normal value; albumin ≥ 3.5 mg/dl. Creatinine ≤ 2mg/dl and
AST ≤ 2- fold upper limit of normal.

- A CBC prior to vaccination with WBC ≥ 3000, platelets ≥ 100,000.

- A negative serum bHCG within 2 weeks of vaccination in women of childbearing age.

- Patients must be free of detectable brain metastases. (Brain MRI or CT pre-protocol)

Exclusion Criteria:

- Patients may not be receiving or have received chemotherapy, immunotherapy or
radiation therapy within the previous 4 weeks or nitrosourea chemotherapy within the
previous 6 weeks. Patients must be fully recovered from any previous therapy or
surgery.

- Patients may not have been previously immunized with vaccines containing tyrosinase
or gp100, or peptides derived from tyrosinase or gp100.

- Creatinine > 2mg/dl (or history of Creatinine > 2 mg/dl) and AST ≥ 2 fold upper limit
of normal.

- Any medical condition or use of medication (e.g., active autoimmune disease,
immunodeficiency or corticosteroids) which might make it difficult for the patient to
complete the full course of treatments or to respond immunologically to vaccines is
grounds for exclusion, at the discretion of the Principal Investigator or
co-Principal Investigators. Patients may not have taken systemic corticosteroids
(orally or intravenously) within the previous 6 weeks. Inhaled or nasal steroids are
permitted.

- Patients who have preexisting retinal or choroidal eye disease (except as outlined in
section 5.1.1) will be excluded.

- Patients with serious underlying medical conditions, active infections requiring
antimicrobial drugs, or active bleeding will be ineligible.

- Pregnant women, women who are less than 3 months post-partum or women who are nursing
are not eligible. Women of childbearing age and sexually active men must be using
appropriate contraception during the course of this study and for 3 months following
completion.

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

To establish the safety and a recommended dose of subcutaneous human GM-CSF DNA given in conjunction with a multi-epitope peptide vaccine in patients with AJCC stage IIB, IIC, III and IV melanoma who are HLA-A2+.

Outcome Time Frame:

Up to 15 years post treatment,

Safety Issue:

Yes

Principal Investigator

Miguel-Angel Perales, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Memorial Sloan-Kettering Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

00-142

NCT ID:

NCT00580060

Start Date:

December 2003

Completion Date:

June 2011

Related Keywords:

  • Melanoma
  • AJCC
  • stage
  • IIB
  • IIC
  • III
  • IV
  • Melanoma
  • HLA-A2+
  • Vaccine
  • Melanoma

Name

Location

Memorial Sloan-Kettering Cancer CenterNew York, New York  10021