Vaccine Therapy in Treating Patients With Stage IV or Recurrent Melanoma

Vaccine Biotherapy of Cancer: Tumor Cells and Dendritic Cells as Active Specific Immunotherapy of Patients With Metastatic Melanoma

RATIONALE: Vaccines made from a person's cancer cells may make the body build an immune response to kill tumor cells.

PURPOSE: Phase I/II trial to study the effectiveness of vaccine therapy in treating patients who have stage IV or recurrent melanoma.

Study Overview

• Status: Completed
• Conditions: Melanoma (Skin)
• Intervention / Treatment: Biological: therapeutic autologous dendritic cells

Detailed Description

OBJECTIVES:

• Determine the safety of immunization with autologous in vitro-treated tumor cells and dendritic cells in combination with sargramostim (GM-CSF) in patients with stage IV or recurrent melanoma.
• Determine the frequency of conversion of delayed tumor hypersensitivity tests in patients treated with this regimen.
• Determine the progression-free and overall survival in patients treated with this regimen.
• Determine the objective tumor response rate in patients with measurable melanoma treated with this regimen.

OUTLINE: Patients are stratified according to presence of measurable disease at study initiation (yes vs no).

Patients undergo tumor cell harvest. Patients with multiple persistent sites of metastatic disease after harvest may receive systemic therapy (biologic therapy and/or chemotherapy) during tumor cell line expansion over approximately 4 months. The tumor cell line is expanded, irradiated, and treated with interferon gamma.

Patients undergo leukapheresis to collect peripheral blood mononuclear cells (PBMC) to obtain dendritic cells (DC). The PBMC are treated with sargramostim (GM-CSF) and interleukin-4 for 7 days to produce DC. The DC are then cultured with the treated tumor cells for 18 hours.

Patients undergo delayed tumor hypersensitivity tests intradermally 1 week prior to vaccination and again at week 4. Patients receive vaccine therapy comprising autologous treated tumor cells and dendritic cells suspended in GM-CSF subcutaneously weekly for 3 weeks. Vaccine therapy continues monthly for an additional 5 months in the absence of disease progression or unacceptable toxicity.

Patients are followed every 2 months for 1 year and then every 3 months for 4 years.

PROJECTED ACCRUAL: A total of 30-80 patients will be accrued for this study.

• Study Type: Interventional
• Enrollment (Actual): 56
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • Newport Beach, California, United States, 92663
      • Hoag Cancer Center at Hoag Memorial Hospital Presbyterian

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Histologically confirmed stage IV or recurrent melanoma

  • Metastatic disease confirmed by MRI or CT scan
• Planned resection of tumor

• No active CNS metastases

  • Radiographically confirmed lack of CNS disease progression
  • No requirement for pharmacologic doses of corticosteroids

PATIENT CHARACTERISTICS:

Age:

• Over 16

Performance status:

• ECOG 0-2

Life expectancy:

• At least 4 months

Hematopoietic:

• Hematocrit greater than 25%
• Platelet count greater than 100,000/mm^3
• No ongoing transfusion requirements
• No active blood clotting or bleeding diathesis

Hepatic:

• Bilirubin no greater than 2.0 mg/dL
• Albumin at least 3.0 g/dL

Renal:

• Creatinine no greater than 2.0 mg/dL

Cardiovascular:

• No underlying cardiac disease associated with known myocardial dysfunction
• No unstable angina related to atherosclerotic cardiovascular disease

Other:

• No other malignancy within the past 5 years except for carcinoma in situ, basal cell carcinoma, or localized squamous cell skin cancer
• No active, eminently life-threatening infection or medical condition
• Adequate venous access
• Not pregnant
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Other prior putative vaccines allowed
• Recovered from prior biologic therapy
• No other concurrent biologic therapy except epoetin alfa for patients with hematocrit less than 36%

Chemotherapy:

• At least 3 weeks since prior chemotherapy and recovered
• No concurrent chemotherapy

Endocrine therapy:

• See Disease Characteristics
• No concurrent endocrine therapy

Radiotherapy:

• At least 3 weeks since prior radiotherapy (including whole brain radiotherapy) and recovered
• No concurrent radiotherapy

Surgery:

• See Disease Characteristics
• Recovered from prior surgery

Other:

• Concurrent bisphosphonates allowed for patients with lytic bone metastases
• No concurrent digoxin or other medications designed to improve cardiac output
• No other concurrent investigational therapy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Biological/Vaccine; Biological/Vaccine: therapeutic autologous dendritic cells. Apheresis procedure collects peripheral blood mononuclear cells (PBMC) for the production of dendritic cell, which are admixed with irradiated tumor cells from autologous tumor cell line for vaccine product.	Biological: therapeutic autologous dendritic cells; Apheresis procedure collects peripheral blood mononuclear cells (PBMC) for the production of dendritic cell, which are admixed with irradiated tumor cells from autologous tumor cell line for vaccine product.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To determine the safety of administration of irradiated autologous tumor cells that have been incubated in vitro with gamma interferon, and subsequently injected subcutaneously with autologous dendritic cells and GMCSF	treatment
To determine the frequency of conversion of delayed tumor hypersensitivity (DTH) tests with irradiated autologous tumor cells, in patients who received an autologous dendritic cell/tumor cell vaccine with GMCSF	treatment

Secondary Outcome Measures

Outcome Measure	Time Frame
To determine the objective tumor response rate in patients with metastatic melanoma who still had measurable disease at the time vaccine treatment was given	follow-up

Collaborators and Investigators

• Sponsor: Lisata Therapeutics, Inc.
• Investigators: Study Chair: Robert O. Dillman, MD, FACP, Hoag Memorial Hospital Presbyterian

Publications and helpful links

General Publications

• Dillman RO, Schiltz PM, Selvan R, et al.: Patient-specific cancer vaccine of cultured autologous tumor cells and autologous dendritic cells. [Abstract] J Immunother 24 (5): S5, 2001.

Study record dates

Study Major Dates

• Study Start: July 1, 2000
• Primary Completion (Actual): April 1, 2011
• Study Completion (Actual): April 1, 2011

Study Registration Dates

• First Submitted: March 3, 2001
• First Submitted That Met QC Criteria: January 26, 2003
• First Posted (Estimate): January 27, 2003

Study Record Updates

• Last Update Posted (Estimate): January 29, 2014
• Last Update Submitted That Met QC Criteria: January 27, 2014
• Last Verified: August 1, 2013

More Information

Terms related to this study

• Keywords: recurrent melanoma; stage IV melanoma
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Neuroendocrine Tumors; Nevi and Melanomas; Melanoma
• Other Study ID Numbers: CDR0000068481; HOAG-VACCINE-MEL; NCI-V01-1646