Tumor Cell Vaccines and ISCOMATRIX With Chemotherapy After Tumor Removal

• INCLUSION CRITERIA:

INCLUSION CRITERIA PRIOR TO SURGERY (SCREENING CONSENT):

1. Patients with clinically evident or histologically proven sarcomas, melanomas, germ cell tumors, or epithelial malignancies metastatic to the lungs, mediastinum, or pleura who can be rendered no evidence of active disease (NED) following standard surgical therapy. Note: Patients with active disease outside the thorax may be eligible for the study once the extrathoracic disease is definitively treated by local modalities such as radiation, surgery, or radiofrequency ablation.
2. Patients must have received or refused first line standard systemic therapy for their metastases.
3. Patients with no more than 3 intracranial metastases, which have been definitively treated by surgery or radiation therapy may be eligible for study provided there is no evidence of active disease for at least 2 months.
4. Patients must have an ECOG performance status of 0 2.
5. Patients must be 18 years of age or older due to the unknown effects of immunologic responses to germ cell-restricted gene products during childhood and adolescent development.
6. Seronegative for HIV antibody. Note: The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who are HIV seropositive can have decreased immune competence and thus may be less responsive to the experimental treatment.
7. Seronegative for active hepatitis B, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then patient must be tested for the presence of antigen by RT-PCR and be HCV RNA negative.
8. Patients must be aware of the neoplastic nature of their illnesses, the experimental nature of the therapy, alternative treatments, potential benefits, and risks.
9. Patients must be willing to sign an informed consent and undergo resection of their malignancies at the NCI, to ensure vaccine development.

INCLUSION CRITERIA FOR TREATMENT PHASE OF PROTOCOL (Standard Consent):

1. Patients must have signed the Screening Consent.
2. NCI Laboratory of Pathology confirmation of diagnosis of sarcomas, melanomas, germ cell tumors, or epithelial malignancies metastatic to the lungs, mediastinum, or pleura must have been obtained
3. Patients who were initially rendered NED by surgical resection must remain NED at the time of treatment.
4. Patients with no more than 3 intracranial metastases, which have been definitively treated by surgery or radiation therapy may be eligible for the study, provided there is no evidence of active disease for at least 2 months and no requirement for anticonvulsant therapy or steroids following treatment.
5. Patients must have an ECOG performance status of 0 2.

6. Patients must have evidence of adequate bone marrow reserve, hepatic and renal function as evidenced by the following laboratory parameters:

   Absolute neutrophil count greater than 1500/mm3

   Platelet count greater than 100,000/mm3

   Hemoglobin greater than 8g/dl ( patients may receive transfusions to meet this parameter

   PT within 2 seconds of the ULN

   Total bilirubin <1.5 x upper limits of normal

   Serum creatin ine less than or equal to 1.6 mg/ml or the creatinine clearance must be greater than 70 ml/min/1.73m2.

7. Seronegative for HIV antibody. Note: The experimental treatment being evaluated in this protocol depends on an intact immune system.

   Patients who are HIV seropositive can have decreased immune competence and thus may be less responsive to the experimental treatment.

8. Seronegative for active hepatitis B, and seronegative for hepatitis C antibody. If hepatitis C antibody test is positive, then patient must be tested for the presence of antigen by RT-PCR and be HCV RNA negative.
9. Patients must be willing to practice birth control during and for four months following treatment.
10. Patients must be willing to sign the standard informed consent.

EXCLUSION CRITERIA

1. Patients requiring corticosteroids (other than inhaled) will be excluded.
2. Patients with life expectancy less than 12 months will be excluded.
3. Patients receiving warfarin anticoagulation, who cannot be transferred to other agents such as enoxaparin or dabigatran, and for whom anticoagulants cannot be held for up to 24 hours will be excluded.
4. Patients with uncontrolled hypertension (>160/95), unstable coronary disease evidenced by uncontrolled arrhythmias, unstable angina,decompensated CHF (>NYHA Class II), or myocardial infarctionwithin 6 months of study will be excluded.
5. Patients with other cardiac diseases may be excluded at the discretion of the PI following consultation with Cardiology consultants.
6. Patients with any of the following pulmonary function abnormalities will be excluded: FEV, < 30% predicted; DLCO < 30% predicted (post-bronchodilator); pO2 < 60% or pCO2 (Bullet) 50 on room air arterial blood gas.
7. Pregnant and/or lactating women will be excluded due to the unknown, potentially harmful effects of immune response to CT-X antigens and stem cell proteins that may be expressed in placenta, fetus, and neonates.
8. Patients with active infections, including HIV, will be excluded, due to unknown effects of the vaccine on lymphoid precursors.