vaccine therapy in treating patients with cancer of the gastrointestinal tract

Conditions: Colorectal Cancer; Esophageal Cancer; Extrahepatic Bile Duct Cancer; Gallbladder Cancer; Gastric Cancer; Pancreatic Cancer; Small Intestine Cancer

Summary: rationale: vaccines may make the body build an immune response to kill tumor cells. purpose: randomized phase ii trial to compare the effectiveness of two different vaccines in treating patients who have cancer of the gastrointestinal tract.

objectives: * determine whether immunization with carcinoembryonic antigen (cea) peptide 1-6d (cap 1-6d) emulsified in montanide isa-51 adjuvant or dissolved in sargramostim (gm-csf) can generate cap 1-6d-specific t cells in patients with cea-producing adenocarcinomas of gastrointestinal tract origin. * determine whether vaccination with cap 1-6d can generate cytotoxic t cells against cea-expressing tumors in these patients. * determine whether this vaccine can produce antitumor responses in these patients. * determine the frequency and severity of toxic effects associated with this vaccine in these patients. outline: this is a randomized study. patients are randomized to 1 of 2 treatment arms. * arm i: patients receive carcinoembryonic antigen peptide 1-6d (cap 1-6d) emulsified in montanide isa-51 adjuvant subcutaneously on day 1. * arm ii: patients receive cap 1-6d dissolved in sargramostim (gm-csf) intradermally on day 1. treatment repeats in both arms every 3 weeks for 6 courses in the absence of disease progression or unacceptable toxicity. patients are followed at 3 weeks and then as necessary. projected accrual: a total of 10-36 patients (5-18 per arm) will be accrued for this study within 36 months.

Eligibility criteria:
disease characteristics: * histologically confirmed stage ii, iii, or iv adenocarcinoma of the gastrointestinal tract originating in 1 of the following: * esophagus * stomach * pancreas * small intestine * colon or rectum * gall bladder * extrahepatic bile ducts * ampulla of vater * completed standard therapy and at risk of recurrent disease or has relatively stable metastatic disease and a life expectancy of at least 6 months * carcinoembryonic antigen (cea)-producing tumor as evidenced by detectable blood levels of cea or positive for cea on immunohistochemical staining * human leukocyte antigen (hla)-a2+ patient characteristics: age: * 18 and over performance status: * southwest oncology group (swog) 0-1 life expectancy: * see disease characteristics hematopoietic: * white blood count (wbc) at least 4,000/mm\^3 * platelet count at least 100,000/mm\^3 * hemoglobin at least 8 g/dl hepatic: * serum glutamic oxalacetic transaminase (sgot) or serum glutamic pyruvic transaminase (sgpt) no greater than 3 times upper limit of normal * hepatitis b and c negative renal: * creatinine no greater than 2.0 mg/dl other: * no other prior malignancy unless currently disease free and off all therapy for that malignancy * early skin cancer allowed * no aids * hiv negative * not pregnant or nursing * fertile patients must use effective contraception during and for 30 days after study participation prior concurrent therapy: biologic therapy: * at least 4 weeks since prior immunotherapy chemotherapy: * at least 4 weeks since prior chemotherapy endocrine therapy: * not specified radiotherapy: * at least 4 weeks since prior radiotherapy surgery: * at least 4 weeks since prior surgery other: * no other concurrent therapy for malignancy

Keywords: stage ii colon cancer stage iii colon cancer stage iv colon cancer stage ii gastric cancer stage iii gastric cancer stage iv gastric cancer recurrent gastric cancer stage ii pancreatic cancer stage iii pancreatic cancer recurrent pancreatic cancer stage ii rectal cancer stage iii rectal cancer stage iv rectal cancer recurrent colon cancer recurrent rectal cancer stage ii esophageal cancer stage iii esophageal cancer stage iv esophageal cancer recurrent esophageal cancer adenocarcinoma of the stomach small intestine adenocarcinoma localized gallbladder cancer unresectable gallbladder cancer recurrent gallbladder cancer localized extrahepatic bile duct cancer unresectable extrahepatic bile duct cancer recurrent extrahepatic bile duct cancer recurrent small intestine cancer adenocarcinoma of the esophagus adenocarcinoma of the colon adenocarcinoma of the rectum adenocarcinoma of the gallbladder adenocarcinoma of the extrahepatic bile duct adenocarcinoma of the pancreas stage iv pancreatic cancer