vaccine therapy in patients with stages iiib/iv non-small cell lung cancer who have finished first-line chemotherapy

Conditions: Lung Cancer

Summary: rationale: vaccines made from gene-modified tumor cells may help the body build an immune response to kill tumor cells. purpose: this randomized phase i/ii trial is studying the side effects of vaccine therapy and to see how well it works in treating patients with stage iiib or stage iv non-small cell lung cancer who have finished first-line chemotherapy.

outline: this is a multicenter study. * phase i (single site \[university of miami sylvester comprehensive cancer center\]): patients receive allogeneic b7.1 and human leukocyte antigen-a1 (hla-a1) transfected tumor cell vaccine intradermally (id) in weeks 1, 3, and 5. treatment repeats every 6 weeks for 2 courses. if no more than 1 of 6 patients experience a probable or definitively treatment related adverse effect (i.e., grade 2 autoimmune or grade 3-4 of any type), patients proceed to the phase ii portion of the study. if 2 or more (out of 6) patients experience treatment related adverse effects the study stops. * phase ii (randomized): patients are stratified according to study site (university of miami sylvester comprehensive cancer center or memorial regional hospital), type of prior first-line treatment (platinum and taxane vs platinum and gemcitabine), and presence of brain metastasis (yes vs no). patients are randomized to 1 of 2 treatment arms. * arm i: patients receive allogeneic b7.1 and hla-a1 transfected tumor cell vaccine id in weeks 1, 3, and 5. treatment repeats every 6 weeks for 2 courses. * arm ii: patients receive a placebo vaccine as in arm i. patients undergo blood sample collection periodically for correlative studies. samples are analyzed for cluster of differentiation 8 (cd8), cluster of differentiation 4 (cd4), and natural killer cell (nk) response and peripheral blood lymphocytes (pbl) and t helper cell 1 (th1)/t helper cell 2 (th2) bias, including levels of interleukin (il) il-1β, il-2, il-4, il-5, il-6, il-13, interferon-gamma (ifn-γ), tumor necrosis factor-alpha (tnf-α) via elisa. after completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 4 years, and then once a year thereafter. projected accrual: a total of 66 patients (6 patients for phase i and 60 patients for phase ii) will be accrued for this study.

Eligibility criteria:
inclusion criteria * patients with stage iiib (non-candidates for radiation) or stage iv pathologically confirmed non-small cell carcinoma of the lung that completed 4-6 cycles of platinum based first line chemotherapy and achieved complete response (cr), partial response (pr) or stable disease. * last administration of chemotherapy occurred no later than 4 weeks prior to the enrollment date. * eastern cooperative oncology group (ecog) performance status 0-2. * renal requirements: the calculated creatinine clearance must be at least 50 ml/min. * pulmonary function requirements: * all patients will undergo evaluation of pulmonary function prior to enrollment. * patients should have a forced expiratory volume in 1 second (fev1) more than 30% of the predicted value and/or diffusing capacity (dlco) more than 30% of the predicted value with a partial pressure of carbon dioxide (pco2) \< 45mm. * any patient enrolled in the protocol whose respiratory symptoms have experienced marked deterioration not related to a known cause (e.g. pneumonia, congestive heart failure (chf) or pulmonary embolism (pe)) will have request pulmonary function test (pft) evaluation and if the above parameters are seen will be excluded from the protocol. * age ≥ 18 years. * signed informed consent. * patients should have absolute neutrophil count (anc) ≥ 1000/mm3; platelets (plt) ≥ 80,000/mm3. exclusion criteria: * small cell carcinoma of the lung. * existing autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, sjogren's disease etc; colitis, inflammatory bowel disease or pancreatitis within 10 years of study. * other active malignancies present within the past three years, except for basal and/or squamous cell carcinoma(s) or in situ cervical cancer. * concomitant steroid or other immunosuppressive therapy. * active infection, or less than 7 days since therapy for acute infections. * pericardial effusion. * currently receiving chemotherapy for another condition (such as arthritis). * time elapsed greater than 4 weeks since last administration of first line chemotherapy for nsclc. * active or symptomatic cardiac disease such as congestive heart failure, angina pectoris or recent myocardial infarction. * pregnant or lactating women (negative test for pregnancy required of women of childbearing potential). * refusal in fertile men or women to use effective birth control measures during and for six months after the completion of treatment on study. * known hiv infection * untreated or uncontrolled brain metastasis. * liver enzymes greater than 3 times the institutional upper limit.

Keywords: stage iiib non-small cell lung cancer stage iv non-small cell lung cancer