Patient case: 69-year-old female with melanoma; genetic feature: high serum LDH levels

Clinical trial: A Comparison of Matured Dendritic Cells and Montanide® in Study Subjects With High Risk of Melanoma Recurrence

Summary: Vaccine adjuvants are compounds used to increase specific immune responses to antigens, but have minimal toxicity or lasting immune effects on their own. This study investigates the use of dendritic cells as an adjuvant for NY-ESO-1 and Melan-A/MART-1 peptides compared to Montanide® in study subjects with melanoma in complete clinical remission.

Detailed description: This is a Phase II open label, randomized two-arm study to evaluate the safety, tolerability, and immunogenicity of Poly-ICLC matured DCs as an adjuvant for NY-ESO-1 and Melan-A/MART-1 peptides (ARM A; DC Vaccine) compared to Montanide® ISA-51 VG (ARM B; Montanide Vaccine), both with systemic administration of Poly-ICLC on days 1 and 2 in study subjects with melanoma in complete clinical remission but at high-risk for disease recurrence.

Eligibility: Inclusion Criteria:
  -  Willing and able to give written informed consent
  -  Histologic diagnosis of malignant melanoma, stages IIB-IV in radiologically confirmed complete clinical remission without clinical evidence of disease
  -  At least 4 weeks since surgery prior to first dosing of study agent
  -  Required values for initial laboratory tests:
  -  Neutrophil count ≥ 1.0 x 10⁹/L
  -  Platelet count ≥ 80 x 10⁹/L
  -  Hemoglobin ≥ 10.0 g/dL
  -  Serum creatinine ≤ 2.0 x mg/dL
  -  AST/ALT ≤ 2.0 x upper limit of institutional normal
  -  Serum bilirubin ≤ 2.0 x upper limit of institutional normal
  -  No active or chronic infection with HIV, Hepatitis B, or Hepatitis C
  -  ECOG performance status of ≤ 2
  -  Life expectancy of ≥ 6 months
  -  Men and women, ≥ 18 years of age
  Exclusion Criteria:
  -  Serious illnesses, e.g., serious infections requiring antibiotics
  -  Previous bone marrow or stem cell transplant
  -  Study subjects with known chronic infection with HIV, hepatitis B or C. Testing will be performed if a study subject exhibits clinical signs of infection or to confirm a history of infection
  -  Study subjects with known autoimmune disease [e.g. SLE, RA] who have had significant symptoms within the past 3 years. Study subjects with vitiligo are not excluded
  -  Metastatic disease to the central nervous system
  -  Other malignancy within 3 years prior to entry into the study, except for treated early-stage melanoma or non-melanoma skin cancer, cervical carcinoma in situ, or incidental or localized prostate cancer treated with prostatectomy or radiation therapy
  -  Prior chemotherapy or tumor vaccine therapy
  -  Radiation therapy or major surgery within 4 weeks prior to first dose of study agent
  -  Concomitant treatment with systemic corticosteroids greater than physiologic doses. Topical (but not at the proposed vaccination sites) or inhalational steroids are permitted
  -  Participation in any other clinical trial involving another investigational agent within 4 weeks prior to first dose of study agent
  -  Pregnancy or lactation. Pregnancy test must be negative on all women of reproductive potential at baseline and they must agree to use birth control measures while on the study
  -  Study subjects previously treated with one of the peptides used in this trial, melanoma protein vaccine, melanoma whole cell vaccines, or with Montanide are not eligible
  -  Any underlying medical or psychiatric condition, which in the opinion of the investigator will make the administration of study agents hazardous or obscure the interpretation of AEs
  -  Lack of availability of study subject for immunological and clinical follow up assessments
  -  Children < 18 years of age
  -  Allergy to shellfish

Relevance to patient case: not relevant