Patient case: 49-year-old male with melanoma; genetic feature: extensive tumor infiltrating lymphocytes

Clinical trial: Vaccine Therapy in Treating Patients With Stage III or Stage IV Melanoma

Summary: RATIONALE: Vaccines made from a person's white blood cells mixed with tumor proteins 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 III or stage IV melanoma.

Detailed description: OBJECTIVES:
  -  Compare the efficacy of vaccination with autologous dendritic cells pulsed with tumor and influenza antigen peptides treated with vs without ex vivo CD40-ligand, in terms of tumor-specific T-cell response, in patients with HLA-A1 and/or HLA-A2.1 positive stage III or IV melanoma.
  -  Determine the safety and tolerability of these vaccinations in these patients.
  -  Determine tumor response and recurrence rates in patients treated with these vaccinations.
  OUTLINE: This is an open-label non-randomized study.
  -  Phase I: Patients undergo leukapheresis for collection of peripheral blood mononuclear cells (PBMC). PBMC are cultured with sargramostim (GM-CSF) and interleukin-4 to generate dendritic cells (DCs) on day -9. DCs are pulsed separately with HLA-A1 and HLA-A2.1-restricted flu matrix peptides derived from melanoma-associated tumor antigens (MAGE-10.A2, Melan-A, MAGE-3, NY-ESO-1, gp100 antigen, and tyrosinase peptide). Half of the DCs are treated ex vivo with CD40-ligand. Patients receive the peptide-pulsed DC vaccinations subcutaneously (SC) on days 1, 14, 42, and 70 in the absence of disease progression.
  Patients who show tumor response (at least stable disease) at day 98 progress to phase II of the study.
  -  Phase II: Patients undergo leukapheresis as in phase I on days 102, 352, and 688. Patients receive up to 6 additional booster vaccinations SC as in phase I on days 126, 184, 268, 356, 520, and 692.
  Patients are followed for 10 years.
  PROJECTED ACCRUAL: A total of 8-30 patients will be accrued for this study within 6-12 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed stage III or IV cutaneous malignant melanoma
  -  HLA-A1 and/or HLA-A2 expression by serologic HLA typing
  -  HLA-A2.1 subtype must be confirmed by polymerase chain reaction on genomic DNA obtained from peripheral blood mononuclear cells
  -  No active CNS metastases by CT scan or MRI
  PATIENT CHARACTERISTICS:
  Age
  -  Over 18
  Performance status
  -  Karnofsky 60-100%
  Life expectancy
  -  At least 4 months
  Hematopoietic
  -  WBC greater than 2,500/mm^3
  -  Neutrophil count greater than 1,000/mm^3
  -  Lymphocyte count greater than 700/mm^3
  -  Platelet count greater than 75,000/mm^3
  -  Hemoglobin greater than 9 g/dL
  -  No bleeding disorders
  Hepatic
  -  Bilirubin less than 2.0 mg/dL
  -  Hepatitis B surface antigen negative
  -  Hepatitis C antibody negative
  Renal
  -  Creatinine less than 2.5 mg/dL
  Cardiovascular
  -  No clinically significant heart disease
  Pulmonary
  -  No clinically significant respiratory disease
  Immunologic
  -  No active systemic infection
  -  No immunodeficiency disease
  -  No evidence of HIV-1, HIV-2, or human T-cell lymphotropic virus-1
  -  No active autoimmune disease including (but not limited to):
  -  Lupus erythematosus
  -  Autoimmune thyroiditis or uveitis
  -  Multiple sclerosis
  -  Inflammatory bowel disease
  Other
  -  Stable medical condition
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception during and for at least 1 month after study participation
  -  No organic brain syndrome or psychiatric illness that would preclude study compliance
  -  No other concurrent active malignancy
  -  No other concurrent serious illness that would preclude study treatment
  -  No contraindication to leukapheresis
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  More than 4 weeks since prior immunotherapy
  -  No other concurrent immunotherapy
  Chemotherapy
  -  More than 4 weeks since prior systemic chemotherapy (6 weeks for nitrosoureas)
  -  No concurrent chemotherapy
  Endocrine therapy
  -  No concurrent corticosteroids
  Radiotherapy
  -  More than 4 weeks since prior radiotherapy
  -  No prior radiotherapy to the spleen
  -  Concurrent palliative radiotherapy allowed
  Surgery
  -  Recovered from prior surgery
  -  No prior splenectomy
  -  No prior organ allograft
  -  Concurrent surgery on selected metastases (e.g., because of pain or local complications such as compression) allowed
  Other
  -  No other concurrent investigational drugs
  -  No concurrent participation in another clinical trial

Relevance to patient case: not relevant