Patient case: 45-year-old female with cervical cancer; genetic feature: ERBB2 (S310Y)

Clinical trial: Biological Therapy in Treating Patients With Advanced Cancer

Summary: RATIONALE: 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 trial to study the effectiveness of biological therapy in treating patients who have advanced cancer that shows no signs of disease following treatment.

Detailed description: OBJECTIVES:
  -  Evaluate the immune response of patients with HER2/neu expressing advanced malignancies showing no evidence of disease after standard treatment when injected with HER2/neu intracellular domain protein pulsed autologous dendritic cells.
  -  Assess time to recurrence in these patients.
  OUTLINE: Autologous dendritic cells (DC) are pulsed with HER2/neu intracellular domain protein (ICD). The pulsed DC are administered subcutaneously (SQ) and intradermally, followed by autologous DC mixed with tetanus toxoid (TT) and autologous DC mixed with keyhole limpet hemocyanin (KLH) SQ and intradermally on day 1. HLA-A2 positive patients also receive autologous DC mixed with CMV pp65 peptide SQ and intradermally on day 1. Treatment continues every 3 weeks for a total of 4 courses in the absence of disease progression or unacceptable toxicity.
  Patients are followed every 3 months for 1 year or until disease progression.
  PROJECTED ACCRUAL: A total of 6 patients will be accrued for this study over 6 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed advanced malignancy that expresses HER2/neu
  -  Stage IIA breast cancer with more than 6 positive lymph nodes
  -  Stage IIB, IIIA, or IIIB breast cancer
  -  Stage III ovarian cancer
  -  Lymph node positive gastric cancer
  -  Metastatic tumor
  -  No measurable or evaluable disease after standard treatment
  -  No previously irradiated or newly diagnosed CNS metastases
  -  Hormone receptor status:
  -  Not specified
  PATIENT CHARACTERISTICS:
  Age:
  -  18 and over
  Menopausal status:
  -  Not specified
  Performance status:
  -  Karnofsky 80-100%
  Life expectancy:
  -  Greater than 6 months
  Hematopoietic:
  -  WBC at least 3,000/mm^3
  -  Hemoglobin at least 9 mg/dL
  -  Platelet count at least 100,000/mm^3
  Hepatic:
  -  Bilirubin less than 2.0 mg/dL
  -  No hepatic disease, including viral hepatitis
  Renal:
  -  Creatinine less than 2.5 mg/dL
  Cardiovascular:
  -  No New York Heart Association class III or IV heart disease
  Pulmonary:
  -  No asthma or chronic obstructive pulmonary disease
  Immunologic:
  -  Must have positive intradermal delayed hypersensitivity test for at least 1 of the following:
  -  Candida
  -  Mumps
  -  Tetanus
  -  Trichophyton
  -  Histoplasmin
  -  No prior autoimmune disease including, but not limited to, the following:
  -  Inflammatory bowel disease
  -  Systemic lupus erythematosus
  -  Ankylosing spondylitis
  -  Scleroderma
  -  Multiple sclerosis
  Other:
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception
  -  HIV negative
  -  Hepatitis B surface antigen and hepatitis C antibody negative
  -  No other concurrent serious chronic or acute illness or infection (including urinary tract infection)
  -  No known shellfish or iodine allergy
  -  No other prior or concurrent malignancy except for nonmelanoma skin cancer, cervical cancer, or controlled superficial bladder cancer
  -  No medical or psychological condition that may preclude study
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  No other concurrent immunotherapy
  Chemotherapy:
  -  At least 4 weeks since prior chemotherapy and recovered
  -  No concurrent chemotherapy
  Endocrine therapy:
  -  Concurrent hormonal therapy allowed (tamoxifen, raloxifene, toremifene, and all aromatase inhibitors)
  -  At least 4 weeks since prior steroid or immunosuppressive therapy (e.g, azathioprine or cyclosporine)
  Radiotherapy:
  -  Prior radiotherapy allowed except to cranium
  -  At least 4 weeks since prior radiotherapy and recovered
  -  At least 12 weeks since prior strontium chloride Sr 89
  -  No concurrent radiotherapy
  Surgery:
  -  At least 4 weeks since prior surgery and recovered
  Other:
  -  Concurrent bisphosphonates allowed
  -  No prior hepatitis B immunization

Relevance to patient case: possibly relevant