Melanoma Clinical Trial
Monoclonal Antibody and Vaccine Therapy in Treating Patients With Stage III or Stage IV Melanoma That Has Been Removed During Surgery
Summary
RATIONALE: Monoclonal antibodies can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Vaccines made from a person's cancer cells may make the body build an immune response to kill tumor cells.
PURPOSE: Phase I trial to study the effectiveness of combining monoclonal antibody therapy and vaccine therapy in treating patients who have stage III or stage IV melanoma that has been removed during surgery.
Full Description
OBJECTIVES:
Determine the safety and adverse event profile of anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody combined with tyrosinase:368-376, gp100:209-217, and MART-1:26-35 peptides emulsified in Montanide ISA-51 in patients with resected stage III or IV melanoma.
Determine if this regimen causes antigen-specific T-cell activation in these patients.
Determine the clearance profile of this regimen in these patients.
Assess the development of host immune response in patients treated with this regimen.
OUTLINE: This is a dose-escalation study of anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody (MDX-CTLA4).
Patients receive tyrosinase:368-376, gp100:209-217, and MART-1:26-35 peptides emulsified in Montanide ISA-51 subcutaneously followed by MDX-CTLA4 IV over 90 minutes at 0, 1, 2, 3, 4, 5, 8, and 11 months in the absence of disease progression or unacceptable toxicity.
Cohorts of at least 6 patients receive escalating doses of MDX-CTLA4 until the maximum tolerated dose is determined.
Patients are followed every 3 months for 1 year, every 6 months for 2 years, and then annually thereafter until disease progression.
PROJECTED ACCRUAL: A total of 18 patients will be accrued for this study.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed completely resected stage III or IV melanoma
Mucosal or ocular subtypes allowed
HLA-A2 positive
Positive staining of tumor tissue with antibody HMB-45 for gp100, tyrosinase, and/or MART-1
Failed (or ineligible for or refusal of) interferon alfa
PATIENT CHARACTERISTICS:
Age:
Not specified
Performance status:
Karnofsky 60-100%
Life expectancy:
At least 12 months
Hematopoietic:
WBC at least 2,500/mm^3
Absolute neutrophil count at least 1,500/mm^3
Platelet count at least 100,000/mm^3
Hemoglobin at least 10 g/dL
Hematocrit at least 30%
Hepatic:
Bilirubin no greater than upper limit of normal (ULN)
AST no greater than 1.25 times ULN
Hepatitis B surface antigen negative
Hepatitis C antibody nonreactive
Renal:
Creatinine less than 1.25 times ULN
Immunologic:
Antinuclear antibody (ANA) negative OR
If ANA positive, must be:
Antithyroglobulin antibody negative
Rheumatoid factor negative
Anti-LKM antibody negative
Anti-phospholipid antibody negative
Anti-islet cell antibody negative
Anti-neutrophil cytoplasmic antibody negative
HIV negative
No autoimmune disease (e.g., uveitis or autoimmune inflammatory eye disease)
No active infection
No hypersensitivity to tyrosinase:368-376, gp100:209-217, MART-1:26-35, or Montanide ISA-51
Other:
No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, superficial bladder cancer, or carcinoma in situ of the cervix
No underlying medical condition that would preclude study
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
See Disease Characteristics
No prior anti-cytotoxic T-lymphocyte-associated antigen-4 monoclonal antibody
No prior tyrosinase, gp100, or MART-1 peptide
No prior antitumor vaccination
No prior interleukin-2
At least 4 weeks since prior immunotherapy for melanoma
Chemotherapy:
At least 4 weeks since prior chemotherapy for melanoma
Endocrine therapy:
At least 4 weeks since prior hormonal therapy for melanoma
At least 4 weeks since prior corticosteroids
No concurrent systemic or topical corticosteroids
Radiotherapy:
At least 4 weeks since prior radiotherapy for melanoma
Surgery:
See Disease Characteristics
Other:
No prior cytotoxic therapy
At least 4 weeks since any other prior therapy for melanoma
Concurrent analgesics allowed if on stable dose for at least 2 weeks before study
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There is 1 Location for this study
Los Angeles California, 90089, United States
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