Melanoma Clinical Trial
Vaccine Therapy With or Without Biological Therapy in Treating Patients With Metastatic Melanoma
Summary
RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Biological therapies such as sargramostim and interferon alfa use different ways to stimulate the immune system and stop cancer cells from growing. It is not yet known if vaccine therapy if more effective with or without biological therapy for melanoma.
PURPOSE: Randomized phase II trial to compare the effectiveness of vaccine therapy with or without biological therapy in treating patients who have metastatic melanoma.
Full Description
OBJECTIVES:
Determine immune response of vaccination with melanoma associated antigens (MART-1:27-35, gp100:209-217 (210M), and tyrosinase:368-376 (370D)) on the number of peptide specific CD8+ T-cell precursors in HLA-A2 positive patients with metastatic melanoma.
Determine the influence of sargramostim (GM-CSF) and/or interferon alfa-2b (IFN-A) on the immune responses of these patients and toxicity of this melanoma peptide vaccine.
Determine any antitumor and anti-pigmentary response that may result from immunization against MART-1, gp100 and tyrosinase peptides, and determine the relationship between such clinical observations and immune responses against lineage antigens with or without GM-CSF and/or IFN-A.
Compare the relapse free survival and overall survival of patients treated with melanoma peptide vaccine alone or in combination with GM-CSF and/or IFN-A.
OUTLINE: This is a randomized, multicenter study.
Patients are randomized to 1 of 4 treatment arms.
Arm I: Patients receive multiepitope peptide (MEP) vaccine comprising MART-1:27-35, gp100:209-217 (210M), and tyrosinase:368-376 (370D) peptides. Each peptide is separately emulsified in Montanide ISA-51 and administered subcutaneously (SC) (for a total of 2 injections per peptide) on days 1 and 15.
Arm II: Patients receive MEP vaccine as in arm I and sargramostim (GM-CSF) subcutaneously (SC) daily on days 1-14.
Arm III: Patients receive MEP vaccine as in arm I and interferon alfa-2b SC three times a week.
Arm IV: Patients receive MEP vaccine as in arm I, GM-CSF as in arm II, and interferon alfa-2b as in arm III.
Treatment continues every 4 weeks for a maximum of 13 courses in the absence of disease progression or unacceptable toxicity.
Patients are followed every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 92 patients (23 per arm) will be accrued for this study within 13-16 months.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically proven stage IV melanoma
Measurable disease
At least 1 lesion must be a minimum of 1.0 cm in diameter
Bone metastases are not considered to be measurable disease
No prior radiotherapy to area of measurable disease unless there is clearly progressive disease in this site or measurable disease exists outside the area of prior radiotherapy
HLA-A2 positive
No brain disease by MRI or CT scan within 4 weeks prior to randomization
Prior brain disease allowed if no evidence of active disease by 2 successive MRI evaluations completed at least 3 months apart
PATIENT CHARACTERISTICS:
Age:
18 and over
Performance status:
ECOG 0-1
Life expectancy:
Not specified
Hematopoietic:
WBC at least 4,000/mm^3
Platelet count at least 100,000/mm^3
Lymphocyte count greater than 700/mm ^3
Hepatic:
SGOT no greater than 2 times upper limit of normal (ULN)
Bilirubin no greater than 2 times ULN
Alkaline phosphatase and lactic dehydrogenase no greater than 2 times ULN
Renal:
Creatinine no greater than 1.8 mg/dL
Other:
No significant detectable infection
HIV negative
No other malignancy within the past 5 years except:
Any carcinoma in situ
Lobular carcinoma in situ of the breast
Carcinoma in situ of the cervix
Atypical melanocytic hyperplasia
Melanoma in situ
Basal cell or squamous cell skin cancer
No autoimmune disorders or conditions of immunosuppression
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception
PRIOR CONCURRENT THERAPY:
Biologic therapy:
No prior MART-1:27-35, gp100:209-217 (210M), or tyrosinase:368-376 (370D) peptide
Greater than 4 weeks since prior adjuvant immunotherapy, including sargramostim (GM-CSF) or interferon alfa-2b
Chemotherapy:
At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin)
Endocrine therapy:
At least 2 weeks since prior and no concurrent systemic corticosteroids, including oral steroids (i.e., prednisone, dexamethasone); continuous use of topical steroid creams or ointments; or any inhalers containing steroids
Radiotherapy:
See Disease Characteristics
At least 4 weeks since prior radiotherapy for local control or palliation and recovered
Surgery:
Recovered from any prior major surgery
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There are 30 Locations for this study
Scottsdale Arizona, 85259, United States
Atlanta Georgia, 30322, United States
Decatur Georgia, 30033, United States
Chicago Illinois, 60611, United States
Chicago Illinois, 60611, United States
Evanston Illinois, 60201, United States
Urbana Illinois, 61801, United States
Indianapolis Indiana, 46202, United States
Indianapolis Indiana, 46202, United States
Des Moines Iowa, 50309, United States
Wichita Kansas, 67214, United States
New Orleans Louisiana, 70121, United States
Baltimore Maryland, 21231, United States
Boston Massachusetts, 02111, United States
Boston Massachusetts, 02215, United States
Kalamazoo Michigan, 49007, United States
Hackensack New Jersey, 07601, United States
New Brunswick New Jersey, 08903, United States
Bronx New York, 10461, United States
Cleveland Ohio, 44106, United States
Toledo Ohio, 43623, United States
Danville Pennsylvania, 17822, United States
Philadelphia Pennsylvania, 19104, United States
Philadelphia Pennsylvania, 19111, United States
Pittsburgh Pennsylvania, 15213, United States
Sioux Falls South Dakota, 57104, United States
Temple Texas, 76508, United States
Charlottesville Virginia, 22908, United States
Green Bay Wisconsin, 54301, United States
Madison Wisconsin, 53705, United States
Madison Wisconsin, 53792, United States
Marshfield Wisconsin, 54449, United States
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