Melanoma
Conditions
Keywords
melanoma, resected local, systemic metastasis
Brief summary
Vaccines contain substances that help us make antibodies. Different antibodies help protect us against a variety of harmful things. GD2 and GD3 gangliosides are substances found on the surface of most melanoma cells. They are also occasionally found on some normal cells. Large quantities of antibodies called monoclonal antibodies have been prepared in the laboratory against GD2 and GD3 and given to patients with metastatic melanoma. In about 10% of cases this has resulted in clinically relevant regression of melanomas. These monoclonal antibodies are not currently available or used in the clinic but studies in the laboratory indicate that vaccines against GD2 and GD3 can be as effective as monoclonal antibodies. In this trial we wish to raise the level of antibodies in your blood against GD2 and GD3. We will vaccinate you with the modified forms of GD2 called GD2 lactone and GD3 called GD3 lactone (GD3L), all attached to the antibody booster KLH, and mixed with the immune booster (immunologic adjuvant) QS-DG. While over a thousand patients have received vaccines with QS-21, the QS-DG used here is synthesized for the first time at MSKCC and is referred to as QS-DG rather than QS-21 which is purified from tree bark. QS-21 and QS-DG are, to the best of our knowledge chemically identical. It is unknown if using this bivalent vaccine will raise the level of antibodies in your blood to either ganglioside. It is unknown if raising the level of antibodies in your blood will lower your risk of relapse. This study will check your blood for production of antibodies, and check you for side effects.
Interventions
BIOLOGICALKLH conjugates with GD2L and GD3L
6 vaccinations (on weeks 1, 2, 3, 8, 20 and 32) which will contain the same KLH conjugates with GD2L and GD3L. All vaccines contain KLH conjugates containing 30mcg of GD2L and 30mcg of GD3L and QS-DG or OPT-821. The initial 8 patients will receive the same QS-DG or OPT-821 vaccine dose in all of their vaccines. This dose will be 50 mcg for the first patient, 75 mcg for the second patient and 100 mcg for the third through eighth patients. In all subsequent patients the 1st, 4th and 5th vaccinations will include 150 mcg of OPT-821. The 2nd and 3rd vaccinations will contain 100 mcg of OPT-821 and the 6th vaccination will contain 200 mcg of OPT-821.
Sponsors
Memorial Sloan Kettering Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients ≥18 with AJCC stage III or IV melanoma two weeks to one year after becoming clinically free of disease will be eligible. * For all patients' pathology slides must be reviewed by the Memorial Hospital Department of Pathology to confirm diagnosis of cutaneous melanoma. * All patients must have a Karnofsky performance status of ≥80. * Patients may have received previous radiation, chemotherapy or systemic immunotherapy (completed at least 4 weeks prior to vaccination). * A CBC must be performed within 2 weeks prior to vaccination with the WBC \> or equal to 3.0 cells/mm3, Platelets \>100,000/mm3, * A screening profile must be performed within 2 weeks prior to vaccination with the total bilirubin ≤ 2.0, and other LFTs within normal limits for patient's age. * Chest, abdomen and pelvic CT or MRI must be performed within 4 weeks of the initiation of treatment showing no evidence of disease. * Women of child bearing potential and sexually active males must be counseled to use an accepted and effective method of contraception (including abstinence) while on treatment.
Exclusion criteria
* Patients previously treated with KLH or ganglioside containing vaccines, or monoclonal antibodies against gangliosides are not eligible. * Women must not be pregnant (negative βHCG within 2 weeks of vaccination if of childbearing potential). * Patients with other active cancers within the past 2 years, (excluding basal cell, squamous carcinomas of the skin or cervical carcinoma-in-situ) are not eligible. * Any medical condition which might make it difficult for the patient to complete the full course of treatments or to respond immunologically to them is grounds for exclusion, at the discretion of the Principal Investigator. * Patients requiring anti-inflammatory medications such a steroids, NSAIDS or full dose aspirin are not eligible. * There must be no evidence of metastatic disease at the time of the first vaccine. However, patients who develop new metastases during treatment may continue on treatment as long as no systemic treatment is indicated and any local treatment such as surgical resection or radiation would not cause a delay in vaccination or two weeks or more.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Toxicity | 2 years | Toxicity will be graded in accordance with Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Cohort 1A Cohort 1A: 50mcg OPT-821 weeks 1, 2, 3, 8, 20, 32 | 1 |
| Cohort 1B Cohort 1B: 75mcg OPT-821 weeks 1, 2, 3, 8, 20, 32 | 1 |
| Cohort 1C Cohort 1C: 100mcg OPT-821 weeks 1, 2, 3, 8, 20, 32 | 10 |
| Cohort 2A Cohort 2A: 50mcg QS-DG weeks 1, 2, 3, 8, 20, 32 | 1 |
| Cohort 2B Cohort 2B: 75mcg QS-DG weeks 1, 2, 3, 8, 20 ,32 | 1 |
| Cohort 2C Cohort 2C: 100mcg QS-DG weeks 1, 2, 3, 8, 20 ,32 | 10 |
| Cohort 3 Cohort 3: 150mcg OPT-821 for first 5 vaccines with a 50 mcg increase in dose for the final vaccine. | 10 |
| Total | 34 |
Baseline characteristics
| Characteristic | Cohort 2A | Cohort 2C | Cohort 3 | Total | Cohort 1A | Cohort 1B | Cohort 1C | Cohort 2B |
|---|---|---|---|---|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 2 Participants | 2 Participants | 7 Participants | 1 Participants | 0 Participants | 2 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 1 Participants | 8 Participants | 8 Participants | 27 Participants | 0 Participants | 1 Participants | 8 Participants | 1 Participants |
| Region of Enrollment United States | 1 participants | 10 participants | 10 participants | 34 participants | 1 participants | 1 participants | 10 participants | 1 participants |
| Sex: Female, Male Female | 0 Participants | 5 Participants | 1 Participants | 11 Participants | 1 Participants | 0 Participants | 4 Participants | 0 Participants |
| Sex: Female, Male Male | 1 Participants | 5 Participants | 9 Participants | 23 Participants | 0 Participants | 1 Participants | 6 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk |
|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 1 / 1 | 1 / 1 | 6 / 10 | 1 / 1 | 1 / 1 | 7 / 10 | 10 / 10 |
| serious Total, serious adverse events | 0 / 1 | 0 / 1 | 0 / 10 | 0 / 1 | 0 / 1 | 0 / 10 | 0 / 10 |
Outcome results
Primary
Toxicity
Toxicity will be graded in accordance with Common Terminology Criteria for Adverse Events (CTCAE) version 3.0.
Time frame: 2 years
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cohort 1A | Toxicity | 1 participants |
| Cohort 1B | Toxicity | 1 participants |
| Cohort 1C | Toxicity | 6 participants |
| Cohort 2A | Toxicity | 1 participants |
| Cohort 2B | Toxicity | 1 participants |
| Cohort 2C | Toxicity | 7 participants |
| Cohort 3 | Toxicity | 10 participants |