Cutaneous Melanoma, Melanoma, Melanoma of Unknown Primary, Mucosal Melanoma, Ocular Melanoma, Stage IIB Cutaneous Melanoma AJCC v6 and v7, Stage IIC Cutaneous Melanoma AJCC v6 and v7, Stage III Cutaneous Melanoma AJCC v7, Stage IIIA Cutaneous Melanoma AJCC v7, Stage IIIB Cutaneous Melanoma AJCC v7, Stage IIIC Cutaneous Melanoma AJCC v7, Stage IV Cutaneous Melanoma AJCC v6 and v7
Conditions
Brief summary
This phase II trial studies the effect of a vaccine called CDX-1401 given with or without a biologic drug called CDX-301 in treating patients with stage IIB-IV melanoma. The cancer vaccine CDX-1401 attaches to a protein that is made in tumor cells. The vaccine helps the body recognize the tumor to fight the cancer. The biologic drug CDX-301 may help the body make more of the tumor fighting cells, known as dendritic cells. Another biologic drug, poly-ICLC, may stimulate the immune system and help these dendritic cells mature so that they can recognize the tumor. Giving CDX-301 may make the immune response to a combination of CDX-1401 and poly-ICLC better.
Detailed description
PRIMARY OBJECTIVE: I. To determine whether the immune response to NY-ESO-1 elicited by vaccination with DEC-205/NY-ESO-1 fusion protein CDX-1401 (CDX-1401) plus polyinosinic-polycytidylic acid stabilized with poly-L-lysine and carboxymethylcellulose (poly-ICLC) is substantially increased by prior expansion in the number of circulating dendritic cells (DC) by therapy with recombinant Flt3 ligand (CDX-301) (fms-related tyrosine kinase 3 ligand \[Flt3L\]). SECONDARY OBJECTIVES: I. To assess the effect of the vaccine regimen on immune responses to other ongoing and nascent antitumor response antigens associated with melanoma (e.g., PRAME, MAGE-A3, p53, and gp100) as well as memory viral responses (influenza A) and chronic viral responses (cytomegalovirus \[CMV\], Epstein-Barr virus \[EBV\]). II. To assess the effect of the vaccine regimen on the frequency and phenotypic character of peripheral blood mononuclear cell (PBMC) subsets including DCs, monocyte populations, T cells, and natural killer (NK) cells. III. To assess the safety, tolerability, and clinical efficacy of the vaccine regimens. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive recombinant Flt3 ligand (CDX-301) subcutaneously (SC) on days -7 to -1, 1-3, and 22-28 of cycle 1 and only on days 1-3 of cycle 2. Patients also receive CDX-1401 SC or intradermally (ID) on day 1 of each cycle and poly-ICLC SC on days 1-2 of each cycle. Treatment repeats every 28 days for 4 cycles in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive CDX-1401 and poly-ICLC as in Arm I. Treatment repeats every 28 days for 4 cycles in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up at 4 and 12 weeks and then annually thereafter.
Interventions
BIOLOGICALDEC-205/NY-ESO-1 Fusion Protein CDX-1401
Given SC or ID
DRUGPoly ICLC
Given SC
BIOLOGICALRecombinant Flt3 Ligand
Given SC
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with fully resected stage IIb through IV melanoma, with melanoma validated by histology or cytology, who have NOT received prior therapy. * Patients may have had primary cutaneous, mucosal, or ocular melanoma or metastasis from an unknown primary site. * Tissue should be submitted for evaluation of NY-ESO-1 expression and T-cell infiltrates. However, availability of tissue and/or positivity for NY-ESO-1 is not mandatory. * Prior radiation, chemotherapy or biologics NOT allowed * Not currently receiving any anticancer therapy * Age \>= 18 years * Because no dosing or adverse event (AE) data are currently available on the use of CDX-1401 or CDX-301 in patients \< 18 years of age, children are excluded from this study, but will be eligible for future pediatric trials. * Eastern Cooperative Oncology Group (ECOG) performance score of 0-1 * Life expectancy of at least 6 months * Leukocytes \>= 3,000/mcL * Absolute neutrophil count \>= 1,000/mcL * Platelets \>= 75,000/mcL * Hemoglobin \> 9 g/dL * Total bilirubin \< 1.5 x institutional upper limit of normal (bilirubin \< 3 x institutional upper limit of normal for Gilbert's syndrome) * Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase \[SGOT\])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase \[SGPT\]) =\< 2.5 x institutional upper limit of normal * Creatinine \< 1.5 x institutional upper limit of normal OR creatinine clearance \>= 60 mL/min/1.73 m\^2 for patients with creatinine levels above institutional normal * The first six patients enrolled in the Flt3L arm of the study cannot be human immunodeficiency virus (HIV)-positive. After the evaluation of safety in the first 6 patients, HIV-positive patients with adequate immune function as evidenced by stable CD4 counts \>= 350/mm\^3 are allowed to participate if the following criteria are met: * maintained on stable antiretroviral therapy with no significant drug interactions, and * no recent history of acquired immunodeficiency syndrome (AIDS) indicator conditions (\> 2 years from enrolling in trial), and * physician providing patient's care for HIV must also approve of patient entering the study * Females of childbearing potential must have a negative pregnancy test within 7 days before the initiation of protocol therapy. * The effects of CDX-1401 or CDX-301 on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) before study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception before the study, for the duration of study participation, and 4 months after completion of CDX-1401 or CDX-301 administration. * NOTE: Subjects are considered not of child-bearing potential if they are surgically sterile, they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy, or they are postmenopausal. Menopause is the age associated with complete cessation of menstrual cycles, menses, and implies the loss of reproductive potential. By a practical definition, it assumes menopause after 1 year without menses with an appropriate clinical profile at the appropriate age. * Ability to understand and the willingness to sign a written informed consent document
Exclusion criteria
* Patients who have had cytotoxic chemotherapy, radiotherapy, interferon (IFN), or ipilimumab before entering the study * Immunosuppressive therapy within 30 days prior to initiation of protocol therapy * Steroid therapy, or steroid therapy with more than 7 consecutive days of steroids within the prior 4 weeks * The use of prednisone or equivalent \< 0.125 mg/kg/day (absolute maximum of 10 mg/day) as replacement therapy is permitted * Inhaled or topical corticosteroids are permitted * Patients who are receiving any other investigational agents * Current or history of systemic autoimmune disease requiring systemic therapy. * NOTE: The following will not be exclusionary: * The presence of laboratory evidence of autoimmune disease (e.g., positive antinuclear antibody \[ANA\] titer) without associated symptoms * Clinical evidence of vitiligo * Other forms of depigmenting illness * Cardiovascular disease that meets one of the following: congestive heart failure (New York Heart Association Class III or IV), active angina pectoris, or recent myocardial infarction (within the last 6 months) * Cirrhosis or chronic hepatitis C virus positivity or chronic hepatitis B infection * NOTE: A positive hepatitis B serology indicative of previous immunization (i.e., hepatitis B virus surface antibody \[HBsAb\]-positive and hepatitis B virus core antibody \[HBcAb\]-negative), or a fully resolved acute hepatitis B virus infection is not an exclusion criterion * Known history of immunodeficiency disorder other than HIV-positive status * Extensive active brain disease including symptomatic brain metastases or presence of leptomeningeal disease * NOTE: Patients with brain metastasis, after definitive therapy with surgery or stereotactic radiation and stable off steroids for \>= 4 weeks, are eligible * Other invasive cancers that are clinically active * Pregnancy or nursing or unwilling to take adequate birth control during therapy * NOTE: Pregnant women are excluded from this study because CDX-1401 or CDX-301 and poly-ICLC have an unknown potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with CDX-1401 or CDX-301, breastfeeding should be discontinued if the mother is treated with CDX-1401 or CDX-301 and poly-ICLC * History of allergic reactions attributed to compounds of similar chemical or biologic composition to CDX-1401 or CDX-301 or poly-ICLC * Prior organ allograft or allogeneic transplantation, if the transplanted tissue is still in place * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Medical or psychiatric illness that would, in the opinion of the investigator, preclude participation in the study or the ability of patients to provide informed consent for themselves * History of pulmonary disease such as emphysema or chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second \[FEV1\] \< 60% of predicted for height and age). Pulmonary function tests (PFTs) are required in patients with prolonged smoking history or symptoms of respiratory dysfunction * Vaccinations other than those given as part of this research study (with the exception of influenza vaccine) are prohibited throughout the duration of study participation. * NOTE: Influenza vaccination (inactivated) is permitted during the flu season. The preferred time is 7 to 14 days after CDX-1401 administration
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Immune T-cell Response to NY-ESO-1 | At 12 weeks after final vaccination | Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| T Cell Responses to Other Ongoing and Nascent Antitumor Response Antigens Associated With Melanoma (e.g. PRAME, MAGE-A3, p53, and gp1000) as Well as Memory and Chronic Viral Responses (CMV, EBV) | Up to 12 weeks after final vaccination | Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10. |
| Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | Up to 12 weeks after final vaccination | Graphical and tabular summaries of the assay data will be made. Linear mixed effects model and possibly weighted generalized estimating equation methods will be considered for a supportive analysis of the longitudinal data over time. |
| Tumor Recurrence | Up to 600 days from first vaccine | Time to first recurrence from first vaccine among subjects who have experienced recurrence. (days) |
| Overall Survival | Up to 1 year after patient's 12 week visit | Overall survival not assessed |
Countries
United States
Participant flow
Pre-assignment details
No enrolled participants were excluded from the study before assignment to groups.
Participants by arm
| Arm | Count |
|---|---|
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) Patients receive recombinant Flt3 ligand (CDX-301) SC on days -7 to -1, 1-3, and 22-28 of course 1 and on days 1-3 of course 2 only; DEC-205/NY-ESO-1 fusion protein CDX-1401 SC or ID on days 1 and 2; and poly-ICLC SC on day 1. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
DEC-205/NY-ESO-1 Fusion Protein CDX-1401: Given SC or ID
Laboratory Biomarker Analysis: Correlative studies
Neoantigen-based Melanoma-Poly-ICLC Vaccine: Given SC
Pharmacological Study: Correlative studies
Recombinant Flt3 Ligand: Given SC | 30 |
| Arm II (CDX-1401 and Poly-ICLC) Patients receive DEC-205/NY-ESO-1 fusion protein CDX-1401and poly-ICLC as in Arm I. Treatment repeats every 28 days for 4 courses in the absence of disease progression or unacceptable toxicity.
DEC-205/NY-ESO-1 Fusion Protein CDX-1401: Given SC or ID
Laboratory Biomarker Analysis: Correlative studies
Neoantigen-based Melanoma-Poly-ICLC Vaccine: Given SC
Pharmacological Study: Correlative studies | 30 |
| Total | 60 |
Baseline characteristics
| Characteristic | Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Arm II (CDX-1401 and Poly-ICLC) | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 8 Participants | 5 Participants | 13 Participants |
| Age, Categorical Between 18 and 65 years | 22 Participants | 25 Participants | 47 Participants |
| Age, Continuous | 54.6 years STANDARD_DEVIATION 13.4 | 51.6 years STANDARD_DEVIATION 14.5 | 53.1 years STANDARD_DEVIATION 13.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 30 Participants | 28 Participants | 58 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) White | 30 Participants | 28 Participants | 58 Participants |
| Sex: Female, Male Female | 10 Participants | 9 Participants | 19 Participants |
| Sex: Female, Male Male | 20 Participants | 21 Participants | 41 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 30 / 30 | 30 / 30 |
| serious Total, serious adverse events | 0 / 30 | 4 / 30 |
Outcome results
Primary
Immune T-cell Response to NY-ESO-1
Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10.
Time frame: At 12 weeks after final vaccination
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Immune T-cell Response to NY-ESO-1 | 15 Participants |
| Arm II (CDX-1401 and Poly-ICLC) | Immune T-cell Response to NY-ESO-1 | 10 Participants |
Secondary
Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold)
Graphical and tabular summaries of the assay data will be made. Linear mixed effects model and possibly weighted generalized estimating equation methods will be considered for a supportive analysis of the longitudinal data over time.
Time frame: Up to 12 weeks after final vaccination
Population: Only a subset of patient specimens were needed to meet statistical power. 15 participants were analyzed in Arm I (CDX-301, CDX-1401, and poly-ICLC and 16 participants were analyzed in Arm II (CDX-1401 and poly-ICLC). One less patient in Arm 1 was analyzed due to sample quality.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | cDCs | 30.4 log 2 fold change | Standard Deviation 16.98 |
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | Monocytes | 6.1 log 2 fold change | Standard Deviation 2.11 |
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | CD4 T cells | 1.2 log 2 fold change | Standard Deviation 0.28 |
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | NK CD56br cells | 5.8 log 2 fold change | Standard Deviation 2.84 |
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | CD8 T cells | 1.3 log 2 fold change | Standard Deviation 0.36 |
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | pDC | 16.5 log 2 fold change | Standard Deviation 7.27 |
| Arm II (CDX-1401 and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | CD8 T cells | 1.0 log 2 fold change | Standard Deviation 0.26 |
| Arm II (CDX-1401 and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | cDCs | 0.9 log 2 fold change | Standard Deviation 0.26 |
| Arm II (CDX-1401 and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | NK CD56br cells | 1.26 log 2 fold change | Standard Deviation 0.32 |
| Arm II (CDX-1401 and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | Monocytes | 1.0 log 2 fold change | Standard Deviation 0.18 |
| Arm II (CDX-1401 and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | pDC | 0.8 log 2 fold change | Standard Deviation 0.24 |
| Arm II (CDX-1401 and Poly-ICLC) | Frequency and Phenotypic Character of PBMC Subsets Including DCs, Monocyte Populations, T Cells, and NK Cells - Highest Peak Fold Change Over Baseline (Log 2 Fold) | CD4 T cells | 1.1 log 2 fold change | Standard Deviation 0.27 |
Secondary
Overall Survival
Overall survival not assessed
Time frame: Up to 1 year after patient's 12 week visit
Population: Data not collected
Secondary
T Cell Responses to Other Ongoing and Nascent Antitumor Response Antigens Associated With Melanoma (e.g. PRAME, MAGE-A3, p53, and gp1000) as Well as Memory and Chronic Viral Responses (CMV, EBV)
Response rates will be analyzed by tabulating the frequency of positive response for each assay by antigen and treatment arm at each time point for which an assessment is performed. Response rates will be presented with their corresponding 95% confidence interval estimates calculated using the score test method. Fisher's exact tests will be used to compare cohort 1 and cohort 2 at the peak time point, with a significant difference declared if the 1-sided P value is =\< 0.10.
Time frame: Up to 12 weeks after final vaccination
Population: T cell responses to MAGE-A3 and PRAME; positive at any timepoint
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | T Cell Responses to Other Ongoing and Nascent Antitumor Response Antigens Associated With Melanoma (e.g. PRAME, MAGE-A3, p53, and gp1000) as Well as Memory and Chronic Viral Responses (CMV, EBV) | 7 Participants |
| Arm II (CDX-1401 and Poly-ICLC) | T Cell Responses to Other Ongoing and Nascent Antitumor Response Antigens Associated With Melanoma (e.g. PRAME, MAGE-A3, p53, and gp1000) as Well as Memory and Chronic Viral Responses (CMV, EBV) | 7 Participants |
Secondary
Tumor Recurrence
Time to first recurrence from first vaccine among subjects who have experienced recurrence. (days)
Time frame: Up to 600 days from first vaccine
Population: Analysis is reported for the number of subjects with recurrence (N=12 Arm I) (N=9 Arm II)
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm I (CDX-301, CDX-1401, and Poly-ICLC) | Tumor Recurrence | 360.3 days | Standard Deviation 191.1 |
| Arm II (CDX-1401 and Poly-ICLC) | Tumor Recurrence | 389.2 days | Standard Deviation 223.2 |