Melanoma
Conditions
Keywords
peptide, vaccine, adjuvant, polyICLC, cyclophosphamide, Montanide ISA-51
Brief summary
This study evaluates whether it is safe to administer a peptide vaccine in combination with different adjuvants. Adjuvants are substances that may boost immune responses vaccines. In this study, the adjuvants are Montanide ISA-51, polyICLC and cyclophosphamide. This study will also evaluate the effects of the combination of the peptide vaccine and the adjuvants on the immune system. The investigators will monitor these effects by performing tests in the laboratory on participants' blood, a lymph node, and tissue from the sites of vaccination.
Interventions
BIOLOGICAL6MHP
6 melanoma helper vaccine comprised of 6 class II MHC-restricted helper peptides
DRUGMontanide ISA-51
Montanide ISA-51 (Incomplete Freund's Adjuvant), local adjuvant
DRUGpolyICLC
polyICLC, local adjuvant
DRUGCyclophosphamide
Cyclophosphamide, systemic adjuvant
Sponsors
Ludwig Institute for Cancer Research
Cancer Research Institute, New York City
Craig L Slingluff, Jr
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
* Part 1 only: Participants with stage IIB, IIC, III, or IV melanoma at original diagnosis or at restaging after recurrence. Patients with high-risk stage IIA melanoma (by DecisionDx Melanoma test, Castle Biosciences, Inc,;Friendswood, TX) also may be eligible. These participants may have had cutaneous, uveal, mucosal primary melanoma, or an unknown primary melanoma. Diagnosis of melanoma must be confirmed by cytological or histological examination. Staging of cutaneous melanoma will be based on version 7 AJCC staging system. * Part 2 only: Patients with a diagnosis of stage IIIB-IV melanoma with one or more tumor deposits accessible for biopsy and/or excision. These participants may have had cutaneous, uveal, mucosal primary melanoma, or an unknown primary melanoma. Diagnosis of melanoma must be confirmed by cytological or histological examination. Staging of cutaneous melanoma will be based on version 7 AJCC staging system. Patients must have adequate cutaneous, subcutaneous, soft tissue, or nodal metastases of melanoma readily accessible for biopsy * Participants will be required to have radiological studies to rule out radiologically evident disease. Required studies include: * Chest CT scan, * Abdominal and pelvic CT scan, and * Head CT scan or MRI * PET/CT fusion scan may replace scans of the chest, abdomen, and pelvis. * Participants who have had brain metastases will be eligible if all of the following are true: * Each brain metastasis must have been completely removed by surgery or each unresected brain metastasis must have been treated with stereotactic radiosurgery. * There has been no evident growth of any brain metastasis since the most recent treatment. * No brain metastasis is \> 2 cm in diameter at the time of registration. * The most recent surgical resections or gamma-knife therapy for malignant melanoma must have been completed ≥ 1 week and for Part 1, ≤ 6 months prior to registration. * All participants must have: * ECOG performance status of 0 or 1 (Appendix 3) * Ability and willingness to give informed consent * Laboratory parameters as follows: * ANC \> 1000/mm3 * Platelets \> 100,000/mm3 * Hgb \> 9 g/dL * HgbA1c ≤ 7.5% * Hepatic: * AST and ALT ≤ 2.5 x upper limits of normal (ULN) * Bilirubin ≤ 2.5 x ULN (except in patients with Gilbert's disease, where bilirubin to 4x ULN is allowed) * Alkaline phosphatase ≤ 2.5 x ULN * Renal * Creatinine ≤ 1.5 x ULN * Serology (within 6 months of study entry) * HIV negative * Hepatitis C negative (no evidence of active virus) * Blood is to be collected for HLA typing (Class I and Class II), which will be analyzed as part of the immunologic endpoints, but HLA type will not be an inclusion/exclusion criterion. * Age 18 years or older at registration. * Part 1 only: Participants must have at least two intact (undissected) axillary and/or inguinal lymph node basins. * Part 2 only: Participants must have at least one intact (undissected) axillary and/or inguinal lymph node basin.
Exclusion criteria
* Participants who have received the following medications or treatments at any time within 4 weeks of registration: * Chemotherapy * Interferon (e.g. Intron-A®) * Radiation therapy (Stereotactic radiotherapy, such as gamma knife, can be used ≥ 1 week and ≤ 6 months prior to registration) * Allergy desensitization injections * High doses of systemic corticosteroids, with the following qualifications and exceptions: * In patients with adrenal or pituitary insufficiency replacement steroid doses are allowed; however, daily doses of 10 mg or more of prednisone (or equivalent) per day administered parenterally or orally are not allowed in patients with normal adrenal and pituitary function. * Inhaled steroids (e.g.: Advair®, Flovent®, Azmacort®) are permitted at low doses (less than 500 mcg fluticasone per day, or equivalent) (76,77). * Topical, nasal, and intra-articular corticosteroids are acceptable. * Growth factors (e.g. Procrit®, Aranesp®, Neulasta®) * Interleukins (e.g. Proleukin®) * Any investigational medication * Targeted therapies specific for mutated BRAF or for MEK * Participants who are currently receiving nitrosoureas or who have received this therapy within the preceding 6 weeks * Participants who are currently receiving a checkpoint molecule blockade therapy, or who have received this therapy within the preceding 12 weeks. * Participants with known or suspected allergies to any component of the vaccine. * Participants may not have been vaccinated previously with any of the synthetic peptides included in this protocol. Participants who have received vaccinations containing agents other than the synthetic peptides included in this protocol and have recurred during or after administration of the vaccine will be eligible to enroll 12 weeks following their last vaccination. * Pregnancy. Female participants of childbearing potential must have a negative pregnancy test (urinary or serum beta-HCG) obtained within 2 weeks prior to registration. Males and females must agree, in the consent form, to use effective birth control methods during the course of vaccination. * Female participants must not be breastfeeding * Participants in whom there is a medical contraindication or potential problem in complying with the requirements of the protocol in the opinion of the investigator. * Participants classified according to the New York Heart Association classification as having Class III or IV heart disease (Appendix 4). * Participants with uncontrolled diabetes, defined as having a HgbA1c ≥ 7.5%. * Participants must not have had prior autoimmune disorders requiring cytotoxic or immunosuppressive therapy, or autoimmune disorders with visceral involvement. Participants with an active autoimmune disorder requiring these therapies are also excluded. The following will not be exclusionary: * The presence of laboratory evidence of autoimmune disease (e.g. positive ANA titer) without symptoms * Clinical evidence of vitiligo * Other forms of depigmenting illness * Mild arthritis requiring NSAID medications * Participants who have another cancer diagnosis, except that the following diagnoses will be allowed: * squamous cell cancer of the skin without known metastasis * basal cell cancer of the skin without known metastasis * carcinoma in situ of the breast (DCIS or LCIS) * carcinoma in situ of the cervix * any cancer without distant metastasis that has been treated successfully, without evidence of recurrence or metastasis for over 5 years * Participants with known addiction to alcohol or drugs who are actively taking those agents, or participants with recent (within 1 year) or ongoing illicit IV drug use. * Body weight \< 110 pounds (without clothes) at registration, due to the amount and frequency with which blood will be drawn.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Adverse Events | 30 days after administration of the last dose of 6MHP or cyclophosphamide | Treatment-related adverse events, by CTCAE v4, Dose-limiting toxicities. |
| Immunogenicity-CD4+ T Cell Responses | through day 85 | CD4+ T cell responses to 6 MHP: durable helper T cell response to 6MHP at 2 or more consecutive timepoints in the PBMC. |
| Immunogenicity-modification of the Tumor Microenvironment (Part 2 Only) | through day 22 | increased infiltration of CD4+ and CD8+ T lymphocytes into melanoma metastases |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Immunogenicity-CD8+ T Cell Responses | through day 85 | CD8+ T cell responses to defined melanoma antigens |
Countries
United States
Participant flow
Recruitment details
Open to accrual: May 12, 2015 Close to accrual: June 21, 2018 Participants all enrolled at an academic medical center.
Participants by arm
| Arm | Count |
|---|---|
| Arm A:6MHP + Montanide ISA-51 Part 1: 200 mcg of 6MHP emulsified in Montanide ISA-51 adjuvant will be administered on 1, 8, 15, 36, 57 and 78.
6MHP: 6 melanoma helper vaccine comprised of 6 class II MHC-restricted helper peptides
Montanide ISA-51: Montanide ISA-51 (Incomplete Freund's Adjuvant), local adjuvant | 3 |
| Arm B:6MHP + Montanide ISA-51 + Cyclophosphamide Part 1: 200 mcg of 6MHP emulsified in Montanide ISA-51 adjuvant will be administered on 1, 8, 15, 36, 57 and 78. Cyclophosphamide (50 mg) will be taken orally once a day for 7 days followed by a 7 day rest period. This will be repeated for 5 cycles. Cycles will begin on the following days:
* Day -6 (Cycle 1)
* Day 8 (Cycle 2)
* Day 22 (Cycle 3)
* Day 36 (Cycle 4)
* Day 50 (Cycle 5)
6MHP: 6 melanoma helper vaccine comprised of 6 class II MHC-restricted helper peptides
Montanide ISA-51: Montanide ISA-51 (Incomplete Freund's Adjuvant), local adjuvant
Cyclophosphamide: Cyclophosphamide, systemic adjuvant | 7 |
| Arm C:6MHP + polyICLC + Montanide ISA-51 Part 1: 200 mcg of 6MHP plus 1 mg of polyICLC emulsified in Montanide ISA-51 adjuvant will be administered on 1, 8, 15, 36, 57 and 78.
6MHP: 6 melanoma helper vaccine comprised of 6 class II MHC-restricted helper peptides
Montanide ISA-51: Montanide ISA-51 (Incomplete Freund's Adjuvant), local adjuvant
polyICLC: polyICLC, local adjuvant | 6 |
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide Parts 1 and 2: 200 mcg of 6MHP plus 1 mg of polyICLC emulsified in Montanide ISA-51 adjuvant will be administered on 1, 8, 15, 36, 57 and 78. Cyclophosphamide (50 mg) will be taken orally once a day for 7 days followed by a 7 day rest period. This will be repeated for 5 cycles. Cycles will begin on the following days:
* Day -6 (Cycle 1)
* Day 8 (Cycle 2)
* Day 22 (Cycle 3)
* Day 36 (Cycle 4)
* Day 50 (Cycle 5)
6MHP: 6 melanoma helper vaccine comprised of 6 class II MHC-restricted helper peptides
Montanide ISA-51: Montanide ISA-51 (Incomplete Freund's Adjuvant), local adjuvant
polyICLC: polyICLC, local adjuvant
Cyclophosphamide: Cyclophosphamide, systemic adjuvant | 32 |
| Total | 48 |
Baseline characteristics
| Characteristic | Arm B:6MHP + Montanide ISA-51 + Cyclophosphamide | Total | Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Arm A:6MHP + Montanide ISA-51 | Arm C:6MHP + polyICLC + Montanide ISA-51 |
|---|---|---|---|---|---|
| Age, Continuous | 61 years | 58 years | 59 years | 48 years | 51 years |
| AJCC stage (v7) AJCC (v7) Stage IIA | 0 Participants | 2 Participants | 2 Participants | 0 Participants | 0 Participants |
| AJCC stage (v7) AJCC (v7) Stage IIB/IIC | 1 Participants | 8 Participants | 6 Participants | 0 Participants | 1 Participants |
| AJCC stage (v7) AJCC (v7) Stage III | 6 Participants | 34 Participants | 21 Participants | 2 Participants | 5 Participants |
| AJCC stage (v7) AJCC (v7) Stage IV | 0 Participants | 4 Participants | 3 Participants | 1 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 7 Participants | 48 Participants | 32 Participants | 3 Participants | 6 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 7 Participants | 47 Participants | 31 Participants | 3 Participants | 6 Participants |
| Region of Enrollment United States | 7 Participants | 48 Participants | 32 Participants | 3 Participants | 6 Participants |
| Sex: Female, Male Female | 3 Participants | 18 Participants | 11 Participants | 2 Participants | 2 Participants |
| Sex: Female, Male Male | 4 Participants | 30 Participants | 21 Participants | 1 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 3 | 0 / 7 | 0 / 6 | 0 / 32 |
| other Total, other adverse events | 3 / 3 | 7 / 7 | 6 / 6 | 32 / 32 |
| serious Total, serious adverse events | 0 / 3 | 1 / 7 | 0 / 6 | 0 / 32 |
Outcome results
Primary
Immunogenicity-CD4+ T Cell Responses
CD4+ T cell responses to 6 MHP: durable helper T cell response to 6MHP at 2 or more consecutive timepoints in the PBMC.
Time frame: through day 85
Population: All ennrolled and treated patients on Parts 1 and 2 of the study.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Arm A:6MHP + Montanide ISA-51 | Immunogenicity-CD4+ T Cell Responses | 0 Participants |
| Arm B:6MHP + Montanide ISA-51 + Cyclophosphamide | Immunogenicity-CD4+ T Cell Responses | 2 Participants |
| Arm C:6MHP + polyICLC + Montanide ISA-51 | Immunogenicity-CD4+ T Cell Responses | 4 Participants |
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Immunogenicity-CD4+ T Cell Responses | 15 Participants |
Primary
Immunogenicity-modification of the Tumor Microenvironment (Part 2 Only)
increased infiltration of CD4+ and CD8+ T lymphocytes into melanoma metastases
Time frame: through day 22
Population: One patient enrolled on Part 2, was on Arm D.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Immunogenicity-modification of the Tumor Microenvironment (Part 2 Only) | CD8 T cells per mm2 in tumor pre-vaccine (day 0) | 401 cells per mm2 of tumor |
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Immunogenicity-modification of the Tumor Microenvironment (Part 2 Only) | CD8 T cells per mm2 in tumor day 22 | 293 cells per mm2 of tumor |
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Immunogenicity-modification of the Tumor Microenvironment (Part 2 Only) | CD4 T cells per mm2 of tumor prevaccine (day 0) | 1202 cells per mm2 of tumor |
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Immunogenicity-modification of the Tumor Microenvironment (Part 2 Only) | CD4 T cells per mm2 tumor day 22 | 1102 cells per mm2 of tumor |
Primary
Number of Participants With Adverse Events
Treatment-related adverse events, by CTCAE v4, Dose-limiting toxicities.
Time frame: 30 days after administration of the last dose of 6MHP or cyclophosphamide
Population: All 48 participants , including 47 on part 1 and 1 on part 2.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm A:6MHP + Montanide ISA-51 | Number of Participants With Adverse Events | 0 participants |
| Arm B:6MHP + Montanide ISA-51 + Cyclophosphamide | Number of Participants With Adverse Events | 1 participants |
| Arm C:6MHP + polyICLC + Montanide ISA-51 | Number of Participants With Adverse Events | 0 participants |
| Arm D:6MHP + polyICLC + Montanide ISA-51 + Cyclophosphamide | Number of Participants With Adverse Events | 2 participants |
Secondary
Immunogenicity-CD8+ T Cell Responses
CD8+ T cell responses to defined melanoma antigens
Time frame: through day 85
Population: Data were not collected for this endpoint. Funding for this trial has ended.