Active Specific Intranodal Immunotherapy of Recombinant Vaccinia Virus in Locally Advanced to Metastatic Melanoma

This study has been completed.
Sponsor:
Information provided by:
University Hospital, Basel, Switzerland
ClinicalTrials.gov Identifier:
NCT00116597
First received: June 29, 2005
Last updated: December 1, 2009
Last verified: December 2009
  Purpose

The purpose of this study is to assess intranodal immunotherapy in locally advanced to metastatic melanoma patients (American Joint Committee on Cancer [AJCC] stages IIb to IV).

For this, the investigators capitalize on their previous melanoma clinical trial (published by Zajac P et al in Human Gene Ther 2003) and take advantage of a proprietary recombinant vaccinia virus (replication inactivated) expressing 5 minigenes: 3 melanoma associated antigens and 2 costimulatory molecules. Immunization with the recombinant vaccinia virus is followed by 3 boosts with soluble, synthetic melanoma associated antigens.

The patients are immunized intranodally (groin lymph node) under ultrasonographic guidance in an outpatient clinic. The protocol foresees 2 cycles of immunotherapy for alternate weeks and lasts 15 weeks.


Condition Intervention Phase
Melanoma
Genetic: Intranodal immunization with a recombinant vaccinia virus expressing 5 transgenes
Biological: Intranodal booster immunizations with synthetic melanoma associated epitopes
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Active Specific Intranodal Immunotherapy With a Recombinant Vaccinia Virus Expressing Three Melanoma Associated Epitopes and Two Costimulatory Molecules, Followed by Immunization With Synthetic Melanoma Associated Epitopes. A Phase I/II Trial in Patients With Stages IIb to IV Melanoma

Resource links provided by NLM:


Further study details as provided by University Hospital, Basel, Switzerland:

Primary Outcome Measures:
  • Safety evaluation
  • Clinical response
  • Immune response assessment

Secondary Outcome Measures:
  • Survival (disease-free survival [DFS], overall survival [OS])
  • Dose adaptation

Enrollment: 15
Study Start Date: November 2002
Study Completion Date: December 2008
Primary Completion Date: July 2007 (Final data collection date for primary outcome measure)
Detailed Description:

The investigators have conducted a phase I/II clinical trial based on the intradermal administration to stage III/IV melanoma patients of a recombinant vaccinia virus encoding tumor associated antigens and costimulatory epitopes for the priming of immune responses, followed by boosts with corresponding synthetic peptides (Zajac P et al in Human Gene Ther 2003). Specific cytotoxic T cells could be induced in a majority of patients following priming, but sustained responsiveness could not be maintained by peptide boosting on a long term basis. Emerging evidence supports the notion that expansion of specific T cells requires trafficking of antigen presenting cells loaded with specific determinants to lymphatic nodes, as induced, among others, by pro-inflammatory stimuli. Therefore, we now adopt the intranodal injection of the immunogenic formulations. As for the former melanoma active specific immunotherapy trial, GM-CSF is used as a supporting cytokine. The epitopes considered are expressed, either all or some of them, in over 90% of the melanomas in Western countries; namely, we immunize with Mart-1/Melan-A epitope 27-35, Gp-100 epitope 280-288 and tyrosinase epitope 1-9. As a consequence, HLA-A2 positivity is mandatory for inclusion in the trial. The 2 costimulatory molecules expressed by cells infected with our replication-incompetent recombinant vaccinia virus are B7.1 (CD80) and B7.2 (CD86).

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients older than 18 years
  • Histologically proven melanoma in AJCC stages IIb to IV
  • Resected, recurrent or disseminated disease
  • HLA-A2.1 MHC phenotype
  • Karnofsky performance status equal or higher than 70%

Exclusion Criteria:

  • Patients younger than 18 years
  • Pregnancy or inability to perform anticonception
  • MHC phenotype other than HLA-A2.1
  • Other concurrent malignant disease
  • Estimated life expectancy of less than 6 months
  • Allergic skin diseases, including eczema, psoriasis and neurodermitis
  • Fever or active infection of the respiratory system
  • Concurrent severe cardiac or pulmonary disease (New York Heart Association [NYHA] III and IV)
  • Significant impairment of liver or kidney function (bilirubin > 30umol/l, GOT >2.5xN, GPT >2.5xN, alkaline phosphatase >2.5xN, creatinine >1.5xN adapted to the age)
  • Impairment of the immune system (leucocyte counts <3000/mm3 or granulocytes counts <1500/mm3)
  • Concurrent immunosuppressive therapy
  • Preexisting severe anemia (hemoglobin lower than 80 g/l)
  • Preexisting thrombocytopenia (platelet counts lower than 75,000/ul)
  • Ongoing chemotherapy or chemotherapy completed less than 6 weeks before enrollment in the trial
  • Any medical or psychiatric condition which, in the opinion of the treating physician or principal investigator, would unacceptably reduce the safety of the proposed treatment, would impair the delivery of treatment, or would preclude obtaining voluntary informed consent
  • Patients receiving any other concurrent investigational treatment, or any other concurrent treatment for their cancer
  • Patients who cannot avoid close contact with children less than 3 years of age or with immunocompromised household members
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00116597

Locations
Switzerland
University Hospital Basel
Basel, Switzerland, 4031
Sponsors and Collaborators
University Hospital, Basel, Switzerland
Investigators
Principal Investigator: Michel Adamina, M.D. University Hospital, Basel, Switzerland
Study Chair: Daniel Oertli, M.D. University Hospital, Basel, Switzerland
Study Director: Michael Heberer, M.D. University Hospital, Basel, Switzerland
Principal Investigator: Giulio C Spagnoli, M.D. University Hospital, Basel, Switzerland
Principal Investigator: Walter R Marti, M.D. University Hospital, Basel, Switzerland
  More Information

Additional Information:
Publications:

Responsible Party: Michel Adamina, M.D., P.D., M.Sc., University Hospital Basel
ClinicalTrials.gov Identifier: NCT00116597     History of Changes
Other Study ID Numbers: GT1999017/05.050, SNF grant NPF 37 4037-55151
Study First Received: June 29, 2005
Last Updated: December 1, 2009
Health Authority: Switzerland: Swissmedic

Keywords provided by University Hospital, Basel, Switzerland:
Active Specific Immunotherapy
Intranodal
Cancer
Melanoma stages IIb to IV
Gene Therapy
Recombinant Vaccinia virus
HLA-A2
Mart-1/Melan-A, Gp-100, tyrosinase
Clinical Trial
Phase I/II

Additional relevant MeSH terms:
Melanoma
Vaccinia
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Nevi and Melanomas
Poxviridae Infections
DNA Virus Infections
Virus Diseases

ClinicalTrials.gov processed this record on October 01, 2014