Immunization With 8 Peptides Mixed With Adjuvant Montanide ISA 51 in HLA-A2 Patients With Metastatic Cutaneous Melanoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00145158
Recruitment Status : Suspended (Availability of Investigational agent)
First Posted : September 5, 2005
Last Update Posted : June 22, 2009
Information provided by:
Ludwig Institute for Cancer Research

Brief Summary:
The purposes of this study are to describe the immune response to individual peptides after immunization with a combination of 8 peptides and Montanide ISA-51; to determine the safety of this vaccine and; to document the tumor response to the vaccine.

Condition or disease Intervention/treatment Phase
Malignant Melanoma Biological: 8 HLA-A2 restricted peptides and Montanide ISA-51 Phase 1 Phase 2

Detailed Description:

Patients will receive six sequential immunizations with 8 peptides presented by HLA-A2 and mixed with Montanide, at 2-week intervals. The 8 peptides will be injected at 8 distinct injection sites. These peptides are the following: MAGE-1.A2, MAGE-3.A2, MAGE-4.A2, MAGE-10.A2, MAGE-C2.A2 (ALKD), and NA17.A2 (20% intradermally and 80% subcutaneously); NY-ESO-1.A2 and Tyrosinase.A2 (100% subcutaneously).

300 µg of each peptide will be mixed with 0.5ml of Montanide.

Tumor staging will be performed before inclusion and at week 13. PBL collections will be performed before starting the treatment, and at weeks 3, 7 and 13. They will provide the T lymphocytes for the immunological analysis.

At week 13, the PCR results of the pre-immune tumor biopsy must be available. Additional cycles of immunization, ONLY with the peptides expressed by the tumor, mixed with Montanide, will be proposed to patients without tumor progression requiring another treatment. A second cycle of 3 injections at 6-week intervals will be started at week 17, followed by a third cycle of 12 injections at 3-month intervals, starting at month 11. At any time, progression of the disease necessitating any treatment not allowed during the study, will result in withdrawal.

The immune response may well be a limiting factor to the therapeutic efficacy of the vaccine. If this is the case, it then becomes crucial to understand why some patients develop a cytolytic T lymphocyte (CTL) response against the vaccine, while the majority of them does not so. One possible explanation for the low frequency of clinical responses is that each injection of a single peptide has a low probability to provide the adequate stimulus to activate very rare CTL precursors. This probability should be increased if several peptides known to be undoubtedly associated with tumor regressions were used together to immunize patients.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 28 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I/II Study of Immunization With Multiple Peptides Mixed With the Immunological Montanide ISA 51 in HLA-A2 Patients With Metastatic Cutaneous Melanoma
Study Start Date : January 2005
Estimated Primary Completion Date : March 2009
Estimated Study Completion Date : December 2009

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Melanoma

Primary Outcome Measures :
  1. - To describe the CTL response to individual peptides after immunization with a combination of 8 peptides and Montanide ISA-51.

Secondary Outcome Measures :
  1. To determine the safety of immunization with combination of 8 peptides and Montanide ISA-51.
  2. To document the tumor response to immunization with a combination of 8 peptides and Montanide ISA-51.
  3. To obtain initial information on the relationship, if any, of T cell response patterns and tumor expression of the corresponding genes.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria

  1. Histologically proven cutaneous melanoma, or clear cell sarcoma, which is considered as a subtype of melanoma.
  2. Melanoma must be at one of the following AJCC 2002 stages:

    • Regional metastatic disease (any T; N2b, N2c or N3; M0).
    • Distant metastatic disease (any T; any N; M1a, M1b or M1c), except brain or leptomeningeal localizations, and except elevated LDH.
  3. Patients must be HLA-A2.
  4. A pre-immune tumor biopsy must be kept frozen for post-study PCR analysis.
  5. Presence of at least one measurable or non-measurable tumor lesion.
  6. Expected survival of at least 3 months.
  7. Karnofsky performance scale ≥70 or WHO performance status of 0 or 1.
  8. Within the last 4 weeks prior to study day 1, vital laboratory parameters should be within normal range, except for the following laboratory parameters, which must be within the ranges specified:

    Lab Parameter Range

    • Hemoglobin ≥ 10 g/dl or ≥ 6,25 mmol/l
    • Granulocytes ≥ 1,500/µl
    • Lymphocytes ≥ 700/µl
    • Platelets ≥ 100,000/µl
    • Serum creatinin ≤ 2.0 mg/dl or ≤ 177 mmol/l
    • Serum bilirubin ≤ 2.0 mg/dl or ≤ 34.2 mmol/l
    • ASAT and ALAT ≤ 2 x the normal upper limits
    • LDH ≤ the normal upper limit.
  9. Viral tests:

    • HIV (human immunodeficiency virus): negative antibodies.
    • HBV (hepatitis B virus): negative antigens; antibodies may be positive.
    • HCV (hepatitis C virus): negative antibodies.
  10. Age ≥ 18 years
  11. Able and willing to give valid written informed consent.

Exclusion Criteria

  1. Previous treatment with more than one regimen of systemic chemotherapy, combined or not with non-specific immunotherapy such as interferon alpha or interleukins. Chemoimmunotherapy or radiotherapy must be stopped within the preceding 4 weeks (6 weeks for nitrosoureas and mitomycin C).
  2. Clinically significant heart disease (NYHA Class III or IV) i.e. NYHA class 3 congestive heart failure; myocardial infarction within the past six months; unstable angina; coronary angioplasty within the past 6 months; uncontrolled atrial or ventricular cardiac arrhythmias).
  3. Active immunodeficiency or autoimmune disease. Vitiligo is not an exclusion criterion.
  4. Other serious acute or chronic illnesses, e.g. active infections requiring antibiotics, bleeding disorders, or other conditions requiring concurrent medications not allowed during this study.
  5. Other malignancy within 3 years prior to entry into the study, except for treated non-melanoma skin cancer and cervical carcinoma in situ.
  6. Lack of availability for immunological and clinical follow-up assessments.
  7. Participation in any other clinical trial involving another investigational agent within 4 weeks prior to enrollment.
  8. Pregnancy or breastfeeding.
  9. Women of childbearing potential: Refusal or inability to use effective means of contraception.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00145158

Clinique Universitaires St-Luc
Brussels, Belgium, B-1200
Ludwig Institute for Cancer Research
Brussels, Belgium, B-1200
Sponsors and Collaborators
Ludwig Institute for Cancer Research
Study Chair: Nicolas VanBaren, MD Ludwig Institute for Cancer Research
Study Director: Thierry BOON, PhD Ludwig Institute for Cancer Research

Additional Information:
Publications: Identifier: NCT00145158     History of Changes
Other Study ID Numbers: LUD2003-007
First Posted: September 5, 2005    Key Record Dates
Last Update Posted: June 22, 2009
Last Verified: June 2009

Keywords provided by Ludwig Institute for Cancer Research:

Additional relevant MeSH terms:
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Nerve Tissue
Nevi and Melanomas
Freund's Adjuvant
Immunologic Factors
Physiological Effects of Drugs
Adjuvants, Immunologic