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NY-ESO-1 Protein Vaccine With Imiquimod in Melanoma (Adjuvant Setting)

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.
 
ClinicalTrials.gov Identifier: NCT00142454
Recruitment Status : Completed
First Posted : September 2, 2005
Results First Posted : October 22, 2020
Last Update Posted : October 22, 2020
Sponsor:
Collaborator:
Cancer Research Institute (CRI)
Information provided by (Responsible Party):
Ludwig Institute for Cancer Research

Brief Summary:
This was a Phase 1, single-arm, open-label, pilot study of NY-ESO-1 protein vaccination with imiquimod as an adjuvant in patients with resected Stage IIB, IIC, and III malignant melanoma. The primary study objective was to determine the safety of NY-ESO-1 protein/imiquimod treatment, and the secondary objective was to evaluate the immunogenicity of treatment.

Condition or disease Intervention/treatment Phase
Malignant Melanoma Drug: Imiquimod Biological: NY-ESO-1 protein Phase 1

Detailed Description:

Patients applied imiquimod (250 mg) topically to a designated area of healthy skin on the upper inner arm or inner thigh (the cream remained on the skin overnight for 6-10 hours) every day for 5 consecutive days (i.e., for the first 5 days of Cycles 1-3 and for the first 4 days of Cycle 4). The NY-ESO-1 protein (100 μg) was injected intradermally into the imiquimod-pretreated area on Day 3 of each cycle for 4 consecutive 21-day cycles.

Safety was monitored continuously. Immunization was assessed by the generation of NY-ESO-1-specific cluster of differentiation (CD)4+ and CD8+ T cell responses in enzyme-linked immunosorbent spot (ELISPOT) assays and by the development or augmentation of NY-ESO-1-specific antibody titers, assessed by enzyme-linked immunosorbent assay (ELISA).

Blood samples were obtained for the assessment of clinical biochemistry and hematology, and physical examinations were performed at baseline, on Day 1 of each cycle, and at a follow-up visit at Week 13.

Skin biopsies of the vaccinated area were obtained 48 hours after the last injection (Day 5 of Cycle 4). To avoid irritation, imiquimod was not applied after the biopsies.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: NY-ESO-1 Protein Vaccination in Malignant Melanoma Administered With Imiquimod as Adjuvant
Actual Study Start Date : August 24, 2005
Actual Primary Completion Date : April 25, 2006
Actual Study Completion Date : April 25, 2006

Resource links provided by the National Library of Medicine

MedlinePlus Genetics related topics: Melanoma
MedlinePlus related topics: Melanoma Vaccines
Drug Information available for: Imiquimod

Arm Intervention/treatment
Experimental: Imiquimod + NY-ESO-1
Patients applied topical imiquimod followed by vaccination with intradermal injections of the NY-ESO-1 protein.
Drug: Imiquimod
Patients applied imiquimod cream at bedtime every day for 5 consecutive days (for the first 5 days of Cycles 1-3 and for the first 4 days of Cycle 4) at a dose of 250 mg as supplied in single-use packets to a 4 x 5 cm area of healthy skin, alternating among the extremities (upper inner arms and inner thighs) in each cycle. The cream was to be rubbed into the skin until it was no longer visible. Patients were encouraged to wash their hands before and after applying cream. The application site was not occluded. The next morning, 6 to 10 hours after initial application, the treated area was washed with mild soap and water to remove any residual cream.
Other Name: Aldara

Biological: NY-ESO-1 protein
NY-ESO-1 protein was injected intradermally by a study physician or nurse at a dose of 100 μg into the imiquimod-pretreated area on Day 3 of each cycle for 4 consecutive 21-day cycles.




Primary Outcome Measures :
  1. Number of Patients With Treatment-emergent Adverse Events (TEAEs) [ Time Frame: Up to 4 months ]
    Toxicity was graded in accordance with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 3.0, as follows: Grade 1 (mild), Grade 2 (moderate), Grade 3 (severe), Grade 4 (life-threatening), and Grade 5 (fatal). Adverse events (AEs) were reported based on clinical laboratory tests, vital sign and weight measurements, physical examinations, performance status evaluations, and any other medically indicated assessments, including patient interviews, from the time informed consent was signed through the last follow-up visit. AEs were considered to be treatment emergent (TEAE) if they occurred or worsened in severity after the first dose of study treatment.


Secondary Outcome Measures :
  1. Number of Patients With Cellular Antibody Response to NY-ESO-1 at Two or More Post-vaccination Time Points [ Time Frame: Up to 4 months ]
    Assays to assess cluster of differentiation (CD)8+ and CD4+ antigen-specific responses were performed at baseline (Cycle 1 Day 1), throughout the vaccination period (Day 1 of Cycles 2 through 4 and Day 10 of each cycle), and at the 2 post-treatment follow-up visits (Weeks 13 and 16) by enzyme-linked immune absorbent spot (ELISPOT) assay following prior in vitro sensitization. A 3-fold increase in spot-forming cells over baseline defined a positive response. Suitable antigens may have included recombinant viral vectors encoding NY-ESO-1, or NY-ESO-1 overlapping peptides, depending upon availability.

  2. Number of Patients With Humoral Antibody Response to NY-ESO-1 [ Time Frame: Up to 4 months ]
    Assays to assess NY-ESO-1 specific antibodies were performed at baseline (Cycle 1 Day 1), throughout the vaccination period (Day 1 of Cycles 2 through 4 and Day 10 of each cycle), and at the 2 post-treatment follow-up visits (Weeks 13 and 16) by enzyme-linked immunosorbent assay (ELISA). Samples were diluted serially. The induction and augmentation of immunity were defined as an increase in antibody titer of ≥ 3× over buffer alone or ≥ 4× the pre-vaccination titer, respectively. Sera from the responding patients were tested a second time against a pool of NY-ESO-1 overlapping peptides to confirm NY-ESO-1 specificity; the number of patients in the table reflect the patients with confirmed NY-ESO-1 specificity.



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

Inclusion Criteria:

  • Had histologically confirmed, resected American Joint Committee on Cancer Stage IIB, IIC or III malignant melanoma
  • Fully recovered from surgery
  • Age ≥ 18 years; children were excluded from this study, as the safety of imiquimod had not been established in patients below the age of 18
  • Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2
  • Adequate organ and marrow function as defined below:

    • absolute neutrophil count: ≥ 1500/μL
    • hemoglobin: ≥ 9 g/dL
    • platelets: ≥ 100,000/μL
    • total bilirubin: ≤ 1.5 × institutional upper limit of normal (ULN)
    • aspartate aminotransferase/alanine aminotransferase (AST/ALT): ≤ 2.5 × institutional ULN
    • creatinine: ≤ 1.5 × institutional ULN
  • Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

  • Received chemotherapy, immunotherapy (including interferon), or radiotherapy within 4 weeks prior to first dosing of study agent
  • Prior treatment with NY-ESO-1 vaccines
  • Known human immunodeficiency virus infection or autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus), as these conditions could have interfered with the evaluation of the induced immune response; patients with vitiligo or melanoma-associated hypopigmentation were not excluded
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to imiquimod or other agents used in the study
  • 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 have limited compliance with study requirements
  • Pregnancy or lactation
  • Women of childbearing potential not using a medically acceptable means of contraception
  • Known history of inflammatory skin disorders, as imiquimod might have exacerbated these conditions
  • Chronic corticosteroid or immunosuppressive therapies, as these might have interfered with the evaluation of the induced immune response
  • Lack of availability for immunological and clinical follow-up assessments

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 ClinicalTrials.gov identifier (NCT number): NCT00142454


Locations
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United States, New York
NYU Cancer Institute
New York, New York, United States, 10016
Sponsors and Collaborators
Ludwig Institute for Cancer Research
Cancer Research Institute (CRI)
Investigators
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Principal Investigator: Nina Bhardwaj, MD, PhD NYU Langone Health
Study Director: Sylvia Adams, MD NYU Langone Health
Publications of Results:
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Responsible Party: Ludwig Institute for Cancer Research
ClinicalTrials.gov Identifier: NCT00142454    
Other Study ID Numbers: LUD2004-006
NYU 04-53 ( Other Identifier: New York University )
First Posted: September 2, 2005    Key Record Dates
Results First Posted: October 22, 2020
Last Update Posted: October 22, 2020
Last Verified: September 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Ludwig Institute for Cancer Research:
Malignant melanoma
Stages IIB-III
Additional relevant MeSH terms:
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Melanoma
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Nevi and Melanomas
Imiquimod
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents
Interferon Inducers