Anti-gp100 Cells Plus ALVAC gp100 Vaccine to Treat Advanced Melanoma

• Status: Terminated
• Trial end date: 2011-02-01
• Target enrollment: 0
• Participant gender: All

Summary

Background:

• gp100 is a protein that is often found in melanoma tumors.

• An experimental procedure developed for treating patients with melanoma uses anti-gp100 cells designed to destroy their tumors. The anti-gp100 cells are created in the laboratory using the patient's own tumor cells or blood cells.

• The treatment procedure also uses a vaccine called plaque purified canarypox vector (ALVAC) gp100, made from a virus that ordinarily infects canaries and is modified to carry a copy of the gp100 gene. The virus cannot reproduce in mammals, so it cannot cause disease in humans. When the vaccine is injected into a patient, it stimulates cells in the immune system that may increase the efficiency of the anti gp 100 cells.

Objectives:

-To evaluate the safety and effectiveness of anti-gp100 cells and the ALVAC gp100 vaccine in treating patients with advanced melanoma.

Eligibility:

-Patients with metastatic melanoma for whom standard treatments have not been effective.

Design:

• Patients undergo scans, x-rays and other tests and leukapheresis to obtain white cells for laboratory treatment.

• Patients have 7 days of chemotherapy to prepare the immune system for receiving the gp100 cells.

• Patients receive the ALVAC vaccine, anti-gp100 cells and interleukin-2 (IL-2) (an approved treatment for advanced melanoma). The anti gp100 cells are given as an infusion through a vein. The vaccine is given as injections just before the infusion of gp100 cells and again 2 weeks later. IL-2 is given as a 15-minute infusion every 8 hours for up to 5 days after the cell infusion for a maximum of 15 doses.

• After hospital discharge, patients return to the clinic for periodic follow-up with a physical examination, review of treatment side effects, laboratory tests and scans every 1 to 6 months.

• Phase: Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: National Cancer Institute (NCI)
• Treatments: Aldesleukin; Cyclophosphamide; Fludarabine; Fludarabine phosphate; Vaccines

Criteria

-INCLUSION CRITERIA:

1. Metastatic melanoma with measurable disease.

2. Previously received high dose interleukin-2 (IL-2) and have been either non-responders (progressive disease) or have recurred.

3. Positive for gp100 by immunohistochemistry (IHC) which will be reviewed by the Laboratory of Pathology at National Cancer Institute (NCI).

4. Tumor infiltrating lymphocyte (TIL) cells not available for treatment on other Surgery Branch protocols.

5. Greater than or equal to 18 years of age.

6. Willing to sign a durable power of attorney.

7. Able to understand and sign the Informed Consent Document.

8. Clinical performance status of Eastern Oncology Oncology Group (ECOG) 0 or 1.

9. Life expectancy of greater than three months.

10. Patients of both genders must be willing to practice birth control for four months after receiving the preparative regimen.

11. Must be human leukocyte antigens (HLA-A) 0201 positive.

12. Serology:

• Seronegative for human immunodeficiency virus (HIV) antibody. (The experimental treatment being evaluated in this protocol-depends on an intact immune system. Patients who are HIV seropositive can have decreased immune -competence and thus be less responsive to the experimental treatment and more susceptible to its toxicities.)

• Seronegative for hepatitis B antigen and hepatitis C antibody unless antigen negative.

13. Hematology:

• Absolute neutrophil count greater than 1000/mm^3.

• White blood cell (WBC) (greater than 3000/mm^3).

• Platelet count greater than 100,000/mm^3.

• Hemoglobin greater than 8.0 g/dl.

14. Chemistry

• Serum alanine aminotransferase (ALT)/aspartate aminotransferase (AST) less than or equal to 2.5 times the upper limit of normal.

• Serum creatinine less than or equal to 1.6 mg/dl.

• Total bilirubin less than or equal to 2.0 mg/dl, except in patients with Gilbert's Syndrome who must have a total bilirubin less than 3.0 mg/dl.

15. Women of child-bearing potential must have a negative pregnancy test because of the potentially dangerous effects of the preparative chemotherapy on the fetus.

16. More than four weeks must have elapsed since any prior systemic therapy at the time the patient receives the preparative regimen, and patients' toxicities must have recovered to a grade 1 or less (except for toxicities such as alopecia or vitiligo).

17. Six weeks must have elapsed since prior MDX-010 therapy to allow antibody levels to decline, and patients who have previously received MDX-010 or ticilimumab must have a normal colonoscopy with normal colonic biopsies.

EXCLUSION CRITERIA:

1. Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the preparative chemotherapy on the fetus or infant.

2. Active systemic infections, coagulation disorders or other major medical illnesses of the cardiovascular, respiratory or immune system, myocardial infarction, cardiac arrhythmias, obstructive or restrictive pulmonary disease.

3. Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease).

4. Ongoing opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system. Patients who have decreased immune competence may be less responsive to the experimental treatment and more susceptible to its toxicities).

5. Systemic steroid therapy.

6. History of severe immediate hypersensitivity reaction to any of the agents used in this study.

7. History of coronary revascularization.

8. Documented left ventricular ejection fraction (LVEF) of less than 45 percent in patients with:

• Clinically significant atrial and/or ventricular arrhythmias including but not limited to: atrial fibrillation, ventricular tachycardia, 2 degree or 3 degree heart block.

• Age greater than or equal to 60 years old.

9. Documented forced expiratory volume in 1 second (FEV1) less than or equal to 60 percent predicted for patients with:

• A prolonged history of cigarette smoking (greater than 20 pack/year within the past 2 years).

• Symptoms of respiratory distress.