Ability of a Dendritic Cell Vaccine to Immunize Melanoma or Epithelial Cancer Patients Against Defined Mutated Neoantigens Expressed by the Autologous Cancer
Background: Exomes are the parts of DNA that make proteins. Researchers are finding a way to read the letters in the exome. Incorrect letters are called mutations. Tumors contain specific mutations. Researchers can find these mutations in tumors to make treatments. Researchers want to use pieces of participants tumors to find the tumor-specific mutations. They also will take participants white blood cells to make a vaccine that they hope will shrink the tumors. Objectives: To see if dendritic vaccine tumor-fighting cells are safe and can cause certain cancer tumors to shrink. Eligibility: Adults ages 18-70 who have metastatic melanoma or metastatic epithelial cancer Design: The first part of this study was done under protocol 03-C-0277. In that study, white blood cells and pieces of participants tumors were taken to make a vaccine. In this study, participants will get a vaccine every 2 weeks for 8 weeks. It will be given both in a vein and under the skin. At each visit, participants will have a physical exam and have blood taken. They will talk about any side effects they have. After treatment ends, participants will have many follow-up visits for the first year, then once each year after that. Visits will last up to 2 days each. They will include lab tests, imaging studies, and a physical exam. Blood will be taken at each visit. At the first follow-up visit, participants may have leukapheresis, which they also had as part of protocol 03-C-0277. Participants may not have to return to the Clinical Center for these visits.
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes.
An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes.
|Eligible Ages||18 Years - 70 Years|
INCLUSION CRITERIA:- Metastatic melanoma or epithelial cancer with at least one lesion that is resectable or in selected cases, available PBMCs - Measurable and evaluable metastatic disease per RECIST 1.1 criteria - Confirmation of the diagnosis of metastatic cancer by the Laboratory of Pathology of NCI.
- - All patients must be refractory to approved standard systemic therapy.
- - Patients with 3 or fewer brain metastases that are less than 1 cm in diameter and asymptomatic are eligible.
- - Prior therapy with at least one first-line standard therapy.
- - Greater than or equal to 18 years of age and less than or equal to 70 years of age.
- - Clinical performance status of ECOG 0, 1, 2 - Patients of both genders must be willing to practice birth control from the time of enrollment on this study and for up to four months after treatment.
- - Serology: - Seronegative for HIV antibody.
- - Seronegative for hepatitis B antigen, and seronegative for hepatitis C antibody.
- - Hematology - Absolute neutrophil counts greater than 1000/mm3 without the support of filgrastim - WBC greater than or equal to 3000/mm3 - Platelet count greater than or equal to 100,000/mm3 - Hemoglobin > 8.0 g/dl - CD4 count > 200/uL - Chemistry: - Serum ALT/AST less than or equa 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 1.5 mg/dl, except in patients with Gilbert s Syndrome who must have a total bilirubin less than 3.0 mg/dl.
- - More than four weeks must have elapsed since any prior systemic therapy at the time the patient receives the vaccine, and patients toxicities must have recovered to a grade 1 or less (except for toxicities such as alopecia or vitiligo).
- - Ability of subject to understand and the willingness to sign a written informed consent document.
- - Subjects must be co-enrolled in protocol 03-C-0277.
- - Women of child-bearing potential who are pregnant or breastfeeding because of the potentially dangerous effects of the treatment on the fetus or infant.
- - Any form of primary immunodeficiency (such as Severe Combined Immunodeficiency Disease).
- - Concurrent opportunistic infections (The experimental treatment being evaluated in this protocol depends on an intact immune system.
- - Active systemic infections (for e.g.: requiring anti-infective treatment), coagulation disorders or any other active major medical illnesses.
- - Patients who are receiving any other investigational agents.
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.
Phase 0: Exploratory study involving very limited human exposure to the drug to determine whether a drug is modulating its target.
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans.
Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data.
Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs.
Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.
|National Cancer Institute (NCI)|
Category of organization(s) involved as sponsor (and collaborator) supporting the trial.
|Overall Status||Not yet recruiting|
The disease, disorder, syndrome, illness, or injury that is being studied.
|Melanoma, Gastrointestinal Cancer, Breast Cancer, Ovarian Cancer, Pancreatic Cancer|
|Study Website:||View Trial Website|
- - Therapeutic vaccination against cancer has proven very challenging with little clinical benefit.
- - Vaccines against non-viral tumors have mainly targeted differentiation antigens, cancer testis antigens, and overexpressed antigens.
- - The Surgery Branch of the National Cancer Institute has developed a pipeline for the identification of immunogenic T cell epitopes derived from neoantigens.
- - In recent studies, we identified the neoantigens recognized by TIL that mediated regression in patients with metastatic cancer.
- - We, therefore, aim to use this pipeline to identify immunogenic neoantigens from epithelial cancer patients and to use these defined epitopes for a personalized therapeutic dendritic cell (DC) vaccine.
- - Age greater than or equal to 18 and less than or equal to 70 years - ECOG 0 - 2 - Evaluable metastatic melanoma or epithelial cancer refractory to standard treatment - Metastatic melanoma or epithelial cancer lesion(s) that is resectable for TIL or in selected cases, available PBMC.
- - Patients with metastatic melanoma or epithelial cancer will undergo surgical resection of tumor followed by exome and RNA sequencing to identify expressed mutations.
- - Patients will undergo apheresis and DC will be cryopreserved for vaccine preparation.
- - Immunogenic neoantigens will be identified from TIL and PBMC by high throughput immunologic screening using long peptides and tandem minigenes covering all mutated epitopes.
- - Patient will be vaccinated with autologous mature dendritic cells loaded with long peptides and minimal epitopes from defined neoantigens or highly expressed mutations in tumor suppressor or driver genes.
- - DC will be administered intravenously and subcutaneously for four cycles at two week intervals.
- - Blood samples will be taken every two weeks, and patients will be monitored for the quantity and quality of circulating neoantigen-specific T cells.
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