Ability of a Dendritic Cell Vaccine to Immunize Melanoma or Epithelial Cancer Patients Against Defined Mutated Neoantigens Expressed by the Autologous Cancer

Phase 2

Terminated

Conditions: Gastrointestinal Cancer
Pancreatic Cancer
Ovarian Cancer
Melanoma
Breast Cancer

Interventions: Biological: Peptide loaded dendritic cell vaccine

Registration Number: NCT03300843

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: Background:

Exomes are the parts of deoxyribonucleic acid (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.

Detailed Description: Background:

* 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. However negative selection in the thymus against these normal nonmutated antigens severely limits the ability to generate high avidity anti-cancer T cells. Such depletion can impair their antitumor activity and limit tumor elimination.

* The National Cancer Institute Surgery Branch (NCI SB) has developed a pipeline for the identification of immunogenic T cell epitopes derived from neoantigens.

* In recent studies, we identified the neoantigens recognized by tumor infiltrating lymphocytes (TIL) that mediated regression in patients with metastatic cancer. Using whole exome sequencing of a resected metastatic nodule followed by high throughput immunologic screening, we were able to demonstrate that tumor regressions were associated with the recognition by the administered TIL of unique somatic mutations that occurred in the 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.

Objectives:

-Primary objectives:

--To determine the clinical response rate in patients with metastatic melanoma or epithelial cancer who receive this DC vaccine

Eligibility:

* Age greater than or equal to 18 and less than or equal to 70 years

* Eastern Cooperative Oncology Group (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 peripheral blood mononuclear cells (PBMC).

Design:

* Patients with metastatic melanoma or epithelial cancer will undergo surgical resection of tumor followed by exome and ribonucleic acid (RNA) sequencing to identify expressed mutations (CONDUCTED UNDER THE National Cancer Institute Surgery Branch (NCI SB) COMPANION PROTOCOL 03-c-0277).

* 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 biweekly 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.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 1

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Peptide loaded dendritic cell vaccine	Peptide loaded dendritic cell vaccine	Peptide loaded dendritic cell vaccine on days 0, 14, 28, and 42

Primary Outcome Measures

Name	Time	Method
Percentage of Patients Who Had a Clinical Response (Complete Response (CR) + Partial Response (PR)) to Treatment	up to 6 months	Response was assessed by the RECIST v1.1. Complete Response is disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Partial Response is at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Serious and Non-serious Adverse Events	Date treatment consent signed to date off study, approximately 6 months and 11 days	Here is the count of participants with serious and non-serious adverse events assessed by the Common Terminology Criteria for Adverse Events (CTCAE v5.0). A non-serious adverse event is any untoward medical occurrence. A serious adverse event is an adverse event or suspected adverse reaction that results in death, a life-threatening adverse drug experience, hospitalization, disruption of the ability to conduct normal life functions, congenital anomaly/birth defect or important medical events that jeopardize the patient or subject and may require medical or surgical intervention to prevent one of the previous outcomes mentioned.
Number of Participants With 2-3 Fold Increase From Baseline in Reactivity to Circulating Antigen-specific T Cells to the Mutated Peptide Compared to the Non-mutated Peptide	Day 0, Day 14 (± 5 d), Day 28 (± 5 d), and Day 42 (± 5 d)	Enzyme-linked immunosorbent assay (ELISA) and enzyme-linked immune absorbent spot (ELISpot) assays assessed reactivity to the mutated peptide compared to the non-mutated peptide. Differences of 2-3 fold in these assays over the baseline measurement are indicative of true biologic differences.