Immunization With the MAGE-3.A1 Peptide Mixed With the Adjuvant CpG 7909 in Patients With Metastatic Melanoma

Phase 1

Terminated

Brief Summary: The purposes of this study are to determine whether immunization with the MAGE-3.A1 peptide mixed with CpG 7909 results in a detectable immune response; to determine the safety of this vaccine and to document the tumor response to the vaccine.

Detailed Description: Patients will be vaccinated every two weeks on six occasions. On each vaccination day, the MAGE-3.A1 peptide (300 µg) mixed with CpG 7909 (5 mg) will be administered twice intradermally (10% of the dose each) and twice subcutaneously (40% of the dose each) in the arms and thighs.

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.

Additional cycles of immunization 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 with the same vaccine, 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 study withdrawal.

Recruitment & Eligibility

Inclusion Criteria

Histologically proven cutaneous melanoma, or clear cell sarcoma, which is considered as a subtype of melanoma.
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.
Patients must be HLA-A1.
Melanoma must express the MAGE-3 gene, as determined by RT-PCR.
Presence of at least one measurable or non-measurable tumor lesion, excluding leptomeningeal metastasis.
Expected survival of at least 3 months.
Karnofsky performance scale ≥70 or WHO performance status of 0 or 1.
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 creatinine ≤ 2.0 mg/dl or ≤ 177 µmol/l
- Serum bilirubin ≤ 2.0 mg/dl or ≤ 34.2 µmol/l
- ASAT and ALAT ≤ 2 x the normal upper limits
- LDH ≤ the normal upper limit.
Viral tests:
- HIV (human immunodeficiency virus): negative antibodies.
- HBV (hepatitis B virus): negative antigens; antibodies may be positive.
- HCV (hepatitis C virus): negative antibodies.
Age ≥ 18 years.
Able and willing to give valid written informed consent.

Exclusion Criteria

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).
Previous treatment with a vaccine known or likely to contain the MAGE-3.A1 antigen, unless there is evidence that no CTL response against this antigen was induced by the vaccine.
Clinically significant heart disease 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).
Active immunodeficiency or autoimmune disease. Vitiligo is not an exclusion criterion.
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.
Other malignancy within 3 years prior to entry into the study, except for treated non-melanoma skin cancer and cervical carcinoma in situ.
Lack of availability for immunological and clinical follow-up assessments.
Participation in any other clinical trial involving another investigational agent within 4 weeks prior to enrollment.
Pregnancy or breastfeeding.
Women of childbearing potential: Refusal or inability to use effective means of contraception.

Arm && Interventions

Group	Intervention	Description
MAGE-3.A1 Peptide mixed with CpG 7909	MAGE-3.A1 peptide and CpG 7909	Patients were vaccinated every two weeks on six occasions. On each vaccination day, the MAGE-3.A1 peptide (300 mcg) mixed with CpG 7909 (5 mg) was administered twice intradermally (10% of the dose each) and twice subcutaneously (40% of the dose each) in the arms and thighs.

Primary Outcome Measures

Name	Time	Method
Number of Patients With a Detectable Cytolytic T Lymphocyte (CTL) Response Following Immunization With the MAGE-3.A1 Peptide Mixed With CpG 7909.	Up to 12 weeks	Blood samples were collected prior to treatment and in weeks 3, 7, and 13. Specific CTL responses directed against the MAGE-3.A1 antigen were to be assessed by using restimulation in vitro, followed by staining with the A1/MAGE-3 tetramer and cloning of the tetramer-positive lymphocytes (MLPC/tetramer/cloning assay).

Secondary Outcome Measures

Name	Time	Method
To Determine the Clinical Effectiveness of the Treatment by Measuring Tumor Response in Patients With Measurable Disease.	up to 12 weeks	Computed tomography (CT) scans were performed at screening, and at week 13. Response was assessed using RECIST version 1.0 (Therasse et al, J Natl Cancer Inst 2000; 92:205-16). Per RECIST, target lesions are categorized as follows: complete response (CR): disappearance of all target lesions (no evaluable disease); partial response (PR): ≥ 30% decrease in the sum of the longest diameter of target lesions; progressive disease (PD): ≥ 20% increase in the sum of the longest diameter of target lesions; stable disease (SD): small changes that do not meet above criteria.
To Determine the Safety of the Treatment by Measuring the Number of Patients With Dose Limiting Toxicities (DLT)	up to 12 weeks	All adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) Scale, version 3.0. DLT was defined as: * Any Grade 3 hematological or non-hematological toxicity other than skin or flu-like symptoms. * Any Grade 4 toxicity. To be dose-limiting, an adverse event must be definitely, probably, or possibly related to the administration of MAGE-3.A1 peptide mixed with CpG 7909.