A vaccine for one of the most lethal cancers, advanced melanoma, has shown improved response rates and progression-free survival for patients when combined with the immunotherapy drug, Interleukin-2, according to researchers from The University of Texas M. D. Anderson Cancer Center.
The findings, presented today at the American Society of Clinical Oncology (ASCO), mark the first vaccine study in the disease - and one of the first in cancer overall - to show clinical benefit in a randomized Phase III clinical trial. Patrick Hwu, M.D., professor and chair of M. D. Anderson's Department of Melanoma Medical Oncology, presented the findings on ASCO's press program.
According to the American Cancer Society, melanoma has one of the fastest growing incidence rates of all cancers. In 2009, more than 68,720 people in the U.S. are projected to be diagnosed with melanoma and 8,650 will likely die from the disease. The five-year survival rates for those with regional and metastatic disease are 65 percent and 16 percent, respectively.
"Obviously, this is a disease, in its advanced setting, in need of better therapies for our patients," said Hwu, a co-investigator on the study. "While more follow up is needed, this study serves as a proof-of-principle for vaccines' role in melanoma and in cancer therapy overall. If we can use the body's own defense system to attack tumor cells, we provide a mechanism for ridding the body of cancer without destroying healthy tissue."
During their tenure at the National Cancer Institute (NCI), Hwu and Douglas Schwartzentruber, M.D., who is currently medical director of the Goshen Center for Cancer Care, were involved in the vaccine's development and early basic and clinical studies. The peptide vaccine, known as gp100:209-217 (200M), works by stimulating patients' T cells, known for controlling immune responses.
"This vaccine activates the body's cytotoxic T cells to recognize antigens on the surface of the tumor. The T cells then secrete enzymes that poke holes in the tumor cell's membrane, causing it to disintegrate," explained Hwu.
After an NCI-led Phase II study combining the vaccine with Interleukin-2 (IL-2) showed response rates of 42 percent in metastatic melanoma patients, a Phase III randomized trial with the two agents opened more than a decade ago.
Conducting a large, multi-institutional trial with IL-2, however, had its own set of unique challenges, explained Hwu, as not all cancer centers and community hospitals are capable of administering the immunotherapy. A highly specialized therapy associated with such significant side effects as low blood pressure and capillary leak syndrome, which poses risks to the heart and lung, IL-2 is often delivered in intensive care units. Just last month, M. D. Anderson opened a special in-patient unit exclusively designed for the drug's delivery; before, the institution was offering the therapy in its ICU.
In the Phase III trial, 185 patients at 21 centers across the country were enrolled in the study. All had advanced metastatic melanoma and were stratified for cutaneous metastasis, a known indicator of response to IL-2. Patients were randomized to receive either high dose IL-2, or IL-2 and vaccine. In the IL-2 arm, 94 patients were enrolled and 93 were treated and evaluated for response; 91 were enrolled and 86 treated and evaluated in the IL-2 and vaccine arm.
The study found that those who received the vaccine had a significant response rate, 22.1 percent, and progression-free survival, 2.9 months, compared to 9.7 percent and 1.6 months respectively in those that did not. While not statistically significant, the median overall survival for those receiving vaccine trended positive, 17.6 months vs. 12.8 months.
"This is one of the first positive, randomized vaccine trials in cancer and the findings represent a significant step forward for treatment of advanced melanoma," said Schwartzentruber, the study's lead author. "However, we've learned a lot over the last decade, and we need to incorporate these new discoveries as we proceed with our validation of this vaccine."
Schwartzentruber, who with Hwu was involved in the earlier trials and the vaccine's development, will present the findings on ASCO's plenary session on May 30.
Hwu agreed that more research with the vaccine is needed, including long-term follow up of the Phase III patients, as well as researching ways to make the study inclusive of more metastatic melanoma patients.
"Right now, the vaccine only can be given to half of those with melanoma because it has to match a patient's tissue type, or HLA. A major priority for us is to figure out ways to broaden our approach and use mixtures of peptides so that more patients are eligible," Hwu said. "We also would like to improve upon it by including other immune-stimulatory agents, such as anti-CTLA4, an antibody that can take the breaks off the immune cells."
The study was funded, in part, by the National Cancer Institute and Novartis, the makers of IL-2.
In addition to Hwu and Schwartzentruber, other collaborators on the study include: David Lawson, M.D., Winship Cancer Institute; Jon Richards, M.D., Ph. D., Lutheran General Hospital Cancer Care Center; and Robert M. Conry, M.D., UAHSF Comprehensive Cancer Center.
About M. D. Anderson
The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For four of the past six years, including 2008, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News & World Report.
Laura Sussman | EurekAlert!
Penn studies find promise for innovations in liquid biopsies
30.03.2017 | University of Pennsylvania School of Medicine
'On-off switch' brings researchers a step closer to potential HIV vaccine
30.03.2017 | University of Nebraska-Lincoln
The Institute of Semiconductor Technology and the Institute of Physical and Theoretical Chemistry, both members of the Laboratory for Emerging Nanometrology (LENA), at Technische Universität Braunschweig are partners in a new European research project entitled ChipScope, which aims to develop a completely new and extremely small optical microscope capable of observing the interior of living cells in real time. A consortium of 7 partners from 5 countries will tackle this issue with very ambitious objectives during a four-year research program.
To demonstrate the usefulness of this new scientific tool, at the end of the project the developed chip-sized microscope will be used to observe in real-time...
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
30.03.2017 | Health and Medicine
30.03.2017 | Health and Medicine
30.03.2017 | Medical Engineering