Vaccine Therapy in Treating Patients With Melanoma

Randomized Comparison of Three Schedules of Peptide Immunization in Patients With Stage II or III, or Completely Resected Metastatic Melanoma

RATIONALE: Vaccines may make the body build an immune response to kill tumor cells. Vaccine therapy may be an effective treatment for melanoma.

PURPOSE: Randomized phase II trial to study the effectiveness of three vaccine therapy regimens in treating patients who have melanoma.

OBJECTIVES:

• Compare the immunologic activity of three different schedules of peptide immunization with gp100:209-217 (210M) or gp100:17-25 antigen and tyrosinase:368-376 (370D), tyrosinase:240-251 (244S), tyrosinase:206-214 (closed to accrual 11/05/01), or tyrosinase-related protein-1 (ORF3):1-9 peptide (closed to accrual 11/05/01) emulsified in Montanide ISA-51 in patients with melanoma at high risk for recurrence.
• Compare the response rate to treatment with interleukin-2 (IL-2) after being immunized with this regimen with the usual response rate to IL-2 in this patient population.
• Determine whether an exploratory cohort of HLA-A2-positive patients demonstrate immunologic activity to immunization with 2 peptides emulsified together.

OUTLINE: This is a randomized study. Patients are stratified according to HLA type (A0201 vs A1 vs A3 vs A24 vs A31). (HLA-A24 and HLA-A31 closed to accrual 11/05/01). Patients are randomized to 1 of 3 treatment arms and are given an assigned vaccine, which is emulsified in Montanide ISA-51.

• HLA typing:

  • HLA-A2: gp100:209-217 (210M) and tyrosinase:368-376 (370D)
  • HLA-A1: tyrosinase:240-251 (244S)
  • HLA-A3: gp100:17-25
  • HLA-A24: tyrosinase:206-214 (closed to accrual 11/05/01)
  • HLA-A31: tyrosinase-related protein-1 (ORF3):1-9 (closed to accrual 11/05/01)

• Arm I: Patients receive assigned vaccine subcutaneously (SC) weekly for 10 weeks followed by 3 weeks of no treatment.

• Arm II: Patients receive assigned vaccine SC on days 1, 22, 43, and 64.

• Arm III: Patients receive assigned vaccine SC on days 1-4, 22-25, 43-46, and 64-67.

Treatment in all arms repeats every 13 weeks for 4 courses in the absence of disease progression or unacceptable toxicity.

After the completion of the randomized arms of HLA-A2 patients, additional HLA-A2 patients receive immunization with gp100:209-217 (210M) and tyrosinase:368-376 (370D) emulsified in Montanide ISA-51 SC once every 3 weeks for 4 courses.

Patients with progressive disease may receive interleukin-2 IV over 15 minutes every 8 hours for up to 4 days. Treatment repeats every 10-14 days for at least 4 courses in the absence of disease progression or unacceptable toxicity. Patients with stable disease or mixed or partial response to treatment may receive additional courses every 2 months.

Patients are followed at 6 months.

PROJECTED ACCRUAL: A total of 324 patients (19-33 per arm for the HLA-A0201 stratum, 13-16 per arm for the other 4 strata, and 33 per the additional HLA-A2 cohort) will be accrued for this study within 2 years. (HLA-A24 and HLA-A31 closed to accrual 11/05/01).

DISEASE CHARACTERISTICS:

• Diagnosis of melanoma, including one of the following characteristics:

  • Lesions at least 1.5 mm in thickness
  • At least 1 positive lymph node
  • Ulcerated lesion
  • Local recurrence
  • Metastatic lesions completely resected within the past 6 months

• Clinically disease free within the past 6 weeks

• HLA-A1, A3, A24, A31, or 0201 positive (HLA-A24 and HLA-A31 closed to accrual 11/05/01)

• No ocular or mucosal melanoma

PATIENT CHARACTERISTICS:

Age:

• 16 and over

Performance status:

• ECOG 0-1

Life expectancy:

• Not specified

Hematopoietic:

• WBC at least 3,000/mm^3
• Platelet count at least 90,000/mm^3

Hepatic:

• Bilirubin no greater than 1.6 mg/dL (3.0 mg/dL in Gilbert's syndrome)
• AST and ALT less than 3 times normal
• Hepatitis B surface antigen negative

Renal:

• Creatinine no greater than 2.0 mg/dL

Cardiovascular:

• For interleukin-2 (IL-2) therapy:

  • No cardiac ischemia, myocardial infarction, or cardiac arrhythmias
  • Stress cardiac test required if abnormal EKG, symptoms of cardiac ischemia or arrhythmia, or older than 50 years

Pulmonary:

• For IL-2 therapy:

  • No obstructive or restrictive pulmonary disease
  • FEV_1 greater than 60% predicted if prolonged history of cigarette smoking or symptoms of respiratory dysfunction

Other:

• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception
• HIV negative
• No active systemic infections, autoimmune disease, or active primary or secondary immunodeficiency

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• At least 3 weeks since prior systemic biologic therapy for melanoma
• No prior gp100 antigen or tyrosinase or TRP-1 peptide
• No other concurrent systemic biologic therapy for melanoma

Chemotherapy:

• At least 3 weeks since prior systemic chemotherapy and recovered
• No concurrent systemic chemotherapy for melanoma

Endocrine therapy:

• At least 3 weeks since prior systemic endocrine therapy for melanoma
• No concurrent systemic steroid therapy

Radiotherapy:

• At least 3 weeks since prior systemic radiotherapy and recovered
• No concurrent systemic radiotherapy for melanoma

Surgery:

• See Disease Characteristics