Vaccine Therapy in Treating Patients With Refractory Metastatic Melanoma

Immunization Of HLA-A0201 or HLA-DPB104 Patients With Metastatic Melanoma Using Epitopes From The ESO-1 Antigen

RATIONALE: Vaccines may make the body build an immune response to kill tumor cells.

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

OBJECTIVES:

• Determine whether an immunologic response can be obtained after administration of ESO-1 peptide vaccine comprising class I , II, or both peptides in HLA-A*201 or HLA-DPB1*04 positive patients with refractory metastatic melanoma expressing ESO-1.
• Determine the toxicity of this vaccine in these patients.
• Determine whether prior immunization with this vaccine results in increased clinical responsiveness in patients treated with interleukin-2.

OUTLINE: Patients are assigned to 1 of 3 groups according to HLA type.

• Group 1 (HLA-A*201 and HLA-DPB1*04 positive): Patients receive ESO-1 peptide vaccine comprising class I (ESO-1:157-165 [165V]) and class II (ESO-1:161-180) peptides subcutaneously once every 3 weeks for 4 courses in the absence of disease progression or unacceptable toxicity.
• Group 2 (HLA-A*201 positive and HLA-DPB1*04 negative):Patients receive ESO-1 peptide vaccine as in group I comprising class I peptide only.
• Group 3 (HLA-A*201 negative and HLA-DPB1*04 positive):Patients receive ESO-1 peptide vaccine as in group I comprising class II peptide only.

Patients who develop disease progression discontinue vaccinations and receive high-dose interleukin (IL-2) IV over 15 minutes every 8 hours for up to 4 days (maximum of 12 doses). Treatment with IL-2 repeats every 10-14 days for 4 courses in the absence of disease progression (after at least 2 courses) or unacceptable toxicity.

Patients who have stable disease or a mixed or partial response to vaccination or IL-2 therapy may be eligible for additional vaccine therapy. Patients who have a complete response to vaccine therapy are eligible for 1 additional treatment.

Patients are followed at 3 weeks.

PROJECTED ACCRUAL: A total of 45-90 patients (15-30 per treatment group) will be accrued for this study within 1 year.

DISEASE CHARACTERISTICS:

• Diagnosis of metastatic melanoma that expresses ESO-1 antigen
• Must have progressed during prior standard treatment
• Measurable or evaluable disease
• HLA-A*201 or HLA-DPB1*04 positive

PATIENT CHARACTERISTICS:

Age:

• 16 and over

Performance status:

• ECOG 0-2

Life expectancy:

• More than 3 months

Hematopoietic:

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

Hepatic:

• SGOT and SGPT less than 3 times normal
• Bilirubin no greater than 1.6 mg/dL (3.0 mg/dL for patients with Gilbert's syndrome)
• Hepatitis B surface antigen negative

Renal:

• Creatinine no greater than 2.0 mg/dL

Cardiovascular:

• No cardiac ischemia*
• No myocardial infarction*
• No cardiac arrhythmias* NOTE: *For interleukin-2 (IL-2) administration

Pulmonary:

• No obstructive or restrictive pulmonary disease (for IL-2 administration)

Immunologic:

• No autoimmune disease
• No active primary or secondary immunodeficiency
• HIV negative
• No active systemic infections

Other:

• Not pregnant
• Negative pregnancy test
• Fertile patients must use effective contraception
• No other active major medical illness (for IL-2 administration)

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• No prior ESO-1 immunization

Chemotherapy:

• Recovered from any prior chemotherapy

Endocrine therapy:

• No concurrent systemic steroid therapy

Radiotherapy:

• Recovered from any prior radiotherapy

Surgery:

• Not specified

Other:

• At least 3 weeks since any prior systemic therapy for cancer
• No other concurrent systemic therapy for cancer