Combination of transient lymphodepletion with busulfan and fludarabine and peptide vaccination in a phase I clinical trial for patients with advanced melanoma.

Details

Serval ID
serval:BIB_1DFBEE45E211
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Combination of transient lymphodepletion with busulfan and fludarabine and peptide vaccination in a phase I clinical trial for patients with advanced melanoma.
Journal
Journal of Immunotherapy
Author(s)
Appay V., Voelter V., Rufer N., Reynard S., Jandus C., Gasparini D., Lienard D., Speiser D.E., Schneider P., Cerottini J.C., Romero P., Leyvraz S.
ISSN
1524-9557
Publication state
Published
Issued date
2007
Peer-reviewed
Oui
Volume
30
Number
2
Pages
240-250
Language
english
Notes
Publication types: Clinical Trial, Phase I ; Journal Article
Abstract
Taking advantage of homeostatic mechanisms to boost tumor-specific cellular immunity is raising increasing interest in the development of therapeutic strategies in the treatment of melanoma. Here, we have explored the potential of combining homeostatic proliferation, after transient immunosuppression, and antigenic stimulation of Melan-A/Mart-1 specific CD8 T-cells. In an effort to develop protocols that could be readily applicable to the clinic, we have designed a phase I clinical trial, involving lymphodepleting chemotherapy with Busulfan and Fludarabine, reinfusion of Melan-A specific CD8 T-cell containing peripheral blood mononuclear cells (exempt of growth factors), and Melan-A peptide vaccination. Six patients with advanced melanoma were enrolled in this outpatient regimen that demonstrated good feasibility combined with low toxicity. Consistent depletion of lymphocytes with persistent increased CD4/CD8 ratios was induced, although the proportion of circulating CD4 regulatory T-cells remained mostly unchanged. The study of the immune reconstitution period showed a steady recovery of whole T-cell numbers overtime. However, expansion of Melan-A specific CD8 T-cells, as measured in peripheral blood, was mostly inconsistent, accompanied with marginal phenotypic changes, despite vaccination with Melan-A/Mart-1 peptide. On the clinical level, 1 patient presented a partial but objective antitumor response following the beginning of the protocol, even though a direct effect of Busulfan/Fludarabine cannot be completely ruled out. Overall, these data provide further ground for the development of immunotherapeutic approaches to be both effective against melanoma and applicable in clinic.
Keywords
Adult, Aged, Antigens, Neoplasm/chemistry, Antigens, Neoplasm/immunology, Antineoplastic Agents/pharmacology, Antineoplastic Agents/therapeutic use, Busulfan/pharmacology, Busulfan/therapeutic use, CD8-Positive T-Lymphocytes/drug effects, CD8-Positive T-Lymphocytes/immunology, Cancer Vaccines/therapeutic use, Combined Modality Therapy, Female, Humans, Lymphocyte Depletion, Male, Melanoma/drug therapy, Melanoma/pathology, Middle Aged, Neoplasm Proteins/chemistry, Neoplasm Proteins/immunology, Peptides/chemistry, Peptides/therapeutic use, Skin Neoplasms/drug therapy, Skin Neoplasms/pathology, T-Lymphocyte Subsets/drug effects, T-Lymphocyte Subsets/immunology, Vaccination, Vaccines, Subunit/therapeutic use, Vidarabine/analogs &amp, derivatives, Vidarabine/pharmacology
Pubmed
Web of science
Create date
18/04/2008 12:00
Last modification date
20/08/2019 13:54
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