A Phase 2 interventional study of incomplete Freund's adjuvant and melanoma helper peptide vaccine in Melanoma (Skin), sponsored by Eastern Cooperative Oncology Group. Completed at 65 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2023-06-28.
Sponsored by Eastern Cooperative Oncology Group · Phase 2, Interventional, and Treatment
RATIONALE: Vaccines made from peptides may make the body build an immune response to kill tumor cells.
PURPOSE: This randomized phase II trial is studying four different vaccines using melanoma peptides from cytotoxic T cells and helper T cells to see how well they work in treating patients with metastatic melanoma.
OBJECTIVES:
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to HLA type (HLA-A1 vs HLA-A2 vs HLA-A1 and -A2 vs HLA-A3) and planned sentinel immunized node biopsy (yes vs no). Patients are randomized to 1 of 4 treatment arms.
In all arms, patients continue therapy in the absence of unacceptable toxicity or disease progression necessitating other urgent therapy.
Patients are evaluated at 8 and 12 weeks. Beginning 2-3 weeks after the week-12 evaluation, patients with no evidence of disease progression may receive booster vaccinations according to their randomized treatment arm. Patients receive booster vaccination ID and SC once weekly for 3 weeks. Treatment repeats every 9 weeks for 1 course, every 12 weeks for 2 courses, and then every 24 weeks for 2 courses OR for up to 2 years (whichever comes first) provided the patient does not require an urgent change in therapy.
After completion of study treatment, patients are followed every 6 months for 2 years and then for survival for 5 years from study randomization.
ACTUAL ACCRUAL: A total of 175 patients were accrued for this study during March 2005 and January 2009.
3,005 studies on the registry are indexed under Melanoma; 519 are open to participants now.
This study's enrollment of 175 is above the median of 38 across 2,350 interventional studies indexed under Melanoma.
Browse Melanoma studies →Eastern Cooperative Oncology Group is the lead sponsor of 173 studies on the registry; 7 are open to participants now.
Of its 10 completed or terminated interventional studies of FDA-regulated products, 5 (50%) have results posted.
Counted across the registry records on this site, refreshed daily.
Histologically confirmed stage IV melanoma
Must have at least 2 intact (undissected) axillary and/or inguinal lymph node basins
Prior sentinel node biopsy may not have violated the integrity of a nodal basin
Prior brain metastases allowed provided all of the following are true:
Adequate organ function measured within 4 weeks before randomization:
More than 30 days since prior systemic corticosteroids, including any of the following:
Steroid inhalers (e.g., Advair)
Exclusion criteria:
Prior or active autoimmune disorder requiring cytotoxic or mmunosuppressive therapy, except for any of the following:
Patients receive 2 injections of multi-epitope peptide vaccine comprising 12 melanoma peptides restricted by Class I MHC (12MP) emulsified with sargramostim (GM-CSF) and Montanide ISA-51 (incomplete Freund's adjuvant) or Montanide ISA-51 VG (ISA-51) intradermally (ID) and subcutaneously (SC) on day 1 of weeks 1-3 and 1 injection at the primary site only on day 1 of weeks 5-7.
Biological: incomplete Freund's adjuvant · Biological: multi-epitope melanoma peptide vaccine · Biological: sargramostim
Patients receive 2 injections of multi-epitope peptide vaccine comprising multi-epitope melanoma peptide vaccine (12MP) and 1 tetanus peptide melanoma vaccine emulsified with GM-CSF and ISA-51 (incomplete Freund's adjuvant) ID and SC on day 1 of weeks 1-3 and 1 injection at the primary site only on day 1 of weeks 5-7.
Biological: incomplete Freund's adjuvant · Biological: multi-epitope melanoma peptide vaccine · Biological: sargramostim · Biological: tetanus peptide melanoma vaccine
Patients receive 2 injections of multi-epitope peptide vaccine comprising multi-epitope melanoma peptide vaccine (12MP) and 6 melanoma helper peptides (6HP) emulsified with GM-CSF and ISA-51 (incomplete Freund's adjuvant) ID and SC on day 1 of weeks 1-3 and 1 injection at the primary site only on day 1 of weeks 5-7.
Biological: incomplete Freund's adjuvant · Biological: melanoma helper peptide vaccine · Biological: multi-epitope melanoma peptide vaccine · Biological: sargramostim
Patients receive 2 injections of multi-epitope peptide vaccine comprising melanoma helper peptide vaccine (6HP) emulsified with GM-CSF and ISA-51 (incomplete Freund's adjuvant) ID and SC on day 1 of weeks 1-3 and 1 injection at the primary site only on day 1 of weeks 5-7.
Biological: incomplete Freund's adjuvant · Biological: melanoma helper peptide vaccine · Biological: sargramostim
Given by injection
Also known as: Montanide ISA-51
Given by injection
Also known as: 6 melanoma helper peptides restricted by class II MHC molecules, restricted by, HLADR molecules,, 6 class II MHC-Restricted Melanoma-Associated Peptides
Given by injection
Also known as: 12 Melanoma peptides from melanocyte differentiation protein (MDP) and cancer testis antigen (CTA),, 12 melanoma peptides restricted by class I MHC molecules,restricted by HLA-A1, A2, or A3 molecules
Given by injection
Also known as: rhu GM-CSF,, Leukine,, Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF)
Given by injection
Also known as: Modified Tetanus p2 peptide restricted by class II MHC molecules,, Peptide-Tet
Cytotoxic T-cell Lymphocytes (CTL) Response Rate
Assessment of CTL response was based on a fold-increase in T cell response measure by interferon-gamma ELIspot assay.
Time frame: Immune response was assessed at pre-registrtion, in weeks 1, 3, 5, 7, 8
Helper T-cells Response to 6MHP
Helper T cell response was evaluated by tritiated thymidine proliferation assay with fresh/cryopreserved PBL in the presence of each of the helper peptides.
Time frame: Immune response was assessed at pre-registration, in weeks 1,3,5,7,8
Helper T Cell Response to Tetanus
Helper T cell response was evaluated by tritiated thymidine proliferation assay with fresh/cryopreserved PBL in the presence of each of the helper peptides.
Time frame: Immune response was assessed at pre-registration, in weeks 1,3,5,7,8
Objective Response Rate
Tumor response was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) v1.0. Objective response rate is calculated as the number of patients with complete response (disappearance of all lesions) or partial response () divided by total number of evaluable patients.
Time frame: Tumor response was assessed in weeks 8, 12, 24, 36, 48, 60, 72, 84, 96, 108, and 6 months after last vaccination
Median Overall Survival (OS)
OS was defined as the time from registration to death from any cause.
Time frame: assessed every 3 month within 2 years and every 6 months betwen 2 and 5 years
This study was activated on March 21, 2005, accrued its first patient on May 9, 2005, and terminated on January 12, 2009 with the final accrual of 175 patients.22 ECOG institutions participated in the study.
| Milestone | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Started | 47 | 43 | 37 | 48 |
| Eligible | 43 | 36 | 33 | 42 |
| Treated | 45 | 38 | 36 | 48 |
| Eligible and treated | 41 | 33 | 32 | 42 |
| Have ctl response data | 40 | 30 | 29 | 41 |
| Have helper t cell response data | 37 | 27 | 25 | 39 |
| Completed | 1 | 2 | 0 | 3 |
| Not completed | 46 | 41 | 37 | 45 |
| Withdrew: Lack of efficacy | 37 | 29 | 30 | 43 |
| Withdrew: Adverse event | 4 | 4 | 3 | 1 |
| Withdrew: Death | 0 | 0 | 1 | 1 |
| Withdrew: Withdrawal by subject | 3 | 1 | 0 | 0 |
| Withdrew: No protocol therapy | 2 | 5 | 1 | 0 |
| Withdrew: Others (not specified in the study) | 0 | 2 | 2 | 0 |
Assessment of CTL response was based on a fold-increase in T cell response measure by interferon-gamma ELIspot assay.
| percentage of participants | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Cytotoxic T-cell Lymphocytes (CTL) Response Rate | 43 (27 to 59) | 47 (28 to 66) | 28 (13 to 47) | 5 (0.6 to 16.5) |
Helper T cell response was evaluated by tritiated thymidine proliferation assay with fresh/cryopreserved PBL in the presence of each of the helper peptides.
| percentage of participants | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Helper T-cells Response to 6MHP | 3 (0 to 14) | 0 (0 to 13) | 40 (21 to 61) | 41 (26 to 58) |
Helper T cell response was evaluated by tritiated thymidine proliferation assay with fresh/cryopreserved PBL in the presence of each of the helper peptides.
| percentage of participants | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Helper T Cell Response to Tetanus | 11 (3 to 25) | 59 (39 to 79) | 4 (0 to 20) | 0 (0 to 9) |
Tumor response was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) v1.0. Objective response rate is calculated as the number of patients with complete response (disappearance of all lesions) or partial response () divided by total number of evaluable patients.
| percentage of participants | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Objective Response Rate | 2.4 (0.06 to 12.8) | 3.0 (0.08 to 15.8) | 6.3 (0.8 to 20.8) | 7.1 (1.5 to 19.5) |
OS was defined as the time from registration to death from any cause.
| months | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Median Overall Survival (OS) | 14.9 (10.1 to 18.6) | 10.2 (6.7 to 12.2) | 12.4 (4.8 to 16.8) | 11.1 (8.8 to 14.2) |
Collected over Assessed at the end of each cycle while on treatment and at 30 days following the last dose of treatment. Reported every 3 months within 2 years of study entry, and every 6 months between 2-5 years of study entry. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Arm I (12MP) | — | 6/45 (13.3%) | 36/45 (80%) |
| Arm II (12MP/Tet) | — | 9/38 (23.7%) | 28/38 (73.7%) |
| Arm III (12MP/6MHP) | — | 6/36 (16.7%) | 28/36 (77.8%) |
| Arm IV (6MHP) | — | 4/48 (8.3%) | 33/48 (68.8%) |
| Event | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| FatigueGeneral disorders | 0/45 | 4/38 | 5/36 | 1/48 |
| Injection site reactionGeneral disorders | 2/45 | 3/38 | 0/36 | 2/48 |
| Alanine aminotransferase (ALT, SGPT)Investigations | 0/45 | 0/38 | 2/36 | 0/48 |
| TinnitusEar and labyrinth disorders | 0/45 | 0/38 | 1/36 | 0/48 |
| LymphopeniaInvestigations | 1/45 | 1/38 | 1/36 | 0/48 |
| UlcerationSkin and subcutaneous tissue disorders | 0/45 | 1/38 | 1/36 | 0/48 |
| NauseaGastrointestinal disorders | 0/45 | 0/38 | 1/36 | 0/48 |
| VomitingGastrointestinal disorders | 0/45 | 0/38 | 1/36 | 0/48 |
| Aspartate aminotransferase (AST, SGOT)Investigations | 0/45 | 0/38 | 1/36 | 0/48 |
| Blood bilirubin increasedInvestigations | 0/45 | 0/38 | 1/36 | 0/48 |
| Event | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) |
|---|---|---|---|---|
| Injection site reactionGeneral disorders | 28/45 | 20/38 | 18/36 | 18/48 |
| FatigueGeneral disorders | 9/45 | 11/38 | 10/36 | 7/48 |
| LymphopeniaInvestigations | 2/45 | 8/38 | 6/36 | 4/48 |
| NauseaGastrointestinal disorders | 1/45 | 6/38 | 3/36 | 2/48 |
| Rash/desquamationSkin and subcutaneous tissue disorders | 1/45 | 2/38 | 5/36 | 1/48 |
| Metabolic/Laboratory-otherInvestigations | 2/45 | 2/38 | 5/36 | 3/48 |
| Muscle, painMusculoskeletal and connective tissue disorders | 6/45 | 1/38 | 2/36 | 1/48 |
| Leukopenia (Leukocytes decreased)Investigations | 3/45 | 5/38 | 1/36 | 0/48 |
| Rigors/chillsGeneral disorders | 1/45 | 5/38 | 4/36 | 2/48 |
| Aspartate aminotransferase increased (AST, SGOT)Investigations | 3/45 | 5/38 | 2/36 | 1/48 |
| Age, Continuous(years) | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) | Total |
|---|---|---|---|---|---|
| Median | 65 (35 to 86) | 69 (31 to 88) | 66 (32 to 89) | 64 (40 to 82) | 66 (31 to 89) |
| Sex: Female, Male(Participants) | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) | Total |
|---|---|---|---|---|---|
| Female | 18 | 14 | 11 | 17 | 60 |
| Male | 23 | 19 | 21 | 25 | 88 |
| Region of Enrollment(participants) | Arm I (12MP) | Arm II (12MP/Tet) | Arm III (12MP/6MHP) | Arm IV (6MHP) | Total |
|---|---|---|---|---|---|
| United States | 41 | 33 | 32 | 42 | 148 |
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Eastern Cooperative Oncology Group