Journal Article

A gynecologic oncology group phase II trial of two p53 peptide vaccine approaches: subcutaneous injection and intravenous pulsed dendritic cells in high recurrence risk ovarian cancer patients

DeLeo, Albert B., Herrin, Vincent E., Shams, Mortada A., Bernstein, Sarah, Merino, Maria, Czystowska, Malgorzata, Bell, Jeffrey G., Berzofsky, Jay A., Ashtar, Ed, Whiteside, Theresa L., Wieckowski, Eva, Rahma, Osama E., Szajnik, Marta E., Khleif, Samir N., Gooding, William, Visus, Carmen, Wolf, Judith K., Steinberg, Seth M.

2012

Overview

Purpose Peptide antigens have been administered by different approaches as cancer vaccine therapy, including direct injection or pulsed onto dendritic cells; however, the optimal delivery method is still debatable. In this study, we describe the immune response elicited by two vaccine approaches using the wild-type (wt) p53 vaccine. Experimental design Twenty-one HLA-A2.1 patients with stage III, IV, or recurrent ovarian cancer overexpressing the p53 protein with no evidence of disease were treated in two cohorts. Arm A received SC wt p53:264-272 peptide admixed with Montanide and GM-CSF. Arm B received wt p53:264-272 peptide-pulsed dendritic cells IV. Interleukin-2 (IL-2) was administered to both cohorts in alternative cycles. Results Nine of 13 patients (69%) in arm A and 5 of 6 patients (83%) in arm B developed an immunologic response as determined by ELISPOT and tetramer assays. The vaccine caused no serious systemic side effects. IL-2 administration resulted in grade 3 and 4 toxicities in both arms and directly induced the expansion of T regulatory cells. The median overall survival was 40.8 and 29.6 months for arm A and B, respectively; the median progression-free survival was 4.2 and. 8.7 months, respectively. Conclusion We found that using either vaccination approach generates comparable specific immune responses against the p53 peptide with minimal toxicity. Accordingly, our findings suggest that the use of less demanding SC approach may be as effective. Furthermore, the use of low-dose SC IL-2 as an adjuvant might have interfered with the immune response. Therefore, it may not be needed in future trials.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Adjuvants / Adult / Aged / Antineoplastic agents / Biological and medical sciences / Cancer Research / Cancer vaccines / Cancer Vaccines - administration & dosage / Cancer Vaccines - adverse effects / Cancer Vaccines - immunology / Clinical trials / Cohort Studies / Combined Modality Therapy / Dendritic cells / Dendritic Cells - immunology / Dendritic Cells - transplantation / Enzyme-linked immunosorbent assay / Fatigue - etiology / Female / Female genital diseases / Granulocyte-macrophage colony-stimulating factor / Granulocyte-Macrophage Colony-Stimulating Factor - administration & dosage / Granulocyte-Macrophage Colony-Stimulating Factor - immunology / Gynecology. Andrology. Obstetrics / Histocompatibility antigen HLA / HLA-A2 Antigen - immunology / Humans / Immune response / Immunology / Immunoregulation / Immunotherapy / Injections, Intravenous / Injections, Subcutaneous / Interleukin 2 / Interleukin-2 - administration & dosage / Interleukin-2 - adverse effects / Interleukin-2 - immunology / Intravenous administration / Kaplan-Meier Estimate / Lymphocytes T / Lymphopenia - etiology / Medical sciences / Medicine / Medicine & Public Health / Middle Aged / Neoplasm Recurrence, Local / Oncology / Original Article / Ovarian cancer / Ovarian Neoplasms - immunology / Ovarian Neoplasms - pathology / Ovarian Neoplasms - therapy / p53 protein / Pharmacology. Drug treatments / Risk Factors / Side effects / T-Lymphocytes - drug effects / T-Lymphocytes - immunology / T-Lymphocytes - metabolism / Toxicity / Treatment Outcome / Tumor Suppressor Protein p53 - immunology / Tumors / Vaccination - adverse effects / Vaccination - methods / Vaccines, Subunit - administration & dosage / Vaccines, Subunit - adverse effects / Vaccines, Subunit - immunology