Adjuvant Autologous Melanoma Vaccine for Macroscopic Stage III Disease: Survival, Biomarkers, and Improved Response to CTLA-4 Blockade

Michal Lotem, Sharon Merims, Stephen Frank, Tamar Hamburger, Aviram Nissan, Luna Kadouri, Jonathan Cohen, Ravid Straussman, Galit Eisenberg, Shoshana Frankenburg, Einat Carmon, Bilal Alaiyan, Shlomo Shneibaum, Zeynep Ozge Ayyildiz, Murat Isbilen, Kerem Mert Senses, Ilan Ron, Hanna Steinberg, Yoav Smith, Eitan ShiloniAli Osmay Gure, Tamar Peretz

Research output: Contribution to journalArticlepeer-review

Abstract

Background. There is not yet an agreed adjuvant treatment for melanoma patients with American Joint Committee on Cancer stages III B and C. We report administration of an autologous melanoma vaccine to prevent disease recurrence. Patients and Methods. 126 patients received eight doses of irradiated autologous melanoma cells conjugated to dinitrophenyl and mixed with BCG. Delayed type hypersensitivity (DTH) response to unmodified melanoma cells was determined on the vaccine days 5 and 8. Gene expression analysis was performed on 35 tumors from patients with good or poor survival. Results. Median overall survival was 88 months with a 5-year survival of 54%. Patients attaining a strong DTH response had a significantly better (p = 0.0001) 5-year overall survival of 75% compared with 44% in patients without a strong response. Gene expression array linked a 50-gene signature to prognosis, including a cluster of four cancer testis antigens: CTAG2 (NY-ESO-2), MAGEA1, SSX1, and SSX4. Thirty-five patients, who received an autologous vaccine, followed by ipilimumab for progressive disease, had a significantly improved 3-year survival of 46% compared with 19% in nonvaccinated patients treated with ipilimumab alone (p = 0.007). Conclusion. Improved survival in patients attaining a strong DTH and increased response rate with subsequent ipilimumab suggests that the autologous vaccine confers protective immunity.

Original languageEnglish
Article number8121985
JournalJournal of Immunology Research
Volume2016
DOIs
StatePublished - 2016
Externally publishedYes

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